Morphine is medicine: The language barrier to opioid availability in more than 83% of the world

The 1998 UN General Assembly Special Sessionon Drugs adopted: “A drug-free world; we can doit!” as its slogan. The Commision on NarcoticDrugs (CND) has set an explicit policy goal of reducing global demand and supply of ‘drugs’.

This leaves a very narrow policy space for palliative care advocates to promote increasedsupply and demand of medical opioids unless wespecifically, consistently (and correctly) refer tothem as ‘essential medicines’

How to talk about 'medicines', not'drugs'

We, as palliative care advocates must eliminate theword “drug” from our vocabularies. We can replacestigmatizing language such as “drug” or “drugs” inall the papers we write, presentations we make,tweets we send, etc. with any of the correct terms,such as “medicines.”

The Single Convention

Morphine and other opioid analgesics are classified as "scheduled drugs" under international law,specifically in the Single Convention on Narcotic Drugs, promulgated at the United Nations in 1961.The Single Convention, which many commentators see as the cornerstone ‘drug war’ treaty, requiresUN member states that ratify it (192 as of 2014) to pass domestic laws prohibiting the manufacture,distribution and consumption of narcotic drugs “except for medical and scientific purposes.”UN member states guard the boundaries of this medical and scientific exception with criminal lawsintended to prevent diversion and misuse.The unintended consequence of this guardianship has been that morphine, an essential medicine for adults and children as per the World Health Organization Model List of Essential Medicines, is nowvirtually unavailable in almost 140 countries.

Barriers to accessing essential medicines

The fact that morphine is largely unavailable means that few medical schools – in even fewer countries – train doctors, nurses and pharmacists to prescribe, compound and dispense this essentialmedication for severe pain. The result on the ground is that millions of patients and their families suffer unnecessarily.Moreover, patients and families don’t know they have the right to ask for pain relief, or clinicians thelegal obligation to provide it. This is despite the fact that under human rights law, specifically theInternational Covenant on Economic, Social and Cultural Rights (ESCR), Article 12, governmentshave the obligation to provide their citizens with “the highest attainable standard of health.”The Committee on ESCR has interpreted this right to include the right to palliative care and painrelief.

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