Do national drug control laws ensure the availability of opioids for medical and scientific purposes?

Despite WHO’s long-standing designation of morphine as an essential medicine for the relief of pain, much of the world still does not have access to this drug or to other opioid medications commonly used for the treatment of pain and dependence syndrome,3 such as hydromorphone, fentanyl, morphine, methadone and oxycodone. Moreover, WHO estimates that over 80% of the world’s population lives in countries with little or no access to controlled opioid analgesics.6^–8 Indeed, most patients in developing countries with cancer, AIDS and other painful conditions are not treated with opioid medicines because access to these controlled drugs is severely restricted.3^,7^,9^,10 According to United Nations’ bodies, there are a number of reasons for the poor availability of, or limited access to, essential opioid medicines, such as concerns about patients developing dependence, insufficient training for health-care professionals and problems with procurement, manufacture and distribution.2^,3^,11^,12 In addition, the availability of these substances for medical use has also been severely limited by administrative requirements that are much stricter than the control measures proposed by the Single Convention.

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Without laws that ensure the availability of controlled medicines, countries may not have a balanced drug control policy that can guide the actions of agencies that control drugs and satisfy the expectations of patients and caregivers.

Even though a country may have ratified the Single Convention, the absence of legislation establishing the government’s responsibility for ensuring drug availability means that health professionals may find it difficult to convince government agencies that drugs should be made available for medical needs, especially if government officials believe that, for example, pain medicine should be strictly controlled.

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Another area of inquiry is to investigate the extent to which governments are able to manage policies and systems that prevent the diversion and abuse of controlled medicines without interfering with their availability for medical purposes. The results would provide the evidence needed for guiding the assessment, planning and systematic improvement of drug control and availability policies and for consolidating our understanding of how such policies affect medication availability and patient care. Research could also be carried out on why United Nations’ guidance on ensuring drug availability has not been accessible to governments until recently, whereas guidance on the strict control of drugs has been thoroughly investigated. In addition, it would be useful to understand why ensuring the adequate availability of narcotic drugs was included in the preamble to the Single Convention after it was amended by the 1972 Protocol but was not mentioned in the original version of the Convention.