Availability of internationally controlled drugs:

Ensuring adequate access for medical and scientific purposes

CND IntersessionalV ie n n a , Au s t r i a

4 Se p tem b er 2014

Ste fa n o Ber te ra m e , Ch ie fN a rc o t i c s Co n t ro l a n d E s t im a te s Se c t io n

Secretar iat o f the Internat iona l Narcot ics Contro l Board

Unnecessary pain and suffering for many 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 of the Conventions

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• 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

Tons

Stocks of opiate raw materialsfor the extraction of morphine

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

100

200

300

400

500

600

700

800

900

Opium Poppy straw and CPS Projected total

Total Utilization

Tons

Supply (stocks + production) ofand demand for opiate raw materials expressed in morphine equivalent

2010 2011 2012 2013 2014 20150

200

400

600

800

1000

1200

1400

1600

1800

Stocks* Production * as at 1 January of each year

Utilization

Year

Tons

Tons

Stocks of opiate raw materialsfor the extraction of thebaine

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

50

100

150

200

250

300

350

400

Opium Poppy straw and CPS Projected total

Total Utilization

Tons

Supply (stocks + production) of and demand for opiate raw materials

expressed in thebaine equivalent

2009 2010 2011 2012 2013 20140

100

200

300

400

500

600

700

800

Stocks* Production * as at 1 January of each year

Utilization

Year

Tons

Availability of opioids for pain management2000-2002 avg – 2010-2012 avg

Availability of opioids for pain management2010-2012 avg

Average consumption of benzodiazepines (anxiolytics)

1997-1999 and 2007-2009

Average consumption of central nervous systemstimulants in Schedule IV, 1997-1999 and 2007-

2009

Recommendations contained

in the 2010 report on Availability

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.

THANK YOU FOR YOUR ATTENTION !

INCB Secretariat