Opioid shortages open up a world of pain, the Global Commission says.

Read this Op-Ed in the Financial Times

Coronavirus has shone a new spotlight on an old problem: the questionable usefulness of policies that criminalise certain drugs.

During the pandemic the US, normally well-supplied with painkillers, suffered shortages of opioids needed to anaesthetise intubated patients. One reason for this alarming shortfall was because the Drug Enforcement Agency had mandated the reduced manufacture of medicines such as morphine and fentanyl as part of its attempt to grapple with the US’s opioids-abuse crisis. Another reason was because of supply chain bottlenecks in the manufacture of needed painkilling drugs.

Yet these distressing pandemic-driven shortages — a perfect storm of spikes in demand and supply chain breakdowns — created a situation that, sadly, is often the norm in low and middle-income countries. The WHO labels 12 medicines, which contain internationally controlled substances, as ‘essential medicines’ that should be available to anyone in need. Yet even IN normal times, over 75 per cent of the world has little or no access to them, and most of the global supply of morphine is consumed in rich countries.

What to do about this? The international system of drug control does not help. Many controlled substances are routinely used in medicine in such diverse areas as analgesia, anaesthesia, maternal and mental health, neurology, and palliative care. Yet the guiding philosophy of international drug control still massively prioritises reducing supplies of substances that contain ‘narcotics’. This constrains responses that could improve access to medically-needed drugs, be that via better systems, training or lower costs.

Hopefully, the pandemic-induced bottlenecks that rich countries have just suffered will lead to change. In many low income countries, painkillers and medicine shortages are endemic. In richer countries, if only for a short time, decision makers who determine the allocation of resources and prioritisation of drug programs, have now shared this pain. As such, a path to practical solutions can perhaps be drawn.

Our confused relationship with opioids needs to be made fit for purpose for the 21st century. The 20th century narrative, which demonised drugs and the people who used them recreationally, won many politicians cheap points. But it came at the expense of millions of people who need access to opioids-based medicine for pain control, especially surgical and terminal cancer patients.

The problem cannot be solved with the mindset that created it. For one, codifying addiction as an evil failed to balance the policies needed to ensure adequate drug supplies for the patients who need them, against the desire to control those drug supplies in case they were diverted to abusive ends. Looked at another way, the need to ensure adequate access to drugs for medical and scientific proposes was overshadowed by an obsession to eradicate non-medical uses. Along the way, many vulnerable innocents suffered harm.

Authentic harm reduction starts at the periphery. It collects voices from the most affected populations, and then works inwards to policymakers. Covid-19 has exposed the fragility of global medical supply chains and revealed many socio-economic faultlines in high-income countries.

Since 2014, alongside our colleagues at the Global Commission on Drug Policy, we have called for an in-depth review of the international drug control system. This remains anchored in a crime-control and law-enforcement model, rather than, as it should be, a public health model.

Many voices have since joined us to call for change. Recognising that the current system can act as a barrier to accessing controlled medicines and painkillers is a first step. But it is only a prelude to the concrete steps that need to come next.

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