The other crisis, the opioid people in poor countries can not obtain pain medication they need ;
There are two opioids crisis in the world today. One is the epidemic of abuse and misuse, present in many countries but increasing at an alarming rate in the United States . The other crisis is greater and affects many more people around the world every year: very few opioids.
Hospitals in the US and Europe routinely prescribe opioids to for chronic cancer pain , at the end of his life in palliative care and some forms of acute pain, such as bone fractures, sickle cell crisis and burns. But patients with these conditions in much of Asia, Africa and Latin America often receive analgesics is not stronger than acetaminophen .
Many factors play into this crisis, but I would say that the International Narcotics Control Board ( INCB ), an independent watchdog agency established by the United Nations, is a fundamental cause of untreated pain in Asia, Africa and Latin America.
How big is the gap in pain relief?
In 2009, the US, Canada and Europe accounted for 18 percent of the world population, but 90 percent of global consumption of morphine.
The global gap in access to opioids grows long. In the US, morphine consumption in 2013 was 32 times higher than in 1964 (from 2.3 mg to 79.9 mg per person per person). In the same period, Tanzania morphine consumption only doubled to 0.15 mg person. In India, in 2013, this figure was only 0.11 mg per person.
Per capita consumption of medicinal opioids in Asia, Central America, the Caribbean and Africa is well below global minimum standard INCB itself. In countries and regions below this benchmark (daily dose set at 200 per million inhabitants per day), we can be sure that patients requiring opioids for legitimate medical reasons do not receive them.
INCB argues that poor countries have very few opiates, since can not afford . While there is a correlation between national income and domestic consumption of opioids, cost is not the main issue.
generic opioids are cheap. A cost immediate release tablet 10 mg generic sulfate or less morphine US $ 0.01 to produce .
The main problem I would say is a policy based on the fear that the increased use of opioids inevitably lead to abuse and trafficking. palliative care physician and ethicist Eric Krakauer calls this fear “ opiophobia .”
INCB’s work has been crucial in raising this fear of opiates and promote restrictive policies that continue to hold millions of patients in unnecessary pain.
Fear of political ‘abuse opiophobic units
INCB has two purposes: to prevent addiction and to ensure availability of opioids for legitimate medical use. However, since its founding in 1968, the INCB has focused almost exclusively on the fight against drug abuse, regardless of access to pain relief.
One way INCB tried to prevent addiction was written by so-called “model laws” encouraged countries to enact. One of those law , written in 1969, establishes controls over prescription and distribution were manageable for the wealthiest opiate countries, but that could be expensive in poor countries, particularly those with few doctors .
Law respective model, for example, opiates may be supplied by doctors. This provision does not affect access to opioids in the United States or other countries rich with many other doctors. However, many poor countries, where doctors were scarce, relied on nurses and other professionals to prescribe medications. The model law did not consider this.
In addition, the Model Law stated that doctors who prescribe opioids inappropriately or could not maintain complete records should be subject to “the same prison terms and fines inflicted on Penal Code for housebreaking.”
INCB laws were promoted by the Fund of the United Nations Control and Drug Abuse ( UNFDAC ), which was founded in 1970. The UNFDAC conducted training sessions for managers national drug control and law enforcement to underscore the dangers of abuse. But, as I discovered in my research, once rare sessions the importance of access to pain relief mentioned.
The model and training sessions laws helped inspire the countries of Latin America, Asia and Africa to spend new, more restrictive laws during the 1970s and ’80s.
For example, in India, a 1985 law requires hospitals to obtain as many licenses before each shipment of morphine that many stopped using the drug at all. medicinal morphine consumption in India declined by 97 percent between 1985 and 1997.
In Panama, nurses were prohibited from prescribing opioids. Paraguay and Guinea Bissau mandated long prison sentences for any physician who could not produce documentation justifying every single pill prescribed for years of practice. Fearing these punishments, doctors avoid prescribing opioids, even when medically necessary.
Countries underestimate opioid requirements in response to pressure INCB
INCB also tried to prevent opiate prescribed to treat pain from being diverted to illegal markets, requiring each country to provide annual estimates of projected opioid requirements for medical and scientific purposes. The INCB was responsible for the approval of these annual budgets, and tried to ensure that countries are more important than the approved amounts.
Between 1960 and 1980, INCB reports punished many countries in Africa, Asia and Latin America to make estimates considered too high.
A country that imported more opiates INCB had approved risked a costly stain on its international reputation. INCB could even recommend that countries impose trade embargoes nations that produce or import more than they had opioid deemed necessary. As a result, countries under tightened its estimates of future needs of medicinal opioids.
However, the INCB did not judge these estimates based on actual medical need. Rather, Insisted estimates should be based on the number of doctors in a country, a potentially misleading piece of data in parts of the world were doctors are scarce, and nurses and other health professionals to fill the gaps and prescribe medicine.
INCB worried that too many opioid prescriptions could lead to abuse. In fact, this is a major cause of the current crisis addiction in the United States. However, in countries where the INCB exerts the greatest influence, the biggest problem was that very few (rather than too) are prescribed opioids.
A 1989 report of the INCB and the World Health Organization revealed that national estimates of the future need for opiates often calculated based nothing more than in previous years imports . The report also quantifies the degree of cancer pain without treatment, estimating that “at least 3.5 million patients with cancer” worldwide “suffer needlessly from pain.”
The INCB is starting to change, slowly
For many years, the only thing that most countries INCB noted was that their estimates were too high. But in 1999, INCB announced would begin contacting governments had “particularly low estimates” to encourage them to increase their imports.
But these small steps have not been enough to overcome the fear of opiates distributed by decades of model laws and training sessions. The recommendations of the INCB still focus almost entirely on abuse.
For example, an INCB 2012 report reported that national applications to import opioid sufficient to meet the existing need may be denied if such imports could increase “the possibility of misuse or abuse.”
international meetings, especially the Special Session of the United Nations World Drug Problem in April 2016, should pay much more attention to untreated pain than they have done in the past .
The most recent estimates of the World Health Organization indicate that each year 5.5 million terminal cancer patients patients and 1 million end-stage HIV / AIDS worldwide do not receive no sufficient treatment or any treatment for moderate to severe pain. WHO estimates that tens of millions of people are denied medically necessary pain treatment each year.
Pain is universal, but its relief is still a function of geography.
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