(Photo credit: Narendra Shrestha, Two Worlds Cancer Collaboration, June 2022 . Udrisya Bista, aged 7, is comforted by his older brother during his treatment at the Pediatric Care Unit of Bhaktapur Cancer Hospital, Bhaktapur, Nepal).    On 9 September, the Global Commission on Drug Policy launched a new policy brief, Making Children and Young People Visible in Drug Policy: A Child Rights-Based Agenda for Reform. Among its central messages is one with particular urgency for the palliative care community: drug policies must ensure, rather than obstruct, children and young people’s access to essential controlled medicines for pain relief, palliative care and other medical needs.   Around the world, children continue to experience avoidable pain and suffering because medicines that could relieve their symptoms remain unavailable or inaccessible. Up to 21 million children are estimated to need palliative care each year, while recent research estimates that approximately 10.6 million children and young people aged 0–19 experience serious health-related suffering annually, 96% of them in low- and middle-income countries.   These gaps are not simply a matter of medicine supply. Restrictive regulatory frameworks, fragile supply chains, insufficient paediatric formulations, inadequate health-worker training and persistent fears surrounding controlled medicines can all prevent children from receiving appropriate treatment.   Although the international drug control system recognises controlled medicines as indispensable for relieving pain and suffering, implementation has too often placed greater emphasis on preventing diversion than on ensuring access for legitimate medical need. “Drug control should never come at the expense of access to essential medicines. Yet for millions of people, including children and young people in need of pain relief and palliative care, overly restrictive policies continue to make effective treatment unnecessarily difficult to obtain. Ensuring access to controlled medicines is one of the core obligations of good drug policy,” said Professor Michel Kazatchkine, Commissioner of the Global Commission on Drug Policy.   The policy brief draws on the United Nations Convention on the Rights of the Child (UNCRC), international human rights law and public health evidence and was informed by 11 consultations across five continents involving more than 150 participants from approximately 47 countries.   Access to essential controlled medicines is one of four priority areas identified. The Global Commission calls on governments to remove unnecessary legal and regulatory barriers, improve the procurement and availability of paediatric formulations, strengthen health-worker education on safe prescribing and pain management, and integrate access to controlled medicines into universal health coverage and child health programmes.   Progress is possible. In Uganda, locally produced liquid oral morphine, nurse prescribing and the integration of paediatric palliative care into hospital- and community-based services have helped expand access in a resource-constrained setting.   For the palliative care community, the message is clear: access to pain relief and other essential controlled medicines is not only a health-system challenge, but also a question of drug policy and children’s rights. If drug policies are intended to protect children, that protection must also ensure that children are not left in treatable pain or denied the medicines and care they need.   Authors: Beatrix Vas, Programme Coordinator, Global Commission on Drug Policy. Anna Tomasi, Executive Secretary, Global Commission on Drug Policy.