The Two Faces of Opioids: A Global Crisis of Access and Excess

by Jon Scaccia March 13, 2025

In one part of the world, a mother watches her child suffer in agony from advanced cancer, unable to get the pain relief he desperately needs. In another, a man battles opioid addiction, his life unraveling due to a prescription he was given years ago. These are the two faces of the global opioid crisis—one marked by a devastating lack of access to pain relief and the other by the catastrophic consequences of overprescription and addiction.

A decade after the World Health Assembly passed Resolution 67.19, recognizing palliative care as a fundamental part of universal health coverage, millions of people still suffer needlessly from untreated pain. At the same time, opioid misuse continues to claim lives in high-income countries (HICs). Finding a solution that addresses both crises without exacerbating either remains one of the biggest public health challenges of our time.

The Global Pain Divide: A Crisis of Access

Pain relief is a basic human right. Yet, over 50 million people living in low- and middle-income countries (LMICs) experience severe, untreated pain due to restrictive opioid policies and supply chain failures. Despite morphine being a low-cost, effective painkiller, 90% of the world’s supply is concentrated in just 10% of countries. Meanwhile, in the remaining 50% of nations, people in excruciating pain are left to suffer, often with tragic consequences.

This disparity is largely a policy failure. Many governments, fearing opioid misuse, have implemented stringent regulations that make it nearly impossible for patients with serious illnesses to obtain needed medication. The lack of training for healthcare providers on opioid prescribing further compounds the problem, leaving patients without options for pain relief.

The Other Side: The Opioid Epidemic

While millions struggle to access opioids for pain relief, the overuse of these drugs has fueled a devastating addiction crisis in countries like the United States, Canada, and Australia. An estimated 39.5 million people worldwide suffer from opioid use disorder, with the vast majority residing in North America.

The crisis began in the 1990s when pharmaceutical companies aggressively marketed opioids for chronic pain management, downplaying their addictive potential. This led to widespread overprescription, followed by a surge in heroin and fentanyl use when prescriptions became harder to obtain. The result? An epidemic of opioid-related overdoses, with thousands of lives lost each year.

The Need for a Balanced Approach

The challenge lies in crafting policies that address both the pain pandemic and the opioid epidemic simultaneously. A knee-jerk reaction to the overdose crisis—tightening regulations on opioid access—has led to unintended consequences, making it even harder for people in LMICs to get the pain relief they need. To truly achieve a balanced approach, public health leaders must focus on the following strategies:

• Expanding Access Without Risking Overuse: Countries should adopt policies that ensure essential pain relief for those who need it while preventing overprescription. This includes better training for healthcare providers on opioid prescribing and the use of alternative pain management strategies when appropriate.
• Increasing Production of Low-Cost Morphine: Pharmaceutical companies often prioritize high-priced, patented opioids over cheap, generic morphine. Governments and international organizations must invest in producing and distributing low-cost morphine to ensure widespread access.
• Strengthening Global Stewardship: International bodies like the World Health Organization (WHO) and the International Narcotics Control Board (INCB) must work together to develop policies that prevent opioid abuse without restricting access for legitimate medical use.
• Treating Addiction as a Public Health Issue: The opioid epidemic should not be approached solely through criminalization. Instead, countries should expand harm reduction strategies, such as medication-assisted treatment (MAT) and safe disposal programs for unused opioids.

What’s Next?

Public health officials, policymakers, and healthcare providers must collaborate to implement a comprehensive, evidence-based strategy that ensures pain relief for those in need while preventing addiction and misuse. We need stronger regulations in places where opioid oversupply is rampant and improved access in regions where people are suffering without pain relief.

The global community must move beyond fear-based policies and embrace a nuanced approach that balances opioid availability with necessary safeguards. Safe and equitable pain relief should be considered a global public good—accessible to all, regardless of geography or economic status.

Join the Conversation

What do you think is the best way to balance opioid access and misuse prevention? Should international organizations play a greater role in ensuring equitable access to pain relief? How can policymakers navigate the fine line between compassionate care and addiction risk?

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