In 2018, medical practitioners, together with the Office of the Secretary General of the Ministry of Public Health of the Democratic Republic of Congo (DRC), organized an awareness-raising initiative entitled Semaine sans douleur (pain-free week). The aim was to raise awareness among government authorities of the urgent need to promote and expand the use of morphine as an analgesic for pain treatment to all healthcare facilities in the DRC.

 

Pallia Familli, a Kinshasa-based NGO established in 2008, is one of the main actors promoting access to palliative care in the DRC. Changing the mentality of healthcare professionals and training them to prescribe controlled medicines for pain relief in the right dosage, is also a key aspect of their work.

 

Thanks to Belgium’s contributions, the UN Office on Drugs and Crime (UNODC) has been implementing a project to improve access to controlled drugs for medical purposes in the DRC since 2016.

Large inequalities remain in the availability of internationally-controlled substances for medical and scientific purposes. According to estimates by the World Health Organization (WHO) and the International Narcotics Control Board (INCB), 75% of the world’s population has limited or no access to controlled medicines. Additionally, less than 10% of children in need of pain medication worldwide can access it. These figures clearly indicate that limited or zero access to controlled medicines must be considered a global health crisis.

 

The 2023 World Drug Report shows that there is a 40-fold difference in the availability of opioids per capita for pain management and palliative care between high-income and low- and middle-income countries. However, the level of national income is not the only factor influencing unequal availability across countries. Several barriers to access to controlled substances for pain management and other healthcare needs are related to legislation and regulatory systems, good governance, culture, adequate clinical skills and training, national supply management systems, and misinformation. The same barriers prevent access to other controlled medicines for the treatment of pain, opioid dependence, mental health, and neurological disorders.

 

Joint efforts and progress achieved so far

In 2015, Member States endorsed the 2030 Agenda for Sustainable Development, including SDG 3 which aims to ensure healthy lives and promote well-being for all at all ages. Target 3.8 of SDG 3, specifically aspires towards achieving universal health coverage, including access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.

Based on this commitment, on 14-15 November 2023, Belgium, in collaboration with UNODC, organized a Panel Discussion on “Equal Access, Empowered Health – No Patient Left Behind” in Brussels, Belgium. The event built upon the dedicated Joint Call to Action, which was launched at the 65^th session of the UN Commission on Narcotic Drugs (CND) by H.E. Ambassador Ghislain D'Hoop and supported at the highest level by UNODC, WHO and INCB. The topic at hand will be at the forefront of the upcoming 2024 Belgian Presidency of the Council of the European Union (EU).

The event brought together about 50 experts, policymakers, and stakeholders from different organizations and geographical regions, who shared successful best practices to expand access to controlled substances and explored new ways to foster cooperation and increase support across the regions. Panellists highlighted the importance of adopting a bottom-up approach, thus involving the community, taking into account the specific national context, and bringing to the table stakeholders from all relevant sectors to change the perception of controlled substances. Additionally, the need to focus on education and training of healthcare professionals, as well as the importance of allocating sufficient financial resources to address this problem, were also noted as key endeavours.

What is next?

Urgent action, collaboration, and reforms on a global scale are needed to ensure that no one is left behind. The 2024 Midterm Review, to be held in March 2024 at the CND, will serve to assess progress made in the implementation of all international drug policy commitments in the 2019 Ministerial Declaration. Among other objectives, it will provide an opportunity for the international community to advocate for policies that prioritize and facilitate access to controlled substances, call for the provision of sustainable funding for capacity-building initiatives, and encourage and raise awareness on evidence-based approaches to pain management and palliative care.

“We must continue to accelerate our efforts, broaden our partnerships, and secure sustainable funding. Together, let us create a future where access to pain relief and palliative care is universal.” Ms Ghada Waly, UNODC Executive Director

Looking ahead, UNODC will continue to lead and advocate for a coordinated and global response to improve availability of and access to controlled substances for medical and scientific purposes, with the goal to increase the number of patients globally receiving appropriate treatment.

More information

• Commission on Narcotic Drugs
• World Drug Report 2023 
• UNODC Joint Global Programme on “Access to Controlled Drugs for Medical Purposes While Preventing Diversion and Abuse”
• E-Learning on "Availability of and Access to Controlled Substances for Medical and Scientific Purposes"