Availability of internationally controlled drugs: Ensuring adequate access for medical and scientific purposes

Most narcotic drugs and psychotropic substances controlled under the international drug control treaties are indispensable in medical practice. Opioid analgesics, such as codeine and morphine, as well as semi-synthetic and synthetic opioids, are essential medicines for the treatment of pain. Psychotropic substances such as benzodiazepine-type anxiolytics and sedative-hypnotics and barbiturates are indispensable medications for the treatment of neurological and mental disorders. Pharmaceutical preparations containing internationally controlled substances play an essential role in medical treatment to relieve pain and suffering.

The first step towards improving access to these essential drugs for medical and scientific purposes is to identify the impediments, which are manifold. While economic considerations may play a role with regard to high-cost medications, low cost preparations do exist, and examples of countries making use of such preparations demonstrate that economic impediments can be overcome. Systemic and regulatory problems may lead to inadequate availability of controlled substances.

3. The conventions established a control regime to serve a dual purpose: to ensure the availability of controlled substances for medical and scientific ends while preventing the illicit production of, trafficking in and abuse of such substances.

4. The international drug control treaties recognize that narcotic drugs and psychotropic substances are indispensable for medical and scientific purposes. However, despite numerous efforts by the Board and the World Health Organization (WHO), as well as non-governmental organizations, their availability in much of the world remains very limited, depriving many patients of essential medicines. The Board continues to monitor the worldwide availability of narcotic drugs and psychotropic substances and has made their availability one of the main topics of its dialogue with Governments on adequate treaty implementation.

5. Narcotic drugs such as morphine, fentanyl and oxycodone are opioid analgesics effective for the treatment of moderate and severe pain. Data from 2009 show that more than 90 per cent of the global consumption of these opioid analgesics occurred in Australia, Canada, New Zealand, the United States of America and several European countries. This means that their availability was very limited in many countries and in entire regions. Although medical science has the capacity to provide relief for most forms of moderate to severe pain, over 80 per cent of the world population will have insufficient analgesia, or no analgesia at all, if they suffer from such pain.

105. The Board calls the attention of Governments to the fact that accurate estimation of requirements for internationally controlled substances is essential to ensure the adequate availability of those substances for medical and scientific purposes. Poor estimation of those requirements can lead to many problems in the use of controlled substances in the health-care system, such as shortages, irrational prescribing, distortion of demand and low cost-effectiveness; it can also lead to surpluses and increased risk of diversion of controlled substances. Proper use of the system of estimates for narcotic drugs and the system of assessments for psychotropic substances is important to ensure adequate availability of internationally controlled substances. For this purpose, national competent authorities need to ensure that health-service providers can easily communicate their requirements to them.

130. It appears that a number of countries have not yet recognized that adequate availability of medicines, including narcotic drugs and psychotropic substances, is an essential part of their responsibility towards their populations. Negligence towards this responsibility is shown when countries do not even estimate their requirements and appear to have no knowledge about the quantities of certain drugs their populations would require for medical treatment. In other countries, where such negligence is not observed, other obstacles continue to prevail, including outdated restrictive regulations and, more frequently, uninformed interpretations of otherwise correct regulations, misguided fears and ingrained prejudices about using opioids for medical purposes.