Volume 23, Number 8: August 2022
Summer “Drug Policy” and Palliative Care Highlights
By Katherine I. Pettus, PhD
IAHPC Senior Advocacy and Partnerships Director
Chart from the World Drug Report 2022. Used with permission.
The World Drug Report 2022 launch, hosted by the United Nations Office of Drugs and Crime (UNODC) on June 28 in Vienna, presented detailed statistics and analysis on multiple aspects of drug trafficking, seizures, illicit consumption, cultivation, and drug-related deaths. The five-volume report gives very little space to availability of “narcotic drugs” for medical use. IAHPC made an effort to balance the skewed narrative by supporting the video statement by Dr. Eve Namisango (research manager of the African Palliative Care Association and an IAHPC Board member) who described the abysmal lack of availability for medical purposes on the African continent. According to a press release issued for the event, “Great inequality remains in the availability of pharmaceutical opioids for medical consumption. In 2020, there were 7,500 more doses per 1 million inhabitants of controlled pain medication in North America than in West and Central Africa.” The 2021 UNODC report noted that the availability of pharmaceutical opioids per capita in the whole of Africa is less than 1% of what is available in North America.
If you are wondering why IAHPC engages in the challenging space of drug policy, read on!
PC & drug policy
are legally linked
Palliative care and drug policy are legally joined in a complex relationship that makes IAHPC’s transnational and interdisciplinary advocacy imperative. Palliative care medicines such as morphine, codeine, hydromorphone, oxycodone, and fentanyl are listed both in the WHO Model List of Essential Medicines and in the schedules of the International Drug Control Conventions. The challenge is that while Model List medicines must be always available in all health systems, the same “scheduled” psychoactive substances must be rigorously controlled at all levels of governance. The tension between the two imperatives of international law sets a high bar for many fragile health systems and results in the well-documented fact that essential palliative care medicines are unavailable, inaccessible, and unaffordable to the majority of people in the lower- and middle-income world who need them for pain and symptom relief.
Medicines, not drugs
Our advocacy for adequate access to internationally controlled essential medicines at the Commission on Narcotic Drugs, which oversees the control conventions and scheduling process, focuses on dismantling palliative care’s tainted association with substances that are widely associated with addiction, violence, trafficking, and prisons. One strategy is to insist on calling them “medicines” rather than “narcotic drugs for medical purposes,” a legal term that perpetuates the stigma!
It’s time to stop clinging
to colonialist conceptions
Bonus: Check out Modules 2 and 3 of the Advocacy Course for details on our work at UNODC in Vienna, and why we engage actively with international, regional, and national drug control policies.
Drug policy’s deep legal and cultural roots in 19th-century colonialism and imperialism generated a stubborn global ideology of prohibition that has resisted 21st-century developments in palliative and addiction medicine as well as human rights law. Many governments, health systems, and advocates cling to negative preconceptions about controlled medicines and remain unaware of the international guidelines and consensus statements that now authorize and, in fact, encourage their rational medical use. IAHPC advocacy brings awareness to the situation by partnering with policymakers to communicate evidence about best practice palliative care and regulatory systems in countries of all income levels.
The Office of the High Commissioner for United Nations Human Rights issued a forceful statement about the many harms of drug policy to mark June 26, the International Day Against Drug Abuse and Illicit Trafficking, even mentioning how it is impacting “a right to palliative treatment.” The statement goes on to say:
“Data and experience accumulated by UN experts have shown that the ‘war on drugs’ undermines health and social well-being and wastes public resources while failing to eradicate the demand for illegal drugs and the illegal drug market. […] Such policies have far-reaching negative implications for the widest range of human rights, including the right to personal liberty, freedom from forced labour, from ill-treatment and torture, fair trial rights, the rights to health, including palliative treatment and care.”
It’s time to plan for Oct. 8!
Don’t forgetto check out WHPCA's resources for World Hospice & Palliative Care Day on Saturday, October 8. The theme is “Healing Hearts and Communities.” It’s time to start planning your event! If you need any help with advocacy, please be sure to contact me.
Katherine recommends:A brilliant conversation about the Compassionate Neighbours project in the London borough of Hackney s. It is part of “The Art of Dying Well” podcast series.
Do you have any comments or questions about this piece or our advocacy program?
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