The International Children’s Palliative Care Network (ICPCN) in collaboration with nine other regional, national and international palliative care organisations is calling for the safe and balanced use of opioids – drugs that act on the nervous system to relieve pain.
Balanced access to controlled substances for medical and scientific purposes is critical both to ensuring rational access to these medicines, and preventing and reducing their diversion and abuse. Access for pain treatment and palliative care is lacking in the majority of the world while illegal diversion and abuse are increasingly prevalent in a few countries.
The statement, Access to Controlled Substances for Medical and Scientific Purposes: Ensuring and Restoring Balance asks governments to ensure access to opioids for medical and scientific purposes and to reduce their abuse.
Besides ICPCN, the other collaborating organisations party to the statement are the International Association for Hospice and Palliative Care (IAHPC), Worldwide Hospice Palliative Care Alliance (WPCA), Pallium India (IAPC), African Palliative Care Association (APCA), Union for International Cancer Control (UICC), European Association for Palliative Care (EAPC), Pain and Policy Studies Group (PPSG), Kenya Hospices and Palliative Care Association (KEHPCA).
Undertreatment of pain
According to the statement, severe undertreatment of pain is reported in more than 150 countries, accounting for about 75% of the world’s population. At least 5 billion people live in countries affected by the crisis of underconsumption, and more than 18 million die annually with treatable pain. Global studies show that up to 84% of patients suffer from pain due to cancer, HIV and other conditions.
The statement affirms that access for pain treatment and palliative care is severely lacking in countries such as those in Asia, the Gulf States, Africa and Latin America. Currently, a small number of countries (e.g., Australia, Canada, and the US) have unbalanced systems characterised by higher consumption of prescribed opioids for medical purposes and increased abuse and illegal diversion of prescription opioids and other drugs.
The statement notes that unrelieved pain from advanced cancer, traumatic injury, AIDS, and other life-limiting illnesses impacts all dimensions of quality of life, including patients’ ability to participate in family, social, and spiritual activities. Relief of severe pain is contingent upon evidence-based education and practice.
Undue influence of pharmaceuticals
The World Health Organization (WHO) calls upon governments to strengthen measures, in collaboration with the WHO, to ensure that pharmaceutical companies with financial interests in opioid production do not exercise undue influence on policy makers and health professionals and the statement notes that US cities and states are presently suing opioid manufacturers, alleging that aggressive and fraudulent marketing has fuelled the opioid epidemic. Governments should also ensure collaboration between global, regional, and national pain and palliative care organisations to train healthcare providers to prescribe opioids safely for the treatment of pain.
To ensure and restore balance, governments across the world need to evaluate their drug control systems for balance, using the WHO Ensuring Balance in National Policies on Controlled Substances guidelines and following recommendations from it.
Governments are also encouraged to implement, in collaboration with WHO, International Narcotics Control Board (INCB), and United Nations Office on Drugs and Crime (UNODC), the recommendations from the WHO Palliative Care Resolution 67/19 and the UNGASS 2016 Outcome Document on the safe and effective use of controlled medicines for pain and palliative care, including enhanced data collection mechanisms throughout the controlled medicines supply chain to better detect diversion in real time.