'Drug control' and pain management: The truth of the matter

By Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines

July was a quiet month for palliative care advocacy, as many UN staff and colleagues in the northern hemisphere take well-deserved summer holidays. We are using this time to develop our new advocacy course to be released in September, catch up on reading, writing, and correspondence, and prepare for upcoming regional meetings of the World Health Organization. The WHO 71st Regional Committee meeting for Europe will be held September 13-15, and our final list of delegates includes myself, our Board Chair Dr. Lukas Radbruch, IAHPC research advisor Dr. Tania Pastrana, Italian primary care physician and geriatrician Dr. Simone Cernesi, our Advocacy Focal Point for the Russian Federation Dr. Galina Khemlina, a palliative care physician in San Diego, and IAHPC board member Ms. Gulnara Kunirova, founder of the Kazakhstan Association for Palliative Care.

News from the Inter-American Drug Abuse Control Commission

In its capacity as a civil society organization in official relations with the Organization of American States, the IAHPC fielded a delegation at the virtual 71st meeting of the Inter-American Drug Abuse Control Commission, or CICAD, on July 30. Our delegation—whose spokesperson was María Adelaida Córdoba, representing the Colombian Association of Palliative Care (ASOCUPAC)—called on CICAD to develop more programmatic support for members in the region wishing to improve access to controlled medicines. Although CICAD’s Hemispheric Drug Strategy and Plan of Action on Drugs have some paragraphs calling for improving access, , as the member state interventions at the meeting clearly demonstrated, much more advocacy by palliative care partners in the region is needed to translate these priority actions that still exist only on paper/PDF into policies that support patients and families. Dr. Cordoba’s intervention can be found here.

Our CICAD delegation included myself, Colombia Advocacy Focal Points María Adelaida Córdoba and Paola Ruiz, El Salvador Focal Point Marvin Colorado, and Argentina Focal Point Sofia Bunge. IAHPC Research Advisor Tania Pastrana assisted with Dr. Córdoba’s statement, and Universidad de la Sabana professor Marta Ximena León completed our institutional list of observers. We will be organizing our advocacy with CICAD around their next meeting, in Costa Rica in November. Anyone who wishes to join, please contact me, and stay tuned for more notices on this new campaign.

Policies fixated on abuse aren’t working

So much of the global, regional, and national drug control strategies—including CICAD’s—are still fixated on the 20th-century model of “supply control” as a solution to public health problems of harmful use of controlled substances, although according to the UN’s own data, harmful use and overdose is more prevalent than ever. Clumsy supply control policies and criminal justice-based approaches to illicit “drug” use have systematically restricted access to controlled medicines for pain control and palliative care, particularly in lower- and middle-income countries, resulting in what the European Association for Medical Oncology called the global pandemic of untreated pain, and what the Lancet Commission on Palliative Care more recently named the “access abyss.”

Tell us about your situation
so that we can help

Dismantling harmful drug control narratives that restrict access to essential palliative care medicines is a key pillar of IAHPC advocacy. We rely on our members to send us information about the situation regarding access in their countries so that we can help them with advocacy and pass on this information to the relevant UN agencies.

The global pandemic of untreated pain as a side effect of almost a century of drug control, exacerbated by the COVID-19 pandemic, has created a secondary public health crisis—suicides, heart attacks, and chronic conditions associated with serious health-related suffering. As clinicians and patients know too well, untreated pain decreases mobility, impairs immunity, decreases concentration, accelerates anorexia, and worsens sleep disturbances, eviscerating quality of life. Pharmaceutical opioids, which should be inexpensive and accessible for rational medical use, are still unavailable in more than 80% of the non-industrialized world.

Illicit use is thriving but
patients are deprived

Recent evidence shows that the US is now sliding into the abyss: the pathological public policies spawned by the original—and much misinterpreted—UN “drug control system” are proliferating in a swamp of ideological contradictions that have simultaneously supercharged trends of illicit substance use worldwide while depriving patients even in countries such as the US of essential pain medicine, as shown in this study. Only clear and consistent advocacy can turn this around.