Academic journal article Bulletin of the World Health Organization

Do National Drug Control Laws Ensure the Availability of Opioids for Medical and Scientific purposes?/Les Legislations Nationales De Lutte Contre la Drogue Assurent-Elles la Disponibilite Des Opioides a Des Fins Medicales et scientifiques?/?Garantizan Las Leyes De Control Nacional De Drogas la Disponibilidad De Opiaceos Para Fines Medicos Y Cientiticos?

Academic journal article Bulletin of the World Health Organization

Do National Drug Control Laws Ensure the Availability of Opioids for Medical and Scientific purposes?/Les Legislations Nationales De Lutte Contre la Drogue Assurent-Elles la Disponibilite Des Opioides a Des Fins Medicales et scientifiques?/?Garantizan Las Leyes De Control Nacional De Drogas la Disponibilidad De Opiaceos Para Fines Medicos Y Cientiticos?

Article excerpt

Introduction

In a report to the United Nations, the International Narcotics Control Board (INCB) stated:

"One of the fundamental objectives of the international drug control treaties is to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes and to promote the rational use of narcotic drugs and psychotropic substances." (1)

Countries that signed the 1961 Single Convention on Narcotic Drugs as Amended by the 1972 Protocol, hereafter referred to as the Single Convention, are expected to abide by the Convention's provisions on the control of certain drugs while ensuring that these drugs are available for medical purposes. The Single Convention established a medicolegal principle of balance: governments have a dual obligation to prevent the diversion and abuse of narcotic drugs and to ensure adequate provision of opioid analgesics for legitimate medical and scientific purposes. (2) In this paper, we use the word "balance" in the way it is used by international organizations, such as the United Nations Economic and Social Council, the INCB, (3) the World Health Organization (WHO) (2) and the Commission on Narcotic Drugs. (4) Drug availability is ensured most effectively in the context of balance and drug control is achieved most effectively when carried out with availability in mind. Table 1 lists the principal measures proposed by the Single Convention to ensure the availability and control of Schedule I drugs in situations in which a closed drug control system has been established to give a government authority over other involved parties, thus preventing the diversion and nonmedical use of these substances. Schedule I drugs belong to one of four schedules of drugs classified by the Single Convention according to their potential for abuse and medical value. These drugs are recognized as being essential for medical and scientific purposes but, since they are also the most susceptible to abuse, are subject to the most stringent control of all medical drugs. Drugs may be added to Schedule I by the Commission on Narcotic Drugs on the recommendation of WHO if they have the same potential for abuse as other drugs on the schedule. (5)

WHO has estimated that tens of millions of people worldwide experience pain associated with late-stage cancer, acquired immunodeficiency syndrome (AIDS) and other painful diseases and conditions. (6) However, despite WHO's long-standing designation of morphine as an essential medicine for the relief of pain, much of the world still does not have access to this drug or to other opioid medications commonly used for the treatment of pain and dependence syndrome, (3) such as hydromorphone, fentanyl, morphine, methadone and oxycodone. Moreover, WHO estimates that over 80% of the world's population lives in countries with little or no access to controlled opioid analgesics. (6-8) Indeed, most patients in developing countries with cancer, AIDS and other painful conditions are not treated with opioid medicines because access to these controlled drugs is severely restricted. (3,7,9,10) According to United Nations' bodies, there are a number of reasons for the poor availability of, or limited access to, essential opioid medicines, such as concerns about patients developing dependence, insufficient training for health-care professionals and problems with procurement, manufacture and distribution. (2,3,11,12) In addition, the availability of these substances for medical use has also been severely limited by administrative requirements that are much stricter than the control measures proposed by the Single Convention (i.e. "regulatory impediments", Box 1). (3,20)

In 2009, the Pain and Policy Studies Group at the University of Wisconsin in the United States of America examined the model law, model drug regulation and model drug abuse bill proposed by the United Nations Office on Drugs and Crime (UNODC)--the body responsible for preparing national model legislation and regulations--to determine whether these models provide governments with language they can use to implement their obligations under the Single Convention. …

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