{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:17:08Z","timestamp":1792264628764,"version":"4.4.0"},"reference-count":87,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Sub-Saharan Africa (SSA) faces a dual opioid dilemma: widespread undertreatment of moderate to severe pain due to limited access to essential opioid analgesics, alongside increasing concern about misuse and diversion in selected contexts. Opioids are clinically indicated for severe cancer-related pain, advanced chronic illness, major trauma, surgery, and end-of-life care; yet, regional consumption remains disproportionately low relative to documented disease burden, indicating systemic under-provision rather than low need. This systematic review synthesizes evidence on opioid policy, regulation, access, and governance in SSA to examine how legal frameworks, institutional arrangements, political dynamics, and data systems shape medical availability. Following PRISMA and SWiM guidance, we reviewed peer-reviewed and gray literature addressing national drug control laws, regulatory implementation, procurement and supply systems, prescribing authority, and surveillance capacity; 33 studies met inclusion criteria. Across settings, restrictive or ambiguously interpreted legislation, multi-layered administrative controls, fragmented mandates across health and enforcement institutions, weak forecasting and distribution systems, concentrated prescribing authority, professional risk aversion, and chronic data gaps were consistently associated with constrained access. Concurrently, rising political and media attention to non-medical use, particularly of tramadol, has reinforced enforcement-oriented narratives that may further limit reform space. Persistent deficiencies in routine consumption data and unmet need assessment contribute to conservative import quotas and regulatory inertia. Addressing this imbalance requires proportionate, sequenced reform that strengthens data and forecasting systems, clarifies and aligns legal mandates with public health objectives, invests in workforce capacity and supply chains, and embeds safeguards against diversion while correcting avoidable under-treatment.<\/jats:p>","DOI":"10.1093\/heapol\/czag035","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T12:51:35Z","timestamp":1773233495000},"page":"898-912","source":"Crossref","is-referenced-by-count":1,"title":["Pain, policy, and the opioid dilemma in sub-Saharan Africa: a systematic review of access, regulation, and health governance from 1990 to 2024"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-6355","authenticated-orcid":false,"given":"Simon","family":"Nyarko","sequence":"first","affiliation":[{"name":"Department of Health Policy, Planning and Management, School of Public Health, University of Ghana , Boz LG 13, Legon-Accra ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7724-4706","authenticated-orcid":false,"given":"Roger A","family":"Atinga","sequence":"additional","affiliation":[{"name":"Department of Health Services Management, University of Ghana Business School , Box LG 78, Legon-Accra ,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius Caesar","family":"Mahama","sequence":"additional","affiliation":[{"name":"University Hospitals of Morecambe Bay NHS Foundation Trust, Furness General Hospital , Dalton Lane LA14 4LF ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"2026052004165697500_czag035-B1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1080\/13216597.2023.2290252","article-title":"Sippin\u2019 on some sizzurp: a qualitative framing analysis of national opioid abuse coverage in Nigerian newspapers","volume":"30","author":"Addie","year":"2024","journal-title":"J Int Commun"},{"key":"2026052004165697500_czag035-B2","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1080\/10401334.2020.1847653","article-title":"Medical educators\u2019 perceptions of research culture in a faculty of health sciences: a South African study","volume":"33","author":"Adefuye","year":"2021","journal-title":"Teach Learn Med"},{"key":"2026052004165697500_czag035-B3","author":"African Palliative Care Association"},{"key":"2026052004165697500_czag035-B4","author":"Africa Union"},{"key":"2026052004165697500_czag035-B5","doi-asserted-by":"publisher","first-page":"e0001045","DOI":"10.1371\/JOURNAL.PGPH.0001045\/OG_IMAGE.JPG","article-title":"Where is the pain? A qualitative analysis of Ghana\u2019s opioid (tramadol) \u2018crisis\u2019 and youth perspectives","volume":"2","author":"Alhassan","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026052004165697500_czag035-B6","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3332\/ECANCER.2016.655","article-title":"Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya","volume":"10","author":"Ali","year":"2016","journal-title":"Ecancermedicalscience"},{"key":"2026052004165697500_czag035-B7","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1080\/24740527.2022.2104699","article-title":"The relationship between patients\u2019 income and education and their access to pharmacological chronic pain management: a scoping review","volume":"6","author":"Atkins","year":"2022","journal-title":"Can J Pain"},{"key":"2026052004165697500_czag035-B8","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1016\/S0140-6736(16)00161-6","article-title":"Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study","volume":"387","author":"Berterame","year":"2016","journal-title":"The Lancet"},{"key":"2026052004165697500_czag035-B9","doi-asserted-by":"publisher","first-page":"734654","DOI":"10.3389\/fphar.2021.734654","article-title":"Contextualising the perceptions of pharmacists practicing clinical pharmacy in South Africa\u2014do we practice what we preach?","volume":"12","author":"Bronkhorst","year":"2021","journal-title":"Frontiers in Pharmacology"},{"key":"2026052004165697500_czag035-B10","doi-asserted-by":"publisher","first-page":"l6890","DOI":"10.1136\/BMJ.L6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"2026052004165697500_czag035-B11","doi-asserted-by":"publisher","first-page":"104160","DOI":"10.1016\/j.drugpo.2023.104160","article-title":"The police paradox: a qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts","volume":"120","author":"Carroll","year":"2023","journal-title":"Int J Drug Policy"},{"key":"2026052004165697500_czag035-B12","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1146\/annurev-criminol-061020-125715","article-title":"Opioids and the criminal justice system: new challenges posed by the modern opioid epidemic","volume":"4","author":"Caulkins","year":"2021","journal-title":"Annual Review of Criminology"},{"key":"2026052004165697500_czag035-B13","doi-asserted-by":"publisher","first-page":"xi7","DOI":"10.1093\/annonc\/mdt498","article-title":"The global opioid policy initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the middle east: introduction and methodology","volume":"24","author":"Cherny","year":"2013","journal-title":"Ann Oncol"},{"key":"2026052004165697500_czag035-B14","doi-asserted-by":"publisher","first-page":"xi14","DOI":"10.1093\/ANNONC\/MDT499","article-title":"Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI)","volume":"24","author":"Cleary","year":"2013","journal-title":"Ann Oncol"},{"key":"2026052004165697500_czag035-B15","doi-asserted-by":"publisher","first-page":"xi24","DOI":"10.1093\/ANNONC\/MDT500","article-title":"Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI)","volume":"24","author":"Cleary","year":"2013","journal-title":"Ann Oncol"},{"key":"2026052004165697500_czag035-B16","doi-asserted-by":"publisher","first-page":"xi60","DOI":"10.1093\/annonc\/mdt504","article-title":"Next steps in access and availability of opioids for the treatment of cancer pain: reaching the tipping point?","volume":"24","author":"Cleary","year":"2013","journal-title":"Ann Oncol"},{"key":"2026052004165697500_czag035-B17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/S12875-019-0947-2","article-title":"Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study","volume":"20","author":"Desveaux","year":"2019","journal-title":"BMC Fam Pract"},{"key":"2026052004165697500_czag035-B18","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.4236\/OJBM.2023.115115","article-title":"Medicine procurement framework for public hospitals under the Ministry of Health in Ghana: a case of the western region","volume":"11","author":"Domie","year":"2023","journal-title":"Open J Bus Manag"},{"key":"2026052004165697500_czag035-B19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1111\/TMI.12201","article-title":"Registering medicines for low-income countries: how suitable are the stringent review procedures of the World Health Organisation, the US Food and Drug Administration and the European Medicines Agency?","volume":"19","author":"Doua","year":"2014","journal-title":"Trop Med Int Health"},{"key":"2026052004165697500_czag035-B20","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/J.JPAINSYMMAN.2015.03.017","article-title":"Understanding models of palliative care delivery in sub-Saharan Africa: learning from programs in Kenya and Malawi","volume":"50","author":"Downing","year":"2015","journal-title":"J Pain Symptom Manage"},{"key":"2026052004165697500_czag035-B21","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1136\/ARCHDISCHILD-2015-308307","article-title":"Children\u2019s palliative care in low- and middle-income countries","volume":"101","author":"Downing","year":"2016","journal-title":"Arch Dis Child"},{"key":"2026052004165697500_czag035-B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.23880\/PPRIJ-16000181","article-title":"Abuse and misuse of tramadol among the youth in the wassa amenfi west municipality in the western region of Ghana","volume":"3","author":"Elliason","year":"2018","journal-title":"Psychol Psychol Res Int J"},{"key":"2026052004165697500_czag035-B23","doi-asserted-by":"publisher","first-page":"274","DOI":"10.21037\/APM.2019.02.02","article-title":"Global palliative radiotherapy: a framework to improve access in resource-constrained settings","volume":"8","author":"Elmore","year":"2019","journal-title":"Ann Palliat Med"},{"key":"2026052004165697500_czag035-B24","doi-asserted-by":"publisher","first-page":"e0004019","DOI":"10.1371\/JOURNAL.PGPH.0004019","article-title":"Prevalence and patterns of substance use in West Africa: a systematic review and meta-analysis","volume":"4","author":"Emmanuel","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"2026052004165697500_czag035-B25","doi-asserted-by":"publisher","first-page":"e0290104","DOI":"10.1371\/JOURNAL.PONE.0290104","article-title":"Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts","volume":"18","author":"Essien-Aleksi","year":"2023","journal-title":"PLoS One"},{"key":"2026052004165697500_czag035-B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/jgo.2017.010090","article-title":"Palliative care development in Africa: lessons from Uganda and Kenya","volume":"4","author":"Fraser","year":"2018","journal-title":"J Glob Oncol"},{"key":"2026052004165697500_czag035-B27","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1080\/10826084.2022.2079133;PAGE:STRING:ARTICLE\/CHAPTER","article-title":"The role of misinformation and stigma in opioid use disorder treatment uptake","volume":"57","author":"Garett","year":"2022","journal-title":"Subst Use Misuse"},{"key":"2026052004165697500_czag035-B28","doi-asserted-by":"publisher","first-page":"e1230","DOI":"10.1002\/cl2.1230","article-title":"PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst Rev"},{"key":"2026052004165697500_czag035-B29","doi-asserted-by":"publisher","first-page":"5835","DOI":"10.3390\/curroncol30060437","article-title":"The stigma surrounding opioid use as a barrier to cancer-pain management: an overview of experiences with fear, shame, and poorly controlled pain in the context of advanced cancer","volume":"30","author":"Harsanyi","year":"2023","journal-title":"Curr Oncol"},{"key":"2026052004165697500_czag035-B30","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3390\/PHARMACY12030082","article-title":"Empowering pharmacists: strategies for addressing the opioid crisis through a public health lens","volume":"12","author":"Hughes","year":"2024","journal-title":"Pharmacy"},{"key":"2026052004165697500_czag035-B31","doi-asserted-by":"publisher","first-page":"108","DOI":"10.2471\/BLT.13.121558","article-title":"Do national drug control laws ensure the availability of opioids for medical and scientific purposes?","volume":"92","author":"Husain","year":"2014","journal-title":"Bull World Health Organ"},{"key":"2026052004165697500_czag035-B32","author":"INCB"},{"key":"2026052004165697500_czag035-B33","author":"International Narcotics Control Board"},{"key":"2026052004165697500_czag035-B34","doi-asserted-by":"publisher","first-page":"2345219","DOI":"10.1080\/20523211.2024.2345219","article-title":"Advancing opioid stewardship in low-middle-income countries: challenges and opportunities","volume":"17","author":"Jadhari","year":"2024","journal-title":"J Pharm Policy Pract"},{"key":"2026052004165697500_czag035-B35","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/S12961-020-00596-8","article-title":"The opioid crisis: a contextual, social-ecological framework","volume":"18","author":"Jalali","year":"2020","journal-title":"Health Res Policy Syst"},{"key":"2026052004165697500_czag035-B36","doi-asserted-by":"publisher","first-page":"1603960","DOI":"10.3389\/PHRS.2021.1603960","article-title":"The burden of drug abuse in Nigeria: a scoping review of epidemiological studies and drug laws","volume":"42","author":"Jatau","year":"2021","journal-title":"Public Health Rev"},{"key":"2026052004165697500_czag035-B37","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/J.INTECO.2021.10.004","article-title":"Does foreign aid impede economic complexity in developing countries?","volume":"169","author":"Kamguia","year":"2022","journal-title":"Int Econ"},{"key":"2026052004165697500_czag035-B38","author":"Kamwanja","year":"2011"},{"key":"2026052004165697500_czag035-B39","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1377\/HLTHAFF.2018.05075","article-title":"News media reporting on medication treatment for opioid use disorder amid the opioid epidemic","volume":"38","author":"Kennedy-Hendricks","year":"2019","journal-title":"Health Aff"},{"key":"2026052004165697500_czag035-B40","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/978-3-030-42917-1_22","volume-title":"Principles of Forensic Toxicology","author":"Kerrigan","year":"2020","edition":"5th edn"},{"key":"2026052004165697500_czag035-B41","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/DAR.12541","article-title":"Addressing the prescription opioid crisis: potential for hospital-based interventions?","volume":"36","author":"Kim","year":"2017","journal-title":"Drug Alcohol Rev"},{"key":"2026052004165697500_czag035-B42","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/S0140-6736(17)32513-8","article-title":"Alleviating the access abyss in palliative care and pain relief\u2014an imperative of universal health coverage: the Lancet Commission report","volume":"391","author":"Knaul","year":"2018","journal-title":"The Lancet"},{"key":"2026052004165697500_czag035-B43","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1007\/S40429-018-0232-9","article-title":"The opioid epidemic in Africa and its impact","volume":"5","author":"Kurth","year":"2018","journal-title":"Current Addiction Reports"},{"key":"2026052004165697500_czag035-B44","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/S13011-024-00600-2","article-title":"Prevalence, correlates, and reasons for substance use among adolescents aged 10\u201317 in Ghana: a cross-sectional convergent parallel mixed-method study","volume":"19","author":"Kyei-Gyamfi","year":"2024","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2026052004165697500_czag035-B45","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/978-3-030-87266-3_70","volume-title":"Anesthesiology In-Training Exam Review: Regional Anesthesia and Chronic Pain","author":"Lefkof","year":"2022"},{"key":"2026052004165697500_czag035-B46","first-page":"331","article-title":"Harm reduction policing: a scoping review examining police training as a strategy to overcome barriers to HIV services","volume":"27","author":"Lohman","year":"2025","journal-title":"Health Hum Rights"},{"key":"2026052004165697500_czag035-B47","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.jpainsymman.2021.12.026","article-title":"Progress update: palliative care development between 2017 and 2020 in five African countries","volume":"63","author":"Luyirika","year":"2022","journal-title":"J Pain Symptom Manage"},{"key":"2026052004165697500_czag035-B48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/6640133","article-title":"Affordability of essential medicines and associated factors in public health facilities of Jimma Zone, Southwest Ethiopia","volume":"2021","author":"Mathewos Oridanigo","year":"2021","journal-title":"Adv Pharmacol Pharm Sci"},{"key":"2026052004165697500_czag035-B49","doi-asserted-by":"publisher","first-page":"1241404","DOI":"10.3389\/fpubh.2023.1241404","article-title":"Pills and the damage done: the opioid epidemic as man-made crisis","volume":"11","author":"McDonald","year":"2024","journal-title":"Front Public Health"},{"key":"2026052004165697500_czag035-B50","doi-asserted-by":"publisher","first-page":"104423","DOI":"10.1016\/j.drugpo.2024.104423","article-title":"Mapping a moral panic: news media narratives and medical expertise in public debates on safer supply, diversion, and youth drug use in Canada","volume":"127","author":"Michaud","year":"2024","journal-title":"Int J Drug Policy"},{"key":"2026052004165697500_czag035-B51","doi-asserted-by":"publisher","first-page":"114992","DOI":"10.1016\/J.SOCSCIMED.2022.114992","article-title":"Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior","volume":"302","author":"Mitchell","year":"2022","journal-title":"Soc Sci Med"},{"key":"2026052004165697500_czag035-B52","doi-asserted-by":"publisher","first-page":"102255","DOI":"10.1016\/j.eclinm.2023.102255","article-title":"The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis","volume":"65","author":"Moyo-Chilufya","year":"2023","journal-title":"eClinicalMedicine"},{"key":"2026052004165697500_czag035-B53","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1016\/s1470-2045(25)00608-4","article-title":"Atlas of palliative care in Africa","volume":"26","author":"Nakkazi","year":"2025","journal-title":"Lancet Oncol"},{"key":"2026052004165697500_czag035-B54","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/j.jpainsymman.2017.11.010","article-title":"Investigation of the practices, legislation, supply chain, and regulation of opioids for clinical pain management in Southern Africa: a multi-sectoral, cross-national, mixed methods study","volume":"55","author":"Namisango","year":"2018","journal-title":"J Pain Symptom Manage"},{"key":"2026052004165697500_czag035-B55","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/S40290-017-0210-X","article-title":"Medicines regulation in Africa: current state and opportunities","volume":"31","author":"Ndomondo-Sigonda","year":"2017","journal-title":"Pharmaceut Med"},{"key":"2026052004165697500_czag035-B56","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12913-025-13813-3","article-title":"Implementation challenges and opportunities in decentralized methadone service delivery","volume":"26","author":"Nkya","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"2026052004165697500_czag035-B57","doi-asserted-by":"publisher","first-page":"17","DOI":"10.11604\/pamj-oh.2022.8.17.35856","article-title":"Prevalence and pattern of psychoactive substance use among government secondary school students in central Nigeria","volume":"8","author":"Oluwafunmilayo","year":"2022","journal-title":"PAMJ One Health"},{"key":"2026052004165697500_czag035-B58","doi-asserted-by":"publisher","first-page":"e03170","DOI":"10.1371\/journal.pone.0317036","article-title":"The burden of unlawful use of opioid and associated epidemiological characteristics in Africa: A scoping review","volume":"20","author":"Onohuean","year":"2025","journal-title":"PLOS ONE"},{"key":"2026052004165697500_czag035-B59","doi-asserted-by":"publisher","first-page":"104078","DOI":"10.1016\/J.DRUGPO.2023.104078","article-title":"Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: a scoping review","volume":"118","author":"Ooms","year":"2023","journal-title":"Int J Drug Policy"},{"key":"2026052004165697500_czag035-B60","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1080\/14737175.2019.1666712","article-title":"The use of new psychoactive substances (NPS) in young people and their role in mental health care: a systematic review","volume":"19","author":"Orsolini","year":"2019","journal-title":"Expert Rev Neurother"},{"key":"2026052004165697500_czag035-B61","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1108\/DHS-11-2022-0045\/FULL\/PDF","article-title":"Beyond evidence and reality: the politics, political economy and fallout of hawkish regulatory policy on prescription drugs in Nigeria","volume":"24","author":"Otu","year":"2023","journal-title":"Drugs Habits Soc Policy"},{"key":"2026052004165697500_czag035-B62","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026052004165697500_czag035-B63","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/BMJ.N71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026052004165697500_czag035-B64","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1200\/JCO.22.02198","article-title":"Use of opioids for adults with pain from cancer or cancer treatment: ASCO Guideline","volume":"41","author":"Paice","year":"2023","journal-title":"J Clin Oncol"},{"key":"2026052004165697500_czag035-B65","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.3390\/PH14111091","article-title":"Opioid analgesia and opioid-induced adverse effects: a review","volume":"14","author":"Paul","year":"2021","journal-title":"Pharmaceuticals"},{"key":"2026052004165697500_czag035-B66","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1089\/JPM.2019.0696","article-title":"Palliative care advocacy: why does it matter?","volume":"23","author":"Pettus","year":"2020","journal-title":"J Palliat Med"},{"key":"2026052004165697500_czag035-B67","doi-asserted-by":"publisher","first-page":"100580","DOI":"10.1016\/J.RCSOP.2025.100580","article-title":"Development of the barriers to opioid access scale among individuals with chronic pain","volume":"18","author":"Ramachandran","year":"2025","journal-title":"Explor Res Clin Soc Pharm"},{"key":"2026052004165697500_czag035-B68","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1002\/jppr.1741","article-title":"Attitudes, barriers and facilitators of hospital pharmacists conducting practice-based research: a systematic review","volume":"51","author":"Reali","year":"2021","journal-title":"J Pharm Pract Res"},{"key":"2026052004165697500_czag035-B69","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1177\/20494637211013052","article-title":"Global, regional, and national consumption of controlled opioids: a cross-sectional study of 214 countries and non-metropolitan territories","volume":"5","author":"Richards","year":"2021","journal-title":"Br J Pain"},{"key":"2026052004165697500_czag035-B70","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1007\/S12630-022-02273-6\/FIGURES\/1","article-title":"The other opioid crisis: the situation in low-resource countries","volume":"69","author":"Roques","year":"2022","journal-title":"Can J Anaesth"},{"key":"2026052004165697500_czag035-B71","doi-asserted-by":"publisher","first-page":"e422","DOI":"10.1016\/S2468-2667(25)00035-0","article-title":"Towards opioid access without excess","volume":"10","author":"Rosa","year":"2025","journal-title":"Lancet Public Health"},{"key":"2026052004165697500_czag035-B72","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1177\/00914509241292480","article-title":"Police officers\u2019 perspectives of harm reduction programs in West Virginia","volume":"52","author":"Rudisill","year":"2025","journal-title":"Contemp Drug Probl"},{"key":"2026052004165697500_czag035-B73","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1207\/s15551407vcq1302_4","article-title":"Selection","volume":"13","author":"Sampson","year":"2006","journal-title":"Vis Commun Q"},{"key":"2026052004165697500_czag035-B74","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s40352-024-00291-8","article-title":"Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners","volume":"12","author":"Satcher","year":"2024","journal-title":"Health Justice"},{"key":"2026052004165697500_czag035-B75","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13722-020-00186-7","article-title":"Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa","volume":"15","author":"Scheibe","year":"2020","journal-title":"Addict Sci Clin Pract"},{"key":"2026052004165697500_czag035-B76","doi-asserted-by":"publisher","first-page":"653","DOI":"10.17159\/1996-2096\/2019\/V19N2A5","article-title":"The right of palliative care for the most vulnerable in Africa is everyone\u2019s responsibility","volume":"19","author":"Sibomana","year":"2019","journal-title":"Afr Hum Rights Law J"},{"key":"2026052004165697500_czag035-B77","doi-asserted-by":"publisher","first-page":"5","DOI":"10.2217\/pmt.13.68","article-title":"Pain management in sub-Saharan Africa: innovative approaches to improving access","volume":"4","author":"Soyannwo","year":"2014","journal-title":"Pain Manag"},{"key":"2026052004165697500_czag035-B78","author":"Tagziria","year":"2023"},{"key":"2026052004165697500_czag035-B79","author":"Tyndall","year":"2010"},{"key":"2026052004165697500_czag035-B80","author":"UNODC"},{"key":"2026052004165697500_czag035-B81","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1038\/S41380-020-0661-4","article-title":"The changing opioid crisis: development, challenges and opportunities","volume":"26","author":"Volkow","year":"2021","journal-title":"Mol Psychiatry"},{"key":"2026052004165697500_czag035-B82","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1177\/0269216319894190","article-title":"The perception of barriers concerning opioid medicines: a survey examining differences between policy makers, healthcare professionals and other stakeholders","volume":"34","author":"Vranken","year":"2020","journal-title":"Palliat Med"},{"key":"2026052004165697500_czag035-B83","doi-asserted-by":"publisher","first-page":"112642","DOI":"10.1016\/j.socscimed.2019.112642","article-title":"A critical content analysis of media reporting on opioids: the social construction of an epidemic","volume":"244","author":"Webster","year":"2020","journal-title":"Soc Sci Med"},{"key":"2026052004165697500_czag035-B84","doi-asserted-by":"publisher","first-page":"e10028","DOI":"10.1371\/journal.pmed.1002837","article-title":"Middle-income countries graduating from health aid: transforming daunting challenges into smooth transitions","volume":"16","author":"Yamey","year":"2019","journal-title":"PLOS Medicine"},{"key":"2026052004165697500_czag035-B85","doi-asserted-by":"publisher","first-page":"1","DOI":"10.29337\/ijsp.184","article-title":"Availability and use of essential opioid analgesics in Sub-Saharan Africa: a scoping review protocol","volume":"27","author":"Yao","year":"2023","journal-title":"Int J Surg Protoc"},{"key":"2026052004165697500_czag035-B86","doi-asserted-by":"publisher","first-page":"443","DOI":"10.2147\/CEOR.S413546","article-title":"Challenges to the availability and affordability of essential medicines in African countries: a scoping review","volume":"15","author":"Yenet","year":"2023","journal-title":"Clinicoecon Outcomes Res"},{"key":"2026052004165697500_czag035-B87","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/tmi.13837","article-title":"Access to opioid analgesics for medical use at hospital level in the Democratic Republic of Congo: an exploratory mixed-method study","volume":"28","author":"Zandibeni","year":"2022","journal-title":"Trop Med Int Health"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czag035\/67360605\/czag035.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/5\/898\/67360605\/czag035.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/5\/898\/67360605\/czag035.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:17:06Z","timestamp":1779265026000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/41\/5\/898\/8524374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":87,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3,16]]},"published-print":{"date-parts":[[2026,5,20]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czag035","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,3,16]]}}}