Indispensable, adequately provided and not unduly restricted Availability of internationally controlled drugs. Ensuring adequate access for medical and scientific purposes.  Presentation by Mr. Werner Sipp, President, International Narcotics Control Board (INCB)  Fifty-ninth session of the Commission on Narcotic Drugs SIDE EVENT: "Resolving the Global Crisis of Untreated Pain by Improving Access to Controlled Medicines within the Framework of the SDGs"   15 March 2016 Check against delivery The drafters of the Conventions used some words to describe their vision on the access to controlled substances for medical purposes: Indispensable, adequately available and not unduly restricted. These words used in the conventions describe the fundamental principles that countries should apply to ensure the availability of internationally controlled drugs for medical purposes. The conventions set out that certain medications are indispensable for the relief of pain and suffering so that their availability “must be” ensured. Ensuring availability of controlled substances for medical and scientific purposes has not yet been met in a great number of countries. Around three-quarters of the global population does not have access to proper pain relief treatment, and around 92 per cent of the morphine used globally is consumed in countries representing less than 17 per cent of the world population. In view of this grave situation, INCB decided to publish a further special report on the matter, reviewing progress made since its last such report in 2010, identifying impediments and making recommendations to Governments and international organizations to improve the situation.

Opioid analgesics: Average annual use in 2011-2013 This map shows the global patterns of consumption of opioid analgesics for the 2011-2013 period. The areas in red are countries with consumption above 10,000 daily doses per million inhabitants. In some of these countries there is also the problem of prescription drug abuse with reports of overdose deaths due to abuse and misuse of opioid analgesics. The areas in dark and light green have a consumption that is above the levels considered as inadequate by the Board. However, these are national averages and we would encourage also these countries that opioids analgesics are equally accessible throughout the whole territory and not only in major cities. The areas in purple are considered inadequate (dark purple) or very inadequate (light purple) by the Board. As you can clearly see, Africa and large parts of Asia as well as some countries in Latin America need to take affirmative action to tackle the lack of access to opioid analgesics.

Anti-anxiety medicines - anxiolytics: Average annual use in 2011-2013 Similarly to opioids, there are considerable imbalances also in the consumption of psychotropic substances., Since there are many psychotropic substances to consider, this map shows, just as an example, the global patterns of the annual average use of anti-anxiety medicines (anxiolytics) for the 2011-2013 period.

Impediments to the availability of psychotropic substances (2015) From our study, the main impediment to availability of psychotropic substances is the lack of awareness and training among health care professionals. Second came the problem of sourcing and the fear of addiction, followed by limited resources.

Impediments to the availability of narcotic drugs (in 1995, in 2010, and in 2015) In the case of narcotic drugs, we were able to analyse some of these impediments over a number of years (1995-2010-2015): Fear of addiction (pink line), for example, was identified in 1995 as an impediment by 2/3 (64 per cent) of the countries it dropped to half (47 per cent) in 2010, and went down to 1/3 (34 per cent) by 2015. This suggests some limited improvements in training and awareness. A similar decreasing trend can be seen for onerous regulations (brown line). Training and awareness among health care professionals (blue line) went down between 1995 and 2010, but has since climbed up to become the most mentioned impediment in 2015, with 36 per cent of the countries reporting it. This is an area that requires much action by Member States and other stakeholders.

Recommendations Legislation and regulatory systems Health system Affordability Training of health care professionals Education and awareness-raising Estimates, assessments and reporting Benchmarks for consumption of substances under international control International community On the basis of our analysis of the consumption data and reported impediments, we are making the following recommendations to Member States: - Review and streamline national legislation and regulatory systems. - Strengthen health care infrastructure for dispensing medications and improving access, without which the problem will remain. - Ensure that opioid analgesics are affordable by ensuring that medications are covered by health insurance schemes and that they are accessible locally at affordable prices. - Ensure that health care professionals are capable of prescribing and administering controlled medicines in a rational manner. - Provide education and Raise awareness in order to reduce resistance to the use of opioid analgesics. - Improve the methods of estimating the needs and requirements, and be more accurate in reporting to the Board. - Establish benchmarks for the consumption of psychotropic substances. Many governments are not in a position to implement the above recommendations on their own. They need advice, training and resources to address the problem. For this reason, there is a role for the international community. INCB is implementing a project aimed at training national competent authorities in selected regions of the world and we would welcome countries to contribute to such a project. We need to improve cooperation among all stakeholders involved, to ensure the sharing of expertise and coordinated delivery of resources and technical support to countries in need of assistance.

Thank you!