2018; Volume 19, No 4, April

Policy and Advocacy

Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, with her latest roundup of advocacy news.

White Paper for Global Advocacy Emerges from Vatican Conference

The Academia Pro Vita (APV, trans. Academy for Life) at the Vatican held a conference in Rome at the end of February to showcase the work of the PAL-LIFE Project, comprising a group of global experts convened by the APV to develop palliative care strategies for health systems in countries of all income levels and faiths. The first product of this multi-year effort is a draft ‘White Paper for Global Palliative Care Advocacy’ addressed to stakeholders from a broad spectrum of global and multilateral institutions and professions.

The APV released the White Paper at the conference, which was attended by more than 200 delegates from around the world. The action-oriented paper calls on the deans of medical and nursing schools, pharmacists, faith-based organizations, international organizations (such as the UN, WHO, etc.), health care providers, patients’ groups, and government officials, among others, to take practical steps to integrate palliative care into their work streams. According to the White Paper, ‘The aim of the PAL-LIFE Project is to heighten social and cultural awareness regarding the existence of palliative care, and to promote dialogue and cooperation between the various stakeholders in the development and implementation of palliative care. The goal is to improve the global treatment and care of patients and their families facing life-limiting illness, taking into account the perspective of different religions.’ IAHPC was an active participant in the PAL-LIFE meeting. Executive Director Liliana De Lima chaired several conference panels, and I presented on advocacy at the level of the UN Organizations.

The Next Step: Communicate widely to garner support

The next step is to develop a paper for Open Access publication in a palliative care journal, and for the APV to communicate the results of the meeting to Papal Nuncios (Holy See Ambassadors) and the Roman Catholic hierarchy throughout the world. It will be important for national and regional palliative care organizations to identify and open communications with representatives of the Roman Catholic hierarchy and other faith-based organizations as appropriate, to create a broader base of support for their policy initiatives. One practical outcome of this collaboration has been the signing of a Memorandum of Agreement between the Catholic Health Association of India (CHAI) and Pallium India.

All the PAL-LIFE presentations can be found on the APV website. The title of my lecture was, ‘International Palliative Care Advocacy: Leaven in the Dough.’

Improving Access to Internationally Controlled Essential Medicines

(L-R) Ms. Heloisa Broggiato, Ms. Kseniya Shapoval (Ukraine), Dr. Pettus, and Dr. Viktoriia Tymoshevska (Ukraine).

Vienna, Austria. The 61st session of the Commission on Narcotic Drugs took place during the second week of March, with two high-level side events focusing on improving access to controlled medicines for the relief of pain and suffering and for palliative care. Internationally controlled essential medicines, such as morphine, oxycodone, fentanyl, and diazepam (for mental health issues) are found both on the WHO Model List of Essential Medicines and in the schedules of international drug control conventions, which require States Parties to closely control their production, distribution, and consumption to prevent non-medical use. IAHPC and partners have been working with the UN’s Commission on Narcotic Drugs for over a decade to highlight the need for balance in drug control policies, and to develop a new multinational narrative that recognizes the value of — and promotes the rational use of — controlled medicines for the relief of pain and suffering.

Detailed Steps for Countries with Low Consumption

Our advocacy efforts came to fruition during the 2015-2016 preparations for the UN General Assembly Special Session (UNGASS) on the World Drug Problem, which approved an ‘Outcome Document,’ containing a stand-alone section detailing the steps that countries with low or inadequate consumption of controlled medicines can take to improve access, affordability, and availability. (See section 2, pp. 8-10.)

Improving Rational Medical Access a Priority in the EU

Several EU countries such as Belgium, Switzerland, and Norway consider improving rational medical access a priority, as do Australia, Canada, and the U.S. This Commission on Narcotic Drugs drew specific attention to the ‘synthetic opioid crisis’ of non-medical use, which has resulted in tens of thousands of overdoses and deaths, creating a sense of despair and helplessness in many U.S. states and cities, where access to evidence-based treatment is limited, while heroin and illicit fentanyls are widely available and often lethal. Non-medical use of tramadol was also the focus of a Commission side event, where speakers from Estonia and Ghana were careful to point out that the fentanyls and tramadols that are being widely misused by their populations are not leaking from the medical supply chain, but are being manufactured illicitly in India and China, and trafficked in strengths far stronger and more lethal than the compounds registered for legally-approved medical use.

A sponsored side event on ‘increasing access to controlled medicines in Africa’ with speakers (L-R): Dr. Emmanuel Luyirika, Executive Director of the African Palliative Care Association; Elizabeth Mattfield, UNODC Drug Prevention and Health; His Excellency Mr. Jean-Louis Falconi (France); (standing) Dr. Kananga Anselme Mubeneshayi (Democratic Republic of Congo) International Youth Association for Development ‘Pallia Familli’; His Excellency Mr. Willem A.G. Van de Voorde (Belgium); Dr. Viroj Sumyai, President International Narcotics Control Board; and Christianah Mojisola Adeyeye, Director General, National Agency for Food and Drug Administration and Control (NAFDAC), (Nigeria).
Side Events Drew Ambassadors from 3 Continents

Ambassadors from Kenya, Lithuania, Belgium, France, and Australia presided at two high-level side events on controlled medicines, whose panels also included drug regulators from Nigeria and Mexico, palliative care physicians from Africa (Dr. Kananga Anselme Mubeneshayi, Democratic Republic of Congo; Dr. Emmanuel Luyirika from Uganda, who is also Executive Director of the African Palliative Care Association), and Dr. Viktoriia Tymoshevsa from Ukraine. Interested readers can view the following statements:

The Ongoing Challenge

The ongoing challenge for IAHPC members, including national and regional palliative care associations, is to partner with governments to implement the recommendations of the UNGASS Outcome Document, which support balanced policies ensuring rational access to controlled medicines while preventing diversion and misuse. IAHPC supports our members in this by working with the International Narcotics Control Board, the World Health Organization, the UN Office of Drugs and Crime, and other partners, including faith-based organizations, to convene advocacy and opioid availability workshops in various regions and countries that have expressed a desire to improve consumption. In the first week of April, we will convene an opioid availability workshop in the Dominican Republic with palliative care providers and national competent authorities (regulators) to identify and remove barriers to rational medical availability of palliative care medicines.

Stay tuned for next month’s report from Santo Domingo and Santiago de Chile, where I will attend the 9th Congress of the Asociación Latinoamericano de Cuidados Paliativos!

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