III. COOPERATION WITH THE INTERNATIONAL NARCOTICS CONTROL BOARD
The INCB plays a critically important 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. Many governments have reported to the INCB that they have excessively restrictive policies. The INCB can assist governments to take a more balanced approach. The Board and its Secretariat have long collaborated with WHO, recognizing 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. For example, 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 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.15
The Board also provides data on the consumption of opioids by each country, which is valuable for monitoring progress and identifying issues. During 2001, the Center received consumption data on morphine and other opioids and used it to study and report on global and national trends according to its terms of reference.
In its 2001 report, the INCB addressed the continuing
“…obligation of all Governments to ensure the availability of narcotic
drugs for the relief of pain and suffering, while preventing their diversion
for illicit use. Among the most frequent reasons for the unavailability of opioids
are: absence of a special policy on the management of acute and chronic pain,
including cancer pain; serious deficiencies in the system for assessing the
requirements for narcotic drugs; budgetary constraints; overly restrictive regulations
and complicated administrative procedures; concerns about the legal consequences
of unintentional errors; concerns about unintended addiction; and inadequate
or insufficient training of health professionals” (emphasis added) (p.
31).16
In addition, it noted in 2001 the improvements made in the
availability of narcotic drugs in India and Italy:
“The Board notes with satisfaction that several Governments have taken
steps to improve the availability of narcotic drugs. For example, in India,
model regulations aimed at simplifying access to morphine for use in palliative
care were developed by the Government, in cooperation with WHO, in 1998 and
have since been introduced in several states in that country; workshops were
organized to explain palliative care to drug control officials and to encourage
their cooperation with health professionals in order to ensure improved access
to morphine. In Italy, a new law on the use of analgesics came into force in
March 2001; prescriptions for analgesics may now cover medication
for a longer period of treatment and access to opioids to meet urgent requirements
has been simplified” (p. 31).16