IV. Relationship Between the Center and the International Narcotics Control Board

The INCB has a critically important role in pain management throughout the world because it administers the international system that controls the availability of narcotic drugs, which includes all opioids used for medical and scientific purposes. These include the pain medications recommended by WHO as essential for cancer pain relief. Governments look to the Board for guidance in implementing the international narcotic control treaties. Since many governments have excessively restrictive attitudes and policies, the INCB can and does play an important role in helping governments take a more balanced approach. The Board and its Secretariat have long collaborated with WHO and have recognized that pain is inadequately managed, that opioids are insufficiently available, and that there are barriers which often involve irrational fears of opioids among governments, the public and health care professionals. In 1995, the Board asked the Center for assistance in surveying all national governments about opioid availability and their efforts, if any, to identify and remove regulatory barriers. The Board used the survey data provided by the Center to conclude that the problem was serious and that few governments had acted to improve the situation. The Board issued a report ²⁷ in which it made a number of recommendations to governments, the U.N. International Drug Control Program, the WHO and other groups such as the IASP; these recommendations were aimed squarely at the problems that had been identified by the survey, collaboration with WHO and experience with governments.

During the reporting period 1997-1999, the Center has requested and received consumption data on morphine and other opioids which it uses to study and report on global and national trends according to its terms of reference. These data, coming as they do from the governments' original reports, are detailed and complete, in contrast to the Board's published reports in which only the statistics from countries that consume over one kilogram are published. Further, national statistics on consumption of some opioids, for example fentanyl, hydromorphone and oxycodone, are not published at all. The result is that important information about consumption trends, and therefore progress or lack of it, is unavailable for some countries with small populations and for all countries for some opioids. The Center hopes that the Secretariat will be able to continue providing these more complete data so that we may continue to implement our Terms of Reference.

In August 1999, three members from the Center met with the INCB Secretariat. The purpose of this meeting was to inform them of our recent work to improve opioid availability and to officially request the raw consumption data for a number of opioid analgesics in addition to morphine.

We were informed that our activities and communications have assisted the INCB in its own efforts to address pain and suffering as a global concern. We were informed that the INCB would, for the first time, address the use of controlled substances for alleviating pain and suffering in their annual report:

In a large proportion of the countries and territories in the world, insignificant amounts of these medicines are available for medical purposes and it is generally agreed that the treatment of chronic or acute pain caused by cancer is still inadequate: only about 10-30 per cent of patients suffering from severe cancer-related pain may be receiving adequate treatment, even in many technologically advanced countries. The Board has requested Governments to pay more attention to this particular problem and to identify and deal with the factors that cause inadequate availability of opioids for medicinal purposes.⁵⁵

In August 1999, the Center invited a staff member of the INCB Secretariat to participate in a workshop on opioid availability in developing countries that was organized by the Center at the IASP meeting in Vienna. It was extremely valuable to demonstrate that the principal narcotic regulatory authority in the world advocates improved availability of opioids for pain relief.

In November 1999, the Center invited an INCB staff member to participate in the working group meeting in Madison co-sponsored by the Center. This meeting provided an additional opportunity to discuss several ideas about what actions are needed (see "Relationship between the Center and WHO" section for details).

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