Like torture and cruel and unusual punishment, the under-treatment of pain is a human rights issue.
“Lack of access to essential medicines such as morphine or methadone for treatment violates the right to the highest attainable standard of health, which is one of the human rights conventions that all countries in the world have signed on to,” says Dr. Katherine Pettus, an advocacy officer for the International Association for Hospice and Palliative Care. “It also violates the right to be free from torture and constitutes cruel and unusual punishment.”
I see I’m not the only one to consider the withholding of pain medication as torture.
The Opioid Gap
Rich nations have access to a wide variety of opioids, from Tylenol with codeine to morphine tablets to fentanyl patches and lollipops. Just four countries—the US, Canada, the UK and Australia—consume an astonishing 68% of the opioids produced by the pharmaceutical industry. Low- and middle-income countries together account for just 7% of global use.
Put even more starkly, opioids are virtually unavailable in over 150 countries.
Opioids are on the WHO list of essential medicines for human health and well-being. Moreover, the drugs are inexpensive—just pennies per dose—and easy to administer.
A Cruel System
The most significant barrier to equality is the international drug control system, led by the United Nations Office on Drugs and Crime (UNODC) and the International Narcotics Control Board (INCB).
Drug war propaganda promotes two myths about opioids: that they are always dangerous and instantly addictive. The exaggeration of the effects of opioids combined with “zero tolerance” spills over into the use of the drugs in medical settings. Widespread “opioidphobia” affects physicians and even patients who would benefit from taking narcotics. Pain is political.
The United Nations Single Convention on Narcotic Drugs was signed in 1961 and tasked the INCB with ensuring that a global supply of licit opioids was available for medical purposes. The convention states: “The medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering and adequate provision must be made to ensure the availability of narcotic drugs for such purposes.” But for 50 years the INCB has focused on preventing illicit use and diversion of narcotics into the black market, rather than ensuring that countries have sufficient supplies of medical narcotics.
To that end, the INCB has created an unnecessarily complicated and expensive narcotic supply chain system.
Governments have to provide estimates and statistical returns to the INCB on the quantities of drugs required, manufactured and consumed.
This onerous structure of surveillance and accountability makes it almost impossible for poor nations to comply.
“The INCB is set up to create barriers for countries to get licit drugs because it’s trying to keep out illicit drugs. On the one hand, it’s supposed to ensure adequate provision of narcotic drugs for medical purposes and, on the other, prevent diversion and abuse. Their sights are set on stopping the latter and as a result access to pain medication suffers.”
In many countries in Africa, where some of the most severe opioid shortages are found, few hospitals or pharmacies choose to stock morphine—the gold standard in treating moderate to severe pain—because of administrative obstacles and cost.
Meanwhile in Mexico City, a metropolis of 21 million-plus people, just nine hospitals and pharmacies stock morphine due to cumbersome regulatory requirements. India is yet another example of a country where cancer patients must suffer unnecessarily; according to Dr. M.R. Rajagopal, a leading palliative care specialist, doctors in 27 of India’s 28 states are too afraid to prescribe morphine for fear of legal consequences.
The lack of access to pain medication has horrific consequences all over the planet. “In Russia, a country where access to morphine is restricted and methadone is illegal, several highly placed military officers have taken their own lives because they had cancer and were in such pain,”
“in countries where these medicines are very limited, family members who don’t want to see their loved ones suffering go to the illicit market to get heroin or whatever they can get on the street. Then they are often imprisoned and subjected to very harsh sentences for helping their family member.”
National governments in rich as well as poor countries, taking their cue from the INCB, continue to erect additional hurdles to obtaining pain relief. In the US, where 24-hour pharmacies stock stacks of prescription painkillers, people in chronic pain are still routinely undertreated. Pain doctors and their patients are caught in the crosshairs of the War on Drugs. All physicians who prescribe opioids must register with the Drug Enforcement Administration (DEA) and every prescription they write is put in a database and tracked.
The DEA has cracked down on prescription narcotics like Oxycontin and Vicodin and the doctors who prescribe them. Their campaign includes enforcement tactics such as heavily armed SWAT raids on physicians’ offices, aggressive undercover investigations, asset forfeiture and the use of coerced informers. Dozens of doctors have been prosecuted and imprisoned. So now, as in India, there are shortages in some states of physicians willing to prescribe opioids for fear of raids or investigation. Pain patients pay the price.
Rejecting the Status Quo
All this explains why the Global Commission on Drug Policy released a report last month, harshly criticizing the international drug control system’s failure to make essential pain medications available worldwide. (See article below)
The War on Drugs has not only failed to prevent illicit drug use, but has also prevented the provision of legal narcotics to millions of people who are suffering from both curable and terminal illnesses. It is well past time to end this atrocity.
A group of former presidents unveils far-reaching proposals for a set of policies to replace the ones that have failed.
“If we were having this debate today without the background of the past 50 years of the war on drugs, a sophisticated system of legal regulation would be the mainstream position—prohibition would be a radical fringe option,” said
Louise Arbour, the former UN high commissioner for human rights, and her fellow members of the heavyweight Global Commission on Drug Policy—including former presidents of Brazil, Chile, Colombia, Mexico, Poland, Portugal and Switzerland, and former UN secretary general Kofi Annan—are seeking to reset that debate. And their status ensures that they will be heard
The commission’s new report, Taking Control: Pathways to Drug Policies That Work, calls for a raft of radical reforms:
*Put health and community safety first through a fundamental reorientation of policy priorities and resources, from failed punitive enforcement to proven health and social interventions.
*Ensure equitable access to essential medicines, in particular opiate-based medications for pain.
*Stop criminalizing people for drug use and possession—and stop imposing “compulsory treatment” on people whose only offense is drug use or possession.
*Rely on alternatives to incarceration for non-violent, low-level participants in illicit drug markets such as farmers, couriers and others involved in the production, transport and sale of illicit drugs.
*Allow and encourage diverse experiments in legally regulated markets in currently illicit drugs, beginning with but not limited to cannabis, coca leaf and certain novel psychoactive substances”
The British business magnate Richard Branson, a longtime backer of drug policy reform and a member of the commission, also took the stage. “As a businessman,” he said, by analogy with the war on drugs, “if I’d had a business that had been running for 50 years and it had progressively got worse and worse and worse, hopefully somebody would had taken me off to psychiatric hospital.”
Jorge Sampaio, the former president of Portugal, which in 2001 took the bold step of decriminalizing all drug use and focusing on public health instead of enforcement, succinctly summarized the benefits that these policies have brought to his country: “In 10 years the number of drug users decreased; the number of drug users who voluntarily enter treatment increased; the number of HIV and hepatitis C infections has declined significantly every year since 2001, and the mortality rate has also decreased.”
“Scientific knowledge… has progressed over the decades,” she said, “however our policies have not—or not enough.”
Noting that “it is important to distinguish the harms produced by drugs…from the harms produced by drug prohibition,”
Ernesto Zedillo, the former president of Mexico—a country that has suffered enormously because of the war on drugs and the attendant cartel violence—spoke with particular passion. ”It is imperative to take the drug trade away from the hands of organized crime [through the legal regulation of drugs],” he said. “Organized crime would not then have the capacity to hurt societies and institutions.
the commission’s target is the UN special session on drugs (UNGASS) in 2016.
“There’s no question now that the genie of reform has escaped the prohibitionist bottle.”
The import of the Commission’s report lies in both the distinction of its members and the boldness of their recommendations,