The Single Convention on Narcotic Drugs of 1961, as amended by the 1972 protocol, “recognizes that the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering, and that adequate provision must be made to ensure the availability of narcotic drugs for such purposes”. Also, the Convention on Psychotropic Substances of 1971 “recognizes that the use of psychotropic substances for medical and scientific purposes is indispensable and that their availability for such purposes should not be unduly restricted”.

In practice, pharmaceuticals with an identified or emergent clinical application whose active ingredients are listed under the 1961 or the 1971 drug conventions (herewith in this document “controlled medicines”) are indispensable for the relief of pain and the treatment of mental and neurological conditions, as well as substance use disorders. Thus, adequate accessibility when needed is essential. Major policy documents of the Commission on Narcotic Drugs (CND), including the 2016 United Nations General Assembly Special Session outcome document and CND resolution 63/3, promote awareness-raising, education and training, as part of a comprehensive approach to ensure availability of and access to internationally controlled substances for medical and scientific use.

Appropriately prescribed controlled medicines are critical for a variety of indications in adults and children including pain relief, surgical anaesthesia and the treatment of various mental, neurological and substance use disorders. Millions of patients suffer from pain due to lack of access to essential controlled medicines. There are, however, significant geographical variations in accessing controlled medicines for identified clinical needs.1 Barriers such as those related to overly restrictive legislation, regulatory systems, healthcare systems, affordability, the training of healthcare professionals, education, awareness-raising, estimates, assessments and reporting, supply chain gaps, prescriber fear of legal repercussions, prescriber fear of non-medical use and diversion, among other factors, all contribute to global inequities in access to controlled medicines.2 It is thus vital to identify the contributors to the main barriers that prevail at national level to ensure that controlled medicines are accessible to patients in need...