This article summarises the main points of the Outcome Document and the CND session relating to controlled medicines.
The document contains a set of well worded recommendations to assist countries in improving access to controlled essential medicines for “the relief of pain and suffering.”
Since the CND works by consensus rather than by vote, member states with different points of view about an issue have to work together to draft language that suits the interests of all.
A lot of discussion took place over the language in the controlled medicines section of the outcome document, according to member state colleagues who were in the room and reported back (only member states can attend the “informal” sessions where language is crafted and agreed upon).
The main cause of tension was the insistence of some member states, mostly Low and Middle Income countries, on language prioritising “affordability.”
Member state delegates worked long hours every day to find language that they agreed upon regarding the balance between law enforcement and public health models of drug policy.
The end product reflects the intense engagement of different perspectives, and bodes well for a positive learning process for countries that have given little or no consideration to this issue until now.
Civil society advocacy
It was great to have so many colleagues from NGOs working on advocacy for controlled medicines represented at CND: Human Rights Watch (Diederik Lohman), International Doctors for Healthier Drug Policies (Sebastian Saville, with Drs. Chris Ford and JudithYates); Pain and Policy Studies Group – (Drs. Jim Cleary, Martha Mauer, and Asra Hussein); Worldwide Hospice and Palliative Care Alliance (Dr Stephen Connor), and Drs. Nandini Vallath and Zipporah Ali, from Pallium India and Kenya Hospices and Palliative Care Association respectively.
Member states saw and heard – at three side events and many more interventions at the plenary – that they need to learn more about how to improve availability of controlled medicines.
It became clear, to some at least, that their key informants will be civil society advocates, particularly physicians and nurses!
Concerns about availability of controlled substances for medical and scientific purposes
The preambular paragraph, or frame of intention of the Outcome Document, “notes 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 parts of the world.”
The agreed language drew heavily on the data and recommendations contained in the International Narcotics Control Board (INCB) 2015 Annual Report Supplement, and on discussions about implementation proposed by civil society partners who had been corresponding with one another and with member states for the past year, specifically on this issue.
Document section on access to medications
The standalone section contains six paragraphs with recommendations for action, including collaborations between government, civil society, and UN agencies such as the World Health Organization, United Nations Office on Drugs and Crime, and INCB to remedy low availability of controlled substances for medical and scientific purposes.
These paragraphs cover the need to:
- simplify and streamline regulatory and legal systems
- strengthen the overall regulatory framework to minimise diversion and abuse, remove barriers and provide technical assistance
- expedite the issuance of import/export licenses
- address affordability, training, and expand prescribing to “appropriately trained and qualified professionals,” which could of course mean nurses, among others
- provide assistance with capacity building and training, including with pharmacists, on rational use
- develop national supply management systems for effective procurement; and
- continue to update WHO model lists of essential medicines, and support the WHO Expert Committee on Narcotic Drugs.
Of course, all these initiatives will be multi-year, and will require resources, entailing the development of new policies and processes of collaborative work that involves government ministries, UN agencies, and civil society including the faith community.
Implementing the recommendations
Member states will only be able to begin to implement these laudable recommendations if they engage with civil society at all levels: from the local to the global.
The controlled medicines advocacy community can frame our policy recommendations to countries in the terms of the Outcome Document and the 2030 Agenda to broaden our policy scope and donor pool.
The International Association for Hospice and Palliative Care (IAHPC) is starting to plan advocacy training workshops, and will introduce this initiative this year at the International Children’s Palliative Care Network conference in May and the 5th International African Palliative Care Conference in August.
At least three side events at the 59th Session of the CND directly addressed the issue of controlled medicines: the first hosted by the World Health Organization, where I presented on the public health impacts of improving access, including IAHPC strategies; the second hosted by the Governments of Lithuania, Panama and Mexico, IAHPC, Human Rights Watch, and many partner NGOs on: “Improving Access to Controlled Medicines in the Context of the SDGs,” and the third on Striving for Equity in the Treatment of Pain, hosted by International Doctors for Healthy Drug Policies.
Drs. Zippy Ali and Nandini Vallath gave expert, first hand presentations about advocacy efforts to improve access to controlled medications in Kenya and India respectively.
There will be two side events at UNGASS in New York in April, both on access to controlled medicines, one hosted by Belgium, and one by Australia.
Dr Zipporah Ali, Executive Director of the Kenya Hospices and Palliative Care Association, will represent the global controlled medicines community with a plenary speech at the UNGASS.
Discussions in context
The international context for the ten-day CND discussion on improving availability of controlled medicines was framed in part by the “opioid abuse over overdose crisis” in wealthy countries such as the US, Canada and Australia.
The Belgium bombings came toward the end of the meeting, as people were beginning to travel home, and reinforced what had been many delegates’ strained commitment to consensus.
The Outcome Document, which hopefully will be adopted by the UN General Assembly, gives hospice and palliative care organisations at all levels – from the local to the global – our advocacy framework for the next few years, indeed until the 2019 UNGASS.
We have our work cut out for us.
Find out more about the work of the IAHPC on their website.