Editor’s Note: Ruth Dreifuss is former President of Switzerland and Minister of Home Affairs. Anand Grover is former U.N. special rapporteur on the Right to Health, India. Michel Kazatchkine is former executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria. The opinions expressed in this commentary are theirs.
Restrictions on controlled medicines are causing needless suffering globally, argue three experts
Fear of recreational drug use limits access to opiates, they say
U.N. drug control conventions require states to provide these treatments to all who require them
Millions of people are dying in pain because of the repressive stance the world has taken on drugs. That’s because states are obsessed by the fear that people will use controlled medicines such as morphine as recreational drugs, thereby neglecting their important medical uses.
Where you live determines whether you will be able to access to controlled medicines, particularly opiates, when confronting an acute terminal, chronic or painful illness. Ninety-two per cent of the world’s morphine is consumed by only 17% of the world’s population, primarily the United States and Europe. Seventy–five percent of the world’s people in need do not have access to pain relieving medicine.
In other words, most of the global population, outside the affluent countries in the North, dying in pain, including from terminal cancers, do so in the absence of dignified palliative care.
This is a horrendous situation for millions of patients and families. Essential medicines such as morphine, taken for granted as the standard relief of severe pain in the global North, do not enjoy the same status in the global South. Quite the opposite. Chances are, if a person living in any developing country ends up with an illness associated with extreme and avoidable pain, they will endure the pain simply because their government has created obstacles to morphine use in hospitals.
Because of unfounded fears of addiction, doctors are hesitant to prescribe these pain relieving drugs. Additionally, people who inject drugs are often denied access to controlled medicines to treat opioid dependence, including methadone and buprenorphine.
This is unacceptable but what is more, this global crisis of pain is avoidable.
‘The international drug control system is broken’
The Global Commission on Drug Policy (GCDP) sees the problem of access to controlled medicines as a critical global issue and finds that restrictions and conditions to avoid these medicines being used for illicit purposes by international drug control bodies and national governments has caused millions of people to needlessly suffer. Because of the stigma associated with certain controlled medicines, particularly opiates, it is more difficult for health systems, doctors and hospitals to access these medicines for their patients.
According to U.N. drug control conventions, states have an obligation to properly provide these treatments to all people who require them. However, barriers such as discrimination, lack of training for clinicians, and heavy bureaucratic restrictions translate into lack of access and uncontrolled pain.
The United Nations and member states must strike a fair balance between ensuring access and preventing medical substances from entering the black market, with a clear focus on health and human rights.
The international drug control system is broken and human suffering is not taken into consideration because of this imbalance. Correcting this gross imbalance is one step in the right direction of moving away from law enforcement towards a public health approach to drugs.
There are solutions.
The World Health Organization’s (WHO) Model Lists of Essential Medicines provides the minimum that governments should provide to people in need, including morphine, buprenorphine and methadone. These controlled medicines should be accessible, affordable and available through mechanisms that are acceptable to the people in need.
Guaranteeing access to the controlled substances enshrined in the international drug control conventions, many of which are essential medicines, would alleviate the suffering of millions of people around the world. We must make sure that access to the essential medicines on the WHO lists does not become a casualty of the “war on drugs.”
‘Reducing the global suffering of all people’
As we look towards the upcoming United Nations General Assembly Special Session on drugs (UNGASS) to be held in April 2016, we urge member states to acknowledge this gap in access, to recognize their obligations under international law, to prioritize the treatment of pain, to remove barriers to access, and address the knowledge and investigative gap created by prohibitionist policies around controlled substances, including cannabis.
Scientific understanding of the many varied uses of these controlled medicines remains low because of the obstacles governments have put in place, the stigma associated with them and the imbalanced approach to drug policy.
Where you are born should not be a determining factor in whether you are forced to live with avoidable pain in the event of illness.
UNGASS provides a key opportunity for national governments and the relevant UN. bodies to ensure equal access, to balance our drug control policies toward health and human rights and ultimately prioritize reducing the global suffering of all people. The capacity and tools exist, but does the political will?