WHO Access to Controlled Medicines Programme (ACMP)
By Willem Scholten (Switzerland)
The ACMP was defined in The Framework of the Access to Controlled Medications Programme. The program was established on several requests by international organizations and was drafted and agreed jointly with the International Narcotics Control Board (INCB).
The program was formally established in 2007, but several activities started earlier. It consists of (A) the development of guiding documents that governments and civil society can use for improving access to controlled medicines, and (B) support to countries to work on improving access to controlled medicines. The program’s activities are described in a Briefing Note.
Guidance documents
One project is the development of new and updated WHO treatment guidelines for pain. The only guidelines WHO developed over time are Cancer Pain Relief (2nd Edition: 1996) and Cancer Pain Relief and Palliative Care in Children (1998).
The WHO Steering Group on Pain Guidelines decided that there will be three guidelines that together will cover all the pharmacological treatment of pain: on persisting pain in children, in adults and on acute pain.
The WHO Guidelines on Persisting Pain in Children with Medical Illnesses were published online (spring 2012) and in print (October 2012). A Spanish translation has been developed with the financial support of IAHPC, SECPAL and ALPC and was published online early December 2012.
The Scoping document for the WHO Treatment Guidelines for Persisting Pain in Adults with medical illnesses was approved in August 2012 by the WHO Guidelines Review Committee. A similar scoping document for treatment of Acute Pain is on its way.
The ACMP also developed the policy guidelines Ensuring Balance in National Policies on Controlled Substances, Guidance for Availability and Accessibility for Controlled Medicines(2011).These guidelines are available in 15 languages downloadable free of charge; the English, French and Spanish versions can be ordered in hardcopy at the WHO Bookshop. (The Spanish version was developed with financial and editorial support from IAHPC.) The publication does not only contain 21 guidelines, but also many examples and documentation on the legal basis for its guidelines. Furthermore, it contains a country checklist, which enables the user to assess for which issues a country does not (yet) meet the guideline requirements.
Together with the INCB, the Guide on Estimating Requirements for Substances under International Control for use by Competent National Authorities was published in the six official UN languages in March 2012. The planning methods described in this guide should contribute to avoid the situation that a country runs out of stock for controlled medicines.
The WHO Expert Committee on Drug Dependence (part of WHO Access to Controlled Medicines) focused on access to controlled medicines, and for instance, made an important statement on ketamine, an essential anesthetic in resource poor settings.
Over the years, the ACMP had approximately 18 publications. From the publications not yet mentioned above, I just want to mention three of them:
The 25 minutes documentary The Two Faces of Opium was a joint development of Rockhopper TV, the ACMP and the UK Department of International Development (DFID).
The Access and Control Newsletter was published at irregular times. All back issues can be downloaded at http://www.who.int/medicines/areas/quality_safety/Access_Contr_Newsletter/en/index.html
Country work
The ACMP initiated the Access to Opioid Medicines in Europe (ATOME) Project. This is a five-year project with ten partnering organizations that address access to opioid medicines in twelve Eastern European countries. The programme addresses the national policies and legislation and has activities to generate critical mass for improvement.
The ACMP participated in a large number of workshops organized by other organizations, including IAHPC and the African Palliative Care Association (APCA). These workshops usually addressed about six countries at a time and were held in Africa, Latin America, Eastern Europe and the Pacific.
The ACMP also prepared the designation of the Trivandrum Institute of Palliative Sciences (Kerala, India) as the WHO Collaboration Centre for Training and Policy on Access to Pain Relief. The Collaborating Centre was designated as such by the WHO Director-General on 17 February 2012.
Achievements
Much has been reached in the past seven years. The problem of access to controlled medicines has become more widely known. Many NGOs like IAHPC, Human Right Watch, the International Association for the Study of Pain (IASP), the European Federation of IASP Chapters (EFIC), the World Institute of Pain (WIP), the Union for International Cancer Control (UICC), etc. are involved in this problem. Also UN institutions like the Commission on Narcotic Drugs, the UN Office on Drugs and Crime (UNODC) and the UN Special Rapporteurs on the Right to Health and on the Right to be Free of Torture are involved with this issue. It is hard to tell to what extent the ACMP contributed, as so many people in so many organizations work hard now for improving access to controlled medicines.
Future
Some of the activities will continue, like the WHO involvement in the ATOME Project, but for most other activities there is no funding. This is a pity, in particular for the development of the remaining pain guidelines: there is nothing as strong as a WHO guideline that shows governments that they need to make opioid analgesics available because it is a normal part of treatment.
Dr. Scholten was the Team Leader, Access to Controlled Medicines, Department of Essential Medicines and Pharmaceutical Policies, World Health Organization from 2005 to 2012.
Willem Scholten, PharmD, MPA
Consultant – Medicines and Controlled Substances
Chemin du Lignolet 18A
1260 Nyon, Switzerland
Email: [email protected]
IAHPC Traveling Scholar's Report
A report by Judith Khavai Egala, MD (Kenya)
In my area, palliative care is not widely recognized. Just a handful of institutions throughout the country provide this service. There are only a few trained personnel and palliative care services are very limited. There is a need for greater access to knowledge and the technical aspects of drug usage. Other forms of therapy like counseling and spiritual care should also be emphasized.
Palliative care is essential. Changes that should be implemented are:
The government should emphasis training in pain control, awareness of palliative care and advocacy for a change in the laws pertaining to palliative care - the government is slowly pressing for this kind of education in Kenya’s medical institutions and in some universities.
I am currently enrolled in a course leading to a Higher Diploma in Palliative Care. I was sincerely humbled to receive this opportunity. I learnt a lot. I updated my skills in leadership, importance of use of opiates, pain management, palliative care, just to mention a few. I will integrate these skills into my clinical area of practice of counselling and pain management.
I thank the IAHPC for their traveling scholarship for this opportunity to learn and earn a diploma. Without your support, especially your financial support, I would never have been able to attend this course. You actually paved a new future for me, may God bless you. I hope you will extend this same opportunity to others.
Judith Khavai Egala
Nairobi, Kenya
E-mail: [email protected]
Morphine tablets available in Ukraine.
A report by Lesya Bratsyun (Ukraine)
On February 1, 2013 the Ministry of Health of Ukraine registered morphine tablets by order # 77. Experts say that morphine tablets will enter the market within two months.
Lesya Bratsyun
Executive Director
NGO “All-Ukrainian League of Palliative and Hospice Care”
Email: [email protected]
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