Chapter IV.
Availability of internationally controlled drugs for
the treatment of opioid dependence
254. Methadone and buprenorphine are used in the management of pain, but they are also extensively used in the
treatment of opioid dependence. In some countries, other
controlled substances, such as opium, opium tincture, ­heroin
and morphine, are used for the treatment of opioid dependence. The data reported by countries to INCB do not indicate the purpose of use, but estimates for methadone and
buprenorphine are mainly submitted in relation to programmes for the treatment of opioid dependence.
Figure 69. Reported manufacture and stocks
of buprenorphine, 1994-2013
255. An analysis of the trends related to the consumption, manufacture and stocks of both substances shows a
steady increase over the past 20 years. The global manufacture of buprenorphine has increased steadily (with the
exception of 2010, when there was a sharp decrease),
reaching a peak of 8.7 tons in 2013. Similarly, the global
manufacture of methadone also increased steadily during
the same period, with some fluctuations, and decreased
slightly in 2013 to 41.4 tons (5.5 tons less than in 2012)
(see figures 69 and 70). As mentioned in relation to other
opioid analgesics, it seems that there is no problem with
the supply of these substances.
Figure 70. Global manufacture, consumption
and stocks of methadone, 1994-2013
9 000
8 000
50
7 000
45
6 000
40
5 000
Kg
35
4 000
Tons
30
3 000
2 000
25
20
1 000
15
0
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13
Year
Stocksa
Manufacture
Consumption
Source: International Narcotics Control Board.
Note: Approximate calculated global consumption, determined on
the basis of statistical data submitted by Governments.
a
Stocks as at 31 December of each year; data are provided on a
voluntary basis and may therefore be incomplete.
10
5
0
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13
Year
Stocksa
Manufacture
Consumption
Source: International Narcotics Control Board.
a
Stocks as at 31 December of each year.
69
70 AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS
present. This is sometimes because of government policies that do not recognize the effectiveness of these kinds
of services in the treatment of opioid dependence, political and cultural resistance, or simply inaction by the
responsible authorities or incapacity to recognize the
problem. In the survey carried out by the Board in 2014,
67 per cent of countries indicated that they were using
narcotic drugs for the treatment of drug dependency with
substitution therapy.
Figure 71. Variations in the consumption of
methadone between 2004-2006 and 2011-2013
Figure 72. Variations in the consumption of
buprenorphine between 2004-2006 and 2011-2013
60 000
50 000
50 000
40 000
40 000
Total S-DDD
60 000
30 000
30 000
20 000
20 000
10 000
10 000
0
0
2004-2006 average
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Total S-DDD
256. However, there are large differences in the patterns
of consumption at the global level, as shown in maps
29-33. In some cases, the different level of consumption
(expressed in S-DDD, see figures 71 and 72) is related to
the presence or absence of people who inject drugs. In
other cases, despite the existence (more or less prevalent)
of that phenomenon, it seems that the consumption of
methadone and buprenorphine, and also the presence of
opiate substitution treatment services, are limited or not
2011-2013 average
Source: International Narcotics Control Board.
2004-2006 average
2011-2013 average
Source: International Narcotics Control Board.
Map 29. Prevalence of people who inject drugs, 2013
Prevalence of
abuse
Very low
Low
High
Very high
Source: UNODC.
The boundaries and names shown and the designations used on this map do not imply official e
­ ndorsement
or acceptance by the United Nations. The final boundary between South Sudan and the Sudan has not
yet been determined. The dotted line represents approximately the Line of Control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by
the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain
and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Chapter IV. Availability of internationally controlled drugs for the treatment of opioid dependence 71
Map 30. Consumption of methadone, 2004-2006
Consumption in
S-DDD per million
inhabitants per day
No data
1-100
101-200
201-2,000
2,001-5,000
> 5,000
The boundaries and names shown and the designations used on this map do not imply official e
­ ndorsement
or acceptance by the United Nations. The final boundary between South Sudan and the Sudan has not
yet been determined. The dotted line represents approximately the Line of Control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by
the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain
and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Source: International Narcotics Control Board.
Map 31. Consumption of methadone, 2011-2013
Consumption in
S-DDD per million
inhabitants per day
No data
1-100
101-200
201-2,000
2,001-5,000
> 5,000
The boundaries and names shown and the designations used on this map do not imply official e
­ ndorsement
or acceptance by the United Nations. The final boundary between South Sudan and the Sudan has not
yet been determined. The dotted line represents approximately the Line of Control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by
the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain
and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Source: International Narcotics Control Board.
72 AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS
Map 32. Consumption of buprenorphine, 2004-2006
Consumption in
S-DDD per million
inhabitants per day
<1
1-100
101-200
201-2,000
2,001-5,000
> 5,000
The boundaries and names shown and the designations used on this map do not imply official e
­ ndorsement
or acceptance by the United Nations. The final boundary between South Sudan and the Sudan has not
yet been determined. The dotted line represents approximately the Line of Control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by
the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain
and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Source: International Narcotics Control Board.
Map 33. Consumption of buprenorphine, 2011-2013
Consumption in
S-DDD per million
inhabitants per day
<1
1-100
101-200
201-2,000
2,001-5,000
> 5,000
The boundaries and names shown and the designations used on this map do not imply official e
­ ndorsement
or acceptance by the United Nations. The final boundary between South Sudan and the Sudan has not
yet been determined. The dotted line represents approximately the Line of Control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by
the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain
and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Source: International Narcotics Control Board.
Chapter IV. Availability of internationally controlled drugs for the treatment of opioid dependence 73
257. For methadone, it is important to note the increase
in consumption in Africa and South-Eastern Europe,
which corresponds to the expansion of opioid substitution treatment services in some countries in those regions.
For buprenorphine, there was a large increase in consumption in Western Europe. The increase in the consumption of buprenorphine registered in some regions
may be the result of various factors: aggressive marketing by producing companies; easier accessibility due to
the less strict control regime of the 1971 Convention
compared with the 1961 Convention (under which
metha­
done is controlled); and increasing use for pain
relief. In Central and South America, methadone is used
for pain management and not for opioid substitution
treatment, because the prevalence of people who inject
drugs in the region is relatively low.
258. A comparison of the level of consumption of
metha­done and the prevalence of people who inject drugs
in various regions indicates an imbalance in that regard
in Eastern Europe (see figure 73). As mentioned above,
the use of methadone is not recognized in some of the
countries of that region. In Western Europe, there seems
to be a very high level of methadone consumption despite
a lower prevalence of people who inject drugs. This may
be due to the fact that the opioid substitution treatment
­services provided in the region reach a large number of
people who inject drugs.
Figure 73. Comparison between consumption of methadone, 2011-2013, and prevalence of
people who inject drugs, 2013
2.5
50 000
2
Total S-DDD
40 000
1.5
30 000
1
20 000
0.5
10 000
Average consumption of methadone, 2011-2013
Regional prevalence of people who inject drugs, 2013
Source: International Narcotics Control Board and UNODC.
W
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Prevalence of people who inject drugs
(percentage of population)
60 000