Medical morphine ready for use for palliative care patients in Sierra Leone. Photo used with permission.
Together to Improve Access to Controlled Medicines: IAHPC & INCB
November’s advocacy highlight was my trip to Vienna to sign a Memorandum of Understanding with the International Narcotics Control Board (INCB) on behalf of the IAHPC. This MoU, which has been years in the making, represents an institutional framework of cooperation to improve the availability of internationally controlled substances for medical and scientific purposes. The objectives include, among others, an annual exchange of research, data, and analysis on controlled medicines, as well as the exploration of possible solutions, such as joint activities to make the information available to the international community.
"Measures of suffering have been absent, and so the need for palliative care and pain relief services has been easy to miss. That excuse no longer holds. The scale of human suffering is massive... The Commission has uncovered an appalling oversight in global health."
—Richard Horton, The Lancet, 2017
The data and analysis objective was catalyzed by the publication of the Lancet Commission report on the global prevalence of serious health-related suffering (SHS) in 2017. Curated by IAHPC Board Member Dr. Felicia Knaul, SHS data provides a more accurate evidence base than was previously available, to help governments determine their annual estimates of the essential medicines listed in the schedules of the drug control conventions. Signatories to the conventions are obliged to submit these annual estimates to the INCB as a precondition for their procurement, purchase, and—ultimately—availability within health systems. Since inaccurate and inadequate national estimates are one of several barriers to optimal health system availability of controlled substances, the publication of SHS data represents both a qualitative and quantitative advance for palliative care and other disciplines that routinely use these medicines.
Katherine Pettus delivering a statement at a session held by the Commission on Narcotic Drugs. Photo used with permission.
As the MoU signing with INCB President Jallal Toufiq took place during the 2024 thematic sessions of the Commission on Narcotic Drugs (CND), I attended the final session, titled “Other Substantive Matters,” giving a statement to the plenary that highlighted the 2024 World Drug Report’s finding that “Some 87 percent of the world’s population live without adequate access to pharmaceutical opioids for pain relief and palliative care.” You can read my statement, a commentary on that finding.
At the same time, the UN’s Third Committee in New York was reviewing the Omnibus Resolution on Drugs that—yet again!—notes “with deep concern that the availability of internationally controlled drugs for medical and scientific purposes, including for the relief of pain and suffering, remains low to nonexistent in many countries, in particular in developing countries” and highlights “the need to enhance national efforts and international cooperation at all levels to address that situation by promoting measures to ensure access to, and the availability of, controlled substances for medical and scientific purposes, including for the relief of pain and suffering,”
Your advocacy can help your patients
As readers familiar with the issue and who may have viewed Modules 2 and 3 of the IAHPC Advocacy Course know, national governments are responsible for improving safe and rational availability of controlled medicines essential for palliative care and other therapies. Although the omnibus resolution just approved by your governments at the UN “[r]eiterates the strong commitment of Member States to improve access to controlled substances for medical and scientific purposes by appropriately addressing existing barriers in this regard, while concurrently preventing the diversion and abuse...” Those aspirational words will remain just words in a PDF in the absence of informed and effective advocacy.
Contact me to learn more about IAHPC’s advocacy work to improve availability of essential palliative care medicines for your patients!
WHO to publish new guidance on pain management
As part of the United Nations' international drug control system, the World Health Organization (WHO) supports governments’ dual obligation to establish a control system that ensures both the adequate availability of essential medications while preventing their abuse, diversion, and trafficking. In 2019, the WHO withdrew its cornerstone guideline on pain management, “Ensuring Balance in National Policies on Controlled Substances,” for what the IAHPC and partners claimed in a joint public statement were spurious and unfair reasons. More than five years on, the secretariat is almost ready to release the replacement guideline, now in the “external review” stage.
As one of the external reviewers, I can confidently say that the new guideline is a strong document with excellent sections on supply chain management, development of national medical policy, pricing and financing, medicines selection, procurement and supply, regulation, prescribing, dispensing, education, knowledge, and attitudes. There is also an excellent section on how to manage aggressive and unethical pharmaceutical marketing, including best practices statements to prevent and manage conflict of interest.
With any luck, the guideline will be released early in 2025.
Human rights agency issues 2 calls for input
Finally, in December I will work on a submission in response to a call from the Special Rapporteur at the United Nations Office of the High Commissioner for Human Rights (OHCHR) on “health and care workers as key protectors of the right to health,” and then on a second call by the same office concerning a report on the right to medicines.
Advocacy tip if you would like to submit your own report to the OHCHR on behalf of your national association, or contribute to the IAHPC report, please let me know and I will be happy to guide you. The more reports the better, especially those from lower- and middle-income countries.
Celebrating this year's work & planning for more
The advocacy team has done an enormous amount of work this year, much of which is documented on our dedicated webpage. Thanks go to our focal points in many different countries, our LEAD cohort, and each and every one of you who supports our efforts in whatever way you can.
We are in the process of forming an online Advocacy Community of Practice, led by IAHPC Board Members Victoria Hewitt, Natalie Greaves, Ebtesam Ahmed, and Stella Rithara, to develop and implement strategies for the next five years.
Thank you for reading my column this year. May you have a blessed and restful holiday season and be ready to join our advocacy work in 2025!