Selection

Essential medicines are meant to satisfy the priority health care needs of the population. Based on the latest scientific evidence on the efficacy, safety and cost effectiveness of medicines, the WHO Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc) are updated and published every two years and are intended as guides for countries to develop their own national Essential Medicines Lists in accordance with local needs, priorities and treatment guidelines.

To learn more about the Expert Committee on Essential Medicines, please visit WHO´s website

WHO Model Lists of Essential Medicines

The current versions of the Model Lists of Essential Medicines were updated in June 2019. Opioid analgesics have been included on the WHO Model List since the first edition was published in 1977.
The EML includes the naturally occurring opioids, codeine and morphine, as well as the synthetic opioids, fentanyl and methadone. The EMLc includes morphine and methadone for use in children. The synthetic opioids, hydromorphone and oxycodone, are accepted in the Lists as possible therapeutic alternatives to morphine.
For more information please visit the WHO website
 
The Model List of Essential Medicines is also available digitally as an online data base which can be searched and customized. 
Morphine

Both the 21st WHO Model List of Essential Medicines and the 7th WHO Model List of Essential Medicines in Children include morphine as a preoperative medication and sedation for short term procedures, as an injection of 10 mg (sulfate or hydrochloride) in 1- mL ampoule. Moreover, in both lists, morphine is included as an opioid analgesic. Listed formulations include:
• Granules (slow release; to mix with water): 20 mg to 200 mg (morphine sulfate)
• Injection: 10 mg (sulfate or hydrochloride) in 1- mL ampoule
• Oral liquid: 10 mg (morphine hydrochloride or morphine sulfate)/5 mL
• Tablet (slow release): 10 mg – 200 mg (morphine hydrochloride or morphine sulfate)
• Tablet (immediate release): 10 mg (morphine sulfate)
For more information about the situation and trends concerning morphine, click here
Codeine


The 21st WHO Model List of Essential Medicines includes codeine phosphate as an opioid analgesic (Section 2.2). Codeine is indicated for the treatment of mild to moderate pain. Codeine was previously included in the EML as a cough suppressant and an antidiarrhoeal, but was removed for these indications in 1997.

Methadone

Methadone is included in the complementary list of the 21st WHO Model List of Essential Medicines and the 7th WHO Model List of Essential Medicines for Children as an opioid analgesic for the management of pain including cancer pain.
Included formulations are:
• Tablet: 5 mg; 10 mg (as hydrochloride)
• Oral liquid: 5 mg / 5 mL; 10 mg / 5 mL (as hydrochloride)
• Concentrate for oral liquid: 5 mg / mL; 10 mg / mL (as hydrochloride)
Methadone is included in the complementary list of the 21st WHO Model List of Essential Medicines for use in the treatment of opioid dependence. (Section 24.5 Medicines for disorders due to psychoactive substance use). 
For information about the situation and trends concerning methadone, click here
Fentanyl

The 21st WHO Model List for Essential Medicines includes fentanyl as an opioid analgesic (Section 2.2) for the management of cancer pain.
Listed formulations are:
• Transdermal patch 12 micrograms/hr; • 25 micrograms/hr;
• 75 micrograms/hr, • 50 micrograms/hr; • 100 micrograms/hr
Fentanyl was added to the core list in 2017 as the need for additional opioid treatment options was recognized for the management of cancer pain, as well as as a response to the limited access to morphine and the absence of pain relief treatments for cancer patients, particularly in lower- and middle-income countries.