Organized by Australia, Belgium, Canada, El Salvador and the Russian Federation, and European Union, UNODC Prevention, Treatment and Rehabilitation Section, Union for International Cancer Control, Vienna NGO Committee on Drugs and World Health Organization

Miwa Kato, UNODC

80% of world defines opioid crises as not having access to opioids. How do we work this out on the ground, and generate more interest? And translate into demand reduction, which is already under resourced. Looking into integration across US agencies. Over prescription, diversion and non-medical use of opioids is a crisis. 5 times more overdose deaths in US in 2017 compared to 2019. First wave of overdose death, now problems with fentanyl. Must keep in mind that most people don’t have access to medicine. Cancer patients, chronic pain and people in palliative care. Balance must be found and prioritised to achieved SDG3. Challenge of access, a whole section of 2016 doc is about this topic. We work with other agencies to do this. No pledges were made at all for this topic last year. Will outline good examples, but the best thing is if we can mobilise more resources. Need specific fundraising. Trainers to educate healthcare workers in Nigeria. Also working in Panama. Training sessions provided. Disseminating successes in regional meeting in Latin America. This demonstrates impact we can have. We are committed to working with you to support doctors, people in pain to get support. I hope we can bring more attention to this.

INCB

Example base don my personal experience – I was in a poor African state. $140,000 to buy antibiotics and pain killers – we had to make a choice. If I buy painkillers and not antibiotics -people will die. Goal of ensuring availability and access to medicines is still far from being met. Some people have surgery without anaesthesia. Others are dying in unnecessary pain. Over prescription is so far concentrated in North America. Low- and middle-income countries have different issues. Necessary to achieve SDGs, particularly SDG3. In 2016 – we published a supplement to annual report on this topic. INCB recognises the importance of this issue and wrote specific recommendations. Published supplement in 2019 report too. Many governments have change legislation for rational use and have implemented awareness raising. Consumption for narcotics has risen. Vast majority of morphine produced.

Low- and middle-income countries are mostly affected. Availability of psychotropic drugs is still a challenge. Up to half of people with mental health conditions such as anxiety and depression receive no treatment. Significant global disparity here. Higher availability reporting in high income countries. To support member states in ensuring accessibility, INCB has been providing technical assistance through INCB Learning Project through UNODC: in Africa, Americas, Asia and Oceania to raise awareness of accessibility. New workshop to take place in El Salvador. The project has launched documents. Will be made available soon.

Unoma Asomugha, NAFDAC

In Nigeria we’ve developed a number of policy guidelines on this topic. What we’re doing is an implementation strategy in place in country. Focused on capacity building. Pre professional and post prof training. Rationales on access to controlled meds. Submitted to national curriculum for training medical doctorss. Mandatory continuous professional training. Not just about teaching people about what to do – narcotic analgesics are able to be found easier. In addition – reviewing documentation practices. Committee later this year. Detection of wrongdoing can be monitored. Expect them to keep records as they should be. Some years we’ve had zero quality in the country. We’ve had a lot of support from EU, UNODC and other bodies and groups.

Heloisa Broggiato – IAHPC – VNGOC

I will focus on lack of access to morphine. Many patients denied access to pain relief with worry of development of dependence. Frontline providers in every country raise ‘opioid phobia’. In many places, opioids are not sold in pharmacies – only available from police twice a week. Only specialised doctors can provide access to opioids in many countries. This increases cost for the health system. Map of opioid use in countries. Lack of access can be helped with collaboration of civil society, UN agencies and member states. Starts with good political guidance – and education in undergraduate curriculum, as well as prevention of abuse. Important to recognise crisis in Nth America due to lack of training. Any doctor can be trained in how to use opioids in just 10 days, such as in Kerala, India. Germany could be described as best practice model. Uganda has a good program – there is a partnership between govt and civil society. More than 33000 patients were treated. Good practices in Rwanda. Monitoring system is better practice in Colombia. Encourage MS to remember UNGASS commitments.

Dmity Kostennikov, Deputy Minister of Health, Russia

We recognise right to health. Here is how we solve this problem in Russia. 2016 Outcome Doc commitments – past 5 years, significant measures undertaken for patients in need of pain relief including those in palliative care. Electronic documents for prescribing are now available. Access from paramedics in some cases. Patients who require long term therapy now have better access. 26 medicines in 40 dosage formulations are now available for pain relief in Russia. Access has increased 5 times, by 490%. Cultivation of narcotic plants is permitted in Russia to licenced state enterprises. Minimum likelihood for illicit trafficking. Evidence based policy to combat drug addiction needs to be in full compliance to conventions and right to health. $480 million USD has gone to this. Increasing training to medical doctors. Work in palliative care. Improving options for access to pain relief.

Barbara Hastie, Union for International Cancer Control

Keenly aware of this issue. We affirm the needs for palliative care. 18.1 million new cases in 2019. 1/4 men, 1/5 women develop cancer. Half of people free of cancer post therapy develop pain. List of medicines should be more available. Recent work shows access abyss globally. 92% of world opioids consumed by 16% of population in high income countries. 87% of world morphine, 16% global pop. Has been some improvements – increase to access, but minimal. Rational cancer pain treatment. Advocate of allegiance, alliance. Need for balance was reasserted in outcome doc and SDGs. UNODC INCB and WHO, have helped with training modules. Working documents to specifically address problems. Critical need for data driven decisions in policy making. Our work highlights need for advanced collaboration. UICC and partners look forward to more collaborative efforts with member states and civil society counterparts.

Kirsten Hopkins, International Atomic Energy Agency

Oncologist with IAEA – I see a lot of side effects. In UK we have universal access. Increase is happening in middle income countries. Member states are trying to address this. Mechanisms to support – using nuclear technology, and helping countries develop national cancer strategies. Informed distribution is necessary. Big need – 85% of patients present with advance stage cancer. Early diagnosis can change this. Radiotherapy and opiates can do this. Many patients with comorbid conditions – cancer and HIV for example. Radiotherapy often difficult.

Gillles Forte – WHO

Very concerned about this issue – these medicines are often lifesaving. Controlled meds important to relive pain and suffering. WHO very keen to work within drug conventions – approach to strive for balance. 2016 Outcome Doc – recognises disparities. Need increased cooperation. WHA resolutions emphasise the importance of this topic. Price and affordability is an issue we need to consider. Strategic targets for access to medicines. Global WHO program of work – specific target on increasing. Morphine as selected target of WHO. Appropriate use of medicines is in WHO guidelines. Also in process of updating and revising guidelines. Importance of quickly collecting and analysing data. Collaboration with UNODC and INCB. We have developed policy on access to controlled meds. Like to acknowledge support of Australia in our work. UN Toolkit on synthetic drugs. Reiterate WHO will continue to foster partnerships, including with CS groups, which for us is a very important partner in this topic.

HE Belgium

HE Australia

Providing $60,000 AUD over 3 years for joint global program – we encourage others to contribute to this issue. We need to reduce this global disparity. Warm thanks to all panellists