Opioid consumption and unmet need in China, 2013-2024: a longitudinal national study.

Abstract

Chronic pain affects approximately 20% of China's population, and rapid aging will further increase demand for pain management and palliative care. Understanding patterns of opioid consumption and disparities in access is essential for informing equitable pain management policies. To assess trends in opioid consumption in China from 2013 to 2024 and to evaluate unmet need and associated factors. This longitudinal study used national-level data from the International Narcotics Control Board (INCB) to assess opioid consumption trends, measured in defined daily doses for statistical purposes (SDDD). The number of patients experiencing serious health-related suffering (SHS) across 21 conditions and their opioid requirements (in morphine equivalents) were estimated. Interrupted time series analysis was conducted using data from 20 cities in the MENET database to evaluate the impact of the COVID-19 pandemic. National opioid consumption increased over time but remained low. In 2021, opioid availability met only 25.97% of the estimated need among SHS patients. Interrupted time series analysis showed a significant decline in opioid consumption at the onset of the COVID-19 pandemic (-5.80 SDDD; 95% CI, -9.08 to -2.51), followed by a gradual recovery (0.51 SDDD; 95% CI, 0.13 to 0.89), with substantial variation across cities (I² > 85%). Opioid consumption in China remains substantially below estimated need, indicating a large and persistent treatment gap. Regional disparities and disruptions during the COVID-19 pandemic further highlight structural barriers to access. Strategies to balance equitable opioid access with regulatory control are needed, particularly as aging increases palliative care demand.