Single Convention on Narcotic Drugs

• Establishes a regulatory system for narcotic drugs• government authorization is required for participation

in the trade and distribution of narcotics;

• each state must provide:

• estimates of its need for medical and scientific purposes;

• data on stocks, production, manufacture, consumption, import and export.

• export and import licences are required

• medical prescriptions are required for dispensation to patients

Single Convention on Narcotic Drugs

• overseen / administered by Vienna-based international agencies

• UN Commission on Narcotic Drugs

• International Narcotics Control Board

• UN Office on Drugs and Crime

Single Convention on Narcotic Drugs

‘Recognizing that the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering and that adequate provision must bemade to ensure the availability of narcotic drugs for such purposes’

• BUT – in practice the focus has been on preventing diversion and misuse

Progress since 2010

• international recognition of the need for action• Vienna-based agencies• UN Pol Dec on NCDs• WHA palliative care resolution

CND Resolution 53/4, March 2010

• a landmark resolution

• historically the focus has been on preventing diversion of controlled substances

• The resolution affirmed the principle for balance

CND Resolution 53/4 - availability

• stressing the importance of promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse

• recalling the Single Convention in which parties recognized that medical use of narcotic drugs continued to be indispensable for relief of pain and suffering and that adequate provision must be made to ensure availability of narcotic drugs for such purposes

CND Resolution 53/4 - balance

• affirming that the international drug control conventions seek to achieve a balance between ensuring availability of narcotic drugs and psychotropic substances under international control for medical and scientific purposes and preventing their diversion and abuse

Developments since 53/4

• significant publications

•

• Report on Availability (2010)

• Ensuring Balance guidelines (2011)

• Discussion Paper (2011)

Developments since 53/4

• CND Resolution 54/6

• Model law review and revision

• Political Declaration on the prevention and control of NCDs

• WHA Palliative Care Resolution• Global Monitoring framework including

essential medicines target

UNODC Discussion Paper

• ‘UNODC has long worked proactively to assist Member States to implement the diversion and abuse prevention aspect of their obligations under the drug Conventions. This should be, and will remain, an essential element of UNODC’s work, but the Office will also focus equally on all elements necessary to guarantee availability and accessibility with particular attention to avoiding any control measures unintentionally impeding high quality medical treatment.’

CND Resolution 54/6, March 2011

• follow-up resolution to CND53/4

CND Resolution 54/6

• recalling 53/4 aimed at promoting adequate availability of internationally controlled drugs for medical and scientific purposes while preventing their diversion and abuse

• note the order• promoting adequate availability while

preventing diversion and abuse• this is now the established formulation

UNODC model law review and revision

Revisions to model laws

• use of neutral terminology to describe drugs that have medical or scientific uses but can cause harm when misused

• eg the Schedule in which morphine is listed described as including ‘[d]rugs and substances having a medical and/or scientific use which should be subject to control in view of the harms that their non-medical and/or non-scientific use can cause’

Revisions to model laws

• contrasts with the previous wording, which referred to ‘[s]trictly controlled substances and plants having a medical use’, and ‘[s]ubstances with a high potential risk to public health but having a medical use’ (emphasis added)

• under the previous formulation, concern about the risk of misuse predominated over the need to ensure appropriate medical treatment

UNODC ‘model’ law

COMPARE to the previous terminology:

"drug of abuse" means a prohibited drug, a high-risk drug, or a risk drug, and includes a preparation;

"high-risk drug" means a substance listed in Schedule II of this Act

SCHEDULE II - HIGH RISK DRUGS OF ABUSE (FROM SCHEDULE I of the Convention on Narcotic Drugs, 1961) Acetylmethadol Ethylmethyl- Normorphine Alfentanil thiambutene Norpipanone Allylprodine Etonitazene Opium Alphameprodine Etoxeridine Oxycodone Alphamethadol Fentanyl Oxymorphone Alphamethylthio- Furethidine Pethidine fentanyl Hydrocodone Pethidine Alphaprodine Hydromorphinol intermediate A Anileridine Hydromorphone (4-cyano-1-methyl- Benzethidine Hydroxypethidine 4-phenyl-piperidine) Benzylmorphine Isomethadone Pethidine Betacetylmethadol Levomethorphan intermediate B Betameprodine Levomoramide (4-phenylpiperidine-4- Betamethadol Levophenacylmorphan carboxylic acid Betaprodine Levorphanol ethyl ester) Bezitramide Metazocine Pethidine Clonitazene Methadone intermediate C Coca (leaf) Methadone intermediate (1-methyl-4- Cocaine (4-cyano-2-dimethyl- phenylpiperidine- Codoxime amino-4,4-diphenyl 4-carboxylic acid) Concentrate of poppy butane) Phenadoxone straw Methyldesorphine Phenampromide Dextromoramide Methyldihydromorphine Phenazocine Diampromide Metopon Phenomorphan Diethylthiambutene Moramide Phenoperidine Difenoxin Morpheridine Piminodine Dihydromorphine Morphine Piritramide Dimenoxadol Morphine methobromide Proheptazine Dimepheptanol and other pentavalent Properidine Dimethylthiambutene nitrogen morphine Racemethorphan Dioxaphetyl butyrate derivatives Racemoramide Diphenoxylate Morphine-N-oxide Racemorphan Dipipanone Myrophine Sufentanil

UNODC ‘model’ law

drug dependent person, in relation to a drug of abuse or analogue, means any person who has a condition such that:

…

(ii) cessation of the administration of the drug is likely to result in the person experiencing symptoms of mental or physical distress or disorder

Further developments

Global monitoring framework on NCDs

• adopted by World Health Assembly May 2013• voluntary target for 2025

• 80% availability in both public and private facilities of basic technologies and generic essential medicines required to treat major NCDs

Global monitoring framework on NCDs

• adopted by World Health Assembly May 2013• indicator for health system response• access to palliative care assessed by

morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer• selected as effective proxy

measurement for palliative care development for all life-threatening illnesses, including NCDs

WHA Palliative Care Resolution

UN General Assembly Special Session on Drugs 2016

Links to relevant documents at

http://www.mccabecentre.org/focus-areas/access-to-medicines/access-to-opioid-analgesics