Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T08:17:47.756Z Has data issue: false hasContentIssue false

Addressing the Global Tragedy of Needless Pain: Rethinking the United Nations Single Convention on Narcotic Drugs

Published online by Cambridge University Press:  01 January 2021

Extract

Important medical advances over the last several decades have vastly improved the technical capacity to control human pain. Millions of patients suffering from cancer, HIV/AIDS, and other conditions have been able to find relief from incapacitating chronic and acute pain. However, despite these developments, pain remains severely under treated worldwide, particularly in developing countries. The tragic consequence is that for millions of people around the globe, excruciating pain is an inescapable reality of life.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Webster, R. Lacey, J. Quine, S., “Palliative Care: A Public Health Priority in Developing Countries,” Journal of Public Health Policy 28, no. 1 (2007): 2839.CrossRefGoogle Scholar
World Health Organization, Single Convention on Narcotic Drugs, 1961, March 30, 1961, at Art. 21–24, available at <http://www.unodc.org/pdf/convention_196l_en.pdf> (last visited September 4, 2007).+(last+visited+September+4,+2007).>Google Scholar
World Health Organization, Access to Controlled Medications Programme: Briefing Note, Geneva, Switzerland, March 2007, available at <http://www.who.int/medicines/areas/quality_safety/AccessControlledMedicationsBrNote.pdf> (last visited September 4, 2007).+(last+visited+September+4,+2007).>Google Scholar
International Narcotics Control Board, Report of the International Narcotics Control Board for 2006, U.N. Doc. E/INCB/2006/1, March 1, 2007, para. 67. Medical availability is also problematic in some wealthy countries, including Japan.Google Scholar
International Narcotics Control Board, Report of the International Narcotics Control Board for 2004, U.N. Doc. E/INCB/2004/1, March 2, 2005, at para. 143.Google Scholar
See World Health Organization, supra note 2.Google Scholar
See Webster, et al. , supra note 1.Google Scholar
Foley, K. M. Wagner, J. L. Jorganson, D. E. et al. , “Pain Control for People with Cancer and AIDS,” in Jamison, D. T. Breman, J. G. Meaham, A. R. et al. , eds., Disease Control Priorities in Developing Countries, 2nd ed. (Oxford: Oxford University Press & World Bank, 2006): 981–93, at 982.Google ScholarPubMed
Since the 1970s, WHO has promoted equitable access to health services through the concept of essential medicines. Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to disease prevalence, evidence on efficacy, safety, and comparative cost-effectiveness. Essential medicines are intended to be available at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. See World Health Organization Expert Committee, The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2005, WHO Technical Report Series No. 933, Geneva, Switzerland, 2006. Opioid analgesics on the WHO Model List of Essential Medicines include codeine tablet 30mg; morphine injection 10 mg+1- ml amouple; morphine oral solution 10mg/5ml and morphine table 10mg. Id., at 63.Google Scholar
Cole, B. E., “The Last Word: The State of Pain Management,” FDA Consumer Magazine 38, March-April 2004, at 40.Google Scholar
International Narcotics Control Board, “Availability of Opiates for Medical Needs,” in Report of the International Narcotics Control Board for 1995, United Nations, 1996; World Health Organization, Achieving Balance in National Opioids Control Policy: Guidelines for Assessment, WHO/EDM/QSM/2000.4, 2000.Google Scholar
Editorial, “Organization of Development of Pain Clinics and Palliative Care in Developing Countries,” European Journal of Anesthesiology 21, no. 3 (2004): 169–72.CrossRefGoogle Scholar
Stjernswärd, J., “Palliative Care: The Public Health Strategy,” Journal of Public Health Policy 28, no. 1 (2007): 4255.CrossRefGoogle Scholar
See Cole, , supra note 11.Google Scholar
See World Health Organization, supra note 2.Google Scholar
Id.; Koshy, R. C. Rhodes, D. Devi, S. et al. , “Cancer Pain Management in Developing Countries: A Mosaic of Complex Issues Resulting in Inadequate Analgesia,” Support Cancer Care 6, no. 5 (1998): 430–37.CrossRefGoogle Scholar
Farmer, P., Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press, 2005): xxivvii.Google Scholar
See Koshy, et al. , supra note 17.Google Scholar
See Webster, et al. , supra note 1.Google Scholar
De Lima, L. Sweeney, C. et al. , “Potent Analgesics Are More Expensive for Patients in Developing Countries,” Journal of Pain and Palliative Care Pharmacotherapy 18, no. 1 (February 3, 2004): 5970.Google Scholar
See World Health Organization, supra note 2; Koshy, et al. , supra note 17.Google Scholar
Editorial, “The Persistent Problem with Pain,” The Lancet 357, no. 9264 (2001): 1217.CrossRefGoogle Scholar
See World Health Organization, supra note 2.Google Scholar
See Webster, et al. , supra note 1.Google Scholar
See World Health Organization, supra note 2; McQuay, H., “Opioids in Pain Management,” The Lancet 353, no. 9171 (1999): 2229–32.CrossRefGoogle Scholar
See Koshy, et al. , supra note 17.Google Scholar
See Webster, et al. , supra note 1.Google Scholar
See Stjernswärd, , supra note 14.Google Scholar
See Koshy, et al. , supra note 17.Google Scholar
Joranson, D. E. Rajagopal, M. R. Gilson, A. M., “Improving Access to Opioid Analgesics for Palliative Care in India,” Journal of Pain Symptom Management 24, no. 2 (August 2002): 152–59.CrossRefGoogle Scholar
See World Health Organization, supra note 2; see also, Scholten, W. Nygren-Krug, H. Zucker, H. A., “The World Health Organization Paves the Way for Action to Free People from the Shackles of Pain,” Anesthesia & Analgesia 105, no. 1 (July 2007): 14.CrossRefGoogle Scholar
Costa e Silva, J. A., “Medicines and the Drug Control Treaties: Is Buprenorphine for Opioid Addiction at Risk of Being Lost?” Human Psychopharmacology 19, no. 4 (2004): 215–24.CrossRefGoogle Scholar
Office on Drugs and Crime, World Drug Report 2006, Volume 1: Analysis, United Nations Sales No. E.06.XI.10, 2006, at 7.Google Scholar
International Narcotics Control Board, Report of the International Narcotics Control Board for 2005, U.N. Doc. E/INCB/2005/1, March 1, 2006 at para. 50.Google Scholar
Interview with Pavel Pachta, Deputy Secretary of the Board and Chief Narcotics Control and Estimates Section, INCB Secretariat, United Nations Office on Drugs and Crime (September 12, 2006).Google Scholar
The first preambular paragraphs to the Convention provide that: “The Parties: Concerned with the health and welfare of mankind, Recognizing that the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering and that adequate provision must be made to ensure the availability of narcotic drugs for such purposes, Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind….” United Nations, Single Convention on Narcotic Drugs, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961, at art. 1.Google Scholar
U.N. Secretary General, Commentary on the Single Convention on Narcotic Drugs, 1961, New York, 1973.Google Scholar
The Board consists of 13 members who are elected by the Economic and Social Council (ECOSOC). Three members with medical, pharmacological, or pharmaceutical experience are elected from a list of persons nominated by the World Health Organization (WHO), and ten members are elected from a list of persons nominated by the Members of the United Nations and by State Parties that are not Members of the United Nations, in accordance with Article 9 of the Single Convention. United Nations, Single Convention on Narcotic Drugs, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961, at art. 9.Google Scholar
Raustiala, K., “Law, Liberalization and International Narcotics Trafficking,” New York University Journal of International Law & Politics 32 (Fall 1999): 89145.Google Scholar
Office on Drugs and Crime, “Drug Abuse and Demand Reduction,” available at <http://www.unodc.org/unodc/en/drug_demand_reduction.html> (last visited October 10, 2007).+(last+visited+October+10,+2007).>Google Scholar
Fazey, C. S. J., “The Commission on Narcotic Drugs and the United Nations International Drug Control Programme: Politics, Policies and Prospect for Change,” The International Journal of Drug Policy 14, no. 2 (2003): 155–69; Bewley-Taylor, D. R. Fazey, C. S. J., “The Mechanics and Dynamics of the U.N. System for International Drug Control,” (2003) (unpublished document copy on file with author).CrossRefGoogle Scholar
See Office on Drugs and Crime, supra note 38.Google Scholar
Bewley-Taylor, D., Emerging Policy Contradictions Between UNODC ‘Universe’ and the Core Values and Mission of the U.N., presentation at the First International Symposium on Global Drug Policy, Lisbon, Portugal, October 25, 2003, available at <http://www.senliscouncil.net/modules/events/lisbon/22_bewley-taylor> (last visited October 10, 2007).+(last+visited+October+10,+2007).>Google Scholar
International Narcotics Control Board, “Annual Report: By Year,” available at <http://www.incb.org/incb/annual_report.html> (last visited September 4, 2007).+(last+visited+September+4,+2007).>Google Scholar
See World Health Organization, supra note 2, at Preamble.Google Scholar
Id., at art. 4.Google Scholar
Id., at art. 9.Google Scholar
International Narcotics Control Board, Report of the International Narcotics Control Board for 1995: Availability of Opiates for Medical Needs, U.N. Doc. E/INCB/1995/1, 1996, at para. 65.Google Scholar
See Costa e Silva, supra note 37; see World Health Organization, supra note 2.Google Scholar
International Narcotics Control Board, “Report of the International Narcotics Control Board for 2006,” available at <http://www.incb.org/incb/en/annual_report_2006.html> (last visited September 4, 2007).+(last+visited+September+4,+2007).>Google Scholar
See International Narcotics Control Board, supra note 4.Google Scholar
Intervention of Willem Scholten, WHO Technical Officer, to the Commission on Narcotic Drugs, 2006, as referenced in supra note 56. (A copy of the intervention is on file with the author.)Google Scholar
See International Narcotics Control Board, supra note 4, at para. 202.Google Scholar
Commission on Narcotic Drugs, Report on the Fiftieth Session, U.N. Doc. E/2007/28 and E/CN.7/2007/16, March 17, 2006 and March 12–16, 2007.Google Scholar
See Costa e Silva, supra note 37.Google Scholar
World Health Organization, Guidelines for the WHO Review of Dependence-Producing Psychoactive Substances for International Control, WHO Doc. WHO/EDM/QSM/2000.5, 2000.Google Scholar
See World Health Organization, supra note 3, at 44.Google Scholar
Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, and World Health Organization Collaborating Center for Policy and Communications in Cancer Care, “Resources for Addressing Barriers to Pain Relief in the World,” available at <http://www.painpolicy.wisc.edu/inter-nat/conf_materials/Seoul/seoul_resources.pdf> (last visited September 4, 2007); Joranson, D. E., “Improving Availability in Opioid Pain Medications: Testing the Principle of Balance in Latin America,” Innovations in End of Life Care 5, no. 1 (January-February 2003), available at <http://www2.edc.org/lastacts/archives/archivesJan03/featureinn.asp> (last visited October 10, 2007).Google Scholar
Id. (Pain & Policy Studies Group), supra note 64.Google Scholar
Leroy, B., International Drug Policy: Challenges and Perspectives, presentation at the First International Symposium on Global Drug Policy, Lisbon, Portugal, October 25, 2003, available at <http://www.senliscouncil.net/modules/events/lisbon/17_leroy> (last visited October 10, 2007).+(last+visited+October+10,+2007).>Google Scholar
See Office on Drugs and Crime, supra note 38.Google Scholar
See International Narcotics Control Board, supra note 5.Google Scholar
U.N. General Assembly, Access to Medication in the Context of Pandemics Such as HIV/AIDS, Tuberculosis and Malaria, G.A. Res. 58/179, U.N. Doc. A/RES/58/179, March 17, 2004, available at <http://daccessdds.un.org/doc/UNDOC/GEN/N03/505/32/PDF/N0350532.pdf?OpenElement> (last visited September 4, 2007). The link between access to medicines and human rights has also been identified by the Committee on Economic, Social and Cultural Rights in General Comment No. 14 to Article 12 of the Covenant on Economic, Social and Cultural Rights, which establishes the right to health. In the Committee's view, Article 12(a) recognizes that the right to health contains a number of essential elements, including essential drugs as defined by the WHO Action Programme on Essential Drugs. As discussed above, the WHO Model List of Essential Medicines includes commonly used and critical opioid analgesics.+(last+visited+September+4,+2007).+The+link+between+access+to+medicines+and+human+rights+has+also+been+identified+by+the+Committee+on+Economic,+Social+and+Cultural+Rights+in+General+Comment+No.+14+to+Article+12+of+the+Covenant+on+Economic,+Social+and+Cultural+Rights,+which+establishes+the+right+to+health.+In+the+Committee's+view,+Article+12(a)+recognizes+that+the+right+to+health+contains+a+number+of+essential+elements,+including+essential+drugs+as+defined+by+the+WHO+Action+Programme+on+Essential+Drugs.+As+discussed+above,+the+WHO+Model+List+of+Essential+Medicines+includes+commonly+used+and+critical+opioid+analgesics.>Google Scholar
Id., at 4.Google Scholar
U.N. Commission on Human Rights, Access to Medication in the Context of Pandemics Such as HIV/AIDS, Tuberculosis and Malaria, C.H.R Res. 2003/29, U.N. Doc. E/CN.4/RES/2003/29, April 22, 2003.Google Scholar
Chayes, A. Chayes, A. H., The New Sovereignty (Boston: Harvard University Press, 1995): 273–85; Mitchell, R. B., “Of Course International Institutions Matter: But When and How?” in Biermann, F. Brohn, R. Dingwerth, K., eds., Proceedings of the 2001 Berlin Conference on the Human Dimensions of Global Environmental Change: Global Environmental Change and the Nation State (Potsdam: Potsdam Institute for Climate Impact Research, 2002): 16–25; Taylor, A., “Making the World Health Organization Work: A Legal Framework for Universal Access to the Conditions for Health,” American Journal of Law and Medicine 18, no. 4 (1992): 301–46; Keohane, R., “International Institutions: Two Approaches,” in Beck, R. Arend, A. C. Vander Lugt, R. D., eds., International Rules (New York: Oxford University Press, 1995): 187–205.Google Scholar
Birnie, P. W. Boyle, A., International Law and the Environment, 2nd ed. (Oxford: Oxford University Press, 2002): at 201.Google Scholar
Taylor, A., “Globalization and Biotechnology: UNESCO and an International Strategy to Advance Human Rights and Public Health,” American Journal of Law and Medicine 25, no. 4 (1999): 479541, at 514.CrossRefGoogle Scholar
See World Health Organization, supra note 2, at art. 15.Google Scholar
See Birnie, Boyle, , supra note 74.Google Scholar
Id.; Szasz, P., ed., Administrative and Expert Monitoring of International Treaties (Yardsley, NY: Transnational Publishers, 1999): at 15.Google Scholar
See Patcha, , supra note 40.Google Scholar
See Birnie, Boyle, , supra note 74.Google Scholar
See World Health Organization, supra note 2, at art. 14.Google Scholar
The INCB also has the authority to recommend to State Parties that they stop the import of drugs, the export of drugs, or both from or to the country concerned, if it is satisfied that such a course is necessary. This remedy, however, does not seem to be an appropriate recommendation in the context of countries that are neglecting opioid analgesics, and appears designed for cases in which failure to control illicit traffic poses an international risk.Google Scholar
Vienna Convention on the Law of Treaties, January 27, 1980, 1155 U.N.T.S. 331, at art. 31Google Scholar
Id., at art. 14.Google Scholar
See Chayes, Chayes, , supra note 73.Google Scholar
See Vienna Convention, supra note 84.Google Scholar