The World Health Organisation (WHO) convened a two-day global consultation meeting in Geneva, Switzerland to discuss access to controlled medications, especially opiate-based medicines. Across the world, millions of people are being denied access to effective pain management and substitution treatments, due to the international conventions controlling opiates. The WHO’s “Access to Controlled Medications Programme” aims to correct this situation, and IHRA was represented at the meetings by the vice chair Mukta Sharma.
Prescribed opiate drugs are essential for, among other things, effective pain management and control for terminally ill patients. Throughout the world, many people are not being provided adequate pain control, and are being denied the quality of a pain-free life. Similarly, many drug users around the world are being denied access to proven medical treatments to help them overcome or manage their addictions. This is because these medicines are associated with onerous regulation requirements, are classed as narcotics in various international conventions and are too expensive for many governments.
For example, the UN Single Convention places onerous restrictions on opiate medications in terms of the required record keeping. As a result, many governments have decided not to supply these medicines because they cannot afford to develop the necessary regulatory mechanisms for storage, transportation, prescription etc (in addition to the costs of the drugs themselves). Also, in many countries, these medicines are classed as “narcotics” as a result of being in the UN Single Convention. For example, in Russia, it is currently illegal to prescribe, possess or even advocate for methadone (an evidence-based medical treatment for opiate addiction).
The global coverage of methadone and buprenorphine treatments remains low, especially outside of the European Union. The “Access to Controlled Medications Programme” is an important WHO initiative which should contribute to the expansion of substitution treatments in countries where it is currently unavailable or poorly accessible. In the past two or three years, the WHO has paid more attention to controlled substances. For example, methadone and buprenorphine are now listed in the WHO Model List of Essential Medicines, advocating for their global availability in adequate doses, at affordable prices, and in accessible settings.
At the consultation meeting, it was agreed that the programme should include all controlled medications on the WHO Model List of Essential Medicines, pay specific attention to the discrimination encountered by patients, and acknowledge the substitution treatments also provide a valuable platform for access to treatments for HIV, tuberculosis and other diseases frequently prevalent among drug users. A framework for action was also agreed, which includes ensuring cooperation and joint partnerships between agencies (including law enforcement authorities), identifying and tackling the existing barriers to the supply of opiate medicines (such as price, regulatory restrictions, and inadequate resources), advocacy and education of the general public, and demonstration projects to show how these medicines can be supplied, managed and controlled.
