Availability of internationally controlled drugs:
Ensuring adequate access
for medical and scientific purposes
CND Intersessional
Vienna, Austria
4 September 2014
Stefano Berterame, Chief
Narcotics Control and Estimates Section
Secretariat of the International Narcotics Control Board
Unnecessary pain and
suffering for many people
– 5.5 million terminal cancer patients
– 1 million end-stage HIV/AIDS patients;
– 0.8 million patients suffering injuries caused by accidents
and violence;
– Women in labour (110 million births each year)
– Patients with chronic illnesses; recovering from surgery;
– WHO estimates that the number of people affected “are
the same in magnitude as those afflicted by conditions
that are recognized as major contributors to the world’s
burden of disease; in particular HIV, malaria and
tuberculosis “
Main goals of the Conventions
Availability for medical purposes
• 1961 Convention
– Preambular paragraph: “recognizing that the medical use
of narcotic drugs continues to be indispensable for the
relief of pain and suffering”.
– Article 9, paragraph 4, 1961 Convention, as amended by
the 1972 Protocol .
– INCB mandate: “ensuring their availability for such
purposes”.
• 1971 Convention:
– Use of psychotropic substances is indispensable.
– Availability for such purposes should not be unduly
restricted.
Preventing diversion and abuse
• 1961 Convention
– Preambular paragraph: “Recognizing that addiction to
narcotic drugs constitutes a serious evil for the individual
and is fraught with social and economic danger to
manking”.
• 1971 Convention:
– Preambular paragraph “Noting with concent the public
health and social problems resulting from the abuse of
certain psychotropic substances” … “Considerng that
rigorous measures are necessary to restrict the use of
such substances to legitimate purposes”
Obstacles to availability
Stocks of opiate raw materials
for the extraction of morphine
Tons
Tons
900
800
700
600
500
400
300
200
100
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Opium
Poppy straw and CPS
Projected total
Total Utilization
Supply (stocks + production) of
and demand for opiate raw materials
expressed in morphine equivalent
Tons
1800
1600
1400
1200
1000
800
600
400
200
0
2010
2011
2012
2013
Stocks*
Production
* as at 1 January of each year
Utilization
2014
2015
Year
Stocks of opiate raw materials
for the extraction of thebaine
Tons
Tons
400
350
300
250
200
150
100
50
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Opium
Poppy straw and CPS
Projected total
Total Utilization
Supply (stocks + production) of and
demand for opiate raw materials
expressed in thebaine equivalent
Tons
800
700
600
500
400
300
200
100
0
2009
2010
2011
2012
2013
2014
Year
Stocks*
Production
* as at 1 January of each year
Utilization
Availability of opioids for pain management
2000-2002 avg – 2010-2012 avg
Availability of opioids for pain management
2010-2012 avg
Average consumption of benzodiazepines (anxiolytics)
1997-1999 and 2007-2009
Average consumption of central nervous system
stimulants in Schedule IV, 1997-1999 and 2007-2009
Recommendations contained
in the 2010 report on Availability
Availability of Narcotic Drugs and Psychotropic substances
• Correct assessment of the needs;
• Geographical distribution of the drugs;
• Affordability (coverage by the health
system)
• Identification of obstacles in various areas
(legislation, undue restrictions, etc.);
• Information and monitoring.
Appropriate use
• Training and education of health
professionals;
• Appropriate prescription practices;
• Education of the public on safe use;
• Registration system to prevent (doctors
shopping, over prescription, etc.);
• Encourage the use of better and safer
therapeutic agents.
National control system
• Control and supervision of supply and
consumption of internationally controlled
drugs;
• Improve regulatory system on
manufacture, export, import and
distribution;
• Combat counterfeit drugs;
Prevention of diversion and abuse
• Measures against illicit manufacture and
diversion narcotic drugs and psychotropic
substances;
• Improvement of information systems and
data collection;
• Increase regional and inter-regional
cooperation.
New Report on Availability in 2016
• At its 108th session, in November 2013 the
Board decided to prepare a special report
to be published in 2016 as a supplement to
INCB annual report for 2015.
• Focus on the implementation by
Governments recommendations contained
in the report published in 2010.
THANK YOU FOR YOUR ATTENTION !
INCB Secretariat