Katherine Pettus, PhD, represented the International Association for Hospice and Palliative Care (IAHPC) at the Vienna NGO Coalition on Drug Policy in Austria. She explains how the Commission on Narcotic Drugs is changing its view of access to essential medicines for palliative care.
The issue of lack of access to opioid analgesics in 80% of the world, drew unprecedented attention at the recent High Level Segment of the Commission on Narcotic Drugs (CND) and the annual (57th) session held on 13/14 March in Vienna. Although the WHO (World Health Organization) classifies opioids such as morphine, used for the relief of severe pain, and methodone used for dependency treatment, as “essential medicines,” access to both is internationally restricted, since they are “scheduled” under the three drug control treaties supervised by the CND. Palliative care physicians in lower and middle-income countries confront multiple legal and regulatory barriers in accessing controlled medicines.
Two side events and a series of speeches by member states in plenary sessions educated delegates on the harmful health effects of national and international drug control policies. Member states were urged to make public health the cornerstone of drug policy and to review the effects of harsh law enforcement on access to essential medicines for palliative care and harm reduction.
Dr Vladimir Poznyak (WHO), called the inequity of access to pain medicines a “scandal” at the Informal Civil Society Hearing. Norway referenced the “tragedy” of inadequate access to essential medicines, while Switzerland pointed out that “we need to recognise the suffering this causes as an unintended and unacceptable side-effect of drug control.” Australia cited the “moral imperative” of ensuring that all doctors be able to access medicines for their patients needing pain relief. India referenced the recent passage of the amendment to the NDPS (Narcotic Drugs and Psychotropic Substances) Act, and the essential role of civil society, including the palliative care community, in educating lawmakers.
Separate side events hosted respectively by Lithuania and Australia highlighted the issue of access to essential medicines. The first featured Vietnamese physician and policy advocate, Dr Khuat Thi Hai Oanh, and Dr Jim Cleary, Director of the Pain and Policy Studies Group. Dr Oanh discussed the multiple public health side effects of drug prohibition, comparing the costs of policies that neglect harm reduction and punish drug users to the number of lives lost in all the Indochina wars. Evidence-based needle and syringe exchange programmes and opioid substitution therapy that reduce HIV and HCV transmission are illegal in many countries. Dr Oanh concluded her presentation by saying that: “As doctors, we try our best to save lives, one by one. A bad policy can kill massive amounts of people; a good policy can save millions.”
Dr Cleary showed a painful film clip of a palliative care team trying to work without morphine in rural India, and then presented the European Society of Medical Oncology’s findings on barriers to opioid availability in the WHO regions, highlighting the successes and remaining structural challenges for palliative care physicians and patients.
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What you can do…
Sign the Prague Charter and support the petition for palliative care and access to essential medicines, including opioid analgesics, for all patients who need it.