Improving access to controlled essential medicines – report from the Commission on Narcotic Drugs meeting

Professor David Oliver, European Association for Palliative Care (EAPC) Board Member, and Dr Katherine Pettus, Advocacy Officer, International Association for Hospice and Palliative Care (IAHPC), report on the Commission on Narcotic Drugs meeting held recently in Vienna.

Prof David Oliver

Dr Katherine Pettus

The United Nations Commission on Narcotic Drugs (CND) in Vienna is holding a series of intersessional meetings this autumn to discuss how governments are implementing the many policy tasks they set themselves in the Outcome Document (OD) of the 2016 United Nations General Special Session (UNGASS) on the World Drug Problem.

Each intersessional focuses on one of the OD’s seven chapters. The Vienna Non-governmental Organisations Committee on Drugs invited David to serve as an expert panellist for Chapter 2, “Ensuring the availability and access to controlled substances exclusively for medical and scientific purposes, while preventing diversion.” UN member states and organisations (such as the World Health Organization, the United Nations Office of Drugs and Crime (UNODC), and the International Narcotics Control Board (INCB), as well as other civil society organisations) reported on progress and challenges in implementation of the recommendations contained in that chapter. View presentations here.

David spoke in his capacity as an EAPC Board Member and representative on the European Union Civil Society Forum on Drugs. Katherine contributed in her capacity as IAHPC Advocacy Officer while other civil society interventions, in the form of video presentations, came from Dr Sunita Panta, from the Nepal Military Hospital in Kathmandu, Dr Sami Alsirafy from the Palliative Medicine Unit at Cairo University, Egypt, and Busi Nkosi from the International Children’s Palliative Care Network.

David Oliver speaking at the meeting

David illustrated the clinical need for medication, particularly oral morphine, through patient stories, and global statistics, namely the increasing need for pain control as the world’s population ages and more people develop non-communicable diseases such as cancer. Europe, USA, Canada, Australia, New Zealand and Japan account for only 19 per cent of the World’s population but consume more than 90 per cent of the world’s morphine, leaving five billion people with little or no access to pain control. This is not because there is not enough raw material, or pharmaceutical products, but because multiple legislative and regulatory barriers, as well as educational and health system barriers, block access for patients and providers.

Responding to a question from the Canadian delegate regarding the opioid over-prescription and overdose crisis in that country, David emphasised the need to train healthcare professionals to diagnose and manage pain effectively, while minimising non-medical use. As a clinician, it is important that each patient is assessed individually, in his or her specific context. It is not about the substances, but about the patients, and their particular needs at a particular time in their illness trajectory.

This was an amazing opportunity to show representatives of countries from all over the world the need for controlled essential medicines in the management of pain and other symptoms together with the essential role of palliative care. It is essential for experienced clinicians to step up and do more advocacy, as member states want to listen to us, and we have the professional credibility they are looking for as they implement mandated public health policies. There was a very positive response in the room, with many countries showing that they wanted to improve accessibility and availability to opioids for the relief of severe pain to fulfil both their human rights obligations and meet the targets of the 2030 Agenda for Sustainable Development.

Countries such as Russia, Pakistan, Kenya, Colombia, Ecuador, Mexico, Spain, El Salvador, the Philippines, reported on the improvements that have occurred over recent years, while the US, Australia, Belgium and the UK reiterated their support for countries working to improve availability.

The challenge is to develop balanced policies that reduce non-medical use while improving rational availability that does not restrict effective patient care. 

Further reading



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