INCB Annual Report for 2013

e) Indonesia

84. Access to opioid medication for pain and palliative care, while improving, continues to be limited. Abuse of amphetamine-type stimulants—primarily methamphetamine—continues to increase in the country. The drug treatment system provides a variety of treatment modalities and rehabilitation and aftercare services through a number of Government ministries and non-governmental organizations. While treatment capacity has increased, greater capacity is needed to address the size of the drugabusing population and the needs of specific populations, such as by providing gender-specific treatment services for females. (…)

f) Kenya

85. Several developments have taken place in Kenya since the Board’s previous mission to the country, in 2002. The Government ensures standards of care and licensing for all centres for the treatment of drug-dependent persons; and the second national household survey on drug abuse was completed in 2012, making Kenya one of only a handful of countries in Africa that have made reliable assessments of the drug abuse situation. However, access to opioids for palliative care was found to be very poor in Kenya, and the Government is encouraged to find ways to ensure the rational use of opioids. (…)

230. Consumption levels of psychotropic substances continue to differ widely among countries and regions, reflecting diversity in medical practice and related variations in prescription patterns. However, as the Board has repeatedly pointed out, high or low levels of drug consumption in a country should be a matter of concern to the Government. High levels of consumption of psychotropic substances that are not medically justified may lead to the diversion and abuse of the substances in question, whereas very low levels of consumption of psychotropic substances in some countries may reflect the fact that those substances are almost inaccessible to certain parts of the population. Where substances are not accessible on the licit market for genuine medical purposes, those substances, or counterfeit medicaments allegedly containing those substances, may appear on unregulated markets. The Board reiterates its recommendation to all Governments to compare the consumption levels in their countries with those in other countries and regions, with a view to identifying unusual trends requiring attention, and take remedial action where necessary. At the same time, the Board encourages all Governments to ensure the rational use of internationally controlled substances, in accordance with the pertinent recommendations of WHO. (…)

232. UNODC continued to develop the global programme to improve the management policies and procedures related to controlled medication, particularly for prescription pain medication. The aim is to increase access to controlled drugs for medical purposes used for treatment of severe pain, thereby reducing existing barriers to rational use and increasing the number of patients receiving appropriate treatment for conditions requiring the use of such medication, while minimizing diversion, misuse and abuse. The global programme has received funding from Australia, and while UNODC is continuing to fundraise, it has decided, together with the Union for International Cancer Control, to start some of the activities foreseen by the programme in a pilot country. (…)

234. In India, an amendment to India’s Narcotic Drugs and Psychotropic Substances Act was introduced to strengthen the Act with regard to opioid accessibility. The amendment was drafted through a cooperative effort by the Government of India’s Department of Revenue and palliative care non-governmental organizations in an effort to achieve a more balanced policy that ensured nationwide consistency in the licensing and movement of opioids between Indian states, while maintaining adequate controls. The Board welcomes the effort of the Government of India and looks forward to the final approval of the amendment. (…)

269. In conclusion, the picture emerging from the survey is that tramadol abuse seems to be a problem for a limited but significant number of countries (32 of the 77  countries responding on that issue). Five countries reported that abuse of tramadol was a significant risk, while illicit trafficking was recorded in a limited number of countries. There were no clear data on abuse, only anecdotal evidence. It seems that a number of States do not intend to strengthen control measures for tramadol because they do not want to limit accessibility and because they do not have strong evidence of abuse and illicit trafficking. (…)

380. The Government of Canada has continued to implement the transition from its existing medical cannabis programme, the Marihuana Medical Access Program, to the Marihuana for Medical Purposes Regulations, a new medical cannabis scheme aimed at reducing the risk of diversion into illicit channels, increasing public security and improving access by programme participants to medical cannabis. The new measures governing the production and distribution of medical cannabis include the phasing-out of cultivation for personal consumption and the strengthening of regulatory requirements applicable to licensed medical cannabis producers. The two programmes will operate concurrently until March 2014, when the Marihuana Medical Access Program will end. The Board wishes to acknowledge the positive changes that have been made to the medical cannabis access scheme in Canada, in particular the phasing out of personal cultivation, and the adoption of other measures aimed at preventing diversion. (…)

Recommendation 5: The Board recommends that all Governments ensure that internationally controlled substances used for pain relief are accessible to people who need them and asks Governments to make every effort to facilitate this process, including through the education of health professionals. In that connection, the Board once again draws attention to the Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes, 26 a supplement to its report for 2010, and invites Governments to make use, as appropriate, of its Guide on Estimating Requirements for Substances under International Control, 27 jointly developed with WHO.