Ensuring Access to Internationally Controlled Drugs for Medical Purposes

Availability of internationally controlled drugs: Availability of internationally controlled drugs: Ensuring adequate access Ensuring adequate access for medical and scientific purposes for medical and scientific purposes CND CND Intersessional Intersessional Vienna, Austria Vienna, Austria 4 September 2014 4 September 2014 Stefano Stefano Berterame, Berterame, Chief Narcotics Narcotics Control and Estimates Control and Estimates Section Secretariat Secretariat of the International Narcotics Control Board of the International Narcotics Control Board Chief Section

Unnecessary pain and Unnecessary pain and suffering suffering for many for many people people 5.5 million terminal cancer patients 1 million end-stage HIV/AIDS patients; 0.8 million patients suffering injuries caused by accidents and violence; Women in labour (110 million births each year) Patients with chronic illnesses; recovering from surgery; WHO estimates that the number of people affected are the same in magnitude as those afflicted by conditions that are recognized as major contributors to the world s burden of disease; in particular HIV, malaria and tuberculosis

Main goals Main goals of the Conventions of the Conventions

Availability for medical purposes Availability for medical purposes 1961 Convention Preambular paragraph: recognizing that the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering . Article 9, paragraph 4, 1961 Convention, as amended by the 1972 Protocol . INCB mandate: ensuring their availability for such purposes . 1971 Convention: Use of psychotropic substances is indispensable. Availability for such purposes should not be unduly restricted.

Preventing diversion and abuse Preventing diversion and abuse 1961 Convention Preambular paragraph: Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to manking . 1971 Convention: Preambular paragraph Noting with concent the public health and social problems resulting from the abuse of certain psychotropic substances Considerng that rigorous measures are necessary to restrict the use of such substances to legitimate purposes

Obstacles to availability Obstacles to availability

Stocks of opiate raw materials for the extraction of morphine Tons Tons 900 800 700 600 500 400 300 200 100 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Opium Poppy straw and CPS Projected total Total Utilization

Supply (stocks + production) of and demand for opiate raw materials expressed in morphine equivalent Tons 1800 1600 1400 1200 1000 800 600 400 200 0 2010 2011 2012 2013 2014 2015 Year Stocks* Production * as at 1 January of each year Utilization

Stocks of opiate raw materials for the extraction of thebaine Tons Tons 400 350 300 250 200 150 100 50 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Opium Poppy straw and CPS Projected total Total Utilization

Supply (stocks + production) of and demand for opiate raw materials expressed in thebaine equivalent Tons 800 700 600 500 400 300 200 100 0 2009 2010 2011 2012 2013 2014 Year Stocks* Production * as at 1 January of each year Utilization

Availability of opioids for pain management 2000-2002 avg 2010-2012 avg

Availability of opioids for pain management 2010-2012 avg

Average consumption of Average consumption of benzodiazepines ( 1997 1997- -1999 and 1999 and 2007 benzodiazepines (anxiolytics) 2007- -2009 2009 anxiolytics)

Average consumption of Average consumption of central nervous system stimulants in Schedule stimulants in Schedule IV IV, 1997 central nervous system , 1997- -1999 and 2007 1999 and 2007- -2009 2009

Recommendations contained Recommendations contained in the 2010 report on Availability in the 2010 report on Availability

Availability of Narcotic Drugs and Psychotropic substances Availability of Narcotic Drugs and Psychotropic substances Correct assessment of the needs; Geographical distribution of the drugs; Affordability (coverage by the health system) Identification of obstacles in various areas (legislation, undue restrictions, etc.); Information and monitoring.

Appropriate use Training and education of health professionals; Appropriate prescription practices; Education of the public on safe use; Registration system to prevent (doctors shopping, over prescription, etc.); Encourage the use of better and safer therapeutic agents.

National control system Control and supervision of supply and consumption of internationally controlled drugs; Improve regulatory system on manufacture, export, import and distribution; Combat counterfeit drugs;

Prevention of diversion and abuse Measures against illicit manufacture and diversion narcotic drugs and psychotropic substances; Improvement of information systems and data collection; Increase regional and inter-regional cooperation.

New Report on Availability in 2016 At its 108th session, in November 2013 the Board decided to prepare a special report to be published in 2016 as a supplement to INCB annual report for 2015. Focus on the implementation by Governments recommendations contained in the report published in 2010.

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