Katherine Irene Pettus, PhD, is a drug policy scholar and represents IAHPC at the International Drug Policy Consortium and the Vienna NGO Coalition.
The United Nations Office on Drugs and Crime (UNODC) frames the ‘world drug problem’ very differently from palliative care activists in the global south and post-Soviet bloc countries. What ESMO (European Society for Medical Oncology) in 2012 called the global pandemic of untreated pain – naming our vision of the world drug problem – is not even on the radar of the drug control agencies at the UN. UNODC says it has “succeeded in bringing the licit market for drugs under control.” Maybe it has, but at the expense of 80% of the world’s people who have no access to opioids.
The International Association for Hospice & Palliative Care (IAHPC) is participating as much as possible in the limited space provided for civil society at the regular Commission on Narcotic Drugs (CND) meetings and intersessionals. We have colleagues like International Doctors for Healthier Drug Policies and the International Drug Policy Consortium. It is crucial that the physician perspective be clearly articulated and transmitted at these meetings. Palliative care activists must make it their business to educate their UN delegations both in Vienna and New York about the pandemic of untreated pain. March 2014 will be a key meeting as the CND will review member states’ progress under the 2009 Political Declaration (PD). The ‘three pillars’ of the 2009 PD are demand reduction, supply reduction, and money laundering. You can bet opioids for palliative care will not be mentioned because our world drug problem involves increasing supply and stimulating demand for medical opioids.
Global drug control, which by definition implicates availability of opioids for palliative care, is intensely political. Perhaps that is why palliative care activists opt for the more neutral human rights discourse and stay away from drug policy. This is a self-defeating strategy. Palliative care professionals trained to conduct sensitive conversations about ‘goals of care’ are in a strategic position to reframe the world drug problem by engaging national and international policy makers in informed, sensitive, and committed conversation.