Saudi Arabia
A high-income country with low recorded opioid sales, an example that income alone does not bring opioid access.
9 domains reviewed · 8 high-confidence · 3 dated estimates · 9 material gaps
WHO region: Eastern Mediterranean. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 2 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 15
- Newest source 2026
Lessons from Saudi Arabia
- A national monitoring platform can itself become the barrier. Where physicians lack access to it, prescribing stops regardless of law. An electronic narcotics register should be designed for universal prescriber access from the start.88
- Morphine on the shelf, an accredited subspecialty and a budget line did not close income and regional gaps. Training and financing need an equity mechanism attached.49,89
- Subspecialists at the top did not raise front-line competence. A programme should train general physicians broadly, not only specialists.88,49
- Faith-based practices such as Quran recitation and Zamzam water are common among cancer patients and rarely replace treatment, so clinicians can ask about them openly.452
Palliative care
Is morphine available in Saudi Arabia?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 1.24 MME per 1,000 people per daySOURCE-CHECKED · 2019 DATA
Opioid analgesic consumption, Saudi Arabia, 20193
Method: IQVIA MIDAS pharmaceutical sales data for opioid analgesics, in morphine milligram equivalents per 1,000 inhabitants per day (Ju et al. 2022; abstract read September 2026). A sales-based proxy for availability, not a measure of palliative access. Last checked 2026-09-25.
Other source: 5.81 to 7.20. Milligrams of oral morphine equivalent per capita per year, 2017, reported jointly for Saudi Arabia, Bahrain and Kuwait from country responses (Sanchez-Cardenas et al. 2022, full text read). A different metric and data basis from the sales series; the same study reports a regional average of 2.40 mg per capita.49
Cite this figure:
Oral and injectable morphine were both reported as consistently available in the regional expert survey. Low consumption here is therefore not a shortage of product on the shelf.3,49
If product is available, which prescribing or monitoring step holds consumption down?
Help answer it:Search PubMedHow does Saudi Arabia regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
- 39.40 percentSOURCE-CHECKED
Surveyed physicians citing excessive regulation of opioids as a barrier, Saudi Arabia, 202588
Last checked 2026-09-24.
Lack of training on opioid dosing was cited by 40.9 percent.
Cite this figure:
Opioids pass through two electronic systems: the Food and Drug Authority's controlled drugs permits and Raqeeb, the Ministry of Health platform that records each prescription and dispensing. Physicians report incomplete access to Raqeeb and over-regulation as barriers alongside gaps in training.88
What day-supply and form requirements apply to oral morphine, and do they differ outside oncology centres?
Help answer it:Search PubMedWho can prescribe morphine in Saudi Arabia?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
- 62.90 percentSOURCE-CHECKED
Surveyed physicians with access to the national narcotics prescribing platform, Saudi Arabia, 202588
Last checked 2026-09-24.
One tertiary hospital in the Eastern Province.
Cite this figure:
Physicians across oncology, surgical oncology and acute care prescribe for cancer pain. No non-physician prescribing authority was found, and access to the prescribing platform, not legal scope, limited who could prescribe in the hospital studied.88
May any nurse practitioner or clinical pharmacist prescribe or titrate opioids?
Help answer it:Search PubMedHow does palliative care reach patients in Saudi Arabia?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 0.09 per 100,000SOURCE-CHECKED · 2020 DATA
Specialised palliative care services per 100,000 population, Saudi Arabia, 202049
Last checked 2026-09-24.
Tied for the highest ratio in the regional survey, against a European standard of two.
Cite this figure: - 3.32 adjusted odds ratioSOURCE-CHECKED
Odds of palliative care access, high-income against low-income cancer patients, Saudi Arabia, 202689
Last checked 2026-09-24.
95 percent confidence interval 1.83 to 6.02. Riyadh sample.
Cite this figure:
The regional survey rated Saudi geographic spread the best in the region, with hospital teams, inpatient units, home care and outpatient clinics. A Riyadh study found access concentrated in central tertiary settings, with income and region compounding the gap.49,89
How far does the ministry's home health care programme reach outside the major cities?
Help answer it:Search PubMedWho pays for palliative care in Saudi Arabia?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Palliative care is funded through the national health budget. Out-of-pocket costs and private insurance still shape who reaches care.49,89
How are palliative care clinicians trained in Saudi Arabia?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 50 specialists, approximateMODELED ESTIMATE · 2020
Palliative medicine specialists, expert estimate, Saudi Arabia, 202049
Last checked 2026-09-24.
The same survey estimates four in Pakistan.
Cite this figure:
Palliative medicine is an accredited subspecialty. Front-line physicians managing cancer pain still reported limited recent training and low awareness of local prescribing guidance.49,88
In what year was the fellowship accredited, and how many hold the Saudi Board credential today?
Help answer it:Search PubMedHow does Saudi Arabia prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Saudi Arabia has a national monitoring system (Raqeeb) for opioid prescribing; at one tertiary hospital 62.9% of physicians had access, and 39.4% cited perceived over-regulation as a barrier. Only 31.1% routinely initiated opioids for cancer pain. Buprenorphine-based opioid agonist therapy, including long-acting injectable forms, is used in at least one addiction service.88,649
How widely is opioid agonist therapy available across the country, and is naloxone accessible outside hospitals?
Help answer it:Search PubMedHow do children get palliative care in Saudi Arabia?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Among 302 child deaths at one tertiary center, the palliative care team was involved in only 27.9%, and most children died in intensive care. In a multi-center survey, 9.13% of healthcare workers had formal pediatric palliative care training.651,652
How many dedicated pediatric palliative care teams exist, and which oral opioid formulations for children are available?
Help answer it:Search PubMedHospice care in Saudi Arabia
How the hospice model works here, who can use it, who pays and who it reaches. Covered 2 of 4.
What does hospice care look like in Saudi Arabia?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
The Saudi sources read describe end-of-life services as hospital palliative care units, community home care, outpatient clinics and consultations. Hospice appears only as a study label ('hospice-eligible') in one Jeddah hospital study.323,324
Does Saudi Arabia license any standalone or home hospice service, and who operates it?
Help answer it:Search PubMedWho can get hospice care in Saudi Arabia?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
What criteria define 'hospice eligibility' in Saudi hospital studies, and are there national rules on prognosis, diagnosis or disclosure for entry to palliative home care?
Help answer it:Search PubMedWho pays for hospice care in Saudi Arabia?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
No hospice-specific funding data found. How are Ministry of Health palliative units and home care financed for citizens and for non-citizen residents?
Help answer it:Search PubMedHow many people reach hospice in Saudi Arabia?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
At one Jeddah tertiary hospital (2021-2024), hospice-eligible cancer patients reached comfort-oriented care at death in 71% of cases, compared with 35% of hospice-eligible non-cancer patients. Non-cancer patients also had more ICU use (58% vs 21%). Single-site data.324
How do regional distribution and non-cancer access to palliative home care vary across the Kingdom?
Help answer it:Search PubMedWhat fills the gap in Saudi Arabia
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Family members carry much of the load in home-based care: in one Jeddah palliative home-care service, 63.3% of caregivers were female and 80.0% reported at least moderate burden. A Riyadh home health care survey of 384 informal caregivers found burden linked to care duration, relationship to the patient and unemployment.453,454
Single-site evidence- Faith communities
Women are the primary caregivers for children in Saudi Arabia, and 24 female caregivers of children at end of life described Islamic beliefs and practices as supporting them through the child's dying.451
- Community health workers and home-based care
A Jeddah home health care team had nurses start subcutaneous fluids at home for advanced cancer patients, with family caregivers monitoring and disconnecting the infusion. The pilot covered 9 patients.455
Single-site evidenceSelf-reported- Traditional and complementary healers
At one Jeddah oncology center, 52.9% of 293 patients used complementary practices, most commonly Zamzam water, Quran recitation, water read upon Quran and black seed. Only 5.8% delayed medical treatment to use them.452
Single-site evidence
Sources cited here
- 3Ju C, Wei L, Man KKC, et al.
Global, regional and national trends in opioid analgesic consumption, 2015 to 2019. Lancet Public Health 2022;7:e335-46. DOI 10.1016/S2468-2667(22)00013-5.
- 49Sanchez-Cardenas MA, Pourghazian N, Garralda E, et al.
Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators. BMC Palliative Care 2022;21:168. DOI 10.1186/s12904-022-01047-7. Expert survey of 12 EMR countries, including Iran, Jordan, Egypt, Morocco and Pakistan. Iran and Jordan are among the countries reported to have a national palliative care strategy, a designated Ministry of Health officer for palliative care and palliative care recognised as a subspecialty; recognition years are not given. Full text read.
- 88AlMarri AS, Eltayeb NS.
Physicians' knowledge and barriers to opioid prescribing for cancer pain at a tertiary hospital in the Eastern Province, Saudi Arabia: a cross-sectional study. Acta Informatica Medica 2025;33(3):237-242. DOI 10.5455/aim.2025.33.237-242. Survey of physicians in 2025 on access to Raqeeb, the Ministry of Health platform that records narcotic prescribing and dispensing, alongside the Saudi Food and Drug Authority controlled drugs system; excessive regulation and lack of training reported as system barriers.
- 89Eid T, Alyahya NM, Alodhailah AM, Almutairy BM, Alshaibany FF, Alshehri WM.
Economic disparities in palliative care utilization among cancer patients in Saudi Arabia: a socioeconomic stratification analysis. Current Oncology 2026;33(4). DOI 10.3390/curroncol33040218. Cancer patients in Riyadh stratified by income; access concentrated in central tertiary settings.
- 649Zuraie MM, Khubrani H, Alzkkri F, et al.
Characteristics of Opioid-Dependent Patients in the Inpatient Setting: A Cross-Sectional Study in Riyadh, Saudi Arabia. Cureus 2026;18(6):e111838. Chart review of 22 male inpatients with opioid use disorder at one Riyadh mental health complex in 2024; single-site, small sample. Abstract read.
- 650Alotaibi NA, Alsuhail AI.
Prevalence of Depression and Anxiety in Cancer Patients Receiving Palliative Care in the Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study. Cureus 2025;17(5):e83493. HADS screening of 130 palliative care patients at one center; single-site scope. Abstract read.
- 453Alharbi HM, Azhari EF, Sindi AH, et al.
Association between quality of life of terminally ill patients and caregiver burden in a Saudi palliative home-care service: a cross-sectional exploratory study. BMC Palliat Care 2026;25(1). 30 patient-caregiver dyads in one Jeddah palliative home-care service; small convenience sample, hypothesis-generating. Abstract read.
- 651Sadler K, Altarifi L, Callaghan S, et al.
Intensity of Care at the End-of-Life in Pediatrics: A Single Center Analysis With Implications for Advanced Care Planning in Saudi Arabia. Am J Hosp Palliat Care 2026;43(6):568-577. Retrospective review of 302 child deaths at one tertiary center (2021 to 2023); single-site scope. Abstract read.
- 652Abulhamail A, AlGhamdi K.
Addressing the missing framework of paediatric palliative care in Saudi Arabia. Int J Palliat Nurs 2026;32(2):60-66. Multi-center survey of 230 healthcare workers on comfort and training in paediatric palliative care; authors are paediatric palliative care consultants. Abstract read.
- 323Alshammary S, Altamimi I, Alhuqbani M, et al.
Palliative Care in Saudi Arabia: An Updated Assessment Following the National Vision 2030 Reforms. J Palliat Med 2024;27(5):651-657. Survey of palliative care managers plus death-record analysis reporting growth in palliative care units, community home care and outpatient services; lead author works in a Ministry of Health palliative service (possible self-evaluation). Abstract read.
- 324Imran M, Alshehri BG, Akhtar MA, et al.
Oncology-embedded supportive care and end-of-life outcomes: a comparative study of hospice-eligible Muslim patients with cancer and non-cancer diagnoses. Support Care Cancer 2026;34(4). Retrospective cohort (2021-2024) of 796 hospice-eligible adults who died in one Jeddah tertiary hospital; non-cancer patients received comfort-oriented care far less often; single site, authors evaluate their own hospital's model. Abstract read.
- 452Almouaalamy NA, Banjar LA, Alshaikh HM, et al.
The prevalence and pattern of complementary and alternative medicine use among cancer patients in a tertiary oncology center: a cross-sectional study. Ann Med Surg (Lond) 2023;85(11):5420-5427. Survey of 293 patients at one Jeddah oncology center documenting Zamzam water, Quran recitation, water read upon Quran and black seed use; single center. Abstract read.
- 454Costa DPS, Ardah HI, Searya A
Burden of Informal Caregivers from an HHC Military Hospital in Riyadh, Saudi Arabia: A Cross-Sectional Study. Int J Environ Res Public Health 2025;22(2). Zarit burden survey of 384 informal caregivers served by one military home health care facility in Riyadh. Abstract read.
- 451Hafez SA, Snethen JA, Ngui E, et al.
Pediatric End of Life Care: Impact of Islamic Faith. West J Nurs Res 2021;44(8):773-779. Qualitative interviews with 24 Saudi mothers and other female primary caregivers of children at end of life, showing Islamic beliefs and practices supported them. Abstract read.
- 455Adem S, ALMouaalamy N
Effectiveness and Safety of Hypodermoclysis Patients With Cancer: A Single-Center Experience From Saudi Arabia. Cureus 2021;13(3):e13785. Pilot of subcutaneous hydration at home for 9 advanced cancer patients, started by home health care nurses and monitored by family caregivers; very small single-center pilot run by the service itself. Abstract read.