The international drug control regime and access to controlled medicines

The World Health Organisation estimates that some 5.5 billion people around the globe inhabit countries with low to non-existent access to controlled medicines and have inadequate access to treatment for moderate to severe pain. This figure translates to over 80 per cent of the world's population. Only in a small number of wealthy countries do citizens stand a reasonable chance of gaining adequate access to pain care, though even here room for improvement remains. According to the International Narcotics Control Board, recent data indicate that more than 90 per cent of the consumption of strong opioids takes place in Australia, New Zealand, Canada, the United States and Western Europe.

In poor and developing nations, meanwhile, and even in several industrialised states, pain remains largely uncontrolled. Africa is the least well served continent for access to analgesia. The situation affects numerous conditions: pain may go untreated for those with cancer and with HIV/AIDS, for women in childbirth, for numerous chronic conditions, for those in post-surgical settings, those who are wounded in armed conflicts, those who have suffered accidents, and so on.

Conclusions and recommendations

• The unacceptable situation with respect to access to controlled medicines is another indicator that the time is right to consider the revision of the international drug control treaties in order to achieve a better balance between the twin objectives of restricting nonmedical drug use and ensuring access for medical and scientific requirements.
• While the treaties remain unreformed, the INCB should achieve a better understanding of the manner in which its concerns with restricting diversion and nonmedical use impacts upon the system's public health imperatives, in particular the provision of access to essential medicines.
• With this in mind, the INCB should refrain from interfering in those areas of the system that are mandated to WHO, such as the scheduling of substances under the 1961 and 1971 conventions.
• The WHO has demonstrated courage and leadership in its defence of public health priorities in its scheduling recommendations. It should continue to adopt this position, and should receive the commendation and support of Parties and NGOs in so doing.
• Again, until the treaties are reformed to represent a better balance between their twin objectives, the INCB should consider utilising Article 14 of the Single Convention in relation to those states who fail to progressively establish access to essential medicines. In most cases, the Article should be invoked together with Article 14 bis, which would allow supportive technical and financial steps to be taken to assist non-compliant countries.
• Funds to assist governments to comply with their obligation along the lines of Article 14 bis could come from individual states with an interest, or from a special group fund dedicated to the purpose.
• NGOs in the field of palliative care and those working to reform the drug control system should cooperate to bring about change.

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