Next week's UN General Assembly Special Session (UNGASS) on the "world drug problem" will be only the third such meeting in the organization's history. And it comes at a critical time in the global drug policy debate.
Much of the attention surrounding this event will focus on the most contentious aspects of the discussion: how the "war on drugs" has been lost and measures are urgently needed to reframe drug policy. Some activists will argue for overhauling the international drug control regime. Indeed, for advocates of alternative policies - including legalization and decriminalization (two different things) - UNGASS is a significant opportunity to build momentum for their views in the mainstream international debate. Their opponents will firmly defend the building blocks of the current international system, although many of them will also acknowledge the need for more flexible, evidence-based policy implementation. Different sides will marshal evidence that seeks to support their case. In a sign of progress, many governments will promote a balanced, health-based approach to prevention and treatment that sits alongside disruption of transnational organized crime networks that feed the "supply" side of the problem.
But there is another pressing issue that has a chance to unite all sides in the drug debate: access to pain relief medicine for the world's poor.
While opioid analgesics such as morphine are a cost-effective medication for treatment of moderate to severe pain related to cancer, HIV/AIDS, surgery, and other conditions, they are not adequately available in most developing countries. This is because of inappropriate legal and regulatory restrictions, weak health systems, inadequate training of healthcare workers, and misconceptions about pain treatment. It was not supposed to turn out like this.
The international drug control conventions were not designed to prevent access to essential medicines. In fact, they recognize "that the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering and that adequate provision must be made to ensure the availability of narcotic drugs for such purposes". Tragically, the unintended consequence of current policies has left around 5.5 billion people, or 75 percent of the world's population, without access to proper pain relief treatment.
The International Narcotics Control Board, the independent international body that monitors implementation of the UN drug control conventions, highlighted the gravity of the situation in a recent report. According to the Board, just 17 percent of the world's population - located in the United States, Canada, Western Europe, Australia, and New Zealand - accounts for 92 percent of morphine consumed worldwide. The UNGASS draft outcome document, negotiated among countries in Vienna last month and to be agreed on next week, gives this global challenge unprecedented attention in a high-level UN political statement.
As an Australian diplomat to the United Nations in Vienna between 2011 and 2014, one of my top priorities was advocating for greater global access to essential pain relief medicine. It was an issue my ambassador knew well and a cause the Australian government strongly supported. I got to work with some intensely smart, dedicated professionals from the UN, NGOs, and academia. We had some successes both diplomatically and in the field, including two pilot projects to strengthen health systems. But a challenge this big requires persistent effort over a long period as well as the collective action of governments, multilateral organizations, civil society, and business.
Even as the issue of limited access has been gaining traction, numerous countries have, in something of a cruel irony, been grappling with a growing prescription opioid misuse problem. As Vox reported recently, "Painkillers now kill more Americans than any illegal drug." It is therefore important to address the question of how to respond to these two public health challenges - ensuring availability and avoiding misuse - at the same time.
It would be understandable for policymakers to assume that increasing availability of these drugs would increase the rate of misuse. But when you look at the data, things get more complicated. By considering consumption of opioid painkillers (measured in milligrams per capita) on a national basis and then comparing this against annual prevalence of misuse of prescription opioids, it becomes clear that there is no simple correlation between the two. Analysis in the UN's 2014 World Drug Report shows a relatively high prevalence of misuse of prescription opioids not only in rich countries such as Australia, Canada, and the United States that have high per capita consumption for medical purposes, but also in lower-middle-income countries such as Nigeria and Pakistan, which have among the lowest per capita consumption of opioids for medical purposes. Meanwhile, Switzerland, Ireland, and the United Kingdom all have high levels of medical consumption but relatively low levels of misuse. While further research is needed in this area, the available data suggests that making painkillers more accessible at the national level does not inevitably lead to greater rates of misuse.
High-income countries should therefore focus less on the risk of exporting the problem of misuse to low-income countries and instead emphasize facilitating the legal international supply of these medicines and, crucially, strengthening health systems to distribute them effectively and responsibly.
Enabling proper access to pain relief medicine is therefore both the right and responsible thing to do. Governments should take the rare opportunity afforded by next week's UNGASS to emphatically make this point and help reverse an ongoing human tragedy.