Commission on Narcotic Drugs: Progress Towards a Pain Free World?

Although the Vienna International Center has upgraded its facilities (it now houses its meetings in an IKEA showroom), the opening session of the 53rd annual Commission on Narcotic Drugs (CND) conference is held in a space too small to hold all of the guests. Sadly, a large number of attendees are consigned an overflow room outfitted with screens; happily this means I can wander in and out in a guilt-free fashion as the opening meaningless but carefully and cautiously crafted speeches recount the progress of the battle against drugs.

To be fair, it's not realistic to expect stimulating opening statements. Even the outgoing United Nations Office on Drugs and Crime (UNODC) Executive Director, the dramatic, attention-loving Antonio Maria Costa, was muted in his remarks. Still, it was a letdown to see only Portugal and Iran deviating from the standard line -- Portugal describing the benefits of its drug decriminalization efforts and Iran referencing its harm reduction activities as well as its law enforcement work.

For the most part, speeches delivered at the CND feel shamelessly political -- aimed at whoever the country wants to impress or pacify; geared toward keeping international donor money flowing; orchestrated as part of a large strategy whereby country X wishes to maintain its influence over country Y.

Like a lot of forums focused on drugs, what's missing is a full discussion of the spectrum of drug use and drug problems. Maybe it's just not realistic to expect a UN body to embrace this kind of realism.

A refreshing exception to the morning's drone was a thoughtful lunchtime presentation that addressed access to pain medication and medically assisted drug treatment (such as methadone for heroin users) from a human rights perspective. This event was primarily organized by Human Rights Watch, which just released an excellent report called "Please, do not make us suffer any more...": Access to Pain Treatment as a Human Right. Co-sponsors included the US Office of Global AIDS Coordinator and the British government. Speakers from Panama, India, Uganda, and Kyrgyzstan all shared incremental success stories about building medical programs that supply pain relief for sick people.

Now, why is this topic so important?

Initially it can be difficult for Americans and other citizens of relatively wealthy nations to understand. After all, when my dad was dying of lung cancer he did it at home with as much morphine as he needed to keep himself comfortable. But this is the exception: 150 countries have no access to medical opiods or other effective pain medication. No morphine, no Fentanyl -- no nothing.

Sometimes a country's limited access to pain medications has its roots in inadequate medical training; more often, it's due to the government's fears about causing addiction, plus concern that the availability of pain medication will lead to diversion and theft.

The US is sponsoring a resolution that balances availability with access. (Its pithy title: "Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing diversion and abuse.") Unlike many UN resolutions, this one could actually have an enormous impact in people's lives if it passes.

Think about it. US donor aid has tentacles all over the world. (I'm thinking particularly of PEPFAR -- President's Emergency Plan for AIDS Relief -- funding.) Consequently, passage of this resolution could mean that governments that currently do not offer access to these drugs will sit up and take notice. When it comes to implementing a resolution passed by the US, there's the real possibility that countries might take some action as well.

Some good may come of this meeting after all.