Inadequate availability of medicines – the gravest world drug problem

Categories: Policy.

Next week, high-level representatives of governments will assemble at UN Headquarters in New York for the 2016 UN General Assembly Special Session (UNGASS) on the World Drug Problem.

There they are expected to adopt an Outcome Document embodying the international “joint commitment to effectively addressing and countering the world drug problem.”

The UNGASS has the potential to galvanise global and local efforts to ensure the provision of adequate pain relief, palliative care and protection of dignity to millions of people around the world living with and dying of cancer and other painful illnesses.

What does an UNGASS on the ‘world drug problem’ have to do with the relief of pain?

The expression ‘world drug problem’ ordinarily connotes the harms that ‘illicit drugs’ (and approaches taken to combat them) cause; and the global challenges of combating drug trafficking, money laundering, organised crime, corruption and terrorism.

The very idea of ‘drugs’ and ‘drug problems’, often understood against the backdrop of the ‘wars’ fought against them, has tended to obscure the critical importance of many ‘licit drugs’ as medicines.

Few would be likely to think of the grossly inadequate availability of essential medicines such as morphine in most of the world as one of the gravest ‘world drug problems’.

In its recently released report: ‘Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes’, the International Narcotics Control Board (INCB) sets out the stark data.

Approximately 5.5 billion people have limited or no access to medicines containing narcotic drugs. Around 92% of the world’s medical morphine is consumed in a small number of developed countries constituting only 17% of the world’s population – predominantly the US, Canada, countries in Western Europe, Australia and New Zealand.

Approximately 75% of the world’s population, predominantly in lower-income countries, has limited or no access to proper pain relief.

The World Health Organization (WHO) estimates that each year, 5.5 million people who are terminally ill with cancer suffer from moderate to severe pain that is not managed at all.

The UNGASS Outcome Document reflects the enormous progress that has been made over the last seven years in international drug control policy, as represented by the decisions and activities of the Vienna-based Commission on Narcotic Drugs (CND), UN Office on Drugs and Crime (UNODC) and INCB, in recognising the scale of the problem of unavailability, and the need to properly address it.

The 50-page 2009 Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem made only passing reference to the problem.

The tide began to turn the following year, with the adoption of the landmark 2010 CND Resolution, Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse. Momentum has been increasing ever since.

The preamble of the UNGASS Outcome Document states:

“We note with concern that the availability of internationally controlled drugs for medical and scientific purposes, including for the relief of pain and suffering, remains low to non-existent in many countries of the world, and we highlight the need to enhance national efforts and international cooperation at all levels to address that situation by promoting measures to ensure their availability and accessibility for medical and scientific purposes, within the framework of national legal systems, while simultaneously preventing their diversion, abuse and trafficking, in order to fulfil the aims and objectives of the three international drug control conventions.”

The Outcome Document contains a substantial standalone section on availability and access, which includes a number of operational recommendations on legislation and regulation; healthcare professional training; prescription, dispensation and administration; clinical guidelines; essential medicines lists; awareness-raising campaigns; supply management; and technical and financial assistance to developing countries.

It underlines the critical role of the three key international organisations – the INCB, UNODC, and WHO. While the three organisations have very different mandates and overall priorities, they share common ground on this global health challenge.

What difference will an UNGASS outcome document make in practice?

The negotiation and adoption of international agreements and political declarations in the UN cities of New York, Geneva and Vienna can often seem remote from the real lives of individuals.

Those of us who put time and effort into these global processes do so because we believe that global and local political and policy settings are intricately related, and that global processes can make a real difference to people’s lives. They can:

  • inform and shape the priorities and activities of governments
  • steer the mandates and practices of international agencies, which often play significant roles in facilitating and supporting local action
  • serve as powerful advocacy documents that can be championed by government officials, civil society organisations and individuals
  • mobilise international cooperation and technical assistance and support; and
  • influence the decisions of donors, both public (such as development agencies) and private (such as philanthropists and foundations).  

To what extent will UNGASS do all of this to the benefit of people suffering from pain due to cancer and other serious illnesses around the world? This remains to be seen. But if we all commit to do all in our power to harness UNGASS’s potential, the benefits will be profound.

Jonathan Liberman is Director of the McCabe Centre for Law and Cancer, a joint initiative of the Union for International Cancer Control and Cancer Council Victoria.

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