International law and controlled opioid medicines

Posted on October 1, 2014 by pallcare

Dr Katherine Irene Pettus, PhD, Advocacy Officer, Human Rights and Palliative Care, International Association for Hospice and Palliative Care, reports on the fifth intersessional meeting of the Commission on Narcotic Drugs.

Dr Katherine Pettus

As Advocacy Officer for International Association for Hospice and Palliative Care (IAHPC), I attend meetings of the Commission on Narcotic Drugs (CND), a UN treaty body, with other civil society organisations concerned with health and human rights. Our goal is to shift CND’s historical emphasis from excessive control and enforcement of illicit drugs, to improved availability of opioid medicines for the relief of pain and suffering. On 4 September, I attended an intersessional meeting in Vienna.

The purpose of this meeting was to prepare delegates of CND member states for 2016 UNGASS (United Nations General Assembly Special Session on Drugs). The afternoon session featured a brief panel to educate delegates on the issue of availability of essential opioid medicines controlled under international law. Presentations were given by representatives from the International Narcotics Control Board, INCB, (Dr Stefano Berterame), World Health Organization, WHO, (Dr Gilles Forte), and United Nations Office on Drugs and Crime, UNODC, (Dr Gilberto Gerra). Links to all three presentations, which include detailed statistics, graphics and references, are available on the UNODC website Special Session of the General Assembly UNGASS 2016.

Fifth intersessional meeting of the Commission on Narcotic Drugs:
Left to right: Dr Gilles Forte (WHO), Dr Stefano Berterame (INCB), Dr Gilberto Gerra (INCB); Ambassador Shamaa (Egypt) CND Chair (screen)

Although the Single Convention on Narcotic Drugs mandates states parties to ensure adequate access to the opioid medicines “scheduled” under its provisions, more than 80% of the world’s people live in countries where access to those medicines is “low to inadequate.” This situation represents a human rights violation of global proportions, a “global pandemic of untreated pain” in the words of the European Society for Medical Oncology.

While those of us who have been working on improving availability welcome increased attention to the issue, it was disappointing that there was still so much narrative emphasis on control and misuse rather than access, particularly from Dr Berterame. Dr Gerra of UNODC did his best to set the stage for a more comprehensive approach, saying that “Access to medicines is 50% of the mandate of the drug control system – it cannot just be relegated to a sub-point under the theme of ‘drugs and health’.”

The US, Netherlands, Norway and Spain all commented on the fact that CND must do better to improve the situation to conform to the mandates of the treaties. Dr Forte, Coordinator of Medicines Policy at the WHO, presented Scholten and Duthey’s powerful data, as well as the results of the ATOME (Access to Opioid Medication in Europe) project, and the Australia/UICC initiative (see link below for Dr Forte’s presentation).

Now, the work is to follow up to ensure that CND delegates integrate this essential educational piece into their policy agendas for the 2016 UNGASS.