Abstract
BackgroundAlmost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment.DiscussionSignificant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses.SummaryAccording to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.
Highlights
Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering
Summary: According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment
Up to 70% of cancer patients suffer from pain [1] and, among individuals living with HIV/AIDS, wide estimates of pain prevalence at all stages of infection have been reported [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]
Summary
Barriers to access to pain treatment globally include: (1) the failure of governments to put in place functioning drug supply systems; (2) the failure to enact policies on pain treatment and palliative care; (3) poor training of healthcare workers; (4) the existence of unnecessarily restrictive drug control regulations and practices; (5) fear among healthcare workers of legal sanctions for legitimate medical practice; and (6) the unnecessarily high cost of pain treatment. Appendix 1: Uganda case study In 1998, Ugandan government officials, representatives of non-governmental organizations and the WHO agreed on ways in which pain treatment could be made available to the population These steps included: developing national palliative care, cancer and AIDS pain relief policies; implementing a training course to complement existing palliative medicine teaching and increasing the number of skilled providers; developing new drug regulations: updating the essential drug list; conducting estimates of the medical need for morphine; and requests from the drug control authority for an increased national allowance from the INCB [77]. Only a few hundred healthcare workers have received training so far, understanding of palliative care among healthcare officials continues to be limited, various regulatory barriers persist and few pharmacies and hospitals stock oral morphine
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