Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, reports on the Commission on Narcotic Drugs Ministerial Segment and the Regular 62nd Session, held in Vienna, Austria. For more information on CND and the context of advocacy for improved access to controlled medicines, read her backgrounder.
This year’s Commission on Narcotic Drugs (CND) saw an unprecedented number of side events addressing the need to improve access to controlled medicines. The IAHPC cosponsored: two ‘high-level’ events also sponsored by member states (Belgium, Australia, Ecuador, Lithuania, the US, Russian Federation) meaning that ministers and ambassadors participated; and a civil society event organized by De Justicia, a Colombian organization working on health, human rights, and drug policy.
IAHPC Participation at CND
An oral submission during the plenary.
IAHPC cosponsored & participated in 3 side events, describing our work and offering our services to member states.
Members of the Board, delegates and members attended.
IAHPC members attended 4 side events:
In April: An IAHPC side event at the 10th Open Ended Working Group on Ageing will address ‘Normative Elements of a Right to Palliative Care for Older Persons.’
Given that it was an extended CND, with a Ministerial as well as a regular session, our IAHPC delegates came and went at different stages of the meeting. Dr. Lukas Radbruch (IAHPC Board Chair) and Dr. Tania Pastrana (ALCP President) came for the High Level meeting on 15 March to present data of the Lancet Commission Report and the situation in Latin America, respectively. Ms. Heloísa Broggiato and Dr. Marta Ximena Leon (Colombia) spoke at the De Justicia event on 20 March, and Dr. Nahla Gafer (IAHPC Board member and oncologist from Sudan) spoke at the High Level event on 21 March. She had a very interesting report and interaction with the President of CND, Ambassador of Sudan.
It was encouraging to hear representatives of member states wrestling with the language of a Resolution [version en español] proposed by the Government of El Salvador (L8) acknowledging the lack of access to controlled medicines around the world and urging governments to take advantage of the training and capacity-building tools available through the International Narcotics Control Board (INCB), United Nations Office on Drugs and Crime (UNODC), and World Health Organization (WHO). After debating the agreed language of the Resolutions, the Committee of the Whole approved L8 and passed it on to the Plenary for a vote. Many thanks to El Salvador for proposing it, and to member states, particularly Belgium, that supported its objectives.
A new challenge at CND is that the dominant opioid narrative concerns the US overdose epidemic rather than the global pandemic of untreated pain, perhaps because the solutions to making controlled medicines are unfamiliar and do not resonate with the traditional supply control narrative, which simply bans substances with the ‘potential to produce dependence.’ The Ecuador Minister of Health, Dr. Verónica Espinosa Serrano, addressed this in her presentation at the High Level side event on access to controlled medicines during the Ministerial Segment.
She asked rhetorically, ‘How does the world perceive the opioid crisis? Most people perceive it as problematic consumption in the North, but when we in Ecuador listen to the expression “opioid crisis,” we think of the pressing challenge of access and availability... I would like to present this different crisis. Not an excess of consumption, but a view from the other perspective.’ She then showed the map produced by the Lancet Commission on global availability and lack thereof.
Though policymakers and NGOs acknowledge the issue, they have little idea how to proceed with ensuring a balanced approach based on public health principles. We can only develop it together, through ‘multi-stakeholder’ dialogues that bring all the players — palliative care providers, narcotics police, authorities, and pharmacists — face to face.
INCB President Dr. Viroj Sumyai presented its new Annual Report Supplement that details barriers to access and how governments might overcome them. The UNODC has also published a Guide with practical steps, and the WHO is always represented by the Department of Essential Medicines, which presents, among other things, the findings of the Expert Committee on Drug Dependence. Thanks to IAHPC advocacy, among other factors, the ECDD recommended that tramadol not be scheduled, much to the dismay of member states such as Egypt, Nigeria, Sudan, and Senegal, which were recommending international control to check nonmedical use. The ECDD did recommend, however, that many of the fentanyl analogs linked to opioid overdoses be scheduled. (See more on the tramadol issue.)
I was heartened that the need to improve access to controlled essential medicines got a lot of high-level airtime at CND62 and the Ministerial Segment. My award for most passionate new advocate goes to Dr. Verónica Espinoza Serrano, Health Minister of Ecuador, for her commitment to improve access to morphine in her country. For more information, go here.
After CND I flew to Panama for a UNODC organized meeting of the ‘competent authorities’ of several Central American countries, including Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, and Panama. All are at different levels of development of palliative care and have different systems to regulate the importation, manufacture, prescription, and consumption of controlled medicines. I learned a tremendous amount from all of them in the two days of intensely interactive sessions, and presented on the work of IAHPC to improve access.
The UNODC Guidance on improving access and availability of controlled medicines, used by participants at the meeting, can be found in English and Spanish.
Next month I will report on the 10th Open Ended Working Group on Ageing, to be held at the United Nations in New York. For more information on the preparations and significance of the meeting, see our Advocacy Page and written submission.
Previous Page News Index Next Page
This newsletter, including (but not limited to) all written material, images, photos are protected under international copyright laws and are property of the IAHPC. You may share the IAHPC newsletter preserving the original design, the IAHPC logo, and the link to the IAHPC website, but you are not allowed to reproduce, modify, or republish any material without prior written permission from the IAHPC.