The International Narcotics Control Board (INCB), set up in 1961, is an independent and quasi-judicial body that monitors licit and illicit narcotic and psychotropic drugs for the United Nations. It cooperates with governments to ensure that there is an adequate supply of licit drugs for medical and scientific use and assists in preventing licit drugs from being illicitly trafficked.
One of the responsibilities of the INCB is to assist governments in balancing the supply of narcotics and psychoactive drugs against demand by issuing an annual report, which provides detailed estimates of each member country’s legitimate requirements as well as data on the worldwide production, trade and consumption of these substances.
Global availability of internationally controlled drugs
In 2011 the INCB published a supplement to their 2010 annual report, providing data on the availability of internationally controlled drugs many of which are used for the management of severe and moderate pain. The data indicate that the availability of these drugs around the world is disproportionate so that a large majority of people are deprived of the health benefits these drugs confer.
In 2009, over 90% of one class of narcotics used globally, the opioid analgesics (which include morphine and oxycodone) were consumed in the United Staes, Canada, Australia, New Zealandand a few European countries. At the same time, over 80% of the world’s population had no or insufficient analgesics for relief from pain, including cancer pain.
Morphine Consumption in 2009
| Region | Proportion of Global Consumption | Proportion of Total Population of Countries Reporting Consumption |
| United States | 56% | 5.1% |
| Europe | 28% | 11.4% |
| Canada | 6% | 0.6% |
| Australia & New Zealand | 3% | 0.4% |
| Japan | 0.8% | 2.2% |
| Africa | 0.2% | 8.0% |
| Other Countries | 6% | 72.3% |
Data from: Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes United Nations 2011
Imbalance issues
The INCB concludes that while the demand for opioid analgesics has increased over the past two decades and there is no shortage of raw materials for producing them (indeed, over the past 20 years production has increased fivefold), nevertheless supply to many countries is inadequate.
Two central questions have been raised:
- What constitutes an adequate amount of analgesics for a country?
- What factors are responsible for the paucity in many countries?
Experts do not agree on what is an adequate level of consumption but, for administrative purposes, the INCB has devised a statistical measure for levels of consumption based on what they call the S-DDD. This is a number that estimates the potency of narcotic drugs of all types consumed per million persons per day.
Based on what it sets as an adequate/inadequate S-DDD level, the INCB estimates that there are 21 countries with inadequate consumption and more than 100 countries (most of them in Africa) that are at very inadequate levels. As to what constitutes an appropriate level of consumption for a specific country will, of course, depend on the morbidity statistics for that country.
Using S-DDD values, the INCB estimates that the US consumed 470 times more opioid analgesics for pain per million persons per day than did Mexico, which is ranked in the very inadequate category, While Canada about 235 times as much.
What explains the disparity in opioid analgesic (pain-killer) consumption?
One factor is the socio-economic status of a country: the data show that consumption is generally positively correlated with higher socio-economic status. (This correlation is very likely true for all kinds of pharmaceuticals, not just opioids.) Other main factors cited include concerns of both health professionals and patients that use of opioids can lead to addiction; and insufficient training of medical personnel in the use of the drugs. Cost of the opioids was not considered a major impediment for their use, nor was insufficient supply.
A recent report argues that it is the mandate of the INCB to both promote narcotics for licit use and pressure governments to block their illicit use, that goes far to explain the global disparity in the availability of analgesics. It accuses the INCB of failing to assist countries in realistically estimate their needs for pain medications and has been ineffective in introducing reforms to rectify a situation it admits is problematic. The authors of the report suggest that the control of licit drugs used for medical and research purposes should be turned over to the World Health Organization (WHO), an agency which has the experience and means to deal with global health issues.
