Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva What is the background for this study?

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries. What are the main findings?
The drug control treaties’ emphasis on supply control restricts access to what they term “narcotic drugs for medical and scientific purposes.” Medical professionals prefer the term “controlled medicines.”
• The cornerstone drug control treaty (The Single Convention on Narcotic Drugs) was enacted in 1961, decades before the development of palliative care and pain medicine, and before the advent of contemporary research.
• The conventions emphasize prevention and punishment of diversion, misuse and “addiction,” which needs to be distinguished from tolerance and dependence, and treated appropriately.
• The contemporary US “overdose epidemic” overshadows the legitimate medical use of these medicines, in the media, academia, government representatives and select civil society campaigns.
• Because few politicians, civil servants, or members of the public have been educated about controlled medicines, some countries lack the necessary procurement and distribution systems to ensure the availability of and accessibility to immediate release oral morphine. What should readers take away from your report?

• The ageing population of the world, and the prevalence of non-communicable diseases, including dementia, require policy experts, healthcare providers, and the public to become “palliative care literate,”
• Countries should embrace a person-centred model of drug control based on health and human rights,
• Countries seeking to improve access to controlled medicines can learn from best practices in countries such as Uganda, Romania, Costa Rica, and Colombia, all of which have made much progress in recent years.
• Inadequate access to palliative care and lack of controlled medicines in countries that are the home to 80% of the world’s population undermine community resilience and sustainable development;
• Countries developing universal health coverage must include palliative care. What recommendations do you have for future research as a result of this study?

• To study the wellbeing, financial impact of illness, and long term health of families and caregivers who receive palliative care vs those who receive mainstream care for catastrophic conditions.
• To study how some countries with high consumption of opioids for legitimate medical needs prevent diversion and misuse and assist countries needing to increase opioid consumption for palliative care and treatment of severe pain Is there anything else you would like to add?
Response: No disclosures.

It is past time for a palliative care peace corps to ensure universal access to palliative care and controlled medicines. Thank you for your contribution to the community.


Reasons for drug policy reform: millions of people are left with untreated pain

BMJ 2017; 356 doi: (Published 19 January 2017)Cite this as: BMJ 2017;356:j309Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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