A team of international experts has called for greater efforts to address the widespread global failure to ensure children—particularly those in low-income and middle-income countries – have access to essential medicines for pain, seizures, anaesthesia, and other serious conditions.
A two-part series, published on the 18th February 2026 in The Lancet Child & Adolescent Health, outlines the stark global inequity in children’s access to controlled medicines, i.e., medicines whose active ingredients are listed within the international drug control Conventions. The authors highlight the frequent neglect of children in research and policy efforts to improve access and call for increased global priority and targeted interventions to address the multiple intersecting barriers that hinder access.
The authors assert that the inaccessibility of key controlled medicines – including morphine for pain relief, benzodiazepines and phenobarbital for seizure management, and methadone for treating opioid use disorder when required in adolescents – represents a public health crisis and raises concerns regarding the protection of the human right to health.
While controlled medicines are essential across all contexts for the treatment of multiple health conditions, these articles outline the compounded disadvantage faced by children in many low-resource settings, where health system gaps are further burdened by challenges providing child-appropriate medicines and formulations. Barriers extend well beyond cost, including regulatory constraints, public and provider knowledge gaps, and a paucity of political will.
Corresponding author Dr Brandon Maser, a PhD candidate at the University of Toronto and a resident physician in Paediatric Medicine at The Hospital for Sick Children, said that these articles aim to draw attention to the immense suffering experienced by children around the world as a result of these persistent access gaps, and to recommend potential paths forward.
“Across the world right now there are millions of children who are suffering needlessly because controlled essential medicines are inaccessible to them due to policy and system failures,” Dr Maser said.
“Children in low-income and middle-income countries experience a convergence of multiple barriers and vulnerabilities for accessing controlled medicines. But the complexity of these barriers does not excuse denying a child relief from pain. These are essential, affordable medicines that should be accessible to every child in need, regardless of setting. The fact that they are not, is a profound injustice and a failure of our collective compassion for those most vulnerable in the world.”
In many countries, paediatric formulations are neglected within national procurement efforts and supply chains, making many medicines functionally inaccessible to younger children or forcing caregivers to crush tablets, which risks harmful dosing errors. At the same time, stringent controlled substance regulations—although intended to prevent non-medical use and diversion—can inadvertently constrain legitimate medical access by imposing burdensome prescribing requirements and discouraging appropriate clinical practice. Access is further limited by persistent misconceptions about children’s experience of pain, stigma surrounding controlled medicines, insufficient professional training in paediatric pain assessment and prescribing, and the scarcity of child-specific clinical guidelines. Addressing these intersecting barriers through coordinated action is essential to ensure that controlled medicines, when clinically indicated, can be safely, rationally prescribed and made accessible for children.
Dr Elizabeth Sáenz – a Drug Control and Crime Prevention Officer at the UN Office on Drugs and Crime, a paediatrician, and a senior author on these articles – noted, “Advocating for access to controlled medicines for legitimate medical and scientific use has been among the most demanding responsibilities of my career.”
“The knowledge that millions continue to suffer unnecessarily due to inadequate access is deeply unsettling. As a paediatrician, I have come to see even more starkly how these gaps disproportionately affect children – those least able to advocate for themselves. This realization has not only shaped my perspective but strengthened my resolve to work tirelessly toward equitable access to essential medicines, as both a scientific imperative and a moral responsibility.”
Senior author Professor Ju Lee Oei said children’s pain and suffering have been largely “invisible” in global policy discussions.
“Regulatory systems designed to prevent non-medical use have unintentionally restricted legitimate medical access for children. We must find a balanced approach that protects communities while ensuring a child with cancer, severe burns or uncontrolled seizures is not left to suffer,” Prof Oei said.
“We don’t need to invent new medicines; we simply need to fix the systems that deliver them. These articles highlight real-world success stories, proving that this crisis is solvable when there are coordinated efforts backed by political will.”
Professor Julia Downing, author and co-chair of the WHO Guidelines on balanced national controlled medicines policies highlighted one of the key messages in the paper, “Attention must be paid to the specific needs of children, ensuring access to appropriate paediatric formulations and dosages. Thus, children must be placed at the centre of policy design and implementation, and children, adolescents, families and caregivers must be included in policy and implementation guidance, alongside health workers. Without this, the inequity in access to controlled medicines for children’s medical needs will increase, and millions of children and their families will continue to suffer needlessly.”
The authors propose several priorities for future research and intervention, along with a functional framework for children’s access to controlled medicines, intended to guide governments, health system actors, and NGOs in strengthening access pathways. They argue that meaningful progress is not only feasible, but it is a “political and moral imperative” that is “urgent and long overdue.”
The full journal articles, titled “Controlled medicines for children’s medical needs: a review of the scope, determinants, and consequences of inequitable access” and “Children’s access to controlled medicines: policy lessons, intervention priorities, and a framework for action” were published in The Lancet Child & Adolescent Health on February 18th, 2026.
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