Advocating for Access to Pain Treatment
By Mugisa Martha
More than 50 years ago, the 1961 Single Convention on Narcotic Drugs was adopted by the United Nations (UN) member states, declaring the medical use of narcotic drugs indispensable for the relief of pain and mandating an adequate provision of narcotic drugs for medical use. The International Narcotics Control Board (INCB), charged with monitoring the implementation of the UN drug conventions, clarified in 1995 that the Convention ‘establishes a dual drug control obligation: to ensure adequate availability of narcotic drugs, including opiates, for medical and scientific purposes, while at the same time preventing illicit production of, trafficking in and use of such drug’.
Pain medications such as morphine and codeine have been added to the list of essential drugs by World Health Organization in its Model List of Essential Medicines. Other international bodies, such as the UN Economic and Social Council and the World Health Assembly, have also called on countries to ensure adequate availability of opioid analgesics. Despite this lucid consensus that pain treatment medications should be available, approximately 80% of the world population has either no, or insufficient, access to treatment for moderate to severe pain.
Worldwide there is unequal distribution of pain medical treatments. Much of these medications are consumed by the greater north and a lesser percentage by the south which consumes only 6%. Myriad reasons have been advanced as barriers to access to pain treatment globally which include the failure of governments to put in place functioning drug supply systems, the failure to enact policies on pain treatment and palliative care, poor training of healthcare workers, the existence of unnecessarily restrictive drug control regulations and practices, fear among healthcare workers of legal sanctions for legitimate medical practice; and the unnecessarily high cost of pain treatment.
These reasons have had and continuously impact on the right to the highest Standard of physical and mental health and the freedom from cruel, inhuman degrading treatment or punishment that is inherent to all. One of the most major causes of suffering and disability in the world is chronic pain. Pain whether chronic or not has a profound effect on the quality of life and can have physical, psychological and social consequences. It can lead to reduced mobility and a consequent loss of strength, compromise the immune system and interfere with a person’s ability to eat, concentrate, sleep, or interact with others.
Pain relief medications were initially reserved for cancer patients who experience severe pain in the advanced stages as well as HIV/AIDS patients. However, a much wider cycle of health conditions has evolved in need of pain relief medications such as renal diseases, cardiac vascular diseases, kidney related illnesses, epilepsy and diabetes to mention but a few. And as such there is greater need for access to pain relief medications to prevent and relief pain.
Worldwide, Uganda, Jordan and Columbia have been considered as model examples for the provision of palliative care services that seek to prevent and relieve pain and other physical, psychosocial and spiritual problems. In Uganda sixty one districts are currently receiving a home based palliative care service which is a good step towards access to pain relief medication. In addition, the government has put in place undergraduate and postgraduate programs aimed at training nurses to administer the pain relief medications particularly morphine. Though in its initial stages, the programs are attracting a number of participants in different countries.
While National Drug Policy and Authority Act Chapter 206 of Uganda places morphine as one of the classified narcotic drugs only to be administered and distributed by those authorized to do so under the Act, the Ministry of Health guided by the Act developed guidelines under which morphine as a drug could be administered by specialized nurses in palliative care from the previous restrictions of a medical doctor
Even with the wide distribution of Palliative care services in the country and the various initiatives taken by the government to provide access to pain relief medications, only 10% of the Uganda population has access to the service. This is mainly due to a number of challenges. For example the procedure that a patient and their attendants have to go through to acquire the medicine. Patients are required to have a prescription from medical personnel qualifying them as candidates for morphine use yet there is little awareness of palliative care services. These and many more pose a threat to access to pain relief medications hence denying a patient the right to health and freedom from cruel or ill- treatment.
The right to the highest standard of physical and mental health is inherent to all. And such as governments are obligated to protect, respect and fulfil their obligations under the international human rights instruments. The right calls upon governments to provide medical services such as access to pain relief medication despite the limited resources to all specifically the vulnerable populace. It is therefore the duty of the government to ensure that there are policies and laws in place that enable access to pain relief medications. It is a right to pain relief.