Katherine Pettus, International Association for Hospice and Palliative Care Association (IAHPC) Advocacy Officer, reports:
A highlight of IAHPC policy advocacy during the month of March was our participation at the 58th annual meeting of the Commission on Narcotic Drugs (CND) in Vienna. I have been active at CND for the past few years, working with other colleagues and IAHPC board members, to highlight the need to improve global access to essential opioid medicines for palliative care and dependence treatment. CND is a functional commission of the UN Economic and Social Council (ECOSOC), charged with supervising the application of the three international drug control conventions. These multilateral treaties govern worldwide access to medicines such as morphine and methadone, which are unavailable in more than 80% of the world.
IAHPC held one of two side events on improving access to essential controlled medicines during the first week. Our event was co-sponsored by the Federal Republic of Germany, the Republic of Lithuania, and the International Association for the Study of Pain. The purpose was to present the results of the ATOME (Access to Opioid Medications Europe) report to CND member states as a model for other regions. (See article in ehospice, 18 March 2015).
IAHPC Board President, Prof. Lukas Radbruch, co-chaired the side event with Human Rights Council Special Rapporteur for Health Dr. Dainus Puras. After reflecting on the work of his predecessor, Dr. Anand Grover, who also used his position as Special Rapporteur to advocate for access to controlled medicines as a human right, Dr Puras said: “failure to ensure access to controlled medicines threatens the fundamental right to health and human rights in general. There is no justification or excuse for not ensuring access.”
Dr. Willem Scholten, an author of the ATOME report, former WHO team leader of the Access to Controlled Medications program, and globally recognized expert on the topic, presented the report, noting that the multi-country, multi-stakeholder participatory project found that “overly restrictive national laws often did not prevent abuse, dependence and diversion but created barriers to medical access.” Dr Scholten finished by addressing the issue of language, which is key to de-stigmatizing morphine and other opioids.
“Use of the word ‘drugs’ to refer to substances of misuse (and) – if you want to promote improved access — is not very useful. It is better to say ‘I want to improve access to medicine’ than ‘increase drug availability’.”
Dr. Anne Merriman, founder of Hospice Africa Uganda and nominee for the 2014 Nobel Peace Prize, flew in from Kampala especially for the side event. She discussed how ATOME could be adapted to the African region as ATOMA (Access to Opioid Medicines Africa) and then she further adapted the acronym to ATOMW – the ‘W’ standing for World. Dr. Merriman showed some very moving slides depicting the work of Hospice Africa Uganda teams who bring compassionate care, as well as essential liquid morphine, to relieve the suffering of patients who would otherwise be untreated in remote rural areas. Dr. Merriman identified lack of compassion in the world as the main source of the problem of lack of access to opioid medicines, saying that countries need “a heart transplant” to ensure that their citizens have access to essential pain medicines such as morphine.
The second highlight of CND for essential medicines advocates was China’s announcement on the plenary floor, that it would withdraw its previously submitted proposal to place ketamine, a widely used essential anesthetic medication, under international control. Had the Chinese proposal, which encountered widespread opposition from many CND member states, succeeded, surgeons, clinicians, and veterinarians worldwide would have encountered significant barriers in accessing ketamine for essential surgery in the lower- and middle-income countries. (See article in EAPC Blog, 6 March 2015).
IAHPC worked with WHO and other expert consultants, including Dr. Willem Scholten, to inform CND missions of the adverse public health effects that would flow from placing ketamine in any schedule of the 1972 Convention on Psychotropic Substances. Fortunately, member states welcomed, and even solicited, our advice on the matter, and supported China’s decision to withdraw its proposal pending “further WHO study”. Countries experiencing problems with diversion and non-medical use of ketamine are free to place the medication under national control, just so long as they ensure its availability for essential surgery.