Knaul Felicia Marie, Arreola-Ornelas Héctor, Kwete Xiaoxiao J, Bhadelia Afsan, Berterame Stefano, Connor Stephen R, De Lima Liliana, Downing Julia, Krakauer Eric L, Méndez-Carniado Oscar, Pastrana Tania, Pérez-Cruz Pedro E, Portenoy Russell K, Rosa William E, Touchton Michael, Vargas Enciso Valentina, Radbruch Lukas
University of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Leonard M. Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA; Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico; Tómatelo a Pecho, A.C. (F.M.K., H.A.O., O.M.C.), Mexico, Mexico.
University of Miami Institute for Advanced Study of the Americas (F.M.K., H.A.O, X.K., A.B., W.R., V.V.E.), University of Miami, Miami, FL, USA; Tómatelo a Pecho, A.C. (F.M.K., H.A.O., O.M.C.), Mexico, Mexico.; Institute for Obesity Research (H.A.O.), Tecnológico de Monterrey, Monterrey, Mexico; School of Government and Public Transformation (H.A.O.), Tecnológico de Monterrey, Mexico City, Mexico; Fundación mexicana para la Salud (FUNSALUD), (H.A.O., O.M.C.), Mexico, Mexico.
J Pain Symptom Manage. 2025 Feb;69(2):204-215. doi: 10.1016/j.jpainsymman.2024.10.026. Epub 2024 Oct 28.
Estimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need.
Present the methodology for calculating Distributed Opioids in Morphine Equivalents (DOME)- introduced in the Lancet Commission on Global Access to Palliative Care and Pain Relief report - and how it can be used as a simple indicator to quantify unmet pain relief and PC need.
Using International Narcotics Control Board (INCB) data, DOME applies relative potency estimates to convert the annualized quantities of clinically appropriate opioids procured by a country to oral morphine equivalent milligrams. To quantify unmet need, an expert group proposed health condition-specific estimates for opioid need and used available data on the burden of SHS to posit the annual opioid quantity required by country for symptomatic treatment of pain or breathlessness. Comparing this to DOME generates DOME%SHSNEED, the proportion of opioids needed for palliative care that can be fulfilled by the opioid procured by a country during a year.
DOME and DOME%SHSNEED can be used to measure, over time, the capacity of countries to meet PC need, as a key component of universal health coverage. Identifying access gaps disproportionately impacting LMICs can promote better health system performance and guide countries and institutions in policy making.
DOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.
对严重健康相关痛苦（SHS）的估计表明，姑息治疗存在巨大的未满足需求，主要集中在低收入和中等收入国家（LMICs）。由于阿片类药物是姑息治疗（PC）中的基本药物，衡量其可及性可用于评估卫生系统满足需求的能力。
介绍《柳叶刀全球姑息治疗与疼痛缓解委员会报告》中引入的以吗啡当量计算的分布式阿片类药物（DOME）的计算方法，以及如何将其用作量化未满足的疼痛缓解和姑息治疗需求的简单指标。
利用国际麻醉品管制局（INCB）的数据，DOME应用相对效价估计值，将一个国家采购的临床适用阿片类药物的年度数量转换为口服吗啡当量毫克数。为了量化未满足的需求，一个专家组提出了针对特定健康状况的阿片类药物需求估计值，并利用严重健康相关痛苦负担的现有数据，推测一个国家每年用于疼痛或呼吸困难症状治疗所需的阿片类药物数量。将此与DOME进行比较，得出DOME%SHSNEED，即一个国家在一年内采购的阿片类药物能够满足的姑息治疗所需阿片类药物的比例。
DOME和DOME%SHSNEED可用于长期衡量各国满足姑息治疗需求的能力，这是全民健康覆盖的关键组成部分。识别对低收入和中等收入国家影响尤甚的可及性差距，可促进卫生系统表现更佳，并为各国和机构的政策制定提供指导。
DOME和DOME%SHSNEED可用于监测卫生系统在纠正差距和促进姑息治疗中获得医学指征的阿片类药物治疗方面的进展。
