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New International Efforts to Ensure Availability of Opioids for Medical Purposes

The International Narcotics Control Board (INCB)¹ is an independent, quasi-judicial body responsible for monitoring implementation of United Nations drug control treaties, in particular the Single Convention on Narcotic Drugs 1961 ² and the Single Convention as amended by the 1972 Protocol.³ The Board and national governments are responsible for ensuring adequate availability of narcotic drugs* for medical and scientific purposes, and also for limiting their production, manufacture, and use only to the amounts required for such purposes.⁴

Most national governments are parties to these international drug control treaties. ⁵ The Conventions recognize that, while opioids are a danger to the public health when abused, they are indispensable for the treatment of pain. According to the Conventions, national narcotic control authorities 6 are to enact laws and enforcement measures to prevent illicit production, manufacture, and use of narcotic drugs. The Conventions also require governments to ensure the availability of narcotic drugs for medical and scientific purposes. Thus, governments are required to estimate the amounts of narcotic drugs, including morphine and other opioid analgesics, needed for medical purposes in the next year. The Board evaluates these estimates to assure they are neither over- nor underestimated. When the estimates have been confirmed, Governments are able to import, manufacture, and distribute products within the estimated amount to medical facilities for treatment of patients. If medical demand in a country increases beyond the estimated amount, or if new products are introduced, governments can request supplementary estimates. These are confirmed expeditiously by the Board, typically in a week or less.

In 1989, INCB published a report ⁷ in cooperation with the World Health Organization (WHO) on the demand for and supply of opioids in the world. The report concluded that, in many countries, the legitimate need for opioids was far from being met, in particular for cancer pain relief. A number of factors accounted for this situation, including an absence of national policies on rational use of opioids, lack of health-care resources, inadequate facilities for storage and distribution of drugs, insufficient training of health professionals, excessive fear of opioid addiction, and overly restrictive laws and regulations governing the availability of opioids. The Board made a number of recommendations to national governments, the WHO, and professional associations (see Figure 1).

Governments should critically examine their methods of assessing domestic medical needs for opiates and of collecting and analyzing data so as to make the changes required to ensure that future estimates will accurately reflect the actual need Government should develop and apply a system for monitoring the extent to which medical need for opiates is being met, so that appropriate corrective action may be taken to cover any hitherto unmet needs Government should examine the extent to which their health care systems and laws and regulations permit the use of opiates for medical purposes, identify possible impediments to such use, and develop plans of action to facilitate the supply and availability of opiates for all appropriate indications Governments should establish national policies and develop guidelines on the rational use of opiates and on the treatment of conditions for which opiates may be indicated Governments should ensure that health professionals receive sufficient education and up-to-date training in the use of opiates and have access to information on drug dependence WHO should develop guidelines and provide assistance to governments in establishing the most appropriate national system for assessing the domestic need for opiates Medical instructors and professional associations of physicians, pharmacists, nurses, and pharmaceutical manufacturers should be urged to promote rational use of opiates for medical purposes, bearing in mind their responsibility that opiates not be abused Source: United Nations Report of the International Narcotics Control Board for 1989. "Demand for and supply of opiates for medical needs." Available from the INCB Secretariat, Vienna International Centre. PO Box 500, A-1400 Vienna, Austria. Fig. 1. International Narcotics Control Board's 1989 recommendations.

**Webmaster's note: A more recent report can be found - 1995 International Narcotics Control Board. Supplement 1: Availability of opiates for medical and scientific needs. United Nations: INCB, 1995. [French] [Spanish] [Note: These files are in Adobe Acrobat format (*.pdf), and will automatically download when you select one at the INCB website. To read them, download a free copy of the Adobe Acrobat Reader.]**

Following analysis of the information provided by governments, WHO, and NGOs, the Board will issue its findings, conclusions, and recommendations. Copies of the report will be available during 1996 and can be obtained by writing to the Secretariat for the International Narcotics Control Board, Vienna International Centre, PO Box 500, A-1400, Vienna, Austria.

Address reprint requests to: David E. Joranson, MSSW, Pain Research Group, 1900 University Avenue, Madison, WI 53705-4013, USA. This material is adapted from Angarola, R.T, and Joranson, D.E. (1995). International efforts under way to provide adequate medication for pain control. APS Bulletin 5(6);9-10, 23. Used with permission of the American Pain Society. Copyright 1995 American Pain Society. "'Narcotic drug" is a legal term that denotes all substances covered by the Single Convention, 1961, or the Single Convention as amended by the 1972 Protocol, and includes the opioid analgesics, both natural and synthetic. While the term also includes cocaine and marijuana, these substances are not discussed in this report.

References

2. Single Convention on Narcotic Drugs, 1961. United Nations sales no. E.62.XI.1, 1962.

3. Single Convention on Narcotic Drugs, 1961, as amended by the 1972 Protocol. United Nations sales no. E77.XI.3, 1977.

4. Angarola RT. National and international regulation of opioid drugs: purpose, structures, benefits, and risks. J Pain Symptom Manage 1990; Vol. 5, No. 2 (Suppl) (Feb 1990).

5. Narcotic Drugs: Estimated World Requirements for 1995. United Nations sales no. E/F/S.95.XI.3, 1995.

6. Competent National Authorities Under the International Drug Control Treaties, 1995, United Nations, Vienna, Austria. UN Sales No. ST/NAR.3/1994/1 (E/NA).

7. Report of the International Narcotics Control Board for 1989. Demand for and supply of opiates for medical and scientific needs, special report prepared pursuant to economic and social council resolution 1989/15. United Nations sales no. E.89.XI.5, 1989.1995 International Narcotics Control Board. Webmaster's note: Link to more recent report: Supplement 1: Availability of opiates for medical and scientific needs.

8. Angarola, RT, Joranson DE. International efforts under way to provide adequate medication for pain control. APS Bull 1995;Vol. 5, No. 6;Nov/Dec:9-10.