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The Inadequate Treatment of Pain: Collateral Damage from the War on Drugs

  • Jason W. Nickerson mail,

    Jason.Nickerson@uottawa.ca

    Affiliation: Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

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  • Amir Attaran

    Affiliations: Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada

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  • Published: January 10, 2012
  • DOI: 10.1371/journal.pmed.1001153

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Misplaced Attack on International Drug Control

Posted by mckeganey on 26 Mar 2012 at 14:01 GMT

In what is a thinly veiled political attack on the International Narcotics Control Board Nickerson and Attaran have presented a caricature of international drug control and in so doing they have served neither the goal of tackling the world’s drug problem nor of ensuring adequate access to pain medication.

Nickerson and Attaran have blamed the INCB for the problem of low access to analgesic medication in some of the poorest countries in the world. However, this is a problem that the INCB president has himself drawn attention to on a number of ocassions. According to Nickerson and Attaran, the continuing low estimates of the quantity of required pain medication which some countries provide to the INCB, is evidence that the Board itself is operating some kind of quota system- effectively starving the poorest countries of the pain medication they need as a result of the Board’s commitment to international drug control. The image of the INCB as some kind of international dispensary- miserly doling out much needed pain medication, whilst obsessing about the goals of international drug control is nothing short of a caricature.

The INCB exists because of the uncomfortable fact that the very same drugs that have a valuable role in pain medication are also associated with the world’s drug problem. As a result there is a need to balance the goals of access to pain medication whilst reducing the scale and impact of narcotic abuse. For Nickerson and Attaran to suggest that the WHO would be a more appropriate organisation to take on the work of ensuring adequate access to pain medication is to misunderstand the nature of these international organisations. Neither the World Health Organisation nor the International Narcotics Control Board can impose their judgements on member countries. Their role is rather to to offer advice, guidance and informed comment to member countries. The WHO would be no less bound by the estimates that member countries provide of their pain medication need than is the INCB presently, though it would be singularly less well equipped to advise on the aspect of international drug control.

It is further offensive to criticise the INCB for its response to the Haiti earthquake. In the week following the earthquake the INCB issued advice to countries that they could export additional pain medication to Haiti without the need for further formal approval. Less politically inclined commentators than Nickerson and Attaran might have seen this advice as evidence of the Board seeking to do what it could to increase Haiti’s access to much needed pain medication.

The intention behind Nickerson and Attaran’s paper must surely have more to do with the goal of undermining international drug control than it does with increasing access to pain medication. It is for this reason that the authors write so disparagingly about the so-called failed “war on drugs” as if this were the responsibility of the INCB. If Nickerson and Attaran are so concerned at the low level of access to pain medication in some of the world’s poorest countries, they would do better to draw attention to the persistent failure of some government’s to better assess their pain medication needs, or to offer help to the government’s involved, than to seek the dismantlement of the existing system of international drug control.

Competing interests declared: I have previously been involved in working with the INCB on its annual report.