Opioid analgesics are among the most effective medicines for the treatment of moderate to severe pain, yet their global use is marked by profound and persistent inequities. While high-income countries have experienced widespread opioid overuse and related morbidity and mortality, low- and middle-income countries continue to face severe under-access to essential opioid medicines, resulting in the systematic undertreatment of pain. This dual crisis—referred to in this thesis as the global opioid paradox—raises critical questions at the intersection of pharmaceutical science, global health, and regulatory policy.
This doctoral thesis adopts an interdisciplinary approach to examine how the pharmacological properties of opioids interact with regulatory frameworks and health system structures to shape population-level outcomes. Drawing on evidence from pharmacodynamics and pharmacokinetics, epidemiological data, and international and national policy analysis, the thesis explores why opioids have produced radically different public health consequences across regions despite their shared biological mechanisms.
The analysis demonstrates that opioids’ potent μ-opioid receptor–mediated analgesic effects are intrinsically linked to risks such as tolerance, dependence, and respiratory depression, making them particularly sensitive to regulatory context. In high-income countries, permissive prescribing cultures, aggressive pharmaceutical marketing, and fragmented oversight amplified these risks, contributing to an unprecedented opioid crisis. In contrast, in many low- and middle-income countries, restrictive interpretations of international drug control treaties, limited regulatory capacity, and inadequate health system infrastructure have created structural barriers to access, leaving millions without adequate pain relief. Through a detailed examination of international drug control conventions, the role of the World Health Organization, the European Medicines Agency, and national implementation mechanisms, the thesis highlights how policy intent, interpretation, and capacity influence opioid availability and use. It further evaluates pharmacological and policy-based solutions, including safer opioid formulations, non opioid analgesic strategies, balanced regulatory frameworks, and harm reduction interventions. The central conclusion of this work is that opioids are neither inherently beneficial nor inherently harmful;
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- Vincent Weiss (Autor:in), 2026, Pharmacological, Regulatory and Global Health Dimensions of Opioid Use, München, GRIN Verlag, https://www.grin.com/document/1733273