Last month on April 13, African Ministers of Health converged in Addis Ababa for the First Session of the African Union’s Specialised Technical Committee on Health, Population and Drug Control (STC-HPDC-1).
The session’s theme, “Challenges for Inclusive and Universal Access” provided the opportunity to look at inter linkages between health and drug control.
Dr Gilles Forte, focal point for essential medicines at the World Health Organization, was at the meeting to provide expert consultation on controlled medicines and on the issue of the potential scheduling of ketamine.
A key outcome of behind-the-scenes palliative care advocacy efforts included a series of drug control recommendations around the scheduling of ketamine, including a Ministerial call upon Member States to:
- unanimously support non scheduling of ketamine internationally as essential, especially for trauma in emergency and in war situations, with limited alternatives available.
- undertake legislative review to allow the roles of doctors to be shifted to specifically trained nurses, enabling them to prescribe oral morphine to patients in severe to moderate pain with an allocation of funds that would include policy maker and health professional training.
Addressing the Ministers at the opening ceremony, the Commissioner of Social Affairs, H.E. Dr. Mustapha Sidiki Kalolo, emphasised the benefits of the combined meetings of health, population and drugs control to harness the opportunities presented through the convergence of the three ministries.
On the inter-ministerial collaboration, Katherine Pettus, Advocacy Officer for the International Association for Hospice and Palliative Care (IAHPC) said, “It is wonderful to see the African Union taking a global lead on this and showing the sort of inter-ministerial collaboration and cooperation that is a feature of the palliative care approach, and has been for the past few years.”
Katamine scheduling: implications for African health systems
The issue of access to internationally-controlled psychotropic substances, and the implications of ketamine becoming scheduled can have a devastating impact on African countries.
“If ketamine was scheduled, doctors in Africa would not be able to do essential surgery in rural areas. It would have a massive effect on access for surgery,” said Pettus.
According to Liliana de Lima, Executive Director of the IAHPC, when a medicine is scheduled, countries have to go through a complex process of estimation, ordering, and licensing. This hinders availability and access.
“If ketamine was scheduled, this would cause a public health crisis in Africa,” noted de Lima, her concerns echoing the WHO’s 2012 Expert Committee on Drug Dependence technical report (p. 9). The report cites ketamine restrictions as limiting a patient’s “access to essential and emergency surgery, which would constitute a public-health crisis in countries where no affordable alternative anaesthetic is available.”
“With Africa being one of the continents with a very big burden of palliative care needs for which opioid medications are required, the move by the African Union to cause easier access to the medications is a very timely one,” said Dr Emmanuel Luyirika, Executive Director of the African Palliative Care Association (APCA).
“APCA will build on these initiatives to continue supporting African countries to strengthen palliative care policy development, medicines availability, training of health workers and ensure even better palliative care implementation on the continent,” he said.
*A prior version of this article erroneously noted that palliative care advocates helped develop the AU Common Position on medical opioids in preparation for the United Nations General Assembly Special Session (UNGASS), scheduled for 2016. The position for UNGASS was in fact identified by member states during the 6th session of the Ministers in Charge of Drug Control meeting in October 2013, which covered a number of issues, including a balanced approach to drug control, including issues of access to pain medication.
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