"Notice: this publication appears on the PPSG website with the express permission of the copyright holder, who should be consulted for further permission to reproduce."
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"Notice: this publication appears on the PPSG website with the express permission of the copyright holder, who should be consulted for further permission to reproduce." |
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Section VII
Method for Preparing the Guidelines
The 1995 INCB report (3) stated:
"The availability of narcotic drugs is guided by national policy that should be consistent with the international conventions on narcotic drugs" (p. 5).
The validity of guidelines used in policy analysis depends on their credibility and relevance to the policies being evaluated (13, 14). The present Guidelines were developed following a review and analysis[9] of sources of authority for international drug control policy. The sources of authority are found in Conventions; in the recommendations of United Nations bodies which monitor implementation of the Conventions; and in the findings and recommendations of WHO experts in the fields of substance abuse and medical and scientific policy concerning the use of opioid analgesics for pain relief. "Balance," the Central Principle of the Guidelines, is directly derived from the treaty obligations of national governments, as defined in the 1961 Convention.
The Central Principle of "balance" is intended to guide the development and implementation of international and national drug control policies. It provides a relevant and credible basis for evaluating national drug control policy and is summarized in Figure 2.
| Figure 2
The Central Principle of
"Balance" The Central Principle of "balance" represents a dual imperative of governments to establish a system of control to prevent abuse, trafficking, and diversion of narcotic drugs while, at the same time, ensuring their medical availability. While opioid analgesics are controlled drugs, they are also essential drugs and are absolutely necessary for the relief of pain. Opioids, including those in the therapeutic group of morphine, should be accessible to all patients who need them for relief of pain. Governments must take steps to ensure the adequate availability of opioids for medical and scientific purposes. These steps include empowering medical practitioners to provide opioids in the course of professional practice, allowing them to prescribe, dispense and administer according to the individual medical needs of patients, and ensuring that a sufficient supply of opioids is available to meet medical demand When misused, opioids pose a threat to society; a system of control is necessary to prevent abuse, trafficking, and diversion, but the system of control is not intended to diminish the medical usefulness of opioids, nor interfere in their legitimate medical uses and patient care. Indeed, governments have been asked to identify and remove impediments to the availability and medical use of opioid analgesics |
The dual purposes of preventing abuse and ensuring availability could pose a question of how to balance what might appear to be competing interests. This matter is clearly addressed by the recognition that efforts to prevent abuse should not interfere with ensuring availability for medical and scientific purposes.
The WHO Expert Committee on Cancer Pain Relief and Active Supportive Care (5) stated in 1996:
"The Single Convention recognizes that governments have the right to impose further restrictions if they consider it necessary, to prevent diversion and misuse of opioids. However, this right must be continually balanced against the responsibility to ensure opioid availability for medical purposes...In deciding the appropriate level of regulation, governments should bear in mind the dual aims of the Single Convention" (p. 56).
[9] The review was conducted by the WHO Collaborating Centre for Policy and Communications in Cancer Care at the University of Wisconsin Pain & Policy Studies Group (PPSG), Comprehensive Cancer Center, Madison, Wisconsin, USA. For more information regarding the use of opioid analgesics for pain relief, please see the PPSG website at: http://www.medsch.wisc.edu/painpolicy.