Opioid consumption, availability, and policy alignment in primary hospice and palliative care in China: a multicomponent comparative analysis

PURPOSE: To assess opioid consumption, availability, and policy alignment for cancer-related pain management in primary health care (PHC)-based inpatient hospice and palliative care (HPC) services in China. METHODS: A multicomponent analysis was conducted, including (1) a cross-national comparison of opioid consumption using International Narcotics Control Board (INCB) data (2020-2022); (2) a census-based assessment of opioid stocking and use in all PHC institutions providing inpatient HPC in a provincial system (2019-2023); and (3) a policy review comparing national Essential Medicines List (EML) with international recommendations. Opioid use was standardized as defined daily doses per million inhabitants per day (S-DDDpm). RESULTS: China's mean opioid consumption (168 S-DDDpm) was less than half the Asian average (368 S-DDDpm) and far below comparable economies. From 2019 to 2023, the proportion of PHC institutions stocking strong opioids rose from 22.5% to 30.2%, yet total consumption declined from 240.3 to 145.3 S-DDDpm (compound annual growth rate: -11.8%). Regional disparities existed. The national EML included only morphine, omitting most internationally recommended strengths and dosage forms. CONCLUSION: Opioid access for cancer-related pain management in China's PHC-based HPC services remains critically inadequate. Expanding essential drug formularies, diversifying formulations, and strengthening PHC prescribing capacity are urgent priorities to reduce disparities and improve quality of life for patients with advanced cancer.