Evidence map›Paper›PMID 39490604›Full record

ArticleJournal of pain and symptom management2025

Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care.

Felicia Marie Knaul, Héctor Arreola-Ornelas, Xiaoxiao J Kwete, Afsan Bhadelia, Stefano Berterame, Stephen R Connor, Liliana De Lima, Julia Downing, Eric L Krakauer, Oscar Méndez-Carniado and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of pain and symptom management, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Towards opioid access without excess.The Lancet. Public health · 2025
    Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Felicia Marie KnaulUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Leonard M. Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA; Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico; Tómatelo a Pecho, A.C. (F.M.K., H.A.O., O.M.C.), Mexico, Mexico.
Héctor Arreola-OrnelasUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Tómatelo a Pecho, A.C. (F.M.K., H.A.O., O.M.C.), Mexico, Mexico.; Institute for Obesity Research (H.A.O.), Tecnológico de Monterrey, Monterrey, Mexico; School of Government and Public Transformation (H.A.O.), Tecnológico de Monterrey, Mexico City, Mexico; Fundación mexicana para la Salud (FUNSALUD), (H.A.O., O.M.C.), Mexico, Mexico. Electronic address: harreola@tec.mx.
Xiaoxiao J KweteUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Yangzhou Philosophy and Social Science Research and Communication Center (X.J.K.), Yangzhou, China.
Afsan BhadeliaUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Department of Public Health, College of Health and Human Sciences (A.B.), Purdue University, West Lafayette, IN, USA.
Stefano BerterameSecretariat of the International Narcotics Control Board (INCB) (S.B.), Vienna, Austria.
Stephen R ConnorWorldwide Hospice Palliative Care Alliance (WHPCA) (S.R.C.), London, UK.
Liliana De LimaInternational Association of Hospice and Palliative Care (IAHPC) (L.D.L.), Houston, TX, USA.
Julia DowningInternational Children's Palliative Care Network (ICPCN) (J.D.), Bristol, UK.
Eric L KrakauerDepartment of Global Health & Social Medicine (E.L.K.), Harvard Medical School, Boston, MA, USA.
Oscar Méndez-CarniadoTómatelo a Pecho, A.C. (F.M.K., H.A.O., O.M.C.), Mexico, Mexico.; Fundación mexicana para la Salud (FUNSALUD), (H.A.O., O.M.C.), Mexico, Mexico.
Tania PastranaInternational Association of Hospice and Palliative Care (IAHPC) (L.D.L.), Houston, TX, USA; Department of Palliative Medicine (T.P.), Medical Faculty RWTH Aachen University, Aachen, Germany.
Pedro E Pérez-CruzPrograma Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (P.E.P.C.), Pontificia Universidad Católica de Chile (PUC), Santiago, Chile.
Russell K PortenoyAlbert Einstein College of Medicine (R.K.P.), Bronx, New York.
William E RosaUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Michael TouchtonUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Department of Political Science, College of Arts and Sciences (M.T.), University of Miami, Miami, USA.
Valentina Vargas EncisoUniversity of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA.
Lukas RadbruchInternational Association of Hospice and Palliative Care (IAHPC) (L.D.L.), Houston, TX, USA; Department of Palliative Medicine (V.V.E.L.R.), University Hospital Bonn, Bonn, Germany.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI SELWYN M VICKERS · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

contextEstimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need.

objectivesPresent the methodology for calculating Distributed Opioids in Morphine Equivalents (DOME)- introduced in the Lancet Commission on Global Access to Palliative Care and Pain Relief report - and how it can be used as a simple indicator to quantify unmet pain relief and PC need.

methodsUsing International Narcotics Control Board (INCB) data, DOME applies relative potency estimates to convert the annualized quantities of clinically appropriate opioids procured by a country to oral morphine equivalent milligrams. To quantify unmet need, an expert group proposed health condition-specific estimates for opioid need and used available data on the burden of SHS to posit the annual opioid quantity required by country for symptomatic treatment of pain or breathlessness. Comparing this to DOME generates DOME%SHSNEED, the proportion of opioids needed for palliative care that can be fulfilled by the opioid procured by a country during a year.

resultsDOME and DOME%SHSNEED can be used to measure, over time, the capacity of countries to meet PC need, as a key component of universal health coverage. Identifying access gaps disproportionately impacting LMICs can promote better health system performance and guide countries and institutions in policy making.

conclusionDOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.

Indexed as

Analgesics, OpioidHealth Services AccessibilityPalliative CareGlobal HealthHealth Services Needs and DemandHumansMorphinePainAnalgesics, OpioidMorphineglobal healthhealth systemsOpioidspainpain managementpalliative careserious illness

Identifiers

PMID39490604
PMCPMC11778810

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.