Rhetoric and the road to hell: The International Narcotics Control regime and access to essential medicines

This article by Katherine I. Pettus, PhD, identifies key rhetorical dimensions of the legal framework governing access to “essential medicines” and analyzes how they obstruct effective public health strategies for palliative care worldwide. The World Health Organization (“WHO”), palliative care physicians from around the world, and civil society organizations such as Human Rights Watch, the Open Society Institute, and the Pain Policy Studies Group at the University of Wisconsin, have focused attention in recent years on the fact that essential medicines are unavailable for palliative care in “low and middle income countries” (LMICs).

Identified barriers to access include lack of effective systems for assessing medical needs; laws and regulations and their administration or interpretation that unduly impede the availability of opioids; under-resourced healthcare systems; fear of addiction among professionals and the public, and lack of up-todate professional training in the use of opioids to treat pain.

These “external barriers” are distinguished from what I consider to be the true source of the problem of access, the internal barriers, or tensions within the mandates of the global narcotics regime itself.Efforts to remove the external barriers will be unproductive and incoherent until tensions between the internal barriers are addressed and resolved. To begin this process key texts of the regime are analyzed as well as more recent conceptual additions such as the socalled “principle of balance,” which has become an integral part of the palliative care advocacy discourse.

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