Organized by the Union for International Cancer Control with the support of Australia, Belgium, Mexico, the Netherlands, the UNODC Prevention, Treatment and Rehabilitation Section, the Asia Pacific Hospice Palliative Care Network, Walther Global Palliative Care and Supportive Oncology, the African Palliative Care Association, the World Hospice Palliative Care Alliance and the International Association for Hospice and Palliative Care – Monday 13/3/2023 14:10 MEO100
Mr. D Hoop, Belgium: There was an important decision to make at the UNODC, to act. Today we want to ask you to help us thinking – how do we best go about making sure controlled substances are better available to the more than 5 billion people who don’t have access to them, that they remain under strict medical control, we are not talking about decriminalizing, but we make sure people who are suffering (mental health, end of life, serious pain) are actually helped. As a former Chair, and key architect of this global call to action, I want to tell you I am continuing the fight and we need allies. I am here with the Union of International Cancer Control and once I retire, I am able to take this further. Now I pass on to the diplomatic representatives and then we will play you a video before we ask UNODC to intervene, then hopefully we will have time for soma audience input. About the video, we are working on materials for possibly a documentary, so I might ask some of you to talk to me on camera. What we do is not just what we want to do, we put a lot of effort into visibility, for example social media.
Mr. Sadleir, Australia: An honor to be here today. We have hope that far reaching effects, beyond Vianna, Geneva and New York will ensure that no patient is indeed left behind. We continue to advocate for human rights, dignity and involvement of communities. The medical indispensability of controlled drugs is universally recognized and is embedded in the SDGs, yet millions continue to suffer due to lack of access. The last World Drug Report found a global disparity in the wake of recent global challenges such as COVID 19 and various humanitarian crises. It is a long standing concern, one that is of priority for Australia. That is why we work across agencies, with civil society and various stakeholders. We work with WHO, UNODC, and the international cancer societies. We are driving change at the local, regional, and international level simultaneously. We are committed to providing support to all our partners.
Mr. Gierveld, Netherlands: The number are astonishing – 5 million people don’t have access to medication they need. This is a complete contradiction of what we promised in the SDGs. I do not have a speech in front of me, sometimes pictures say a lot more than words. Last night my wife and I saw a movie about the end of the war, there is a scene when a medical professional kicks out youngsters from their car, and you see the conditions in which people are suffering in hospitals. There is a lot more out there than we can say in these conference rooms. The Netherlands is clearly aware of this issue. The Atomic Agency is doing so much on health, it is time we join forces. So, keep up the good work and let us join forces!
Mr. D Hoop, Belgium: Thank you. Indeed we need to learn more about the work of other agencies.
Ms. Vermeulen, Belgium: I am glad to see that already on the first day we are highlighting this issue. Belgium will definitely make a statement on this topic and our side event on Thursday is also related to this issue. We are working on two important policy areas in this domain. It is important to underline the gap between the geographies and I invite all of us to exchange best practices and keep this point high on the agenda during our upcoming presidency of the EU.
Dr. Hastie, UNODC: Right after the reconvened session, we interviewed a few key figures in Geneva to address availability as a human rights issue. This is so central to what we do. The right to health and access of central controlled medicines has been at the top of our priorities.
Mr. D Hoop, Belgium: This video highlights one of the key elements where our actions should be directed to – the link we have with the WHO is something we are proud of. (UNOHCHR reel on how palliative care is a human right with speakers from the WHO and service providers and shots from the international palliative care conference). There are also the aspect, I am handing over to dr …. A neonatologist from Mexico.
Dr. Coronado Zarco , Mexico: This is a true story of two brothers with significant birth-diseases that their family didn’t afford to take care of as they live far away from infrastructure. The babies received morphines and they had to get adult tablets. Suffering in children is a result of separation from their family, shortness of breath and pain.. with children, chronicity and complications are also more prevalent. In our current environment, war, political crises, pandemics, immigration, etc. can cause higher stains of newborn. So when we think of available medicines, how do we alleviate the pain of children? There is a slew of ethical issues, conflicts of interest and a lack of sensibilization. Fisclaization and control of narcotics is important, it is true. Health has other issues that need attention: cure, development, alleviation of suffering… We have to provide opportunities for life, opportunities for alleviating suffering. Remember “The chain is only as strong as its weakest link” , think of babies, think of children!
Dr. Cleary: Think of the children!
Ms. Seins, UNODC: I was in Geneva for the past 3 years. I am committed to this topic. The first document on this topic, I was in charge of it. The purpose of the conventions is to ensure and not restrict the access to medicines. I want to share an anecdote from Venezuela. When I graduated as a medical doctor, I got my “purple book”, the prescription book, I felt that I was given a tool to help but also to harm. I compare it to data, many things can go wrong in a medical practices – for example a 160 thousand deaths are administered as bad reactions to drugs. Overuse and overprescription is an issue and there is large number of people who die from secondary effects of medications, such as suicidal ideation. Coming from the field of drug treatment, despite that I believe cancer pain and palliative care is important, we cannot forget about people who are suffering from the abuse of opioids. I would also like to detach from the exclusive concept of disease and talk about circumstances of normal people who are burnt, who need operation, etc. These medications go beyond cancer patients and end-of-life care. Half of UNODC´s budget goes to medicine, so who is taking care of drugs? In closing, yes, time is of the essence. For terminally ill patients, the end of their life is not dying, it is living until the last minute, so UNODC needs to strengthen their strategy.
Dr. Hastie, UNODC: This side event demonstrates the interest in this particular topic. Over 85% of the World’s population doesn’t have access to controlled medicine. Especially those who are nearing the end of their life… it is not just the patient that suffers! As we reflect on the imperatives set forth, the unprecedented joint call for action all harken back to the preamble of our very first convention – adequate provisions must be made so access is ensured to those who need it. The massive global inequalities continue to mount and are interconnected. The joint call for action should really serve as a springboard. We hope to continue to making momentum. In closing, I will say that the pandemic has exacerbated the need to the point where there has never been this level of need and there has never been a better time than now. Despite the efforts of NGOs, there is still need for tangible plans of action and we need to galvanize. Failure is not an option.
International Association for Hospice & Palliative Care: (In response to the call for ideas) Delegates, representatives need to really robustly include civil societies in this effort, including faith communities. In Christian communities, there is tremendous knowledge and experience.
Belgium: Indeed, I have experience in the challenge of convincing patients to trust medications over their traditional healers.
Physicians for Responsible Prescribing: The experience in the US was that the increase in opioid prescribing that was called for by many in the palliative community, funding by the opioid manufacturers has led to disorders and overdoses. This is begin experienced now across Europe. I am concerned that the advocacy to expand access to morphine might not take into consideration these lessons from the USA. You mentioned that a patient who are fearful of physicians, in effect the palliative care advocates have hurt the very population they were interested in. So how do we refine the message?
Dr. Cleary: It is a complex issue, the USA had not had a balanced model(…) we have said for many years that there should be no marketing for opioids. If we use the US healthcare model for the World, we are digging ourselves in a ditch. Germany and Belgium do not have the same problems.
Physicians for Responsible Prescribing: Yes they do. I will share a report with you about it. So, how do we operationalize it?
Mr. D Hoop, Belgium: If we are as specific as we possibly can be, that is the best we can do. We advocate for the end of suffering. I do not want to go down the road of recreational use. I am also acutely aware, we are calling many people to action.
Students for Sensible Drug Policy: I am representing youth and young scientists. I want to bring up the topic of stigma.
Dr. Cleary: There are many people who would like to see decriminalization and many who like to see medicalization. Well, if we are studying medicine, let us study it properly. I am all for using these products, if they have a safety profile, as medicine.
Belgium: MS have come out pointing out the challenge of stigma. You are right in pointing out this issue. I am dying to say the last word – thanks to the strong women championing this issue. See you later!