Side Event: Resolving the Global Crisis of Untreated Pain by Improving Access to Controlled Medicines within the Framework of the SDGs

Marie-Paule Kieny, WHO: Emphasize that access to essential medicines is a fundamental pillar. Not nearly enough focus has been paid to access to essential medicines. One of the most important medicines, morphine, is emblematic of the fight to ensure access of medicines. Considered the gold standard for pain relief, yet more than 5 billion people do not have access to pain relief when they need it. Association with illicit drug use has created stigma and hampered availability. WHO’s position, in line with the drug conventions, is that illicit drug use needs to be tackled through effective and culturally sensitive measures, not overregulation that negatively impacts public health. The problem will not disappear with repressive laws. UNGASS as an opportunity to ensure that access to controlled medicines goes beyond well-intentioned words and becomes a reality. Encouraged by SDGs. Non-communicable diseases, like cancer, are raising everywhere. In low and middle income countries, where diagnosis comes late, demand for pain relief will increase. Yet these places have it least available. Must pay special attention to issue of essential medicines and address barriers. People should be able to access the care they need to ensure they are healthy in all aspects of life. Physical, mental, and social wellbeing means living without unnecessary pain. As we move towards universal health coverage, must ensure access to essential medicines. Palliative care is at the center of universal health coverage. Morphine is an essential medicine according to WHO. Oral morphine is a cost effective pain medication. Promoting measures to ensures its availability and accessibility is crucial to realizing the SDGs, but also the very goals of the international drug control conventions, which aim at improving the health and welfare of humankind. We have the science and strong human right imperatives. It is our moral duty to ensure that people suffering from pain can readily access affordable medicine that is proven effective.

Werner Sipp, INCB: Indispensable, adequately available, and not unduly restricted. These are the fundamental principles that countries should apply to ensure availability of internally controlled drugs for medical purposes. Has not yet been met in a grave number of countries. Around ¾ of global population does not have access. INCB special report on the matter. Impediments to availability include lack of awareness/training, and fear of addiction. Legislation and regulatory systems, health systems, affordability, training of health care professionals, education and awareness, benchmarks, and improving estimates are all key areas for improvement. Member states need advice, training, and resources to address the problem. Improve cooperation among all stakeholders involved to improve sharing of expertise, resources and technical support.

Mabvuto Kango, African Union (AU): AU heads of states adopted joint position. Agreed that they would like to seize the opportunity to eradicate poverty from the continent, as this is one of the root causes of drug trade. Main objective of drug policies should be improving health and wellbeing. Effective drug policy should achieve a balanced and integrated approach including demand reduction, supply reduction, harm reduction, and international cooperation. Greater support to ensure the provision of opiates and other essential and controlled medicines. Urgent need to respond to increasing links between drug trafficking, corruption, and other forms of organized crime. Urge CND to propose short, substantive, concise outcome to be presented at UNGASS. Emphasized importance of UNGASS and should enhance capacity of regional groups. If no different views are brought back for discussion, this will remain the position of the AU heads of state.

Sergio Chaparro, Universidad Nacional de Colombia: Working on palliative care from a human rights perspective. A series of UN bodies have recognized that lack of access violates right to health, life, freedom from torture and other cruel or degrading treatment, freedom from discrimination. The principles in the UN charter, including human rights principles, prevail over obligations in other treaties. Estimates from WHO show that essential medicines for pain relief are not available for 80% of global population. 90% of use concentrated in ten countries. In most countries, particularly developing, poor access is explained by restriction to prescribing these medicines, such as paperwork barriers, fear of repercussions, such as abuse in their patients. 0.05% risk of developing dependence. Human rights tools used to increase access. Litigating disproportionate normative barriers or practical barriers is a practical way to increase access. UNGASS is an opportunity to raise awareness and exchange knowledge. Opening up the discussion on illness and more humane ways to deal with pain, and breaking down cultural and institutional barriers. Placing public health at the center.

Olatz Aguirre Lesaca: HRW report on Mexico showed palliative care situation was devastating. Palliative care become a priority since then and there has been improvement in situation. Promote palliative care actions. Sever shortage of professionals trained in palliative care. Difficult and slow process for obtaining special prescription pads for prescribing opioids. Physician has to comply with mandatory requirement of providing personal information, which contributed to their fear. Complicated and obsolete controlled substance law in which companies had to hand register records of trading in narcotics. Explains lack of pharmacies that supply and distribute, causing a critical shortage. Now, doctor personal information visible only when prescription is validated in pharmacy. Developing a web platform for transmitting data from company inventory, rather than log books. Pharmacists offering opioids has increased. We have increased the number of physicians who have special prescription pads. Amount has increased gradually. Number of prescriptions in pharmacies increased by 963%. Thanks to validation, we can conduct surveillance and targeted campaigns. Providing training for medical personnel. Work closely with stakeholders to hold forums around the country. Risk mitigation course. Any person with moderate or severe pain or illness deserves palliative care for a better quality of life. Even though strong regulatory process is necessary, it should not be an obstacle.

Gilberto Gerra, UNODC: Clear evidence that availability is not related to abuse. Understand that availability doesn’t create abuse. National laws should be changed. Must prepare a new generation of health care professionals knowledgeable about this matter. Ask the pharmaceutical companies to provide these medicines at a low price, as they have done, so affordability doesn’t become a barrier. We created a joint program, already operating in Ghana. Soon in Caribbean.

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