How countries prevent opioid misuse without blocking pain relief

In 2017 Armenian opioid prescribing required several signatures, police oversight of prescribers and storage, and in some cases return of empty ampoules. Opioids were dispensed from one specialized pharmacy in Yerevan, and oral morphine was registered but not available. Draft procedures were meant to abolish police oversight and multiple signatures.¹⁵⁶

OpenWere the new narcotics procedures adopted and is oral morphine now available, and what methadone, buprenorphine or naloxone services exist?

After Victoria made real-time prescription monitoring mandatory, high-dose opioid prescribing did not fall, while starts of unmonitored pain medicines such as pregabalin rose. Opioid agonist treatment starts did not change, and people on high doses had lower odds of starting it. Among people who inject drugs, 92% of those trained had acquired take-home naloxone, and 63% of recent opioid users with a kit usually carried it.^{163,686,687,688}

OpenHas mandatory real-time prescription monitoring changed opioid access for people receiving palliative care, and what share of community pharmacies nationally now stock core end-of-life medicines?

Among 135 palliative care providers, morphine syrup was the main opioid (68.1%), oxycodone and buprenorphine were unavailable, only 10.4% knew national opioid policies, and 60.7% cited prescribing restrictions. At palliative outpatient units of two Dhaka teaching hospitals, 51.42% of 140 patients with cancer were prescribed morphine. MSF staff in Bangladesh and India described burdensome regulatory processes for obtaining opioids.^370,559,119

OpenDoes Bangladesh run a prescription monitoring system for opioids, and are opioid agonist treatment and naloxone available outside Dhaka?

Brazil schedules strong opioids under ANVISA lists, limits prescribing to registered physicians and dentists, requires a special prescription notification covering up to 30 days, and records all dispensing in a national controlled substances system. Reviewers describe Brazil as highly restricted for opioid access, with rules criticized for neglecting pain care, while non-medical use stays far below North American levels.²³²

OpenHow widely available are methadone or buprenorphine treatment and take-home naloxone in Brazil's public health system?

In Alberta, 23% of people with metastatic cancer received long-term opioids, and 3.4% of them had opioid-related hospital or emergency visits, more often with high doses or co-prescribed sedatives. Across Ontario long-term care homes, the mean share of residents prescribed end-of-life medications in their last two weeks ranged from 37.3% in the lowest-prescribing fifth of homes to 82.5% in the highest. After children died at home, 75.6% of surveyed families had unused opioids, pointing to a need for simple disposal processes.^694,695,696

OpenDid Canada's 2017 opioid guideline or provincial monitoring programs reduce opioid access for people dying of cancer or other serious illness, and how do palliative services support patients who use drugs or receive opioid agonist treatment?

Chile has one of the highest medical opioid consumption levels in Latin America (1,363 S-DDD per million per day in 2016-2018), backed by a national cancer pain relief and palliative care program set up in 1994 and expanded in 2014. National drug surveys put non-medical use of opioid analgesics at 1.2% to 1.5%, described as stable and low.^107,232

OpenDoes Chile run a unified electronic prescription monitoring system for opioids, and how available are methadone or buprenorphine treatment and take-home naloxone?

China's mean opioid consumption in 2020 to 2022 (168 S-DDDpm) was less than half the Asian average, and the national Essential Medicines List included only morphine. In one province, primary care hospice institutions stocking strong opioids rose from 22.5% to 30.2% between 2019 and 2023 while consumption fell. Long-term methadone participants in Guangdong reported economic hardship and gaps in dose adjustment and emergency treatment continuation.^180,669

OpenIs naloxone available outside hospitals in China, and how do narcotic prescription controls affect primary care hospice prescribing?

Palliative care public policy from 2010 to 2019 was followed by a gradual increase in opioid use, and stakeholders still cite limited medication availability as a barrier. National pharmacovigilance data recorded 4,437 opioid-related problems in 3,063 patients, mostly adverse drug reactions, with tramadol and morphine most common.^84,731,732

OpenWhat opioid agonist treatment and naloxone access exist in Colombia, and do misuse controls such as dispensing rules limit palliative prescriptions in rural areas?

Costa Rica tracks opioid dispensing through a Ministry of Health narcotics registry and a national Digital Prescription System for controlled substances. Total opioid consumption fell about 70% from its 2018 peak through 2023, with morphine down 72.2% and methadone down 82.4%, from a 2014 baseline already at or below 5 mg morphine equivalent per capita.^143,232

OpenDid the post-2018 decline in morphine and methadone dispensing reduce access for palliative care patients, and what opioid agonist treatment and naloxone access exists in Costa Rica?

Among 178 cancer patients at two centers, 51% said they would refuse tramadol for pain, most citing fear of addiction; tramadol was the only available WHO step-II analgesic in Egypt. Experts reported that injectable morphine is only occasionally available. Government and non-governmental organizations provide harm reduction and addiction treatment, and primary care physicians need more addiction training.^622,49,626

OpenDoes Egypt provide methadone or buprenorphine treatment and community naloxone, and how have tramadol controls affected access for people with cancer pain?

In a simulated-client study in one town, community drug outlets dispensed tramadol and pethidine without prescription, filling 60.5% of direct requests by name. Patients and key informants in Addis Ababa and Sidama described opioid shortages and restrictive opioid regulations that undermine palliative care for women with breast and cervical cancer.^614,138

OpenDoes Ethiopia offer methadone or buprenorphine treatment or naloxone, and how are retail dispensing rules enforced without cutting morphine supply to palliative care?

Georgia allows outpatient opioids only for terminally ill patients, with a maximum 7-day supply dispensed from pharmacies at police stations. In a survey, 38% of primary care physicians avoided prescribing opioids, and those following liberalized rules were investigated three to five times more. Meanwhile a fully government-funded methadone program has enrolled 30747 patients since 2008, and harm reduction vending machines have distributed kits including naloxone.^{154,153,641,642}

OpenHave the terminal-illness requirement and police-station dispensing been removed, and is naloxone available beyond pilot projects?

In a national survey, 35 of 39 hospital palliative consultation services said ward staff inexperience or reservations about opioids sometimes or often led to recommended opioid therapy not being implemented or given at lower doses. In one national insurer, 5.7% of insured adults without cancer received an opioid in 2021. Take-home naloxone pilots date from 1998, and prescription requirements and lack of funding still limit its spread.^173,715,716

OpenHow many people receive opioid substitution treatment in Germany, and do narcotics prescription rules delay opioid access at hospital discharge or in the dying phase?

India's 1985 NDPS Act set harsh custodial sentences even for minor clerical errors in hospitals stocking opioids, and the 2014 amendment to improve medical access has been slow to implement. Opioid substitution therapy with buprenorphine, buprenorphine-naloxone and methadone grew through the National AIDS Control Programme, though coverage targets are still far off. Delhi doctors named tough opioid regulations as their most common barrier to prescribing, and people who use opioids in Kashmir reported low naloxone knowledge and poor access.^{540,541,542,543,544}

OpenHow many Recognized Medical Institutions stock oral morphine under the 2014 NDPS amendment, state by state, and is take-home naloxone available outside deaddiction centers?

A 2015 review describes extremely low opioid use for cancer patients in Indonesia and cites fear of addiction and overly tight regulation among the causes. People who inject drugs and providers in Indonesia, Ukraine and Vietnam described complicated procedures to start opioid agonist treatment, misconceptions about methadone and stigma.^573,574

OpenHas Indonesia's opioid consumption for pain changed since the 2023 Health Law mandated palliative care, and is naloxone available in community settings?

Iran runs a large methadone maintenance program, and opioid agonist therapy is also available in prisons, though 32.5% of eligible people in prison had no uptake. Methadone-related poisoning and deaths are rising concerns. Opioid analgesic consumption remained low through 2018, with tramadol making up most use and strong opioids only 13.2%.^644,645,646

OpenIs naloxone available in the community, and what rules govern prescribing strong opioids for cancer pain?

A 2024 survey of 300 community pharmacists found no national prescription monitoring system and limited treatment for people who misuse medicines. Moderate-weak opioids were among the prescription drugs most often suspected of misuse (11.3%), and pharmacists most often limited access by saying the medicine was unavailable.⁶⁴⁰

OpenDoes Iraq offer methadone or buprenorphine treatment or naloxone, and how do narcotics rules affect morphine access for cancer patients?

Japan has good formulary availability of opioids for cancer pain, but prescribing stays low by international standards: 2.7% of the population received an opioid in 2015, the lowest of 19 jurisdictions. Among people who died of cancer, opioid prescription before death rose only from 60.8% to 65.9% between 2010 and 2019.^200,674,675

OpenDo Japan's narcotics licensing and prescriber rules, or clinician attitudes, explain why about one in three people dying of cancer receive no strong opioid, and what access exists to methadone or buprenorphine treatment and take-home naloxone for people with opioid use disorder?

Experts reported that oral and injectable morphine are available at all times in Jordan, and opioid access is one of six domains in the 2018 national palliative care framework. Limited opioid access still persists, and 79.6% of oncology health professionals surveyed named patients' fear of addiction as a barrier.^49,630,629

OpenDoes Jordan offer methadone or buprenorphine treatment and naloxone, and does it run a prescription monitoring program?

Kenya integrated palliative care units with oral morphine into 11 provincial hospitals. Opioid agonist therapy started in Nairobi in 2014 and had reached 3,354 people by 2023; methadone is free in public facilities, but daily dosing costs clients time and travel. Among people who inject drugs living with HIV in Nairobi, naloxone awareness was 25%.^{61,580,581,582}

OpenDoes Kenya have prescription monitoring for controlled medicines, and do opioid control rules limit morphine prescribing in county hospitals?

Lebanon launched a national buprenorphine substitution program in 2011, and users reported that registration protected them from arrest while access was geographically restricted. The narcotics department adjusted prescription rules and registered new opioids in 2012. Before the 2019 crisis there was no methadone, hydromorphone or liquid immediate-release morphine, and a local company later began producing immediate-release morphine at low cost.^{637,638,139,327}

OpenIs naloxone available outside hospitals, and has the buprenorphine program kept supply and enrollment through the economic collapse and 2024 war?

Malawi orders morphine in bulk through the Central Medical Store, provides essential opioids free in the public sector, and has a national task force monitoring morphine availability. Barriers identified in 2013 included two-week prescription limits, and the 1957 Narcotic Act still does not allow nurse prescribing even though professional councils have approved it. Stockouts still occur, mainly in district hospitals.¹⁰³

OpenDoes Malawi have any opioid agonist treatment or naloxone program, and has the Narcotic Act been amended to allow nurse prescribing?

A national audit found oral morphine available in 135 of 140 (96.4%) Ministry of Health hospitals. Malaysia had the highest strong opioid consumption of five Southeast Asian countries in 2005 to 2014 (11.2 DDD/1000 inhabitants/day), mainly methadone, and methadone maintenance therapy has been offered nationally since 2005.^151,70,657

OpenDoes Malaysia operate an opioid prescription monitoring program, and can families or outreach workers obtain naloxone?

After Mexico introduced regulatory changes and an electronic prescribing system in 2015, opioid dispensing rose by an average of 13% per quarter, and wealthier states dispensed more than poorer states. In 2023 the closure of the main methadone production facility interrupted supply nationwide, and methadone treatment among Tijuana clinic patients fell from 36% to 13%. A WHO indicator assessment still finds limited access to essential palliative medicines.^95,738,740

OpenHas buprenorphine been authorized for opioid use disorder, and is naloxone available to communities outside pilot programs?

Experts reported that injectable morphine is only occasionally available in Morocco. Methadone maintenance is offered, including at a medico-psychological center in northern Morocco that treated 166 people who use heroin in 2017.^49,627

OpenHas Morocco revised the opioid prescribing rules described as restrictive, and is naloxone available outside hospitals?

Oral morphine is now manufactured in Nepal, but a single manufacturer imports all raw materials, rural health centres rarely stock it, and methadone syrup is available only for addiction treatment. Opioids are not on the government free or fixed-price medicine lists. Opioid agonist treatment operates in the Kathmandu Valley, and patients discharged on opioids in Western Nepal reported little counseling on dependence or tapering.^{56,52,55,566,567}

OpenIs naloxone stocked at hospitals and health posts that dispense morphine in Nepal, and how are opioid prescriptions recorded and monitored?

Women who use drugs in Uyo said opioid prescribing restrictions, cost and stigma kept them from medical pain care and pushed them toward falsified or substandard medicines from informal sources. A 2026 review found opioid agonist therapy highly centralized, and clinicians named opioid costs and stigma as barriers to palliative care.^607,608,609

OpenDoes Nigeria run a prescription monitoring system or community naloxone distribution, and how many people receive methadone or buprenorphine outside central sites?

An anthropological study argues that narcotics enforcement aimed at illicit supply and unviably low price ceilings make morphine scarce in Pakistani hospitals while heroin circulates illicitly. In a national survey of 2,838 hospital health professionals, only 27.7% knew patients must sign an opioid agreement and 22.2% knew of the drug monitoring program. A mystery-shopper study found 95% of 200 sampled Punjab pharmacies were run by non-qualified staff and sold controlled drugs without prescription.^551,552,553

OpenIs opioid agonist treatment (methadone or buprenorphine) available in Pakistan outside pilot HIV programs, and is naloxone stocked in hospitals and pharmacies?

Hospice Casa Sperantei reports that Romanian legislative changes included a review of opioid policy along with health insurance reimbursement for palliative care. Methadone treatment is available, and in a 74-person cohort methadone adherence was linked to better quality of life.^189,727

OpenHas the opioid policy review increased morphine consumption for palliative care, and does Romania run prescription monitoring or take-home naloxone programs?

Rwanda's Ministry of Health set a 2011 goal of universal palliative care access and worked with partners to secure adequate opioid supplies. A 2019 to 2020 survey of 307 people who inject drugs in Kigali found 43% knew someone who died of an overdose, and the authors called for naloxone distribution and drug treatment services.^58,586

OpenDoes Rwanda offer methadone or buprenorphine treatment, and how are morphine prescriptions tracked without restricting access for palliative patients?

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

OpenHow widely is opioid agonist therapy available across the country, and is naloxone accessible outside hospitals?

Tshwane's Community Oriented Substance Use Programme, the first publicly funded community-based harm reduction program, provided counseling and opioid substitution therapy to 1513 adults at 17 sites. Service users named therapy costs and program bureaucracy as reasons for dropping out. In Cape Metro, morphine use rose in some sub-districts after the national palliative care policy was implemented, though integration stayed uneven.^615,616,130

OpenIs naloxone available in the community in South Africa, and does a prescription monitoring system cover scheduled opioids?

South Korea tracks all narcotic manufacturing, distribution and sales through its Narcotics Information Management System, but a national study found only minor changes in indicators of inappropriate opioid use after it started, possibly because it lacks real-time monitoring. Among 946 cancer patients on strong opioids, only 0.2% of each sex scored high risk for aberrant opioid behavior.^681,680,674

OpenHas the Narcotics Information Management System changed opioid access for people with cancer or at end of life, and how available are methadone or buprenorphine treatment and take-home naloxone in South Korea?

In 2012 Spain removed the extra authorization, a duplicate prescription, needed to prescribe strong opioids. In Catalonia, monthly strong opioid use fell 3.15% afterward while the study's measure of opioid misuse rose. National opioid-related deaths ranged from 14 to 23 per 1,000,000 inhabitants from 2000 to 2019 and tracked prescribing, which researchers propose as a surveillance signal.^722,222

OpenIs take-home naloxone available in Spain, and how is opioid agonist treatment coverage monitored alongside palliative opioid access?

Among 216 physicians at Teaching Hospital Jaffna, mean confidence in starting morphine was 4.84 out of 10, and reasons for not prescribing included unfamiliarity with palliative care, drug shortages and refusal by patients or relatives. A regional review notes some recent progress in opioid access in Sri Lanka while pain remains grossly undertreated across South-East Asia.^74,540

OpenWhat controls govern opioid prescribing in Sri Lanka, and are opioid agonist treatment and naloxone available?

In 2014 oral morphine was rarely available in Tanzania, and nurses in 13 rural hospitals reported distress at being unable to relieve severe pain. By 2021 the government had yet to commit to publicly funded palliative care. Methadone is offered through specialized clinics in Dar es Salaam, with a move to community health centers, and 85% of 200 women who use heroin there had witnessed an overdose.^{100,101,588,589}

OpenWhat share of Tanzanian hospitals now stock oral morphine, and is naloxone available outside hospitals?

In 14 tertiary hospitals, one quarter of palliative inpatients in pain were not prescribed analgesics. At the largest referral center in southern Thailand, opioid use for cancer patients was lower than the global average, which the authors linked to opiophobia. In Bangkok in 2011 to 2012, people on methadone reported low doses, intense police surveillance of clinics and no methadone in prisons.^667,666,665

OpenHas Thailand changed methadone dosing or prison access since 2012, and is naloxone distributed in communities?

Strong opioids in Turkiye are written on a separate red prescription under a color-coded system, which a national review names as one barrier alongside opiophobia. Consumption rose to 12.2204 mg morphine equivalence per capita in 2011 against a global average of 61.66. In a 2024 survey, 38.1% of oncology-department physicians were reluctant to prescribe opioids, linked to fear of opioid use disorder and lack of training.^39,634

OpenDoes Turkiye offer methadone or buprenorphine treatment and take-home naloxone, and has the red prescription process been simplified since 2020?

Uganda lets trained nurses prescribe oral morphine, and Hospice Africa Uganda assessed 34 patients on long-term oral morphine, finding two cases of addiction and one probable diversion among people with chronic non-cancer pain. Uganda introduced methadone treatment in 2020, with 55.2% of 343 clients retained at 12 months, and a Kampala pilot started 55 people on buprenorphine. Patients and supply staff still report legal barriers to an adequate opioid supply for pain.^{288,597,598,599,600}

OpenDoes Uganda run any prescription monitoring for oral morphine, and is naloxone available to palliative care teams or to people who use drugs?

Before the 2022 invasion, opioid analgesic use for palliative care averaged 120 mg morphine equivalent per patient with serious illness, meeting 7% of national need. Ukraine runs a national opioid agonist maintenance program; in a registry cohort of 17,211 patients, 29.3% stopped treatment in the first two years of full-scale war, with displacement the main driver and unsupervised dosing protective.^194,711,712

OpenHas the wartime expansion of ePrescription changed community access to oral morphine for palliative patients, and is take-home naloxone available outside NGO programs?

UK primary care prescribing of multiple strong opioids at end of life dipped by about 7.5% around the time of the Shipman case, in which a doctor murdered patients with opioids. Coroner reports on opioid deaths during or soon after hospital stays described zero-tolerance policies and undertreated withdrawal or pain, and called for hospital guidance on take-home naloxone, continued opioid agonist therapy and access to palliative care.^700,701

OpenHow do current UK controlled-drug rules and monitoring affect timely opioid access for people dying at home, and how often do people on opioid agonist therapy receive palliative care?

Among Medicare decedents with poor-prognosis cancers, the share filling an opioid prescription near the end of life fell from 42.0% to 35.5% between 2007 and 2017, while pain-related emergency visits rose from 13.2% to 19.9%. Mandatory prescription monitoring without a cancer exemption was linked to fewer oncology patients receiving opioids, with no significant fall where states exempted cancer.^252,705

OpenHow have the 2022 CDC guideline and state prescribing limits affected opioid access for people in hospice or with non-cancer serious illness, and how often do people receiving opioid agonist treatment get hospice care?

Clinicians, regulators and patients described limited oral morphine, hard-to-obtain certifications of continued need and overly strict enforcement blocking cancer pain relief; proposed fixes included oral morphine at district level and an electronic prescription monitoring system. In a 2022 survey, 32.4% named excessively restrictive pharmacy dispensing as a major barrier. Community methadone treatment was linked to larger drops in heroin use than compulsory detention.^471,149,653

OpenHas Vietnam adopted electronic opioid prescription monitoring, and is naloxone available in communities or only in hospitals?

Doctors at a Lusaka tertiary hospital report growing comfort with morphine, but fear of addiction and poor pain recognition were more common among non-cancer doctors. Morphine use was mostly limited to cancer and sickle cell disease, and outpatient prescribing was rare outside oncology.¹⁸⁷

OpenWhat controlled medicine rules, prescription monitoring, opioid agonist treatment and naloxone access exist in Zambia?