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Narcotics Board Calls for Closing the Global Pain Divide

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By Jaya Ramachandran | IDN-InDepthNews Analysis

BERLIN | VIENNA (IDN) - About 92 percent of morphine used worldwide is consumed by only 17 per cent of the world population – predominantly in the United States, Canada, Western Europe, Australia and New Zealand.

While consumption in those countries has increased significantly since the early 1990s and there is growing concern about prescription drug abuse, more than 75 per cent of the people in several low and middle-income countries have no medical access to narcotic drugs and psychotropic substances.

With this in view, the International Narcotics Board (INCB) has warned countries that inadequate access contradicts the notion of article 25 of the Universal Declaration of Human Rights, including the right to medical care, which also encompasses palliative care. This warning comes ahead of the Special Session of the UN General Assembly on the World Drug Problem (UNGASS), which will take place in New York in April 2016.

The Report states that the international community made a solemn commitment with the Single Convention on Narcotic Drugs of 1961 and the Convention on Psychotropic Substances of 1971 to make adequate provision to ensure, and not to unduly restrict, the availability of drugs that were considered indispensable for medical and scientific purposes.

INCB notes that enough pain relief substances and raw materials are produced to fully cover global demand, yet three out of four people in the world have only limited or no access to pain relief. This is due to various obstacles such as the lack of training and awareness of health care professionals, fear of drug dependence and limited financial resources, according to the Availability Report of the International Narcotics Control Board that was published in Vienna on February 3.

In its Report, the Board publishes the findings of a study on the availability of narcotic drugs and psychotropic substances under international control based on global consumption data and information on impediments and barriers at country level. The Availability Report is a supplement to the 2015 INCB Annual Report, which is due to be published on March 2, 2016.

The Board highlighted just one day ahead of World Cancer Day that pain relief medications like morphine are indispensable for the treatment of pain caused by cancer, HIV/AIDS, heart disease, diabetes or surgery, among other conditions, as well as childbirth. Despite UN Conventions stipulating that certain essential pain-relief medicines must be made available, 5.5 billion people (75 per cent of the world population) still have limited or no access to essential painkillers, such as codeine or morphine, says the report.

Marking World Observance of the Day, UN Secretary-General Ban Ki-moon said on February 2: “Cancer affects all countries, but those with fewer resources are hit hardest.  Nothing illustrates this better than the burden of cervical cancer. The world’s poorest countries are home to more than 8 in 10 women newly diagnosed with cervical cancer, and 9 in 10 deaths from the disease. While applauding the success of cervical cancer screening in many high-income countries, we have a responsibility to replicate this progress in low-income States, where cervical cancer remains one of the most common cancers among women.”

INCB notes that psychotropic substances such as sedatives, hypnotics, anxiolytics, stimulants and antiepileptics are essential for the treatment of several mental health conditions including anxiety, insomnia, epilepsy and attention deficit and hyperactivity disorder (ADHD). However, more than three-fourths of the population in many low and middle-income countries has no access to such treatment.

Disparities

INCB remains alert about the disparities for consumption of psychotropic medicines, as levels of their use vary greatly between regions and among countries. Excessive availability of psychotropic substances, as a result of unregulated supply and inappropriate or non-medical use of controlled drugs, is as much of a concern to the Board as inadequate supply.

Compared to the last survey by the Board in 2010 on narcotic drugs, the obstacles to availability of pain relief medications cited by responding countries have shifted in emphasis. In 2015, countries saw the lack of training and awareness among health professionals as the major obstacle to availability of opioid analgesics. The same was true for psychotropic substances.

In the case of opioid analgesics, fear of drug dependence was the second most important reason for a lack of availability, whereas problems in sourcing from industry was seen as the second largest obstacle to availability of psychotropic medicines.

Fear of drug dependence is related to lack of awareness and training, but also to cultural attitudes, whereas lack of sourcing can be the result of pharmaceutical companies not being interested in producing certain medicines because of insufficient market demand in the country. Imports, on the other hand, can often be hindered due to burdensome regulations, causing delays in the supply chain.

INCB therefore calls on countries to close the global pain divide and ensure worldwide access to pain relief medications and to ensure balanced availability of psychotropic substances.

The Board recommends that countries review their laws and regulations to ensure they are not overly restrictive, and improve access by, for example, allowing a larger base of health care professionals to prescribe, in particular, substances under international control. Better training and increased awareness for health care professionals can reduce fears, stigmas and prejudices hindering access to pain relief medications and psychotropic substances.

INCB is an independent, quasi-judicial expert body established by the Single Convention on Narcotic Drugs of 1961 by merging two bodies: the Permanent Central Narcotics Board, created by the 1925 International Opium Convention; and the Drug Supervisory Body, created by the 1931 Convention for Limiting the Manufacture and Regulating the Distribution of Narcotic Drugs.

INCB has 13 members, each elected by the Economic and Social Council for a period of five years. INCB members may be re-elected. Ten of the members are elected from a list of persons nominated by Governments. The remaining three members are elected from a list of persons nominated by the World Health Organization (WHO) for their medical, pharmacological or pharmaceutical experience. [IDN-InDepthNews – 4 February 2016]

Logo: INCB

2016 IDN-InDepthNews | Analysis That Matters

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