Short Summary
Moderate-to-severe pain remains untreated for millions of people in low- and middle-income countries despite the availability of inexpensive, effective opioid medicines
Regulatory, training, and supply barriers restrict access to opioids for palliative care
A new charity could address this gap by supporting policy reform, clinician training, and supply-chain strengthening to enable safe, appropriate access to pain relief
The Problem
What’s the problem?
In most LMICs, patients with advanced cancer, HIV, or other life-limiting illnesses receive little to no pain relief for moderate-to-severe pain
Although opioids are inexpensive and medically essential, access remains limited
Less than 5% of global opioid need for serious health-related suffering is met in LMICs, compared with 98% in high-income countries
Why does it matter?
Severe, untreated pain is one of the strongest negative influences on subjective wellbeing
Persistent pain undermines daily functioning and often causes profound psychological distress
For some patients, suffering is so intense that continued life in pain is described as worse than death
Effective palliative care enables people with life-limiting illness to live and die with dignity
Neglectedness:
There is substantial unmet need for opioid access in LMICs, alongside limited organized effort
Existing efforts tend to be fragmented, under-resourced, or focused on only one part of the problem (training or advocacy alone)
Few organizations address the full set of barriers, including regulation, prescriber training, and supply chains, meaning progress remains slow even when there is political will
We have not found evidence that current efforts are close to saturation in any country
The Solution
What’s the proposed solution?
Support coordinated reform across regulation, training, and supply chains, to improve access to opioids for palliative care
Focus on palliative care as the entry point, where need is greatest, risks of misuse are lower, and the case for access is most widely accepted
Work as a technical partner to the government, supporting policy reform and implementation rather than delivering services directly
Sequence activities: begin with policy reform to enable access, then support training and supply chains to ensure opioids are available, prescribed and used safely
Why do we trust this solution?
Evidence from prior initiatives suggest that isolated reforms are unlikely to succeed on their own
Case studies show that coordinated action across policy, training, and supply systems, can increase opioid access without replicating high-income-country harms
Progress appears to depend on combining legal reform with operational capacity and clinician confidence, rather than focusing on any single constraint alone
How robust is the evidence?
The evidence base is wide, but programmatic and qualitative
Patient-level outcome data are limited, with most programs tracking opioids dispensed rather than pain scores or quality-of-life outcomes
Given the policy-driven nature of the intervention, this type of evidence is broadly consistent with what we expected
The Impact
What impact could this have?
At scale, this intervention could avert a substantial burden of untreated pain in LMICs
Our modeling suggests an average impact of ~146,000 DALYs averted per year, with wide variation depending on country context
Estimated cost-effectiveness:
Advocacy for improved opioid access appears highly cost-effective in several settings
Across the ten countries modeled, estimated cost-effectiveness ranges from $145 to $1,096 per DALY averted, with an average of $151 per DALY averted
This meets our cost-effectiveness bar of $220/DALY averted in 8 out of the 10 countries analyzed
Ideal Founder Profile
Who is best suited to do this? *
Founders with an interest in policy advocacy and systems change, and who are comfortable working on problems with long timelines, limited short-term feedback, and high dependence on outside actors
What might our ideal candidate look like?
Individuals who are able to build and maintain relationships with key stakeholders, and who are comfortable navigating bureaucratic and political environments
Experience in monitoring, evaluation, and learning, public health, or government would be an advantage but not essential
*We think candidates with the following skills will have a comparative advantage/be especially promising for founding this idea, but we would like to still encourage applicants from people who do not match this criteria who are enthusiastic about this idea and believe they may be well-suited for reasons not captured here
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