5.5 million people in needless pain
The World Health Organization (WHO) estimates that each year 5.5 million terminal cancer patients suffer moderate to severe pain that is not managed at all. An absurd number considering that moderate to severe pain can be easily treated with inexpensive, safe and easy to administer opioid analgesics such as morphine.
Yet as it currently stands, 92% of the world’s morphine is consumed by 17% of the world’s population, essentially in high-income countries, while low- and middle-income countries, which account for 83% of the global population, consume only 8% of the medical morphine.
Global access to pain relief: a public health issue
In recent years, the cancer and wider health community have been pressing governments to ensure that access to pain relief and palliative care is prioritised within the world health and development agenda, with efforts being rewarded by UN Member States finally passing a ground-breaking resolution on palliative care at the 2014 World Health Assembly. It is hoped that this resolution, ‘Strengthening of palliative care as a component of comprehensive care throughout the life course’, will help drive national action to reduce barriers to the accessibility and availability of palliative care.
Yet despite great step, little progress has been made since, and access to pain medicines remains constrained by several well-known barriers including inadequate training of healthcare workers, misconceptions about pain and its treatment with morphine and other opioids, and overly restrictive laws and regulations. The UN Member States are also facing an important drug control related challenge: ensuring the availability of controlled substances for medical and scientific purposes while preventing their misuse and diversion. To date, however, few countries have achieved this objective.
April 2016: time to put words into action
UNGASS 2016 is therefore a major opportunity for palliative care advocates to ensure that the availability of controlled medicines gets the attention it needs and deserves and that the international community acts to resolve this longstanding problem that causes millions to experience unnecessary pain each year.
Although UN bodies and agencies have repeatedly expressed concern about the limited availability of controlled medicines, a concerted, multi-sectorial response has yet to be implemented. Progress on this issues requires a whole-of-UN response, as it involves regulatory and enforcement infrastructure, health system strengthening, including health worker training, and development-related measures.
The international community has decided that the UNGASS will adopt a “short, substantive, concise and action-oriented document comprising a set of operational recommendations…including…ways to address long-standing and emerging challenges in countering the world drug problem”. The Commission on Narcotic Drugs, which is leading the process, has asked countries to submit their priorities for this outcome document by 11th September 2015.
The Union for International Cancer Control (UICC) as well as a number of undersigned organisations have therefore put forward their recommendations and call for the outcome document of the UNGASS to include the establishment of an action plan to address the limited availability of controlled medicines in much of the world:
To achieve this, it is essential that as many countries as possible list the development of an action plan on controlled medicines as one of their priorities for the UNGASS.
How can you help?
The palliative care community is highly encouraged to brief government officials and key decision makers who are involved in preparations for the UNGASS. You can contact your health ministry, foreign ministry, drug control agency, interior/home ministry, justice ministry or other relevant authorities, to make sure that your country’s delegation includes the development of the action plan on controlled medicines as one of their priorities.
To find out who to approach, you can access this list of delegations to the 2015 session of the Commission on Narcotic Drugs to help determine which ministries and officials from your country are likely to be involved in the UNGASS process.
Useful resources and related links
 World Health Organisation, Ensuring balance in national policies on controlled substances, Guidance for availability and accessibility of controlled medicines, (2011), p3; available at http://www.who.int/medicines/areas/quality_safety/GLs_Ens_Balance_NOCP_Col_EN_sanend.pdf
 International Narcotics Control Board (INCB), Report 2014, (2014), p3; available at https://www.incb.org/documents/Publications/AnnualReports/AR2014/English/AR_2014.pdf
 United Nations Office on Drugs and Crime, World Drug Report 2014, p 30 available at http://www.unodc.org/documents/wdr2014/World_Drug_Report_2014_web.pdf
 These include the CND, ECOSOC, INCB, UNODC, WHO and the World Health Assembly.
 United Nations Office on Drugs and Crime, Resolution 58/8, (2015) available at http://www.unodc.org/documents/commissions/CND/CND_Sessions/CND_58/2015_Resolutions/Resolution_58_8.pdf