Examining Influences on the Availability of and Access to Opioids for Pain Management and Palliative Care
A recent essay by King and Fraser, published in the April 2013 issue of PLOS Medicine, highlighted the important global health problem of unrelieved pain and underscored the complexity of regulatory and other systemic barriers that often prevent patients from receiving adequate treatment for their pain.1 Concerns were expressed about the function of international treaties, as well as the International Narcotics Control Board (INCB) (a quasi-governmental body responsible for implementing the international conventions), in promoting a generally prohibitive regulatory environment regarding medication availability, including opioid analgesics. Although national, state, and other jurisdictional policies governing opioid prescribing undoubtedly pose significant barriers to adequate pain relief, we suggest that the overall influence of international treaties and the INCB on this situation is not as straightforward, and perhaps even less restrictive, than is commonly perceived. In fact, King and Fraser raised a number of points that warrant further consideration when formulating responses to the global unavailability of controlled medicines for pain management, palliative care, and end-of-life care.1 These points included:
(1) The role of international treaties in medication availability,
(2) The role of the INCB in medication availability,
(3) The role of regulatory policy in treating pain, and
(4) The role of opioid analgesics in treating pain.
This commentary elaborates on each of these points, in an attempt to offer a broad perspective based on our insights from many years of experience collaborating with international and national authorities and country governments in our efforts to improve the global availability of opioid analgesics for medical and scientific purposes.