2013; Volume 14, No 9, September
Policy Issues
By Katherine Pettus, PhD.
As a global network, the International Drug Policy Consortium (IDPC) is beginning to articulate key advocacy messages for the UN General Assembly Special Session on Drugs (UNGASS) in 2016. IDPC Executive Director Ann Fordham reminded member states at the most recent Commission on Narcotic Drugs meeting in Vienna that “We cannot afford to miss the opportunity to take stock of the negative consequences of the current system and to ensure that the drug control treaties remain "fit-for-purpose" in the coming decades”.
Global palliative care advocates understand that the drug control treaties are not fit for purpose with regard to adequate access to medical opioids in more than 80% of the world where more than 550 million people suffer and die in uncontrolled pain because of a lack of palliative care.
Since much of the negotiations on the positions and outcome documents will happen a long time before 2016, IDPC has outlined three preliminary key advocacy areas:
- Cannabis reform
- The centrality of "health" within drug policy – in particular harm reduction measures
- Promoting institutional reform of the UN drug control architecture
Although this is not an exhaustive list, IAHPC will be in a position to define our own specific advocacy area since all three of the above are relevant to global palliative care. The last two bear on the issue of improving access to medical opioids in those parts of the world where access is restricted by domestic and international law for legal, political, cultural, and education reasons. The third advocacy area involves a challenge to the role of the International Narcotics Control Board (INCB) in promoting and increasing access to opioids for palliative care as per their defined responsibility in the Single Convention on Narcotic Drugs.
IAHPC is the only NGO specifically focusing on this issue in IDPC, and there are important practical ways that members and readers of this newsletter can be involved in the process from now through 2016 and beyond. I will be keeping members regularly informed and trust that this will be a “two-way street” and that you will also keep me informed of developments in your countries and at your UN Missions and institutional progress toward the UNGASS. I can then pass this information on to the IDPC network.
In parallel to the UNGASS, and in fact approaching much more quickly, is the 2014 mid-term review of the 2009 Political Declaration and Action Plan of the Commission on Narcotic Drugs (CND). This Plan, which is evaluated by the member states at the CND, with some input from civil society, addresses three domains of international drug control policy:
- Demand reduction
- Supply control
- Money laundering
Although the first two categories directly implicate policy advocacy for access to opioids for palliative care in countries where this is a problem, neither official CND delegates nor NGOs have mentioned palliative care or access to medicines at any of the sessions I have attended or in any of the reports I have read. The silence is deafening and more education is needed at every level.
IAHPC members and readers of this newsletter can also have an impact here by educating their government health ministers and UN and CND delegates that:
- Drug control policies with emphasis on demand reduction and the rhetorical stress on the need for countries to be “drug free” reinforce negative stereotypes attaching to morphine and other strong pain relievers that also have the potential to be diverted or misused. This does not mean that control should trump availability at the expense of clinicians, families and patients.
- Similarly, policies with emphasis on supply control of narcotic drugs, when over 80 percent of the world's people have no legitimate supply at all, leaves no rhetorical space for productive conversations about the need to improve access to opioids for palliative care.
I will be presenting on international law and access to opioids at the African Palliative Care conference in Johannesburg in September, and will also give an update on the UNGASS and the 2014 High Level Review at the International Palliative Care Leadership Development Initiative course in Columbus this October.
For more information and education materials on this issue, please contact me.
Katherine Pettus, International Association of Hospice and Palliative Care
Email: [email protected]
This section is written by Katherine Pettus, PhD, a lifetime member of IAHPC. Dr Pettus is a scholar of international law and drug policy committed to promoting access to palliative care and human rights, and serves as the IAHPC representative to several drug control policy meetings and discussions. She is a teacher of American Politics and International Relations at the University of Pécs, in Hungary. This section highlights her participation in several international meetings and conferences related to drug policy and her proposal for collaborative advocacy strategies to ensure that all patients have access to care they need.