A question of balance: the overconsumption and unavailability of internationally controlled drugs

Ensuring the use of controlled drugs for medical and scientific purposes

Narcotic drugs such as cocaine, opium and heroin were appreciated and enthusiastically applied worldwide in medicine until their addictive properties and therapeutic limitations in wide-scale application were recognized. It was soon universally accepted that the health and social risks that such drugs posed to individual consumers and society largely outweighed the benefits derived from their medical use. Manufacture of and international trading in those drugs became subject to national and international regulation.

As the global regulatory system received wide acceptance, manufacture of and trading in many drugs with a high dependence potential, such as opium and cocaine, for medical purposes quickly diminished. Yet, in the absence of perfect alternatives, many less-than-ideal narcotic drugs and psychotropic substances continue to be used today as pharmaceuticals for the treatment of diseases and the alleviation of pain and other forms of human suffering. Ensuring adequate availability, under regulated conditions, for medical purposes is an important task of government authorities. Controlled drugs must also be available for scientific purposes to permit research on safer drugs for the same and related purposes.

Although unavailability of drugs may deprive patients of their fundamental rights and the opportunity for relief from pain, excessive availability of drugs may result in the diversion of such drugs to illicit trafficking and drug abuse, leading to drug dependence, and may thus cause unnecessary suffering.

The synergy produced by easy availability, inappropriate use of controlled medicinal drugs and spreading illicit consumption of drugs is well documented. Drug abuse has reached significant levels in the past as a result of unregulated, medically inappropriate consumption of controlled drugs. In many countries, both developed and developing, Governments have been extending control to an increasing number of psychotropic substances used for medical purposes since 1971.

National regulatory controls and the international control system have been applied more consistently and more universally during the last two decades and have thus become more effective. Those achievements have to be maintained and bettered in the future.

Governments, in cooperation with the International Narcotics Control Board, therefore have to monitor closely the supply of and demand for such drugs. In its report for 1999, the Board reviewed the adequacy of the supply of controlled drugs for the relief of pain and suffering. The Board noted with concern the continuing global disparities in the actual availability and the unjustifiable discrepancies in the consumption of important licit narcotic drugs and psychotropic substances in different regions.

Unlimited or excessive availability and inappropriate or non-medical use of controlled drugs are as much of a concern to the Board as insufficient supply. On the basis of its previous reviews, the Board considers that there is sufficient reason to believe that unregulated, excessive drug supply and consumption trends in certain countries may be continuing and that new problems may be developing.

Medical requirements and availability: two variables to be assessed and adjusted

The national supply of drugs in general should correspond to medical (and scientific) needs as closely as possible and, therefore, it is important to assess those needs as accurately as possible. For narcotic drugs and psychotropic substances, a close balance is even more important given their abuse potential and the risk that they may be diverted into illicit markets. Figures for global consumption of licit drugs show that the bulk of the medicine continues to be consumed in a handful of countries, and the proportion is even higher for narcotic drugs and psychotropic substances. Economically weak countries and the poorer segments of society continue to have little or no access to medicines and medical care, and the treaty system can do little in this respect.

Most developing countries lack the resources and expertise required for determining medical needs and adjusting drug supply to meet those needs. Medical practice shows undesirably large variations attributable to a chronic shortage of staff and inadequate training and information. At the same time, experience shows that the actual availability of drugs tends to exceed drug requirements in many developed countries. In such countries, societal, cultural and attitudinal factors that influence consumption distort the perception and measurement of real medical needs.

Comparisons of consumption data between countries and regions appear to be the most useful indicators for discerning differences in consumption levels and unusual trends requiring attention. The Board has pointed out in its recent reports the large and consistent differences between the consumption levels of countries in North America and those in Europe. Reported annual figures show that the consumption of amphetamine-type stimulants is considerably higher in the United States of America than in countries in Europe and elsewhere, whereas the consumption of benzodiazepine-type sedative hypnotics and anxiolytics is consistently higher in European countries.

Largely due to economic limitations, drug consumption levels are considerably lower in developing countries. Large inter-country variations are also typical of developing countries; some countries consume considerably higher quantities per capita than the majority, whereas many others report virtually no consumption.

Excessive drug consumption that is medically unjustified, predominantly in developed countries, has a number of general and sometimes country-specific causes and driving forces, the most significant of which are the commercial, sociocultural and educational environments in those countries. Similarly, newly gained wealth or affluence appears to be the origin of quickly growing drug consumption in countries and territories experiencing rapid economic growth (for example, in Malaysia, Singapore and Thailand and in the Hong Kong Special Administrative Region of China), especially if such consumption (anorectics) is perceived to be part of a new fashion.