INCB, WHO and UNODC statement on access to internationally controlled medicines during the COVID-19 pandemic

Scope (patients with COVID-19 and non-COVID-19 with pandemic)

The International Narcotics Control Board (INCB), the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) call on governments to ensure that the supply and supply of drugs controlled in countries meet the needs of patients, both COVID 19 and those in need of internationally controlled medicines for other health conditions.

Access to controlled drugs such as sedatives and analgesics for intubation protocols for the treatment of patients with COVID-19 should be provided. Patients without COVID continue to require controlled medications to treat pain and palliative care, surgical care and anesthesia, mental health and neurological conditions, and to treat drug use disorders.

It is important to remember the needs of existing patients who need controlled medications to manage these health conditions. These patients faced barriers to accessing controlled drugs prior to the COVID-19 pandemic. The COVID-19 pandemic has further resulted in disruptions in the drug supply chain, and it is crucial that access to basic health services and medicines is not forgotten or given priority during this pandemic.

The need for equal access

As the pandemic increasingly affects countries with health infrastructure and services with insufficient resources, it is ethically imperative to ensure that all people in all countries of the world have access to basic medicines. This includes those drugs that are under international control.

Governments should ensure that sufficient quantities of internationally controlled medicines, of guaranteed quality, are available and accessible to persons under medical care. During a pandemic and beyond the acute phase of the health infrastructure burden, it is crucial that governments work cooperatively to ensure that no country, region, district, city and no patient is left behind. National competent authorities, manufacturers, suppliers and distributors play a key role in ensuring that internationally controlled medicines urgently needed for medical treatment are available within and across national borders. The supply chain is the foundation of quality medical care because without the necessary supplies, including necessarily controlled medicines, patients will suffer.

Barrier solutions

We remind governments that in acute emergencies, simplified procedures for controlling the export, transport and delivery of medicines containing controlled substances can be used in accordance with the International Convention for the Suppression of Medicinal Products, especially in cases where the competent authorities of importing countries cannot operate at full capacity. The competent national authorities may authorize the export of medicinal products containing narcotic drugs and / or psychotropic substances to the affected areas even if there are no appropriate import authorizations and / or assessments. Emergency deliveries should not be included in the estimates of recipient countries affected by emergencies. Where possible, national competent authorities are also encouraged to issue electronic import and export licenses through the INCB International Import and Export Authorization System (I2ES), PEN Online and to exchange related security measures in the Forum.

Countries should ease transport restrictions for COVID-related controlled drugs and consider local manufacturing solutions where feasible, to meet demand jumps caused by COVID-19.

To help countries as they work to find solutions to the lack of access and availability of controlled medicines, the three organizations propose the following technical assistance and support documents:

• Countries are encouraged to refer to the Guidance on the Assessment of Applications for Internationally Controlled Substances developed by the International Narcotics Control Board and the World Health Organization for use by the competent national authorities.
• Countries are encouraged to refer to the WHO Manual on the Clinical Care of Severe Acute Respiratory Infections which includes instructions for the use of controlled drugs for the treatment of patients with COVID-19.
• Countries are further advised to use WHO operational guidelines for the maintenance of essential services during outbreaks to balance the response requirements to the COVID-19 pandemic, while ensuring the maintenance of basic health services and the provision of medicines for other current health conditions.
• Countries are encouraged to refer to normative guidelines such as the WHO Essential Medicines List and guidelines for the pharmacological and radiotherapeutic treatment of pain in adults and adolescents.
• Countries are further advised to refer to and use the strategies presented in the UNODC Technical Guide: Increasing access to and availability of controlled medicines developed in collaboration with experts, civil society partners and other international partners.
• Under the joint UNODC-WHO-UICC global program, countries are encouraged to turn to UNODC and WHO for technical assistance and support at a national level that includes civil society partners.

Findings

The work of doctors, nurses and health professionals in general, who provide treatment and care to people including the most vulnerable, must be supported, and safe and effective medicines should be available, accessible and accessible at all times to the people who need them. .

INCB, WHO and UNODC are committed to further working to address this critical issue and will expand joint efforts to work with other partners and increase advocacy and technical assistance to countries to improve access to controlled drugs during the COVID-19 pandemic and alleviate barriers to ensure that both patients affected by COVID-19 or other non-COVID-related conditions and requiring drugs under international control have access to those drugs when they need them.