III. Relationship Between the Center and the International Narcotics Control Board
The INCB has a critically important supportive role in pain management and palliative care throughout the world because it administers the international system that controls the availability of opioid analgesics including 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 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 themselves 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 report25 in which it made a number of recommendations to governments, the United Nations International Drug Control Program, the WHO and other groups such as the International Association for the Study of Pain; these recommendations were aimed squarely at the problems that had been identified by the survey, and urged further collaboration with WHO and governments.The Board also provides data on the consumption of opioids by each country which is valuable for monitoring progress and identifying issues. During 2000, the Center requested and received consumption data on morphine and other opioids which it used 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. Statistics on consumption of some opioids for example fentanyl, hydromorphone and oxycodone, while collected, are not published. 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 has asked the Secretariat to provide more complete data.