Is morphine available? Country by country

Argentina reported the highest opioid availability in Latin America in 2014 in a regional review. Barriers to cancer pain relief persist despite guidelines and essential medicines: fragmented care, late referral, training gaps and misconceptions about analgesics.^232,238

OpenWhat are strong-opioid consumption trends after 2018?

Oral morphine was added to the essential medicines list but remained unavailable, and opioids were dispensed through a single specialised pharmacy in Yerevan.^155,156

OpenHas oral morphine become available in practice, and what is consumption now?

Prescribed opioid use fell from 2015 to 2022 as subsidized dispensing dropped, with part of the fall shifting to privately paid and hospital use. Palliative physicians report essential medicines readily available in hospitals but several hard to obtain at home, and a national core list of community palliative medicines followed.^159,160,161

OpenHow much of community access difficulty comes from pharmacy stocking, shortages or the 2020 subsidy restrictions?

• 0.11 mg per person Morphine consumption, Bangladesh, 2020⁵²

OpenIs local oral morphine production continuous, and what is consumption on a morphine-equivalent basis?

Medical opioid availability is a small fraction of high-income countries' and mid-level for Latin America. Pharmacy sales rose steeply from 2009 to 2015, mostly codeine, and dispensing concentrates in wealthier southern states. Many pediatric palliative services report difficulty obtaining opioids.^232,233,234

OpenHow has access to morphine, not codeine, changed for palliative patients since 2018?

A 2016 British Columbia prescribing standard for chronic noncancer pain also reduced opioid access for people with cancer or in palliative care. In Quebec, new opioid claims fell slightly after 2016 while cancer pain became a larger share of indications.^213,214

OpenWhat are national opioid consumption and palliative access trends, beyond single provinces?

• 1,692 S-DDD per million inhabitants per day Opioid consumption, Chile, 2024¹⁰⁸
• 114 percent of need Distributed opioid morphine equivalent against modelled palliative need, Chile, 2025¹⁰⁷
• 2.50 percent Non-medical opioid use, national drug survey prevalence, Chile, 2018¹⁰⁷

Consumption has risen roughly eightfold since 2000 to the highest level in Latin America, with distributed supply now above modelled palliative need. Non-medical use in national surveys stayed low. Two papers read the same trend in opposite ways, one as an early warning and one as legitimate access.^108,107

OpenWhat share of supply is domestically produced, and what is the reporting year of the INCB figure?

National opioid consumption rose from 2013 to 2024 but stayed low against estimated need and below the Asian average. The national essential medicines list includes only morphine, in few forms, and fewer than half of primary care hospice units in one pilot province stocked strong opioids.^179,180

OpenDid primary care opioid stocking outside the studied province follow the same pattern?

• 8 mg per person Opioid consumption, morphine equivalent, Colombia, 2010⁸⁴
• 14 mg per person Opioid consumption, morphine equivalent, Colombia, 2014⁸⁴
• 17 mg per person Opioid consumption, morphine equivalent, Colombia, 2019⁸⁴
• 2.25 odds ratio Odds of an analgesic patient receiving an opioid in a capital city rather than a municipality, Colombia, 2020⁸⁶

Consumption rose across the years before the law, of the law and after it, reported through the national narcotics fund, which imports and distributes controlled opioids. Professionals describe adequate access in Bogota and central regions and barriers in the Amazon and Orinoquia.^84,86

OpenDoes an INCB-comparable series confirm the change after 2014, and how often does the national narcotics fund let stock expire? Press reports of expiry were not verified.

• 70 percent, approximate Fall in national opioid consumption from the 2018 peak, Costa Rica, 2023¹⁴³

Costa Rica was classed a moderate consumer in regional surveys. National registry data show consumption peaking in 2018 and then falling sharply, with morphine among the largest declines.^144,143

OpenDid the fall reflect reduced misuse or reduced access for patients in pain? The registry study does not separate them.

• 0.61 MME per 1,000 people per day Opioid analgesic consumption, Egypt, 2019³

Injectable morphine was reported only occasionally available, against constant availability in Saudi Arabia, Jordan and several Gulf states.^3,49

OpenWhat is consumption since 2019, and does the prescription cap explain part of it?

A 2009 working group of the ministry, supply agency, regulator and industry led to local oral morphine syrup from 2009. The single manufacturer stopped in 2012, facility stocks ran out by 2014, and imports did not meet demand as cancer services expanded.¹³⁴

OpenWhat is national consumption, and has any manufacturer resumed production?

• 60 to 66 S-DDD per million inhabitants per day Morphine consumption, Georgia, 2022¹⁵⁴

Morphine is the only opioid used for pain, with oral forms available since 2012 but mainly in cities. Consumption sits in INCB's very low band, and opioids are free for cancer patients.^154,152

OpenHow much morphine is produced domestically, and what is the trend over the past decade?

Germany had the highest per-person controlled opioid consumption among countries in a 2015 to 2017 international comparison. Outpatient opioid volume rose until 2016 and has declined since. Bereaved relatives report needing help with out-of-hours care and pain management at home.^169,170,171

OpenHow often do home palliative patients face delays getting strong opioids at night, at weekends or after discharge?

• 3.45 MME per 1,000 people per day Opioid analgesic consumption, India, 2019³
• 1.39 MME per 1,000 people per day Opioid analgesic consumption, India, 2015³
• 716 kg per year Medical morphine consumption, India, 1985¹⁵⁸
• 18 kg per year Medical morphine consumption, India, 1997¹⁵⁸
• 278 kg per year Medical morphine consumption, India, 2014¹⁵⁸
• 0 percent Kerala government palliative care providers able to prescribe oral morphine, India, 2020¹²¹

No peer-reviewed before-and-after evaluation of the 2014 amendment's effect on consumption was found. Years after it, dispensing was still confined to hospital pharmacies in several states, and in Kerala no surveyed government provider could prescribe oral morphine.^3,11,119,121

OpenDid national consumption rise because of the 2014 amendment, on an INCB-comparable series?

• 0.01 DDD per 1,000 inhabitants per day Strong opioid consumption, including methadone, Indonesia, 2005⁷⁰
• 0.03 DDD per 1,000 inhabitants per day Strong opioid consumption, including methadone, Indonesia, 2014⁷⁰

Fentanyl, not morphine, led strong opioid consumption across the decade to 2014. Use rose steeply from a very low base. Low cancer pain treatment is attributed to poor assessment, fear of addiction and overly tight regulation.^70,73

OpenWhat is consumption after 2014, and what share of morphine is produced domestically?

Opium tincture is produced domestically and approved alongside methadone for opioid agonist treatment. The evidence concerns addiction treatment, not cancer pain.^98,99

OpenWhat is consumption of opioid analgesics for pain, and is oral morphine consistently available for cancer patients?

Iraq was not among the regional countries reporting oral and injectable morphine consistently available.⁴⁹

OpenWhat is national consumption, and is oral morphine stocked at facility level in federal Iraq and in the Kurdistan Region?

The share of terminally ill cancer patients prescribed opioids rose over the decade to 2019, yet availability is described as extremely low, below the WHO adequacy measure in the early 2010s and varying by prefecture. Lower opioid doses were linked to more severe pain.^200,201,202

OpenHow does national consumption after 2021 compare with the WHO adequacy measure?

OpenWhat share of national consumption runs through the anchor cancer centre?

• 3 percent Health facilities offering palliative care, Kenya, 2018⁶⁰

Oral morphine solution is produced nationally, and the integration programme moved morphine powder to hospitals through the national medical supplies agency. Availability at facility level remained low.^63,61

OpenWhat is national consumption on a morphine-equivalent basis, and is morphine stocked at county level?

Lebanon was named among Middle Eastern countries with severe opioid formulary deficiencies and over-regulation, and was not among the regional countries reporting oral and injectable morphine consistently available.^140,49

OpenDid the 2019 collapse cause opioid shortages specifically, and what is consumption before and after?

• 0.41 mg per person Morphine consumption, Malawi, 2009¹⁰³
• 0.82 mg per person Morphine consumption, Malawi, 2013¹⁰³

Oral morphine is produced nationally and procured through the Central Medical Store, free in the public sector. Stockouts persist, especially at district hospitals outside the larger towns.¹⁰³

OpenWhat is consumption after 2013?

• 90 percent Share of strong opioid consumption that was methadone for opioid dependence, Malaysia, 2014⁷⁰
• 96.40 percent Ministry of Health hospitals with oral morphine available, Malaysia, 2023¹⁵¹
• 24 percent Cancer pain patients receiving regular opioid analgesia, Malaysia, 2008¹⁵⁰

Malaysia's large rise in strong opioid consumption was almost entirely methadone for addiction treatment; morphine for pain fell over the same decade, and fentanyl led pain use. Oral morphine is nonetheless stocked in nearly every Ministry of Health hospital.^70,151,150

OpenWhat is consumption of opioid analgesics for pain after 2014?

• 36 percent Opioid need for palliative care met, Mexico, 2013⁹⁵
• 26.30 prescriptions per 10,000 people National opioid dispensing rate, Mexico, 2019⁹⁵
• 13 percent Average quarterly change in opioid dispensing after the reform, Mexico, 2019⁹⁵

Before 2015 Mexico ranked last among OECD members for opioid availability. Dispensing rose after the reform but remained low by international comparison.⁹⁵

OpenWhat is consumption on a morphine-equivalent basis after 2019?

Generic low-cost opioids were made available early in the programme. A domestic manufacturer now produces morphine and other opioids, and essential palliative care drugs have been available nationally since 2015.^93,94

OpenWhat is national consumption on a morphine-equivalent basis, and how much morphine is produced domestically?

Injectable morphine is only occasionally available, in contrast to the regional countries where oral and injectable morphine are both consistently available.⁴⁹

OpenWhat is national consumption on a morphine-equivalent basis? An atlas figure was seen only in a search summary, on a different metric.

• 0.88 mg per person Morphine consumption, Nepal, 2020⁵²
• 0.27 mg per person Opioid consumption, morphine equivalent, Nepal, 2015⁵³
• 1 manufacturer Licensed domestic manufacturers of oral morphine, Nepal, 2025⁵²
• 2,582.20 times the minimum daily wage One month of fentanyl patch, cost, Nepal, 2025⁵²

Oral morphine has been licensed for domestic manufacture since 2009, after imports from India began in 2005. A single manufacturer produces it from imported raw material, and shortages have followed delays in import licensing. Rural facilities rarely stock morphine.^52,56

OpenHas any second manufacturer been licensed, and what is consumption after 2020 on a morphine-equivalent basis?

• 0.01 index, reference average of 100 Adequacy of Opioid Consumption index, Nigeria, 2015⁶⁷

Oral morphine solution is reconstituted locally from imported powder at selected tertiary hospitals, established with the American Cancer Society's Treat the Pain programme and the Federal Ministry of Health. Stock-outs outside those centres are described as persistent.^65,68

OpenWhat is national consumption on a morphine-equivalent basis, and what share is reconstituted locally?

• 3.71 MME per 1,000 people per day Opioid analgesic consumption, Pakistan, 2019³
• 4.88 MME per 1,000 people per day Opioid analgesic consumption, Pakistan, 2015³

Low opioid availability limits palliative care in the Philippines, and up to 75% of cancer patients have inadequate pain relief. Restrictive Philippine Drug Enforcement Agency rules, few licensed prescribers and bureaucracy hinder access, especially in rural areas, and primary care facilities often lack secure systems for controlled medicines.^303,79

OpenWhat share of Philippine primary care facilities stock oral immediate-release morphine?

Before the 2005 reform, drug-control rules built around inpatient acute pain made opioid treatment hard to obtain for outpatients with cancer or HIV. No recent study of availability was found.¹⁹¹

OpenHow have oral morphine availability and national opioid consumption changed since the 2005 law?

• 149,410 mg Oral morphine consumed at three study hospitals, Rwanda, 2014⁵⁷

Hospital oral morphine consumption rose from nil during the integration programme, alongside a national morphine procurement framework.⁵⁷

OpenWhat is national consumption, and when did domestic reconstitution of oral morphine from imported powder begin? Press accounts disagree on the year and no primary source was read.

• 1.24 MME per 1,000 people per day Opioid analgesic consumption, Saudi Arabia, 2019³

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

OpenIf product is available, which prescribing or monitoring step holds consumption down?

• 28 mg per person Morphine consumption, South Africa, 2020¹³⁰

Consumption rose after the 2017 policy but remained well below high-income levels, and NGOs could not meet national need.¹³⁰

OpenWhat is consumption on an INCB-verified basis, and how much morphine is produced locally?

Chronic strong opioid use in the general population rose from 2002 to 2015. Pain medication is widely stocked in urban primary care, with more access problems in rural areas.^207,79

OpenWhat is national opioid consumption for palliative patients against an adequacy benchmark?

Opioid prescribing and opioid-related deaths have both risen and correlate. After immediate-release fentanyl was restricted, morphine use rose but did not replace it.^222,223

OpenWhat are palliative-specific morphine consumption trends, distinct from total prescribing?

• 0.90 mg per person Morphine consumption, Sri Lanka, 2020⁵²
• 58.80 percent Surveyed physicians citing drug shortage as a reason not to prescribe, Sri Lanka, 2024⁷⁴

Oral morphine is described as restricted for fear of abuse, and drug shortage was among the leading reasons physicians gave for not prescribing it.^77,74

OpenIs oral morphine stocked at base hospital level, and did the 2022 foreign exchange crisis interrupt it?

• 4 hospitals Hospitals licensed to dispense morphine, Tanzania, 2010¹⁰⁰

Oral morphine solution is produced nationally, but access was licensed hospital by hospital and national consumption was described as very low.^63,100

OpenWhat is national consumption, and which body produces and distributes oral morphine?

• 0.29 mg per person Morphine consumption, Thailand, 1999¹¹³
• 1.16 mg per person Morphine consumption, Thailand, 2010¹¹³

Immediate-release oral morphine has been produced by the Government Pharmaceutical Organization since 2010. Consumption rose steadily but stayed well below global and Asian averages, and patients can receive oral morphine only at a hospital pharmacy.^111,113

OpenWhat is consumption after 2015?

• 24.19 MME per 1,000 people per day Opioid analgesic consumption, Turkiye, 2019³

Government supplies free oral morphine as an essential medicine and has co-manufactured it nationally since 2011.¹²

Before the war, opioid access for palliative care met only a small share of national need, and painkillers were not supplied in full volume. War conditions have worsened pain relief.^194,196

OpenHow did oral morphine availability change after the 2022 invasion?

• 638.72 MME per 1,000 people per day Opioid analgesic consumption, United Kingdom, 2019³

Anticipatory prescribing of injectable end-of-life medicines is routine in community care, though robust evidence of its effectiveness is missing. Community pharmacy access is delayed by stock and communication problems, and in England, commissioned pharmacy stocking schemes remain unevaluated and out-of-hours cover is patchy.^{3,243,244,245}

OpenAre opioid availability and dispensing for palliative patients adequate UK-wide?

• 737.51 MME per 1,000 people per day Opioid analgesic consumption, United States, 2019³

Among Medicare patients dying of cancer, opioid use fell substantially from 2007 to 2017 while pain-related emergency visits rose. Black and Hispanic patients had persistently less access, and state mandates to check prescription monitoring data were linked to further reductions, larger for some minority groups.^{3,252,253,254}

OpenDid tighter prescribing rules cause the decline, and did pain control in hospice worsen?

• 0.00 DDD per 1,000 inhabitants per day Morphine consumption, Vietnam, 2005⁷⁰
• 0.01 DDD per 1,000 inhabitants per day Morphine consumption, Vietnam, 2014⁷⁰

Morphine consumption rose every year after the reforms, and morphine rather than fentanyl became the predominant strong opioid. National use remained far below regional leaders.^70,146

OpenWhat is consumption after 2014?

A ministry and national association morphine pilot raised availability, but use stayed low. In a multi-country government hospital program, every participating hospital had oral morphine by the end. Advocates reported in 2022 that essential palliative medicines were still not reliably available.^{184,57,186,187}

OpenHas national morphine consumption changed since the 2021 strategic plan?