The question you're asking is what are the obstacles,
the barriers to access to essential medicines and
specifically to opioids for the treatment of pain?
Well, my answer is that this is indirectly
a negative consequence of the way drugs are controlled.
Its a negative impact of Prohibition.
Just think of the 1961 conventions.
In the preamble to the conventions,
it is said that these conventions are there to promote the welfare,
the well-being of the population.
The original intention is to prevent the diversion of drugs for nonmedical use but
also to promote the use for medical purposes of the drugs,
medicines that are needed by people.
However, what has happened is that because of prohibition,
because of the way the Conventions have been interpreted,
most governments have put all of their money and their energy in actually
preventing diversion in criminalizing drugs,
criminalizing use, incarcerating, arresting people,
rather than actually promoting these medicines for the people in need.
So, what do I mean by that?
First, the system has put limitations and
a huge bureaucracy behind the prescription of these medicines for people in need.
Special forms, limitation in how much you can prescribed,
for our long you can prescribe,
availability of the drugs is maybe a problem.
I've seen in some countries in Ukraine for example that you
actually need an armored convoys to
bring the medicines from the Central Store to a hospital or to a methadone clinic.
So, these drugs are treated like something special and something potentially dangerous.
Then the doctors themselves.
In many countries, they actually fear that if they over-prescribe,
if they do not prescribe in the right way,
they will be punished or they will be prosecuted by the system.
Finally, the patients and their families themselves have
such a misconception about what morphine
can be because of the overlaps because of the ambiguity
of these substances being both medicines and illegal drugs,
that families themselves may be reluctant that the idea that the doctor will prescribe.
"Doctor will my brother become an addict?
Are you sure he needs even morphine?"
Now, that's the question I have been asked so many times whereas
whenever a medicine that is well prescribed is a medicine that
is prescribed when it is needed and not prescribed when it is not needed.
Sorry to state the obvious,
but when it is needed,
everything should be done so that the patient access it,
and I'm absolutely convinced that the misconceptions,
the myths we have in society around these substances,
and that the priority given to control of diversion,
over promotion of health,
has really been unhelpful here,
and that's one of the main reasons,
direct and indirect why 85 percent the people in
the world do not have access to these medicines when they need them.
One of the concerns I have though here is that
the recent opioid epidemic in the US and in
Canada will not help us in our fight for access
to essential medicines and opioids for the treatment of pain,
because that may be seen as look at what happens if these drugs are too easily available.
But when you think of it,
they're too easily available because they have been poorly prescribed,
because they were advertised on TV,
because they were poorly regulated.
So to me, bringing this issue of the access to medicines and the issue of moving to
legal regulation of what is currently illicit drugs
in general converges somehow to one concept,
a properly and adequately regulate these substances.
Regulate these substances just as we regulate anything that can potentially be dangerous,
be it preservatives in food,
be it a medicine,
be it a radio isotope,
be it as I often say, a car.
It's dangerous to drive cars,
but you put on a safety belt,
you drive carefully on the right side of the road.
If things are regulated,
that's the way a society address something that is risky and potentially dangerous.
