By Dr Katherine Pettus

Seen through a palliative care lens, the 2021 World Drug Report (WDR) reiterates in living color the sad truth that half a century of UN supervised so-called drug control – more than two generations worth of ideologies, policies, and practices conceived by “moral entrepreneurs” during the golden age of Western imperialism – perpetuate inequities that condemn millions of people worldwide to entirely preventable suffering. As UNODC’s own graphs show, drug “control” policies have simultaneously supercharged trends of harmful illicit substance use worldwide while depriving patients who need them of essential pain medicines.

These perverse inequities, encoded in clumsily designed national policies and regulations, flow from a post-WW2 United Nations treaty (the ‘Single Convention on Narcotic Drugs’) whose lofty goal was to protect “the health and welfare of mankind” by eliminating “the evils of addiction.” Although neither palliative medicine nor modern substance use disorder treatment had been developed when the treaty was drafted, this binding legal instrument has yet to undergo serious course correction by UN member states – our own governments. Worse still, the official narrative and public speech around legitimate use of opioids (controlled under the Convention) is more confused and ideological than ever.

The ongoing global pandemic of untreated pain,  one serious  side effect of almost a century of ineffective drug control, has created its own public health crisis: the suicides, heart attacks and chronic conditions associated with serious health related suffering in rapidly ageing populations without appropriate access to essential medicines. As clinicians and patients know only too well, untreated pain decreases mobility, impairs immunity, decreases concentration, accelerates anorexia, and exacerbates sleep disturbances, negatively affecting quality of life.