NOVEMBER- DECEMBER 2021

ANALYSIS
Forging humane policies on narcotic drugs
Five years after the UN General Assembly Special Session on Drugs (UNGASS), a
virtual meeting was held in September that reviewed the progress of the programme.
Lansana Gberie, a co-sponsor of the gathering organised by the Global Commission
on Drug Policy, looks at how the initiative has evolved since 2016
THE UNGASS gave
unprecedented visibility to
the issue of access to essential
controlled medicines. In the Outcome
Document, an entire chapter was dedicated
to controlled medicines, with detailed
recommendations aimed at “addressing
existing barriers, including those related
to legislation and regulatory systems in
accessing controlled opioids for pain
management and palliative care”.
Internationally controlled medicines
such as morphine, diazepam and
midazolam, which are listed as World
Health Organisation (WHO) essential
medicines, are vital for the management
of pain, palliative care, surgical care and
anaesthesia, as well as the treatment of
drug-use disorders, mental health and
neurological conditions.
Yet, progress since has been very
modest, in particular for low- and middleincome
countries. According to the WHO,
each year over five million people suffer
moderate to severe pain because of the lack
of access to control management drugs.
Currently, Africa is experiencing a
shortage of adequate pain management
and palliative care medicine. According
to the 2021 World Drug Report, there
are just four standard doses of controlled
medicines to relieve pain available daily
per million people in Western and Central
Africa, compared to 31,826 doses in North
America.
Patients have been severely affected
in these regions in Africa with the onset of
the Covid-19 pandemic, according to the
Report.
In early September, a joint statement
on Access to Controlled Medicines
in Emergencies by the International
Narcotics Control Board (INCB), the UN
UNGASS 2016: getting it right on the use of
controlled medicines in humanitarian emergencies
Office on Drugs and Crime (UNODC)
and the WHO called on governments to
facilitate access to medicines containing
controlled substances in emergency
settings, including during pandemics and
the increasing number of climate-related
disasters.
Despite a strong commitment made
by member states to improve access to
controlled substances for medical and
scientific purposes by appropriately
addressing existing barriers in this regard
– including those related to legislation,
regulatory systems, health-care systems,
and affordability – progress remains
limited on the ground.
Improving equitable access to
controlled medicines in particular for the
management of pain and for palliative care
is in line with the objectives of the three
international drug control conventions.
Ensuring access to essential controlled
medicines must also be at the heart of
national drug control policies that play
a significant role in limiting access to
internationally controlled medicines.
Today, Sierra Leone only imports
500mg-1kg of cheap powdered morphine
for pain treatment, which is obviously
inadequate to meet the demand for
essential medicines needed for pain
management. Yet these medicines are
inexpensive and patent-free, but are still
routinely denied or severely limited in
many countries.
The explanations for the striking gap
in supply and demand are complex and
include misperceptions, fear of addiction
and deviation, drugs costs and inadequate
funding, complex drugs procurement
procedures, and, of course, drug control
policies.
Extraneous laws and excessive
regulation perpetuate this situation and
are among the main barriers in many
countries in Africa. And this comes at a
high cost: unnecessary suffering of the
most vulnerable, including children and the
poorest.
Therefore, African countries must
be prepared to adopt more efficient
and balanced drug policies in line with
the Sustainable Development Goals
and the African Common Position on
Controlled Substances and Access to Pain
Management Drugs.
It is crucial to work for the
achievement of an international drug
control system. Such a system should be
focused not only on the illicit use and
the prevention of abuse of controlled
medicines, but rather on a balanced
approach. Africa cannot afford repressive
drug control policies that have proven to be
ineffective and harmful to people.
It is time to rethink our policies and
work towards addressing the fundamental
challenges and not exacerbate them. The
choice of balanced national drug policies
that are respectful of human rights are key
to the future of Africa.
Let’s remember that access to palliative
care and pain relief is a health, equity, and
human rights imperative that can no longer
be ignored.
AB
Dr Lansana Gberie is Sierra Leone’s Ambassador to Switzerland and Permanent Representative to the UN in Geneva. In 2014,
he was the lead author of a landmark report produced by the West Africa Commission on Drugs, launched by Kofi Annan, the late
Secretary General of the UN.
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