Page 136 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

In its annual report of 2004, the INCB furthermore acknowledged that there was a huge disparity in
countries’ access to opioid analgesics for pain relief. It reported that six developed countries accounted A1
for 79% of the global consumption of morphine. Conversely, developing countries, which represent
80% of the world’s population, accounted for approximately 6% of the global consumption of morphine
(123). A study on the adequacy of opioid consumption around the world concluded that 5 683 million
people live in countries where the consumption level of strong opioid analgesics is below adequate,
against 464 million in countries with adequate consumption of strong opioids. An additional 433 million
people live in countries for which no data are available (124).
A2
Drug control conventions were established to enhance public health, which is affected positively by the
availability of controlled medicines for medical treatment and negatively by misuse and dependence.
Countries should seek the optimum balance in order to attain the best outcomes for public health.

Governments should examine their drug control legislation and policies for the presence of
overly restrictive provisions that affect delivery of appropriate medical care involving controlled
medicines. They should also ensure that provisions aim at optimizing health outcomes and take
corrective action as needed. Decisions which are ordinarily medical in nature should be taken by A3
health professionals. For doing so, they can use the WHO policy guidelines mentioned earlier in
this annex (95), in particular the Country Check List comprised in that publication.

A6.4 competent national authorities under the

international drug control treaties A4

The national legislation in countries that have ratified the Single Convention on Narcotic Drugs, 1961,
as amended by the 1972 Protocol, designates a competent national authority to liaise with the INCB
and the competent authorities of other countries. These competent national authorities also administer
national regulations relating to controlled substances for medical use. The office of the competent
national authority is usually located in the national medicines regulatory authority and/or in the ministry
of health. In certain countries, the competent national authority is a separate government agency; in
others, it is an office located in another ministry, such as the ministries of justice, police or finance. A5

The identification of the competent national authority is a necessary step for any manager and officer
involved in the planning of the procurement and supply of opioid analgesics. A list of country competent
authorities and their contact details is available at:
http://www.painpolicy.wisc.edu/internat/countryprofiles.htm

A6.5 the convention’s requirements for national A6

estimates of medical need for opioids

Every year, competent national authorities must prepare estimates for the following calendar year
of their requirements for Schedule I narcotic drugs (morphine and other strong opioid analgesics
considered for safe switching in children with persisting pain) and Schedule II (125). These estimates
are submitted to the INCB and set the yearly limits for the amount of strong opioids to be procured A7
for medical use. The estimates must be submitted to the INCB by 30th June, six months in advance
of the period for which they apply. The Board notifies confirmed estimates to the competent national
authorities by December of the same year.

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