Side event: Addressing global disparities in access to controlled substances for medical purposes, with focus on treatment and pain relief

Organised by the Governments of Australia, Belgium, Ghana, Norway and Panama, the International Narcotics Control Board, the World Health Organisation, the United Nations Office on Drugs and Crime and the International Union Against Cancer.

The Hon. Ken Wyatt AM, Assistant Minister for Health and Aged Care, Government of Australia (Chair)

5.5 billion people do not do not have proper access to pain relief. Australia was the first government to fund access to pain relief. I am pleased to announce that Australia will provide another $100 000 to UNODC to increase access to pain relief.

H.E. Mr Willem Van de Voorde, Permanent Representative of Belgium to the UN in Vienna

We have to ensure the health and welfare of mankind in drug policies. The UNGASS outcome document delivers key messages to increase access to treatment and pain relief. Sub-saharan Africa is much lower than the global average consumption rate . Our (Belgium’s) decision to join Australia and Global Programme was an easy one. We will pledge 100 000 euro from Belgium to global programme.

Mr Aldo Lale-Demoz, Deputy Executive Director, UNODC.

Thank you. Over past 5 years, UNODC has increased support for access to medical treatment. We with the WHO and other partners. Adequate access with trained professionals will not promote dependence. 83% the world’s population receives only 8% of the global share of essential medicines – the rest all goes to countries such as the USA and Australia. Adequate provision must be made to ensure availability of internationally controlled drugs. Our report demonstrates complexity and highlights potential areas that need to be looked at. In 2013 the UNODC started the global programme for access to controlled drugs – in collaboration with the WHO and the Union for International Cancer Control. Contributions from Australia meant they could pilot the program in Ghana. We would like to acknowledge the support and contribution of Australia. UNODC would also like to thank Belgium for the funding that led to the program in the Democratic Republic of the Congo.

Mr Werner Sipp, President, INCB.

Thank you. I am pleased to participate in this side event. ‘Indispensable’, ‘adequately available’, and ‘not unduly restricted’ are the terms used in the conventions. Ensuring that there is no diversion is also highlighted in human rights conventions.

92% of morphine is consumed in areas where 17% of the worlds population live. There is a similar situation with psychotropic substances. 4 out of 5 people who need treatment for mental disorders do not receive treatment. Fear of addiction has declined considerably since 1995. Access is defined by affordability. Inadequate estimates do not respect actual needs. Delays in the supply chain also cause limited availability. Lack of training and awareness among professionals is also high, with fear of diversion. Addressing the training of health care professionals is recommended. Ensure that opiate analgesics are accessible and available. Ensure that healthcare professionals are capable of prescribing. Raise awareness of risks a stigma. Improve the way countries report to board.

Professionals need advice, training and resources. The outcome document will hopefully translate into concrete action on the ground.

Dr Miguel Mayo, Vice Minister of Health, the Republic of Panama.

Financial limitations and lack of knowledge of pain management are the main issues here. The focus on pain management control is aimed at improving accessibility to drugs for medical use. We have taken part in evaluation methods. Our country has criteria to point out – the drug problem is a global problem. Availability of controlled treatments contributes to succeeding in the sustainable development agenda. The WHO continues leadership with world health approach to drugs. We need an actual plan to address availability. We need to encourage the review of regulations to provide controlled medications to reflect actual needs. The use of controlled medications in diversion is important. We need to train healthcare workers in substance control and appropriate access to palliative care. This to be included in health insurance coverage.

Dr Marie-Paule Kieny, Assistant Director General, WHO.

Thank you. WHO thanks Australia and Belgium for their support. In the preamble of the outcome document, drug control conventions state that availability is indispensable. Morphine is emblematic of this fight. 15% of people worldwide actually get the treatment they need. Member states need to provide access to these treatments. Together with INCB, the WHO has created a tool to provide. Guidance by the WHO has been aimed at improving access to opioid medication in 12 countries in Europe. To conclude, WHO is committed to continuing and scaling up this work in collaboration with INCB and the Union of International Cancer Control.

Minister, Ghana: (Present on behalf of another minister – Mary Eyram Ashinyo) I acknowledge our partners. We are very grateful for Australia’s support. We aim to control for misuse and diversion at the same time. The main focus is on policy and enforcement, and advocacy. Access to appropriate medicines is low in Ghana, that is why we were chosen for the pilot program. 80% of cancer patients cannot be treated appropriately in Ghana and access morphine. In 2014, surveys were conducted on opioid use, and on African palliative outcomes. The way forward as a country is to address prescription levels, and make sure the right medicines are on the medicine list. Thank you to our partners for their support.

Professor Mary Gospodarowicz, Immediate-Past President, Union for International Cancer Control.

Thank you for the leadership in this session. Access to pain relief has been a priority of the Union for International Cancer Control for years. We propose to reduce the global burden of cancer, and to make sure cancer has the right place on the development agenda. We have identified pain and suffering at a priority. This year almost 15 million patients will develop cancer in the world. In the next 10-15 years there’ll be more. 8% of cancer increase in next 10 years will be in countries that do not have access to pain medication. There is no access to pain relief and palliative care. Fear of pain, fear of interventions are barriers to reducing the burden of cancer. We need to properly address this and skill up our efforts. Problems can all be solved. We are here to strengthen link with civil society. I hope our efforts will reduce the amount of people who cannot access pain relief.

The Hon. Mr Bent Høie, Minister of Health and Care Services, Government of Norway

This is an important side event. Let me thank the government of Australia. Previous speakers amply illustrated the gaps in provision of pain relief. We depend on these substance to elevate pain to individuals and their families, and to promote healing. We regret that we could not get the exact wording in the outcome document to address mental health issues with medication. INCB have prepared. The WHO develops norms and guidance to address regulation and availability of health care systems. We need to ensure dignity if dying in pain.

Access is a key area when addressing to world drug problem. Collaboration between WHO, UNODC and the Union for International Cancer Control is very important.

Question: We applaud efforts to improve access to medicines in the developing world – you all framed the need for a balanced approach – thousands of people die from using opioids – so many people die from overdose – North America and Australia should not be seen by the UN as countries that have appropriate opioid consumption levels.

WHO: this is why we are working on access – and accompanying training to professionals.

University of Wisconsin: I have just returned from Timor Leste – the issue of balance is important. We need to understand the problem that the US has now. I agree with the WHO that one of problems we face is that we don’t know what appropriate use is. We need something to measure this. We need a balanced public health approach, it’s not all at the hands of prescribing. For this multi pronged problem, need a multi pronged response.

African Palliative Care Association: In Africa we still have a challenge in access – patients have no access to pain medications – this shouldn’t be discouraged by what has happened elsewhere. More measures are needed for strengthened interventions. It is in this area that the WHO needs to respond to and comment on .

WHO: The education of health professionals is important in access to opioids and other substances. We work on normative guidance, and the need to provide training and work with other partners. We are looking forward to continued work with our collaborators.

Diedrich, CSTF. It is a tremendous step forward to have significant part of the outcome document dedicated to the access to essential medicines – used to be tucked away under demand reduction. How do you see the implementation of recommendations as made in the document.

Dr Mayo, Panama: This is a world problem and we see it as such. It is important that we have it in mind that all human beings have a right to a dignified life. Access to these medications is key to those who need it. The key here is education. It is important to increase human resources in order to cover big populations. Panama aims to make easy access from a price point of view, and a geographical point of view. Control of palliative care medications is important, therefore we are bringing this information to families.

Jennifer, Tillray: We work to improve access to cannabis drug medicine. What are your thoughts on access to cannabis medicines?

WHO: We need more evidence. It is on the work plan that we are proposing now. There are no current systematic reviews. After that we will be able to say something about it.

?? It is the 20th year working to provide to pain relieving medicines. The lack of available guidance has been a problem. We ask that the UNODC and INCB provide technical assistance to programs.

Mr Aldo Lale-Demoz: This has already been reviewed and recommended by the WHO and Civil Society. Before the end of May we will have a new round of model laws.

Mr Werner Sipp: Concluding statements: there has been a large number of different questions – but the most important is: what political action will be taking in order to implement what is written in the outcome document. You all know the special repot from the INCB on availability. There are a lot of different reasons for different impediments. Not one action, but many actions are needed. In every country the situation is different. This is why I think having an action plan to address complexity of problems is a good way to come forward. Regarding the last question concerning regulatory aspect – model law cannot give solutions to all countries. We need a better infrastructure for pain relief and palliative care. This depends on different health systems in different countries. We must envisage a great deal of plans and alternatives.

 

 

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