UNODC World Drug Report 2014

A high-level review of the implementation of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem was conducted in March 2014 in Vienna by the Commission on Narcotic Drugs, followed by a regular session of the Commission. These meetings provided contributions to a special session of the General Assembly on the world drug problem, which will be held in 2016. The high-level review was more than a stocktaking exercise; it provided a much-needed forum for an open, inclusive dialogue, involving not just Governments but also the scientific community, civil society and young people, on the most effective ways to counter the world drug problem.

UNODC is committed to ensuring evidence-informed HIV interventions for all key populations. We have seen that countries that have adequately invested in harm reduction services have lowered remarkably HIV trans- mission among people who inject drugs.

As stated in the International Narcotics Control Board (INCB) annual report for 2009, “One of the fundamental objectives of the international drug control treaties is to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes and to promote the rational use of narcotics drugs and psychotropic substances”.

While opioids are essential in the management of pain experienced by millions of people who might be suffering from late-stage cancers, AIDS, surgical procedures and other debilitating diseases and conditions, they are also susceptible to abuse. This means that countries face the challenging task of balancing two public health needs: ensuring the availability of these controlled substances for medical purposes and preventing their misuse and diversion.

Many countries have expressed concern about misuse, and available data show a high prevalence of misuse of prescription opioids in some countries. This includes the high-income countries,3 such as Australia, Canada and the United States that have high per capita consumption of opioids for medical purposes, and even lower-middle-income countries such as Nigeria and Pakistan, which have the lowest per capita consumption of opioids for medical purposes. That suggests that the dynamics of misuse of prescription opioids does not necessarily follow making opioids accessible or available for medical purposes.

As a response to potential or real misuse of these medicines, many countries, contrary to the provisions of the drug control conventions, have laws and regulations that are unduly restrictive or burdensome, resulting in a situation where a large part of the population does not have access to most of the opioid medications commonly used for the treatment of pain and dependence syndrome.

Globally, in 2011, the opioid consumption for medical purposes in morphine equivalence (ME) per person was 61.66 milligrams (mg) per person. This comprises six main opioids: fentanyl, hydromorphone, methadone, morphine, oxycodone and pethidine. However, there is a great disparity among levels of consumption and accessibility of pain medications. The high-income countries, which comprise 17 per cent of the global population, account for 92 per cent of the medical morphine consumed, whereas more than half of the countries that reported to INCB in 2011 had consumption levels of less than 1 mg of morphine per person. (…)

A survey conducted by INCB in 2011 found that the laws and regulations in place for control of pain medications in many countries were unduly restrictive or burdensome and were perceived to be a significant limitation on availability. Other impediments to accessibility to pain medication included insufficient training of health-care professionals in the recognition and management of pain, and economic and procurement impediments such as deficiencies in drug supply management due to low financial resources or low priority given to health care, among other areas.