Policy Issues

2014; Volume 15, No 4, April

Policy Issues

By Katherine Pettus, PhD.

This month we present the transcript of Dr. Pettus’ article about the recent High Level Segment of the Commission on Narcotic Drugs and the annual (57th) session and side event sponsored by IAHPC.

There was unprecedented attention to the issue of lack of access to medicines for pain and palliative care at the recent High Level Segment of the Commission on Narcotic Drugs and the annual (57th) session. NGOs addressed the topic in the Civil Society Hearings and in plenary speeches, pointing out the fact that it was a core area in which the drug control conventions were not being implemented. The fact that several member states, including Norway, Australia, Switzerland and India mentioned the issue in their national statements shows the momentum behind the growing awareness. Delegates highlighted the “tragedy” of inadequate access to essential medicines, with Switzerland saying “we need to recognize the suffering as an unintended and unacceptable side-effect of drug control,” and Australia citing the “moral imperative” of ensuring that all doctors be able to access medicines for their patients needing pain relief and opioid substitution therapy. The delegate from India referenced the recent passage of the amendment to the NDPS Act, and the essential role of civil society, including the palliative care community, in educating lawmakers about the importance of improving access to opioid analgesics.

Two side events at CND highlighted the issue of access to essential medicines for palliative care. The first, co-sponsored by IAHPC and International Doctors for Healthier Drug Policies and hosted by the Republic of Lithuania, featured Vietnamese physician and harm reduction policy advocate Dr. Khuat Thi Hai Oanh and Dr. Jim Cleary, Director of the Pain and Policy Studies Group, and an IAHPC Board Member. Dr. Oanh discussed harm reduction policies in Vietnam and the tremendous public health toll of international drug prohibition policies. Citing the serious health consequence of drug use, the fact that 1.2 million injecting drug users are HIV positive; that 60% injecting drug users have Hepatitis C, and that there were 211,000 drug-related deaths in 2011 (underestimated) - most of which were preventable, she compared these costs to the number of lives lost in the Indochina and other wars. Harm reduction practices, such as needle and syringe exchange programs and opioid substitution therapy with methadone, can save many lives and improve public health outcomes, but are illegal in many countries or not supported by public health systems. Dr. Oanh concluded her presentation by saying that “As doctors, we try our best to save lives, one by one. A bad policy can kill massive amounts of people; a good policy can save millions.”

Dr. Jim Cleary’s presentation began by showing a film clip of a palliative care team trying to work without morphine in rural India, (link) and then went on to present the European Society of Medical Oncology’s findings on barriers to opioid availability in the WHO regions of the world (link) highlighting both the successes and many remaining structural challenges for palliative care physicians and patients. For more information on the session and a video of the entire event, see here.

The second, two days later, sponsored by the Australian mission and the Union for International Cancer Control (UICC) had many more speakers, including the Executive Director of UNODC, Mr. Yuri Fedetov, and other representatives from WHO, UICC, and Dr. Cleary of PPSG. For a detailed description of the talk and topics addressed by other speakers see http://www.cndblog.org/2014/03/coordinated-efforts-to-increase-access.html#more

All this exposure of the issue of lack of access to opioid analgesics scheduled under the drug control conventions has educated both member states and NGO representatives on the need to pay more attention to structural issues and harmful health effects of national and international drug policies. The CND is urging member states to emphasize public health priorities and take a second look at the effects of harsh law enforcement on both the HIV and HCV epidemics, as well as on access to essential medicines.

For more information and education materials on this issue, please contact Katherine Pettus, International Association of Hospice and Palliative Care, at kpettus@iahpc.com

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