About 11 percent of Ugandans needing morphine get it. Inadequate as that is, it makes Uganda a standout not just in Africa, but in the world.

Yet there is very little opioid abuse here; alcohol, marijuana and khat are far bigger problems.

No Relief in Sight

A recent major study by The Lancet Commission on Global Access to Palliative Care and Pain Relief described a “broad and deep abyss” in access to painkillers between rich countries and poor ones.

The United States, the report said, produces or imports 31 times as much narcotic pain-relievers it needs whether in legal or illegal form: morphine, hydrocodone, heroin, methadone, fentanyl and so on.

Haiti, by contrast, gets slightly less than 1 percent of what it needs. And Nigeria, on a per-capita basis, gets only a quarter of what Haiti gets: 0.2 percent of its need.

Even in big countries with domestic pharmaceutical industries, citizens still get shortchanged on pain relief, the report said. India and Indonesia, the second- and fourth-most populous countries on the planet, each supply only 4 percent of their own needs. Russia is at 8 percent. China, at 16 percent, barely beats Uganda.

“Each country has its own barriers,” said Dr. James F. Cleary, director of pain and policy studies at the University of Wisconsin’s medical school and a member of the commission that produced the Lancet study.

In some countries, doctors get no palliative care training; in others, legislators or the police oppose importing narcotics or deliberately make prescribing them difficult because of what the report deems “opiophobia.”