Opening David Stuart – Permanent representative Australia: Access to these medicines globally is very unequal

Single convention on narcotic drugs (1961) establishes framework to :
1. Ensure the availability of drugs for medical and scientific purposes.
2. Prevent diversion and abuse.
High Income Countries account for 93% of all medical morphine yet 70% of deaths from cancer occur in low-middle income countries.
Low Income Countries: Only  1/50 of IDU’s can receive treatment for opioid dependence with controlled medicines.

A number of barriers limiting accessibility: Cost, Fear of abuse of controlled medicines and problems in building effective regulations. However, partnerships between civil society and gov’s have had some success.

Mr Cary Adams CEO union for international cancer control: UCC commitment to enhancing global access to pain relief for cancer patients

Created Global Access to Pain Relief Initiative to work on the ground and improve access, especially in Africa and to put pain relief on the global health agenda.
Working with WHO and have the global monitoring framework –
Delighted to see within the global action plan that the issue of palliative care and pain relief appears.The full spectrum of cancers have to be included to this plan of action. Commitment to a 25% reduction in avoidable deaths

Dr Jim Cleary – Pain and policy studies group: Survey results from an international collaborative to evaluate availability and accessibility of opioids for the management of cancer pain

The single convention highlights that the medical use of narcotic drugs is vital in relieving suffering, however, most the world’s countries fall far below the global need. Nevertheless  there have been some improvements although these improvement appear almost totally in high income countries. There are still too many barriers in limiting low income counties’ access:
– Regulation
– Lack of distribution
– Lack of knowledge
– Costs

Up until 2003, large disparity between use of opioids in East and Western Europe. Many countries in E.Europe have almost no opioids for cancer patients.

While many countries technically have such treatments available, they aren’t available most of the time,

In many places on oncologists can prescribe these drugs. In Cambodia for example, physicians have to pay  to even obtain the form to access drugs.
There are numerous restrictions on pharmacists.

More info here painpolicy.wordpress.com

Dr Navchaa Gomboorj – Deputy director in charge of medicinal services, Mongolia: Policy and program implementation in Mongolia

Health expenditure = 3.1%GDP
Health services concentrated on urban settings.
Most common cancers:  liver 38%, stomach 14%, other 21%, oesophagus 8% lungs 8%, breast 3%
One cancer centre in country (16 beds, 1 radiotherapy department).
The lack of access to radiotherapy increased the need for opioids in pain relief.
Over 50% who receive radiotherapy with palliative purposes, 70% are diagnosed with late stage (too late to be cure)

Palliative care service in Mongolia: 7 hospices in region, Oncology unit established in aimag and district hospitals. Doctors allows to prescribe generic cost effective opioids since 2004. Education on palliative care is now incorporated in undergrad curricula of doctor’s nurse’s social workers. Palliative care guidelines developing in 2012 – 28 trainings organized, 550 doctors trained

Challenges:
Weakness of healthcare systems
Problem delivering in rural areas
Lack of knowledge of palliative care among doctors and nurse (at a local level)
Limited access top radiotherapy
Unknown number of patients who need opioids

PACT program is increasing Mongolia ability to deal with this issue.

Prof. Guido Fanelli – University of Parma: The Italian law on access on pain medication: an innovative approach 

Morphine not available in 115 countries. The only therapy in many places is alcohol.
In Italy, it used to be the bottom country in Europe in terms of opioid consumption. Pain used to be treated as a symptom, now it is treated as a disease. Significant progress has been made.

Dr Gilberto Gerra, Chief drug prevention and health, UNODC: UNODC commitment on access and availability of controlled drugs for medicinal purposes.

This has been a totally neglected issue and no one was ensuring poor countries had access to medication.