Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Human Rights and Palliative Care, was in New York to represent us at this important meeting.
Of all the multiple harms visited on vulnerable populations by national and international drug control policies, limited access to controlled medicines for the treatment of pain, palliative care, surgery, substance use disorder and mental and neurological conditions in the Lower- and Middle-Income Countries (LMICs) is one of the least recognized and most egregious. Over several years, health professionals from different disciplines and civil society organizations have raised the issue of lack of access for legitimate medical needs. This has finally caught the attention of member states and so improving access to controlled medicines worldwide, given that more than 75% of the people in the world who need them lack access, is one of the few areas of consensus in the 21st century drug policy debate.
The yearlong United Nations General Assembly Special Session on Drugs (UNGASS) preparatory process, as well as the event itself, which took place from April 19-21 in New York, was unique in many ways. First, the officially designated Civil Society Task Force was committed to bringing the providers, who work with populations affected by harmful drug policies, from their home countries to address the United Nations General Assembly. Populations affected by lack of access to controlled medicines were represented at UNGASS by Dr. Emmanuel Luyirika, Executive Director of APCA (African Palliative Care Association), who presented at the Civil Society Hearing on Day One, and Dr. Zipporah Ali, Executive Director of KEHPCA (Kenya Hospices and Palliative Care Association), who addressed the plenary on the final day. Ms. Rose Kiwanuka, a nurse who heads up the Palliative Care Association of Uganda, spoke about her experience prescribing oral morphine for patients in severe pain in Uganda during the preparatory Interactive Dialogue with the Office of the President of the General Assembly in February.
The official UNGASS program was divided into roughly three concurrent processes: plenary, roundtable, and side events. Many states highlighted the need to improve access and the efforts they were making at the national level (these included, but were not limited to, Mexico, Panama, Uganda, Trinidad and Tobago, and Namibia for the LMICs, and Switzerland, Belgium, Norway, Australia, the UK for the HICs).
The Drugs and Health roundtable received many comments on lack of access to controlled medicines and much interaction and learning took place in the multiple side events organized by member states, UN Agencies and civil society. A side event hosted by the governments of Australia, Belgium, Ghana, Norway, and Panama entitled ‘Addressing global disparities in access to controlled substances for medical purposes, with focus on treatment and pain relief’ featured a high-level panel and a serious interactive discussion.
The UNGASS was held concurrently with a high-level UN meeting on the Sustainable Development Goals (SDGs) or ‘2030 Agenda,’ and many speakers at the plenary, roundtables, and side events acknowledged that member states must align their drug policies with the SDGs. As the 2030 Agenda explicitly states that health, education, development and monetary policies (among others) must ensure that no one is “left behind”; lawmakers must consider how drug control regulations, for example, affect the welfare of the most marginalized and vulnerable in their societies. Health professionals and providers, who work in palliative care and mental health in the LMICs, know very well that unduly restrictive regulations governing access to controlled medicines leave the vast majority of their most vulnerable and marginalized patients in agonizing pain and distress. They also know that untreated pain traumatizes families, caregivers, and providers themselves.
Both the SDGs and the operational recommendations in the UNGASS Outcome Document, which refers specifically to Agenda 2030, require UN member states to develop new inter-governmental processes and synergies to achieve the 17 goals. In order to improve access to palliative care and controlled medicines, healthcare providers, government officials, and representatives of UN agencies such as the World Health Organization, will need to be involved in ongoing ‘multi-stakeholder dialogues’ that will be a feature of this process. IAHPC, in collaboration with partners, will help our members develop and engage in these processes.
The next drug policy milestone for the international community is the UNGASS scheduled for 2019, the ten-year marker for UN member states to report on their progress in achieving the goals set out in the 2009 Political Declaration and Plan of Action. Great progress has been achieved in making the international community more aware of the issue of lack of access to controlled medicines: from the one sentence in the 2009 document to the six constructive paragraphs in the UNGASS2016 Outcome Document. The hard work now begins to operationalize those recommendations at the national level. Providers and advocates have the next three-year period to assist member states reporting low to no access to controlled medicines, to develop the measures and processes to improve access so they can report on their achievements at the 2019 UNGASS. IAHPC is developing an advocacy strategy to help them do just that.
Detailed information about the UNGASS can be found on the IDPC blog (International Drug Policy Consortium) and multiple news articles.
Look out for Katherine’s next policy and advocacy briefing in the July IAHPC Newsletter.
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