CLINICAL
PAIN
LIVING AND DYING IN PAIN
One of the barriers to good pain management is access to opioid medication to manage severe pain
and the international efforts to address these barriers.
In 2014, the World Health Assembly
adopted a resolution identifying
that access to palliative care and
pain relief are human rights.
However, access to opioid
medication, termed narcotic drugs,
is controlled by the International
Narcotics Control Board and law
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40 MAY 2017 | MEDICAL CHRONICLE
enforcement agencies guided by the
following conventions:
1) Single Convention on Narcotic Drugs,
1961 (amended 1972);
2) Convention on Psychotropic
Substances, 1971; and
3) United Nations Convention against
Illicit Traffic in Narcotic Drugs and
Psychotropic Substances, 1988.
International Narcotics Control
Board (INCB) has repeatedly stated its
role to be that of ensuring a balance
between the supply of and demand for
narcotic drugs for medical and scientific
purposes and helping to prevent the
illicit drug cultivation, production,
17-02-20 8:58 AM
Liz Gwyther, CEO,
Hospice Pallative Care Association of South
Africa and Council Member of PainSA
manufacture, traffic and use.
Efforts to create a ‘drug-free world’
have resulted in profound imbalance
in policy and significant harms,
leaving many millions in pain, and with
substance-use disorders, without the
medicines they need”. WHO estimates
that 85% of the world population (5.5bn
people) live in countries with ‘low or
non-existent access to controlled
medicines for the treatment of
moderate to severe pain’.
This whole situation derived from
the US 'War on Drugs' started as one
of Richard Nixon’s election campaigns.
The War on Drugs has failed. There has
not only been failure to achieve drug-
free world but also serious, negative,
unintended consequences. A huge
criminal blackmarket has been created.
There has been prioritisation of law
enforcement over health and a global
perception of people who use drugs
as criminals. The IDPC describe that
globally there are estimated to be 246
million people who use drugs, one in 10
of whom experience problems linked to
their drug use. The IDPC advocate for a
public health response to the problem
of drug misuse and propose prevention
programme that address risk factors
for drug abuse and identification of
protective factors. They advocate for
harm-reduction programmes including
needle exchange programmes,
substitution treatment and availability
of naloxone for opioid overdose. They
also emphasise the importance of
drug dependence treatment and call
for alternatives to criminalising drug
dependence that results in arrest
and incarceration.
The African Union and the South
African Depuity Minister of Social
Development found that the world
drug problem requires an ‘integrated
approach to drug supply, demand
reduction and harm reduction
strategies as well as ensuring the
availability of controlled substances for
medical and scientific use’.
According to the African Union’s
Common African Position: “The
consumption of drugs and drug
addiction must be considered as
public health problems that have
socio-economic root causes and
consequences. Drug education should
be prioritised in education curricula.
People who use drugs must be
given support, and must benefit
from treatment, health services
and protection.”
It calls for greater support to ensure
the provision of opiates and other
essential and controlled medicines for
palliative care and pain relief.