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In April, the United Nations General Assembly will review the international response to drugs for the first time in 18 years. An issue that has been neglected for decades – ensuring access to controlled substances for medical treatment, such as pain relief—has finally made its way on to the agenda. Dealing effectively with this issue will require profound changes in how most countries and the UN deal with drugs.

A shipment of oral morphine pills arrived at Dakar's Dantec Hospital in July 2013, after a shortage. © Bellus matrimonii amputat plane fragilis cathedras

There’s a paradox at the heart of the issue: Some substances that are strictly controlled because they can cause harm are also critical to providing relief to millions suffering chronic pain and treating other health conditions. Consider, for example, the role of morphine, chemically a cousin of heroin, but also used to treat cancer pain.

The UN drug control conventions recognize that controlled substances are “indispensable for the relief of pain and suffering” and that countries must make “adequate provision” to ensure their availability for medical use. Yet, in the heat of the ‘war on drugs’ many countries – and much of the UN machinery – have focused primarily on rooting out illicit use and neglected the need to ensure medical availability of these substances.

The consequences have been disastrous. A new report of the World Health Organization estimates that 5.5 billion people live in countries with “low or non-existent access to controlled medicines for the treatment of moderate to severe pain.”

While the issue is gaining traction, addressing it will require a significant shift away from the focus on eliminating or reducing illicit drug use. A new Human Rights Watch study found that 25 of 29 reviewed national drug control strategies fail to identify objectives or measures that would ensure adequate medical use of controlled substances, including countries with very low use. Some of these countries fail to acknowledge the medical importance of controlled substances while outlining steps to counter the potential for their misuse – in other words, they seek to prevent misuse of medications that are barely even available.

Drug strategies on both the national and international level need to clearly articulate objectives to ensure medical access to controlled substances. In making this change, countries should learn from Nigeria and Ukraine, among others, which clearly integrate the promotion of legitimate medical use of controlled substances into their national drug control strategies.

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