Abstract
Background The International Narcotics Control Board (INCB) has overseen international drug control since 1968 with the dual remit of restricting illicit production and use of controlled substances, whilst enabling access for clinical purposes. Two opioid crises are present under its jurisdiction: i) abuse, dependence and premature mortality in high-income countries; and ii) inadequate supply of opioids for clinical purposes for most of the world represented almost exclusively by low- and middle-income countries. Methods Systematic critical analysis using corpus linguistics as a method of document analysis to investigate the regulatory climate promoted by the INCB, through language used regarding opioids in a representative sample of annual Reports, 1968-2018. Instances of key terms (narcotics, opiates, opioids, analgesia) were retrieved, with surrounding text for context. Two systematic coding phases were undertaken by two researchers, adjudicated by a third, to develop themes. We report frequencies per-1000 words of themes and key terms, aggregated and by decade. Results Five themes were developed within three domains: abuse and dependency, illegal trade (domain 1: illicit uses); policy, enforcement and context (domain 2: illicit and therapeutic uses), and access for therapeutic use, estimates of need (domain 3: therapeutic uses). For fifty years, the INCB has focussed predominantly upon domain 1: illicit uses, with little attention to domain 3: therapeutic Uses. Decreasing attention is provided to the estimates of annual requirements system, under which global opioid access to opioids is documented as inadequate. Conclusions The INCB must consider how improving availability of therapeutic opioids could reduce widespread suffering safely and effectively. Urgent international and national action is required to improve methods of accurately estimating population-level needs for opioids for all therapeutic requirements. Fears of illicit production or use should not limit the prospects of accessing appropriate therapeutic opioids where the majority of the world, today, have no realistic access.
Highlights
The International Narcotics Control Board (INCB) has overseen international drug control since 1968 with the dual remit of restricting illicit production and use of controlled substances, whilst enabling access for clinical purposes
We investigate the regulatory climate promoted by the INCB as represented through the language used about opioids in a representative sample of six Annual Reports each one a decade apart, from 1968-2018
Use of quantitative and qualitative methods allowed investigation of our primary interest in how language is used by the INCB in relation to opioids, seeking to identify the relative emphasis on licit and illicit issues, and whether this has changed over time
Summary
Systematic critical analysis using corpus linguistics as a method of document analysis to investigate the regulatory climate promoted by the INCB, through language used regarding opioids in a representative sample of annual Reports, 1968-2018. The INCB is required to publish an annual report which provides a comprehensive account of the global drug situation.[31] Further publications include: 'Precursors and chemicals frequently used in the illicit manufacture of narcotic drugs and psychotropic substances’ and technical reports on narcotic drug use/production and estimates of legitimate requirements of each country. Such reports are relevant to opioid analgesia, the INCB lists the production of an annual report as part of its Mandate and Function and may be considered as the key vehicle to connect the organisation with policy makers, law makers and the public in relation to accountability.
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