One thing that frustrates me every week is the overuse of opiates. This is often due to poor prescribing, or in the case of the Oxycontin crisis in America, a drug company’s aggressive marketing and minimisation of addiction risk[1] - it’s not the fault of the individual patient.
However, while some countries are experiencing an opioid overuse epidemic, many others are struggling with access to opiates for essential pain relief and palliative care. This is something that had not occurred to me before - despite having worked in palliative care for two years (on and off). A 2018 Lancet Commission report found that 50% of the global population living in the poorest countries receive less than 1% of the total opiates distributed globally.[2]
The global atlas of palliative care has mapped these inequalities in a newly published study and ranked countries by the development of their palliative care services. Interestingly, Uganda achieved a standout result: it is the only low-income country to rank as providing advanced palliative care status - ranking just one place behind the US.[3] One key reason is Uganda has pioneered the safe production of low-cost morphine which means palliative patients experiencing pain can access much needed medications.[4]
These contrasting realities highlight the fine balance of opiate prescribing and the stark inequalities that determine who receives adequate pain relief, and who goes without.
From my time working in palliative care, I learned the importance of promoting dignity at death. This is often overlooked in a world where TV shows glamourise and glorify miraculous recoveries and inaccurate rates of success with CPR. Taking time to comfort a patient, ease their distressing symptoms, and spend time explaining things to their relatives is a part of medicine that has offered my immense satisfaction.
[1] Ross JS, Berenson HB, Goldsmith JD, et al. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Perspect Biol Med. 2007;50(4):523–39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
[2] Knaul FM, Farmer PE, Krakauer EL et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018;391(10128):1391–1454. doi: 10.1016/S0140-6736(17)32513-8.
[3] Tripodoro VA, Fidalgo JFL, Pons JJ, et al. First-ever global ranking of palliative care: 2025 world map under the new WHO framework. J Pain Symptom Manage2025;70:447-58. doi:10.1016/j.jpainsymman.2025.07.026. pmid:40782892
[4] Bokinni Y. How Uganda became an advanced nation in palliative care. BMJ. 2025;391:r2099. Available from: https://www.bmj.com/content/391/bmj.r2099