Human Rights and Drug Control: Access to Controlled Essential Medicines in Resource-Constrained Countries

Abstract

Millions of people worldwide suffer a range of health and socio-economic related problems because of inadequate availability and use of controlled essential medicines like morphine and codeine for pain treatment. As a result, millions of people, often living in lesser-advanced conditions, suffer in disabling and degrading situations on a daily basis. This latent, yet devastating public health crisis raises important questions in light of human rights protection. While medicine provision is generally subject to a complex interplay of multisectoral factors, controlled medicine provision is particularly difficult. Controlled essential medicines are those medicines that appear on the essential medicines list of the World Health Organization, and of which the active substances are listed under the international drug control treaties. Their manufacturing, distribution, use, and thus their availability and accessibility fall under both the human rights and international drug control legal systems. Paradoxically, however, the international drug control system obstructs instead of promotes controlled medicine provision. A human rights interpretation of the international drug control framework is analyzed in which specific attention is paid to medicine provision in resource-constrained countries. The approach goes beyond a more conventional legal analysis and includes an ethical analysis and two case studies in Uganda and Latvia. A normative framework is formulated by examining how human rights norms would balance the tension underlying drug control regulation. Controlled substances are sinners and saints. They are sinners because if used for non-medical purposes they may lead to dependency and addiction disorders. However, if used with due respect for medical guidelines they have a demonstrated beneficial effect on certain medical treatments and interventions. This makes it evident that States should regulate this delicate equilibrium, the challenge being how they can do so legitimately in light of human rights norms. The study demonstrates that securing access to medicines and protecting society against the hazardous effects of controlled substances are equally important aspects of public health if considered within the context of the human rights framework. Yet, in terms of realization, human rights norms require States to prioritize ensuring access to medicines over prevention and drug control efforts. By no means is such outcome a blunt call for liberalization, rather it establishes the idea that drug control efforts may not in law nor in fact halter access to medicine provision. Having explored this premise in the context of human rights law and theory, these findings are applied in Uganda and Latvia, –two ‘best practice’ countries – when it comes to improving the accessibility of morphine for pain treatment. Relying on qualitative research methods, the study explores whether States can implement this ‘access-led’ approach whilst complying with the applicable administrative and procedural requirements of the international drug control system. These technical procedures regulate the medical supply/demand chain of controlled substances including controlled medicine. The study demonstrates that these international requirements are unnecessarily burdensome, counterproductive and structurally hamper local best practice initiatives of improving access to adequate pain control medicines such as morphine and codeine. The study concludes with a proposal on how a human rights approach to drug-control may be advanced. Key recommendations include that the international community should integrate human rights monitoring tools in international drug control enforcement and adopt a system of international control that is designed on the constrained conditions in which the large majority of countries have to provide for medical goods and services.