2. Single Convention on Narcotic Drugs Establishes a regulatory system for narcotic drugs government authorization is required for participation in the trade and distribution of narcotics; each state must provide: estimates of its need for medical and scientific purposes; data on stocks, production, manufacture, consumption, import and export. export and import licences are required medical prescriptions are required for dispensation to patients

3. Single Convention on Narcotic Drugs overseen / administered by Vienna-based international agencies UN Commission on Narcotic Drugs International Narcotics Control Board UN Office on Drugs and Crime

4. Single Convention on Narcotic Drugs ‘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’ BUT – in practice the focus has been on preventing diversion and misuse

5. Progress since 2010 international recognition of the need for action Vienna-based agencies UN Pol Dec on NCDs WHA palliative care resolution

6. CND Resolution 53/4, March 2010 a landmark resolution historically the focus has been on preventing diversion of controlled substances The resolution affirmed the principle for balance

7. CND Resolution 53/4 - availability stressing the importance of promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse recalling the Single Convention in which parties recognized that medical use of narcotic drugs continued to be indispensable for relief of pain and suffering and that adequate provision must be made to ensure availability of narcotic drugs for such purposes

8. CND Resolution 53/4 - balance affirming that the international drug control conventions seek to achieve a balance between ensuring availability of narcotic drugs and psychotropic substances under international control for medical and scientific purposes and preventing their diversion and abuse

9. Developments since 53/4 significant publications Report on Availability (2010) Ensuring Balance guidelines (2011) Discussion Paper (2011)

10. Developments since 53/4 CND Resolution 54/6 Model law review and revision Political Declaration on the prevention and control of NCDs WHA Palliative Care Resolution Global Monitoring framework including essential medicines target

12. UNODC Discussion Paper ‘UNODC has long worked proactively to assist Member States to implement the diversion and abuse prevention aspect of their obligations under the drug Conventions. This should be, and will remain, an essential element of UNODC’s work, but the Office will also focus equally on all elements necessary to guarantee availability and accessibility with particular attention to avoiding any control measures unintentionally impeding high quality medical treatment.’

13. CND Resolution 54/6, March 2011 follow-up resolution to CND53/4

14. CND Resolution 54/6 recalling 53/4 aimed at promoting adequate availability of internationally controlled drugs for medical and scientific purposes while preventing their diversion and abuse note the order promoting adequate availability while preventing diversion and abuse this is now the established formulation

15. UNODC model law review and revision

16. Revisions to model laws use of neutral terminology to describe drugs that have medical or scientific uses but can cause harm when misused eg the Schedule in which morphine is listed described as including ‘[d]rugs and substances having a medical and/or scientific use which should be subject to control in view of the harms that their non-medical and/or non- scientific use can cause’

17. Revisions to model laws contrasts with the previous wording, which referred to ‘[s]trictly controlled substances and plants having a medical use’, and ‘[s]ubstances with a high potential risk to public health but having a medical use’ (emphasis added) under the previous formulation, concern about the risk of misuse predominated over the need to ensure appropriate medical treatment

18. UNODC ‘model’ law COMPARE to the previous terminology: "drug of abuse" means a prohibited drug, a high- risk drug, or a risk drug, and includes a preparation; "high-risk drug" means a substance listed in Schedule II of this Act

20. UNODC ‘model’ law drug dependent person, in relation to a drug of abuse or analogue, means any person who has a condition such that: … (ii) cessation of the administration of the drug is likely to result in the person experiencing symptoms of mental or physical distress or disorder

21. Further developments

25. Global monitoring framework on NCDs adopted by World Health Assembly May 2013 voluntary target for 2025 80% availability in both public and private facilities of basic technologies and generic essential medicines required to treat major NCDs

26. Global monitoring framework on NCDs adopted by World Health Assembly May 2013 indicator for health system response access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer selected as effective proxy measurement for palliative care development for all life-threatening illnesses, including NCDs

27. WHA Palliative Care Resolution

28. UN General Assembly Special Session on Drugs 2016

29. Links to relevant documents at http://www.mccabecentre.org/focus-areas/access- to-medicines/access-to-opioid-analgesics