Access to Therapeutic Opioids: A Plan of Action for Donors, NGOs, and Governments
Temple Law School Working Paper Series
31 Pages Posted: 13 Mar 2011
Date Written: 2010
Throughout the world, millions of people suffer pain caused by late-stage HIV/AIDS, cancer and other conditions; and millions more suffer the harms associated with addiction to illicit opioids, particularly heroin. Medical best practice recognizes that therapeutic opioids are central to the treatment of severe pain, and indispensible in palliative care. Likewise, long-term pharmacotherapy (referred to here as Medication Assisted Treatment or MAT) is proven to be an effective treatment for opioid dependence; and to significantly reduce the risks of HIV/AIDS and other harms associated with injection drug use. As a result, the World Health Organization (WHO) includes opioid medications that are commonly used to treat both pain and opioid dependence on its list of essential medicines.
Despite widespread recognition that opioid medications are necessary for medical treatment, severe global inequality in access to these medicines persists. The United States, with 4.7% of the world’s population, consumes nearly 55% of the world’s morphine. Poor and middle-income countries, where over 80% of the world’s people live, consume only about 8%. Similar disparities are found with MAT, which has become widespread in the developed world, but remains largely inaccessible in middle and low-income countries. As efforts to improve HIV and cancer care in developing countries progress, attention must be paid to the chronic lack of essential medicines for the care of pain and drug dependence.
A significant driver of access inequality is imbalanced drug policy. In countries throughout the world, restrictive national policies emphasize prevention of drug dependence at the expense of ensuring access to essential opioid medicines. International drug control bodies – the Commission on Narcotic Drugs, the United Nations Office on Drugs and Crime, and the International Narcotics Control Board – have too often over-emphasized drug control and under-emphasized the issue of access. This need not and should not continue. The international conventions governing drug control unambiguously require states to balance control of illicit drug use with affirmative steps to ensure adequate access to opioids for medical and scientific use. Over the past two decades, an informal coalition of dedicated international non-governmental organizations (NGOs) and United Nations programs have worked with advocates in a number of countries to expand access to therapeutic opioids. In recent years, both state parties to the international drug conventions and the international drug control organs have affirmed their support for access. With broad agreement in theory, all that now stands in the way of large-scale change at the international level is the lack of a unifying vision and a clear, adequately funded action plan.
This article is based on research commissioned by the United Kingdom’s Department for International Development (UKAID) that identified successful national opioid policy reform strategies. Based on the results of that work, we argue that moderate international investment can transform the current international consensus for improved therapeutic opioid access into meaningful reform.
Part II makes the humanitarian case for national drug regulatory reform, describing the widespread medical need for opioid medicines and global inequity in their use. Part III provides a brief overview of the international law that obligates states to ensure adequate access to opioid medicines. It also discusses two kinds of impediments that national governments commonly face in improving access to opioid medicines. Part IV identifies three major elements of past successful national reform efforts. In addition, this section makes the case for funding and support to use these elements in a single, comprehensive intervention model for future drug policy reform. These sections make it clear that the NGOs, UN programs, and national champions committed to the cause understand what changes are needed and how to initiate such change. What these groups need now is the financial and political support of the world’s donor nations.
Keywords: controlled medicine, essential medicine, opioid medicine, pain, palliative care, drug treatment, drug policy, reform
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