I did a double take when I read that the theme of the 5th session of the AU Conference of Ministers of Drug Control in Addis Ababa, Ethiopia in October 2012 was “promoting good practices in drug policy development and implementation” and that the title of the report was “African Common Position on Controlled Substances and Access to Pain Management Drugs.”  Drug Control Ministers, pain management?? What’s going on here? The report reads like a global palliative care advocate’s dream of the best possible world: after acknowledging the shocking official statistics about the lack of pain medication on the African contentment, experts at the African Union Plan of Action on Drug Control And Crime Prevention (2007-2012), agreed that the issue of pain management drugs and the availability of narcotic drugs and psychotropic substances for the relief of pain is a Continental priority. I would not have believed it if I hadn’t seen the slides with my own eyes and heard the AU delegate present at the African Palliative Care Association Conference in Johannesburg this week. 

Years of committed grassroots advocacy on pain management and the lack of opioid analgesics in most African countries as a result of irrational narcotics laws and lack of trained health personnel spurred the AU to invite the INCB in 2010 to advise on how the international drug control treaties could serve as a mechanism to ensure availability of narcotic drugs and psychotropic substances for medical and scientific requirements while at the same time preventing their inappropriate use and abuse.  Although the language of “preventing inappropriate use and abuse” is a standard INCB qualification on ensuring “licit” access, palliative care clinicians in both Johannesburg and Kampala where oral morphine is supplied to terminal cancer and AIDS patients in the home, assure experts that in twenty odd years of service there has been no diversion or abuse.  And they monitor it carefully.  Dr. Anne Merriman of Hospice Africa Uganda told delegates at the APCA conference this week that oral morphine solution does not give people a high.  Liquid morphine is indicated only for acute pain, and patients and families have never been known to abuse or divert it. Using this false fear to prevent essential medical access and distribution is irrational and breaches basic medical ethics.  Common sense is finally prevailing in national and regional policies…in Africa.

A link to the full document will all the details of the joint statement can be found here.

By Katherine Pettus, PhD – IDPC representative for IAHPC, International Association of Hospice and Palliative Care