Why is it that in remote African villages one can easily buy a Coke or mobile phone refill cards but can’t have access to essential medicines?
Although significant efforts have been made to improve access to essential medicines, the anecdote rings true to many across developing countries, and more particularly in Sub-Saharan Africa where up to 50 per cent of the population lacks access to essential health products.
One reason for the scarcity of essential medicines includes bottlenecks at any step in the supply chain: supply shortages at the manufacturer, wholesaler or distributor; poor forecasting and ordering processes or even legal, political or financial constraints. It is also true that most diseases that are common to populations in developing countries are no longer common in developed countries. As a result, pharmaceutical companies find that producing these drugs is no longer profitable and may decrease or stop the production of these drugs.
As defined by the World Health Organization, essential medicines are those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford
The access to controlled substances
The same is true for substances under international control; according the World Health Organization (WHO) , for example, some 5.5 billion people around the globe live in countries with low to non-existent access to controlled medicines and have inadequate access to treatment for severe pain. Only in a small number of wealthy countries do citizens stand a reasonable chance of gaining adequate access to pain care. The International Narcotics Control Board (INCB) estimates that more than 90 per cent of the consumption of prescription pain medications (opioids) takes place in Western Europe, the United States, Canada, Australia and New Zealand.
In poor and developing countries, meanwhile, pain management is poorly addressed and it is estimated that over 80% of the world’s population is inadequately treated for moderate to severe pain, despite the capacity of science to relieve most such pain.
The situation affects numerous conditions: in many places worldwide, pain may go untreated for those with cancer and with AIDS-related maladies, for women in childbirth, for chronic conditions, for those who are wounded in armed conflicts or have suffered accidents, etc.
The causes of underuse
Among the causes of the underuse of controlled substances, we must point out that regulations are frequently applied in an inappropriately restrictive manner, thus becoming impediments to access to adequate patient care. In addition, there are attitude and knowledge impediments among politicians, doctors, patients and their families due to misconceptions. In countries where adequate analgesia is an uncommon practice, even healthcare professionals do not realize that the use of opioids conforms with current medical standards.
Lastly, there are also impediments due to economic factors and issues relating to insufficient medical infrastructure, limited resources for the purchase of medicines and barriers from the supply system capacity – however, although significant, these impediments are not specific to controlled medicines.
Improving access to controlled medicines
The preamble of the UN Single Convention on Narcotic Drugs implies not only to have supplies of controlled medicines available to states, but also for states to make those medicines available to their populations. However, International and national drug policies are clearly imbalanced toward preventing diversion of these medicines rather than ensuring access for medical purposes.
For example, since most governments choose to emphasize a criminal justice approach to drug control, rather than one grounded on public health and human rights, healthcare professionals work in a climate of fear and legal uncertainty which leads them to avoid prescribing controlled medicines lest they be charged with professional misconduct.
This situation is no longer acceptable. Along with other NGOs, we hope that the rapidly approaching United Nations General Assembly Special Session on the world drug problem (UNGASS 2016) will provide an opportunity to revise the international treaties and reform the whole drug control system in order to achieve a better balance between the objectives of cutting down on nonmedical drug use and ensuring equitable access to essential medicines, including opioid-based medications for pain.
The Dianova Network defends universal access to essential medicines and pain relief for all patients.
The drug control system does not allow fair access to certain medications such as opioid analgesics that are essential for the treatment of avoidable suffering and pain. Dianova demands the elimination of all political obstacles that prevent some States with low and middle income to ensure adequate provisions of such substances, which is a basic human right. Excerpt from Dianova’s Organizational Positioning on Drug Policies (2014)