Committee of the Whole (Thursday morning) L4. Promoting awareness-raising, education and training as part of a comprehensive approach to ensuring access to and the availability of controlled substances for medical and scientific purposes and improving their rational use

EC77/2020/L4

 

Belgium:There are some paras where the wording is ‘non-stigma’. A couple of paras have been agreed in informals pending on the solution of non-stigmatisation.

Chair: Canada was the state proposing language on stigma

Canada: If we are going to focus on PPs first we did have discussions during informals. Linking PP that references stigma to the OP that will reference stigma. Can we move down the PP8bis – this is where we are currently in discussions in the latest informals. We are comfortable with this language as long as we are able to revise the OP relating to stigma.

OP 8bis

OP 4quarter

Canada: OP4 quarter alt is which Canada and UK are proposing. There is concern to the word specifically ‘stigmatising attitudes’. Another way of describing non-stigmatising attitudes. ‘Amember states to includer […] on how the negative impact that discrimination against a person based on their drug use behaviours, acts as a barrier to’ and then you can delete ‘effect that stigmatising attitudes have’ and then delete ‘to drug users’.  – A UK/Canada compromise to not use term ‘non-stigmatising’ 

Chair: Para 4 quarter would be deleted and instead have 4 quarter alt

Russian Federation: Delegation also tried to find an option. Canada/UK compromise is not agreed by Russian Federation. This wording does not fully reflect or fall in line with the resolutions. During informals delegations explained to us what stigmatisation means in respect to access to medications. We want a broader description?  Patients are afraid to use pain killers because they are afraid this will lead to abuse, and thus Drs are afraid to prescribe for the same reason. This wording does not involve this element of the description. We would like to take this to informals. 

Canada: This is a good compromise trying to describe stigma. It’s broad enough to cover PWUD when they try to access control substances. Maybe better do informals on it.

Chair: I see problem not only with the wording but with the notion of stigmatisation. Let us take it to the informals.

Cuba: In the same Vein as Russia, we cannot accept.

US: We thank Canada and UK to come much closer to a common position. It was hard to understand the type Russia was eluding to. We propose “how the negative attitudes conserving drug use impacts act as a barrier to access and delivery of services.” I wonder if that helps since we are not trying to identify the attitudes.

Nigeria: We remain positive. We thing that the idea of non stigmatising attitudes generate problems. We have not made much progress on that. We can use terms such inclusiveness etc that do not generate problems. We support US amendment.

Netherlands: We support US proposal.

Russia: We are not correctly interpreting the Canadian. In our view here this should be about negative attitudes of drug users. There is a cultural notion of use painkillers. We could propose otherwise.

Chair: Perhaps we can use “adverse impact of drug use”. I see Russia cannot accept it so perhaps remove the “adverse”

South Africa: Canadian proposal has merits. Drug users face problems every time they have to take their medications. Perhaps we can refer to the use of “illicit” to clarify. 

Chair: Russia perhaps can propose new language.

4quarteralt

Russian Federation: To proposed language, we are trying to reflect their concerns. Instead of negative attitudes concerning illicit drug use, we proposed INCB wording in report accessibility to narcotic drugs for medical purpose 2016: ‘how cultural attitudes towards the management of mental health disorders and palliative care are acting as an impediment to access and availability of drugs for medical purposes’. We understand that patients are afraid to use pain killers because they are afraid they will become addicted, and that doctors are afraid to prescribe painkillers to drug users. 

Colombia: We  would like to second Russia’s proposal

Canada: I still don’t see reference to the stigma associated with people using drugs when accessing medical services. They are missing the component of ‘people who use drugs’ and how stigma or cultural attitudes affect their access to medical purpose. This needs to be reflected. 

Russian Federation: Thank you for the clarification. We could add ‘for drug users’ after ‘palliative care’. 

Canada: has to be clear there is an impediment for drug users, but not just for mental health reasons and palliative care.

Belgium: We suggest to take this to informals or bilaterals 

Canada: ‘towards the management of health conditions and removing ‘mental health disorders and palliative care’. We believe this is a significant compromise on our original proposal

Russian Federation: We think we are very close to consensus. Our preference would be to leave in ‘palliative care’ because we understand the main barrier is that drug users are not being given powerful painkillers. ‘Palliative care and management of health conditions’.

United Kingdom: This has moved quite far from our original proposal. We propose to make acceptable: the comment on palliative care, this is perhaps an element of ‘health conditions’ reversing ‘management of healthcare conditions including palliative care’

Japan: Change to ‘urges’ to ‘encourages’ – urges is too strong for us.

Canada: I am supportive of UK and Japan suggestion of language. 

Belgium: We now have a mention of drugs for medical purpose, and instead add ‘internationally controlled substances’. 

We propose to move to make it OP6. 

Colombia: We think there is a limitation to the text. Many people are not drug users but do have impediments for cultural reasons when they are mere patients. ‘Impediment for all those in need, including drug users’ – a broader language. 

Australia: That is acceptable. Move ‘including palliative care’ to the end of the paragraph, it is not a health condition but a medical purpose.

Russian Federation: We believe ‘palliative care’ could be at the end but also in the middle of the para.

Chair: I see its acceptable by all. 

USA: We would use in the first instance “the relief of pain” instead of palliative care which takes us closer to our obligation to the conventions.

Belgium: The relief of pain is not a management of a condition.

Chair: Accepted and agreed in the CoW.

Belgium: Is it accepted as a OP bis6?

Chair: Currently we care for the language. In a later stage we will check that.

Canada: As it was linked to the OP8, it’s approved.

Russia: We ask for delegation to agree to PP8 so we can delete the objections.

Chair: There is lang on stigmatising attitudes so let’s take it on the afternoon session. Also, 3bis and 4bis accepted and agreed at CoW. Now on para “Deeply concerned”

Belgium: We propose to work on the Alt para.

Brazil: We are not able to accept the Alt as it stands. We have strong concern on the last part of this para [and that the lack of…falsified medicines]. If though they are UNODC issues these are connected with this resolution. We propose the deletion of that part. We are very supporting of the resolution but we should touch on a different topic.

Russia: We support Brazil. Using fake substances is serious but its not the preview of the commission. here we discuss controlled substances by WHO listing and the 3 Conventions. Nevertheless we support this resolution.

Chair: I understand “internationally controlled substances”.

Guatemala: This is a confusing para with complicated text.

France: We support the retention of the last part of this para. This is very much in line with the purview of this resolution. We think this is a manifest link. Also, after lengthy consultations I understand we have come to agreement at the informals on the “falsified medicines”. It is included in other resolutions at the CND. Falsified medicines are widespread accessible.

Finland: We echo France.

Netherlands: We support France.

South Africa: We agree with Brazil.

Croatia: Regarding this para, we support the retaining of the last part.

Chair: I see there is no agreement.

Brazil: I think we go back to informals. In reference to previous resolutions the meaning was on trafficking. We are ready in engagement in discussions.

Chair: We have to work on the language so I invite that. I understand that the first lines till “..efforts” are acceptable.

Belgium: There is no agreement either to keep it or to delete that part. We have showed a great flexibility but indeed we need to go to informals.

Chair:

PP12 alt? No objections – accepted 

12 bis alt

Russian Federation: We suggest we could ask for secretary of the committee to tell us the source of the data.

INCB: provides explanation

Russian Federation: after Member States ‘on estimate of their legitimate requirements of narcotic drugs, assessments of their legitimate requirements in psychotropic substances as well as on licit manufacture and trade in such substances’. And then if Belgium has a preference to link this with the theme of the resolution, we might not delete the end, but add a sentence. ‘[in such substances] in order to assess the global situation with regard to…’

Belgium: if we have a reference to psychotropic substances we should have references to the other conventions of 1971. Can we also speak of ‘access and availability of international controlled substances’

Chair: in that case should we keep ‘in cooperation with governments’ or do we delete this?

USA: 12bis alt is based on language approved in resolution 62/5  of last year. If we go to article 12 of the single convention, and similar responsibilities are in 71. Our preference is to stay with the original language

El Salvador: My delegation supports US. We prefer the original wording, its language from the resolution submitted by El Salvador last year. We want to co-sponsor this draft resolution

Russian Federation: We don’t have a strong preference to the of the paragraph. 

USA: We want to retain the last line ‘endeavours to ensure their availability of such purpose’

Belgium: I propose to add after ‘statistical data provided by Member States’ ‘and assessments on’

INCB: Assessments and estimates are different from the statistics we receive, more precise language could be use. The board collects more data than that, also following up with member states how the implement recommendations issued by the board.

Belgium: ‘Collect statistical data by Member States, estimates of their legitimate requirements of narcotic drugs and assessment sof their legitimate requirements of psychotrpoic substances as well as on licit….’

Chair: 12 bis alt – Agreed

12 ter – 

Russian Federation: Request for clarification: is this the collection of statistical data of the ARQ or is this the collection of this type of data through other means.

Belgium: While UNODC has now in its mandate possibility to collect data on access and availability. 

UNODC: UNODC does have information at the national level from countries and member states where we have funding to conduct those activities

Russian Federation: We don’t object to the para now. 

12 ter – Agreed 

16bis – Agreed 

OP2

Belgium: This is also linked to previous resolutions. We propose Alt: Taking note of the efforts of the UNODC to coordinate and ensure effective UN interagency … for medical and scientific purposes.”

Canada: We  support this language.

Chair: I see no objections. I propose we take the alternative lang. Accepted and agreed at CoW. ALso, we proceed with para1, I see no objections. Accepted agreed at CoW. We proceed with OP2.

Egypt: The focus of the resolution is to deal with some barriers that have been mentioned at resolution 62 last year. In order to have some balance we propose to add “including among other affordability”.

Belgium: Since this is not focusing on the price but on awareness raising we see no use to that reference on affordability since that has already been mentioned in other parts of that resolution. 

South Africa: For us the issue of affordability is very dear. We would rather have it expressed at an OP to get proper attention. We fully align with Egypt.

Finland: We echo Belgium.

Chair: We invite Belgium for the relevant reference.

France: We support Belgium mainly on the agreement found at the informals yesterday. My delegation understand the argument made by Egypt but still we don’t see the need to highlight one barrier over the others. We wish to have it deleted.

Nigeria: We think affordability is very important and key for developing countries. I don’t see why to hesitate on this here.

Chair: I see no agreement so we may use the language from the PP by enumeration of the barriers however my preference is to keep it sort.

Belgium: Indeed affordability is mentioned at PP5, so its not like its lost in the para. Likewise at PP6 and PP7. I understand that by increasing availability, affordability is included.

Brazil: We understand there is a list of those barriers at the UNGASS OD.

Australia: We are of the view that including affordability is not needed here. We support your proposal Chair to keep it sort and sharp.

Guatemala: We need to be reflecting what is happening on the preambular para. But that para is not operative so once is not mentioned earlier on so possible not use it here. Also, availability and affordability is not the same. If you want to compare them it not possible. We should better stick to established language. I don’t understand why “including affordability” is problematic.

Nigeria: We align with Guatemala and Brazil. Just want to say that nobody has to lose if we add affordability and in that we acknowledge the problems developing countries are facing. Availability does not mean affordability.

Denmark: We agree with Belgium. No need to include to concept of affordability.

China: If it is too prominent we propose to delete the “among others” to just “including affordability”.

Chair: I see there is no consensus.

Netherlands: We have heart many options so we propose the all the existing barriers.

Norway: Most reps from developing countries are eager to include affordability so I think we should listen to them.

Chair:

OP3? No comments – Agreed

OP4

Russian Federation: Add after ‘the WHO’ ‘, within their existing mandates’

OP4 – Agreed

OP4bis

Russian Federation: Traditionally our condition provides a mandate on the activites ofthe UNODC, but ont other organisations the mandate is clearly laid down in the 3 conventions and the commission can only inviti the INCB to give proposals. So add ‘invites’ instead of encourages’ and then ‘INCB to continue, within its existing mandate’

OP4bis – Agreed 

4ter – Agreed

6bis

Canada: this new para is also linked to PP8, if we have agreement on this para, then there is also agreement on PP8 

6bis – Agreed

OP6 – Agreed

OP7

Chair: we will take out reference to ‘non-stigmatising’

OP7 – Agreed. 

OP9? No comments – Agreed 

OP10

Chair: Canada has proposed 10alt to replace 10 

10alt ? No comments – agreed

OP11? No comments – agreed

PP8bis

Canada: propose to highlight specific resolution 61/11 relating to stigma and the UNGASS agreement to non-stigmatising attitudes.This is the proposal we have agreed upon 

PP8bis – Agreed and 4bis replaced by PP8bis

Guatemala: Before we go to break, Guatemala be added as co sponsor to resolution

Belgium: We have asked for a room at 3pm for informals. We invite delegates on this to attend our side event on Access and Availability at 3pm in M4. 

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