INTERNATIONAL NARCOTICS CONTROL BOARD

2010

Report of theInternational Narcotics Control Board on the
Availability ofInternationally Controlled Drugs:
Ensuring Adequate Access for
Medical and Scientific Purposes

United Nations publication
Printed in Austria

USD 12
ISBN 978-92-1-148260-7

Sales No. E.11.XI.7
E/INCB/2010/1/Supp.1

UNITED NATIONS*1058065*
V.10-58065—January 2011—3,840

Reports published by the International Narcotics Control Board in 2010
The Report of the International Narcotics Control Board for 2010 (E/INCB/2010/1) is
supplemented by the following reports:
Report of the International Narcotics Control Board on the Availability of InternationallyControlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes(E/INCB/2010/1/Supp.1)
Narcotic Drugs: Estimated World Requirements for 2011 — Statistics for 2009 (E/INCB/2010/2)
Psychotropic Substances: Statistics for 2009 — Assessments of Annual Medical and Scientific
Requirements for Substances in Schedules II, III and IV of the Convention on Psychotropic
Substances of 1971 (E/INCB/2010/3)
Precursors and Chemicals Frequently Used in the Illicit Manufacture of Narcotic Drugs andPsychotropic Substances: Report of the International Narcotics Control Board for 2010 on the
Implementation of Article 12 of the United Nations Convention against Illicit Traffic in Narcotic
Drugs and Psychotropic Substances of 1988 (E/INCB/2010/4)
The updated lists of substances under international control, comprising narcotic drugs,
psychotropic substances and substances frequently used in the illicit manufacture of narcotic drugs
and psychotropic substances, are contained in the latest editions of the annexes to the statistical forms(“Yellow List”, “Green List” and “Red List”), which are also issued by the Board.

Contacting the International Narcotics Control Board
The secretariat of the Board may be reached at the following address:
Vienna International Centre
Room E-1339
P.O. Box 500
1400 Vienna
Austria
In addition, the following may be used to contact the secretariat:
Telephone:
Telex:
Fax:
Cables:E-mail:(+43-1) 26060
135 612(+43-1) 26060-5867 or 26060-5868
unations vienna
secretariat@incb.org

The text of the present report is also available on the website of the Board (www.incb.org).

INTERNATIONAL NARCOTICS CONTROL BOARD

Report of theInternational Narcotics Control Board on the

Availability ofInternationally Controlled Drugs:
Ensuring Adequate Access for
Medical and Scientific Purposes

UNITED NATIONSNew York, 2011

E/INCB/2010/1/Supp.1

UNITED NATIONS PUBLICATION
Sales No. E.11.XI.7
ISBN: 978-92-1-148260-7© United Nations: International Narcotics Control Board, January 2011. All rights reserved.
The designations employed and the presentation of material in this publication do not imply theexpression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning thelegal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its
frontiers or boundaries.
Countries and areas are referred to by the names that were in official use at the time the relevant data
were collected.
Publishing production: English, Publishing and Library Section, United Nations Office at Vienna.

Preface
The objective of the international drug control conventions is to ensure adequate availability ofnarcotic drugs and psychotropic substances for medical and scientific purposes while ensuring thatsuch drugs are not diverted for illicit purposes. The International Narcotics Control Board is
mandated to monitor the implementation of this treaty objective, and has repeatedly voiced its
concern about the disparate and inadequate access to controlled substances for medical and scientificpurposes worldwide.
For many years, global consumption of narcotic drugs and psychotropic substances has been
below the levels required for the most basic treatments. As a result of growing recognition of thetherapeutic value of controlled substances, as well as the efforts of the international community,
substantial increases in consumption have been achieved. However, while consumption levels haverisen in several regions of the world, the bulk of the increase has occurred in a limited numberof countries, particularly in three regions: Europe, North America and Oceania. Within somecountries or regions, consumption levels have stagnated or even decreased. As long as these drugs
remain inaccessible to the large majority of people around the world, patients will not be able
to derive the health benefits to which they are entitled under the Universal Declaration of
Human Rights.
For these reasons, the Board has decided to highlight this critical issue in a stand-alone supplement to
its report for 2010. The supplement presents a thorough analysis of the global situation and regionalvariations in the consumption of internationally controlled substances, identifies the main
impediments to adequate availability and provides recommendations on how the problem can beaddressed.
Most narcotic drugs and psychotropic substances controlled under the international drug control
treaties are indispensable in medical practice. Opioid analgesics, such as codeine and morphine, as
well as semi-synthetic and synthetic opioids, are essential medicines for the treatment of pain.
Psychotropic substances such as benzodiazepine-type anxiolytics and sedative-hypnotics andbarbiturates are indispensable medications for the treatment of neurological and mental disorders.
Pharmaceutical preparations containing internationally controlled substances play an essential role inmedical treatment to relieve pain and suffering.
The international drug control treaties continue to be highly effective in preventing the diversionof drugs from licit to illicit markets and in protecting society from the consequences ofdependence. However, in many countries equal attention has not been given to the other objectiveof the treaties — ensuring the adequate availability of controlled substances. Measures taken
by Governments to prevent the abuse of and trafficking in narcotics drugs and psychotropic
substances must not hinder the utilization of such drugs for medical treatment. Governments
need to meet the dual objective of the international drug control treaties, namely, preventing
the diversion and abuse of internationally controlled substances while ensuring theiravailability for legitimate use. This balance should be reflected in national drug control laws andregulations.

iii

The first step towards improving access to these essential drugs for medical and scientific purposes is
to identify the impediments, which are manifold. While economic considerations may play a rolewith regard to high-cost medications, low cost preparations do exist, and examples of countries
making use of such preparations demonstrate that economic impediments can be overcome. Systemic
and regulatory problems may lead to inadequate availability of controlled substances.
To assist Governments in eliminating these impediments, the present supplement includes a wide
range of practical recommendations that can be tailored to each national situation. I truly hope that
Governments will make full use of this report to assess the situation in their countries and to
implement the relevant recommendations. Unless remedial measures are urgently implemented, thegap between high-consumption and low-consumption countries may widen, with unnecessary pain
and suffering continuing in many countries.

Hamid Ghodse
PresidentInternational Narcotics Control Board

iv

Summary
The International Narcotics Control Board was invited by the Commission on Narcotic Drugs at its
fifty-third session, in March 2010, to include in its report for 2010 information on the availability ofinternationally controlled substances for medical requirements. The Board is aware of the growinginterest of the World Health Organization, other intergovernmental bodies and non-governmentalorganizations in this matter. In recognition of its importance, the Board has decided to devote a
supplement to its annual report to this subject. This format allows the Board to provide adequate
information on the present situation, globally and regionally, to highlight major impediments and toformulate recommendations to improve the availability of internationally controlled substances for
medical and scientific purposes. A detailed analysis is contained in the Board’s technical publications
on narcotic drugs and psychotropic substances.

v

CONTENTS
Page
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

iii

Chapter I.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

Chapter II.

Action taken by the Board to ensure adequate availability . . . . . . . . . . . . . . . . . . . . .

5

Chapter III.

Supply of opiate raw materials and opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9
10
11
12
13

A.
B.
C.
D.
E.

Chapter IV.

Availability of medicines containing internationally controlled substances . . . . . . . .
A.
B.
C.
D.
E.
F.

Chapter V.

Supply of opiate raw materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Supply of opioids controlled under the 1961 Convention . . . . . . . . . . . . . . . . . .
Supply of opioids currently controlled under the 1971 Convention . . . . . . . . . .
Supply of stimulants controlled under the 1971 Convention . . . . . . . . . . . . . . . .
Supply of benzodiazepines and barbiturates controlled under the1971 Convention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Availability of opioid analgesics controlled under the 1961 Convention . . . . . . .
Opioids controlled under the 1971 Convention . . . . . . . . . . . . . . . . . . . . . . . . . .
Anti-epileptics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stimulants in Schedule II of the 1971 Convention that are used for thetreatment of attention deficit disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stimulants in Schedule IV of the 1971 Convention that are used as anorectics . .
Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Achieving a balance between ensuring availability of internationally controlled
substances for medical and scientific purposes and preventing their diversion andabuse
A. Impediments to availability of opioid analgesics
B. Availability of internationally controlled substances above levels required forsound medical practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Ensuring adequate availability in emergency situations . . . . . . . . . . . . . . . . . . . .

Chapter VI.

13
15
18
26
28
29
30
32

43
44
47
49

Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51

I. Tables on consumption of opioid analgesics in regions . . . . . . . . . . . . . . . . . . . .
II. Joint letter from the President of the International Narcotics Control Board andthe Chair of the United Nations Development Group
III. Follow-up joint letter from the President of the International Narcotics Control
Board and the Chair of the United Nations Development Group . . . . . . . . . . . .
IV. Letter from the President of the International Narcotics Control Board to all
countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59

Annexes

vii

69
71
73

I

Introduction

1.
Ensuring the availability of internationally controlled substances for treatment in accordancewith article 9 of the Single Convention on Narcotics Drugs of 1961 (1961 Convention),1 as amended
by the 1972 Protocol,2 and the preamble of the 1971 Convention on Psychotropic Substances(1971 Convention)3 is a mandate of the International Narcotics Control Board.
2.
By becoming parties to the international drug control conventions, Governments have accepted
the obligation to introduce the provisions of those treaties into their national legislation and to
implement them. The International Narcotics Control Board is the body established by the
1961 Convention that is responsible for monitoring the compliance of Governments with theinternational drug control treaties and for providing support to Governments in this respect.
3.
The conventions established a control regime to serve a dual purpose: to ensure the availabilityof controlled substances for medical and scientific ends while preventing the illicit production of,trafficking in and abuse of such substances. The 1961 Convention, while recognizing that addiction to
narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic
danger to humankind, affirms that the medical use of narcotic drugs continues to be indispensablefor the relief of pain and suffering and that adequate provision must be made to ensure theavailability of narcotic drugs for such purposes. Equally, the 1971 Convention recognizes that, while
the parties to the Convention were determined to prevent and combat abuse of and trafficking in
psychotropic substances, their use for medical and scientific purposes is indispensable and that theiravailability for such purposes should not be unduly restricted. The implementation of theinternational drug control treaties by parties is monitored by the Board, whose responsibilities underarticle 9 of the 1961 Convention expressly include the responsibility to ensure the availability ofnarcotic drugs for medical and scientific purposes.
4.
The international drug control treaties recognize that narcotic drugs and psychotropic
substances are indispensable for medical and scientific purposes. However, despite numerous efforts
by the Board and the World Health Organization (WHO), as well as non-governmentalorganizations, their availability in much of the world remains very limited, depriving many patientsof essential medicines. The Board continues to monitor the worldwide availability of narcotic drugs
and psychotropic substances and has made their availability one of the main topics of its dialogue
with Governments on adequate treaty implementation.
__________________
1

United Nations, Treaty Series, vol. 520, No. 7515.
Ibid., vol. 976, No. 14152.
3
Ibid., vol. 1019, No. 14956.
2

1

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

5.
Narcotic drugs such as morphine, fentanyl and oxycodone are opioid analgesics effective for thetreatment of moderate and severe pain. Data from 2009 show that more than 90 per cent of the global
consumption of these opioid analgesics occurred in Australia, Canada, New Zealand, the UnitedStates of America and several European countries. This means that their availability was very limited
in many countries and in entire regions. Although medical science has the capacity to provide relief
for most forms of moderate to severe pain, over 80 per cent of the world population will haveinsufficient analgesia, or no analgesia at all, if they suffer from such pain.4
Figure 1. Distribution of morphine consumption, 2009
United States

Proportion of global morphine
consumption

EuropeCanadaAustralia and New Zealand
Japan

56%

AfricaOther countries
Proportion of total population of countries
reporting morphine consumption

28%
6%

5.1%

3%

0.6%
0.4%

6%

0.2%
0.8%

11.4%
2.2%
8%

72.3%

6.
Similar disparities exist for the consumption levels of psychotropic substances, although theiridentification is more difficult, as the 1971 Convention does not require Governments to provide
consumption data on such substances to the Board.
7.
Taking into account that the global supply of opiate raw materials is sufficient for the
production of opioid analgesics such as morphine, codeine and other alkaloids, and does not__________________
4

2

There are a number of safe and effective methods to treat pain. Opioid analgesics continue to be the mainstay for the relief ofmoderate to severe pain.

INTRODUCTION

constitute a barrier to the availability of narcotic drugs, it should be possible to significantly improve
this situation through appropriate action by Governments. However, many other barriers to adequate
availability, identified and highlighted by the Board in the past, continue to exist. The present
supplement to the report of the Board for 2010 focuses on efforts undertaken to ensure adequate
availability, developments over recent years and the current levels of availability of narcotic drugs andpsychotropic substances, and provides recommendations for action to be taken at the internationaland national levels.

3

II

Action taken by the Board to ensure adequate
availability

8.
The Board, acting under the mandate assigned to it by the Conventions, was among the first toissue a warning that availability of narcotic drugs was not ensured in a majority of countries. Morethan 20 years ago the Board became aware of this problem, being in a singular position to assess
consumption in various countries. The 1961 Convention requires Governments to submit to theBoard annual statistical data, including data on the consumption of narcotic drugs. Consumption
data submitted by Governments are analysed by the Board and then published in its annual technicalpublication on narcotic drugs. While reporting on consumption of psychotropic substances is not
required by the 1971 Convention, consumption is calculated on the basis of other statistical data
provided to the Board5 and is published in the annual technical publication on psychotropic
substances.
9.
The regular analysis of consumption data, particularly regarding narcotic drugs, convinced theBoard that the level of consumption of narcotic drugs was very low in a number of countries.
Therefore, in 1989, the Board, in cooperation with WHO, assessed the medical need for opiates in theworld. They found that medical needs for opiates were not being fully satisfied, in particular for thetreatment of cancer pain.
10. The Board found that only a few countries had established effective systems for assessing
medical needs. A number of interrelated factors were identified as important impediments. Laws andregulations, and their administration or interpretation, unduly impeded the availability of opiates.
Lack of resources in the health-care system prevented the optimal availability and use of opiates. Fearof addiction among professionals and the public was also a deterrent to the appropriate medicalprescription of opiates. In addition, lack of up-to-date professional training impeded the adequate useof opioids to treat pain.
11. The findings of this study were published in the Board’s special report for 1989 on the demand
for and supply of opiates for medical and scientific needs.6 The Board made a number ofrecommendations to Governments to help them to minimize or overcome many of the impediments
to making opiates available for medical needs. Governments were requested to examine their
methods of assessing medical needs for opiates; evaluate their health-care systems and laws andregulations for impediments to opiate availability; develop plans of action to facilitate the availabilityof opiates for all appropriate conditions; and establish national policies, guidelines and professional
education on the rational medical use of opiates.
__________________
5
6

Data on manufacture, imports, exports and stocks of psychotropic substances.
United Nations publication, Sales No. E.89.XI.5.

5

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

12. Five years later, in 1994, the Board examined the effectiveness of the international drug control
treaties in a supplement to its annual report, entitled Effectiveness of the International Drug Control
Treaties.7 In its evaluation the Board concluded that the treaty objective of ensuring an adequate
supply of narcotic drugs, especially opiates used for medical purposes, had not been universallyachieved.
13. Therefore, in 1995, the Board published another special report, entitled Availability of Opiatesfor Medical Needs,8 which included specific recommendations to Governments, the United Nations
International Drug Control Programme, the Commission on Narcotic Drugs, WHO, internationaland regional drug control, health and humanitarian organizations and educational institutions andnon-governmental health-care organizations, including the International Association for the Study ofPain, and other health-care representatives. The recommendations of the special report are still valid.
Furthermore, chapter I of the report of the Board for 19999 was dedicated to the issue of availability ofnarcotic analgesics. The Board identified in that chapter, inter alia, constraints and impediments tothe adequate availability of opioids for the treatment of pain and made recommendations toGovernments for corrective action. As internationally controlled drugs were overused in somecountries, leading to prescription drug abuse and related problems, chapter I of the report of theBoard for 200010 dealt with overconsumption of internationally controlled drugs and recommended abalanced approach in their use.
14. One tool to assess whether countries improve availability levels, or at least are aware of the
problem and show the intention to improve, is the analysis of the estimates for narcotic drugs, which
all countries submit to the Board. The Board regularly contacts countries with missing or particularly
low estimates in order to ensure adequate availability of opioids for the treatment of pain. This
practice was formalized in November 1999, when the Board started selecting certain groups ofcountries with low levels of consumption of opioid analgesics (mainly morphine) and with common
characteristics.11 In 2004 the Board contacted four countries12 that had significantly increased theirconsumption levels and requested information on the policies and activities they considered the maincauses for their growing consumption of opioid analgesics, in particular morphine, in order to makethis information available to countries that needed to improve their consumption levels.
15. The matter was repeatedly brought to the attention of Governments in circular letters to all
countries and specific letters to individual countries. In August 2001, a joint letter from the Presidentof the Board and the Chair of the United Nations Development Group was sent to all resident
coordinators of the United Nations system at the country level, urging them, inter alia, to be aware ofunderconsumption and the lack of medicaments available for the treatment of severe pain in many
developing countries (see annex II). This request was confirmed in February 2005, in a follow-up
joint letter from the President of the Board and the Chair of the United Nations Development Group(see annex III). In April 2006, the President of the Board emphasized in a letter to all__________________
7

United Nations publication, Sales No. E.95.XI.5.
United Nations publication, Sales No. E.96.XI.6.
9
United Nations publication, Sales No. E.00.XI.1.
10
United Nations publication, Sales No. E.01.XI.1.
11
Main characteristics for selection: no estimates for morphine; large population and very low level of consumption of morphine;
very high cancer rate and low level of consumption of analgesics; functioning control administration but low level of availability;
high-income countries outside Europe and North America with inadequate availability.
12
Brazil, Canada, France, United States of America.
8

6

ACTION TAKEN BY THE BOARD

countries the difficulties of access to narcotic drugs and psychotropic substances for needy
patients and encouraged Governments to take measures to ensure the inclusion of
the subject of rational use of drugs in the curricula of the appropriate university faculties(see annex IV).13
16. The subject of availability of opioids for the treatment of pain is discussed with individual
Governments during all missions of the Board. The letters of recommendation sent to Governments
after the missions include, if appropriate, specific recommendations on the availability of opioids forthe treatment of pain. Equally, the WHO guidelines on achieving balance in national opioids control
policy14 are always included in the information material provided to competent authorities during
Board missions.
17. The Board regularly includes the subject of the availability of narcotic drugs in speeches atmeetings of intergovernmental bodies, such as the twentieth special session of the General Assembly,
sessions of the Commission on Narcotic Drugs, the Economic and Social Council and World Health
Assembly, and regional meetings of international organizations. In March 2010, at the fifty-third
session of the Commission on Narcotic Drugs, the discussion of availability resulted in Commission
resolution 53/4, entitled “Promoting adequate availability of internationally controlled licit drugs for
medical and scientific purposes while preventing their diversion and abuse”.
18. WHO is the main partner of the Board in activities to increase the availability of opioids for thetreatment of pain. Specific cooperative activities between the Board and WHO include the promotion
by the Board of the WHO guidelines on achieving balance in national opioids control policy; theestablishment of a working group on availability in 2003, which prepared a proposal forstrengthening working relationships between the Board and WHO with regard to the availability ofnarcotic medicines and promoting rational use of psychotropic medicines; and cooperating in the
WHO global strategy against pain, aimed at providing assistance to countries in, inter alia, building
capacity and raising awareness in the area of using opioids in pain treatment.
19. The World Health Assembly, in its resolution WHA58.22, and the Economic and Social
Council, in its resolution 2005/25, invited WHO and the Board to examine the feasibility of anassistance mechanism to facilitate the adequate treatment of pain using opioid analgesics.
WHO and the Board reviewed documents and studies on the availability of opioid analgesics at thecountry level and examined activities conducted and planned by various bodies to assist
Governments to ensure the availability of those medicines for legitimate medical use. They concluded
that although there was no shortage of licitly produced opioid analgesic raw material worldwide andglobal licit consumption of opioids had increased substantially in the past two decades, access toopioid analgesics continued to be difficult in many countries, owing to several constraints.
20. WHO and the Board found that an assistance mechanism to facilitate adequate treatment ofpain using opioid analgesics was feasible. Therefore, WHO started the preparation of the Access toControlled Medications Programme and developed the framework of that Programme inconsultation with the Board. The Programme is implemented by WHO. The Board actively promotes__________________
13
14

Those three letters are also posted on the Board’s website at www.incb.org/incb/en/other-issues_correspondence.html.
World Health Organization, document WHO/EDM/QSM/2000.4.

7

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

the Programme during its missions, in speeches on the subject of availability and through specificreferences and recommendations in its annual reports.
21. However, while consumption of narcotic drugs for medical purposes had increased significantly
in some countries, owing inter alia, to the efforts of the Board, the level of availability of substances
controlled under international conventions remained low and inadequate in most countries. The
Board therefore concluded that the promotion of a better understanding of the provisions of theinternational drug control treaties was required. One major part of this effort is the provision ofassistance to Governments in establishing more realistic estimates of requirements for medications
containing controlled substances. The Board and WHO are at present jointly developing guidelines
on estimating requirements for substances under international control. This initiative is intended to
identify methods to be applied by countries to arrive at adequate estimates for narcotic drugs,
assessments for psychotropic substances and estimates for some precursors for medical purposes.

8

III

Supply of opiate raw materials and opioids

22. “Opiate” is the term generally used to designate drugs derived from opium and their chemicallyrelated derivatives, such as the semi-synthetic alkaloids, while “opioid” is a more general term forboth natural and synthetic drugs with morphine-like properties, although the chemical structure may
differ from that of morphine.
23. The natural alkaloids contained in opium or poppy straw that are under international control
are morphine, codeine, thebaine and oripavine. Morphine and codeine are under international
control because of their potential for abuse, while thebaine and oripavine are under such control
because of their convertibility into opioids subject to abuse. Morphine is the prototype of naturalopiates and many opioids, and, because of its strong analgesic potency, it is used as a reference
parameter for comparative purposes.
24. Opioids are used mostly for their analgesic properties to treat severe pain (fentanyl,hydromorphone, methadone, morphine and pethidine), moderate to severe pain (buprenorphine15
and oxycodone) and mild to moderate pain (codeine, dihydrocodeine and dextropropoxyphene).
They are also used to induce or supplement anaesthesia (fentanyl and fentanyl analogues such as
alfentanil and remifentanil), as cough suppressants (codeine, dihydrocodeine and, to a lesser extent,
pholcodine and ethylmorphine) and to treat addiction to opioids (buprenorphine and methadone).
Main opioids controlled under the 1961 Convention and buprenorphineaaNatural alkaloids

Semi-synthetic opioids

Synthetic opioids

Morphine
CodeineThebaine
Oripavine

Dihydrocodeine
Ethylmorphine
HeroinHydrocodone
Hydromorphone
Oxycodone
Pholcodine
Buprenorphine

Dextropropoxyphene
Diphenoxylate
Fentanyl and analogues
Ketobemidone
Methadone
Pethidine
Tilidine

Buprenorphine is controlled under the 1971 Convention.

25. Semi-synthetic opioids are made by relatively simple chemical modifications of naturalopiates, such as morphine, codeine and thebaine. Some examples of those derivatives
are dihydrocodeine, ethylmorphine, heroin, oxycodone and pholcodine. Synthetic opioids are fully__________________
15

Buprenorphine is controlled under the 1971 Convention.

9

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

man-made and not related to opiates, although they have similar effects when used in treatment. The
most commonly used synthetic opioids include fentanyl and fentanyl analogues, methadone andpethidine.

A. Supply of opiate raw materials
26. Opiates consumed by patients for medical treatment are obtained from opiate raw materials(opium, poppy straw and concentrate of poppy straw). Adequate availability of opiate raw materials
for the manufacture of opiates is therefore a precondition for ensuring the adequate availability of
opiates used for medical and scientific purposes.
27. Pursuant to the 1961 Convention and the relevant resolutions of the Commission on Narcotic
Drugs and the Economic and Social Council, the Board examines on a regular basis developments
affecting the supply of and demand for opiate raw materials. The Board endeavours, in cooperation
with Governments, to maintain a lasting balance between supply and demand. When analysing thesituation regarding the supply of and demand for opiate raw materials, the Board uses informationfrom Governments of countries producing opiate raw materials, as well as from Governments ofcountries where those materials are utilized for the manufacture of opiates or substances notcontrolled under the 1961 Convention. A detailed analysis of the present situation with regard to the
supply of opiate raw materials and demand for those materials worldwide is contained in the 2010
report of the Board on narcotic drugs.16
28. Global stocks of opiate raw materials should cover global demand for about one year toensure the availability of opiates used for medical and scientific purposes in the event of an
unexpected decline in production resulting from, for example, adverse weather conditions in
producing countries.17 At the end of 2009, global stocks of opiate raw materials rich in morphine
were sufficient to cover global demand for 12 months. Global stocks of opiate raw materials richin thebaine were sufficient to cover global demand for slightly less than 12 months; however, thatwas compensated for by the high level of stocks of thebaine and opiates derived from thebaine,
which were sufficient at the end of 2009 to cover global demand for those opiates for about
14 months.
29. According to information available to the Board, in 2010 global production of opiate raw
materials rich in morphine was greater than the utilization of those materials. The global supply(stocks and production) of opiate raw materials rich in morphine was fully sufficient to cover global
demand. For 2011, Governments of producing countries are planning to further extend the area
cultivated with opium poppy rich in morphine.
30. As for opiate raw materials rich in thebaine, information available to the Board indicates that
global production exceeded global demand in 2010. Total stocks of opiate raw materials rich inthebaine were sufficient to cover global demand for less than one year. The plans of the producing
countries indicate that global production of opiate raw materials rich in thebaine will exceed global__________________
16
17

Narcotic Drugs: Estimated World Requirements for 2011 — Statistics for 2009 (United Nations publication, Sales No. T.11.XI.2).
Report of the International Narcotics Control Board for 2005 (United Nations publication, Sales No. E.06.XI.2), para. 85.

10

SUPPLY OF OPIATE RAW MATERIALS AND OPIOIDS

demand in 2011 as well. Total stocks of opiate raw materials rich in thebaine are therefore expected toincrease to a level that can cover about 14 months of demand. The global supply (stocks andproduction) of opiate raw materials rich in thebaine will continue to be sufficient to fully cover global
demand.
31. Global demand for opiate raw materials rich in morphine and rich in thebaine is expected torise in the future as well. It is anticipated that, as a result of the activities of the Board and WHO toensure the adequate availability of opioid analgesics, global demand for opiates and opiate raw
materials will continue to rise.

B. Supply of opioids controlled under the 1961 Convention
32. As in the case of steadily rising production of opiate raw materials, manufacture of opioids has
also progressively increased in the last 20 years. The manufacture of morphine and the major
synthetic and semi-synthetic opioids has increased fivefold in the last 20 years, with the synthetic andsemi-synthetic opioids recording higher growth rates than morphine. This development is strongly
related to the increasing demand for certain narcotic drugs, as well as the development of new
products.

Figure 2. Growth in manufacture of opioids, 1989-2009

Millions of S-DDD

10 000
9 000
8 000
7 000
6 000
5 000
4 000
3 000
20 0002 000

Millions of S-DDD

18 000

1 000

16 0000
1989

14 000
12 000
10 000
8 000

1999

2009

6 000

Morphine
Semi-synthetic opioids
Synthetic opioids

4 000
2 000
0
1989

1999

2009

11

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

33. Figure 2 shows the aggregated growth in manufacture of morphine and synthetic and semisynthetic opioids over a period of 20 years. The term S-DDD (defined daily doses for statistical
purposes) represents a technical unit of measurement used for statistical analysis and is not arecommended prescription dose. This unit of measurement is used whenever narcotic drugs or
psychotropic substances with different levels of potency, and therefore different levels of daily dosage
in treatment, are aggregated to show the quantities available for a group of substances in acomparable unit of measurement.
34. Particularly strong growth rates were recorded for fentanyl, which has become the mostmanufactured synthetic opioid when amounts are expressed in S-DDD. When used as an analgesic,
fentanyl is about 100 times as potent as morphine and is used for anaesthesia in very small doses (forexample, 0.005-0.1 mg in injectable form). The use of controlled-release patches of fentanyl for thetreatment of severe pain, containing higher dosages and used for up to three days, has been increasing
in all parts of the world resulting in increased manufacture of fentanyl. Methadone is also
manufactured in much larger quantities than it was 20 years ago, although mostly for use in
substitution treatment. The manufacture of the semi-synthetic drugs hydrocodone, hydromorphone,oxycodone and oxymorphone has also shown very high rates of increase. International trade innarcotic drugs increased comparably: fivefold for morphine, by nearly 300 times for fentanyl and by
more than 130 times for oxycodone.
35. Those are impressive growth rates for manufacture of and international trade in narcotic drugs.
However, the major reason for those rates was the strong increase in imports in some highconsumption countries, while most other countries either increased imports to a much lesser extent
or started out from such low levels that even very high increase rates did not translate into large
absolute quantities. Moreover, out of 211 countries and territories, 17 did not import any morphine,
22 did not import any fentanyl and 9 did not import any opioids.
36. Data available to the Board show that the manufacture of morphine and the synthetic and semisynthetic opioids at present is fully adequate to satisfy global demand. In addition, ongoing research
into new applications and preparations allows the manufacture of new medications that are easierand more comfortable to use. At the same time, other, less costly types of preparations continue to be
manufactured. Increasing demand for products in different price ranges can be covered by thepharmaceutical industry. The supply side for opioids can therefore not be considered an obstacle tothe adequate availability of narcotic drugs.

C. Supply of opioids currently controlled under the1971 Convention
37. Global manufacture of buprenorphine has also risen fivefold in the last 20 years and hasreached a level comparable to that of the major opioids. It increased sharply in the late 1990s, as thesubstance started to be used in higher doses for the treatment of opioid addiction, and another sharp
rise is evident since 2006. Equally, international trade in the substance increased sharply, and80 countries reported imports of buprenorphine in the period from 2007 to 2009. However, thenumber of countries importing buprenorphine is much smaller than the number of countries

12

SUPPLY OF OPIATE RAW MATERIALS AND OPIOIDS

importing at least one of the main opioids. There is much less manufacture and trade of pentazocine,
another major synthetic analgesic controlled under the 1971 Convention, which did not show acomparable trend. While there are fluctuations in manufacture and trade, no steady increase rate isdiscernible.

D. Supply of stimulants controlled under the 1971 Convention
38. Stimulants included in Schedule II are manufactured in about a dozen countries and imported
by a further 90 countries. Particularly high growth rates in manufacture in the last
20 years were recorded for methylphenidate (16-fold) and dexamfetamine (2.5-fold), while
manufacture of amfetamine18 reached a peak in 1998 and has been declining since. International
trade of stimulants in Schedule II also increased, more so for methylphenidate than for theamphetamines. During the last 10 years the manufacture and trade of stimulants in Schedule IV,
mostly used as anorectics in anti-obesity treatment, remained at roughly the same level. The level ofmanufacture of the whole group, comprising 14 substances and expressed in S DDD, is below thelevel of manufacture of the major opioids.

E. Supply of benzodiazepines and barbiturates controlled underthe 1971 Convention
39. The manufacture and trade of benzodiazepine-type anxiolytics and sedative hypnotics, afterstrong growth rates 20 years ago, have reached a plateau (between 20 billion and 30 billion S-DDD for
anxiolytics; between 5 billion and 9 billion S-DDD for sedative-hypnotics) at which they fluctuate.
Manufacture of barbiturates has also remained stable during the last 10 years. The significant regional
differences in international trade in anxiolytics and sedative-hypnotics remained, and in certain
regions that had always reported only very low levels of such imports, further reductions were noted(mostly African countries, but also in some parts of Asia). The two most traded psychotropic
substances in terms of the number of countries importing are diazepam, a benzodiazepine-type
anxiolytic, and phenobarbital, a barbiturate, both of them imported by more than 160 countries. The
most manufactured psychotropic substance when expressed in S-DDD is the benzodiazepine-type
anxiolytic alprazolam.

__________________
18

Most of the substances in the schedules of the 1971 Convention are listed by their international non-proprietary names (INN). The
INN system was developed by WHO to facilitate the identification of pharmaceutical substances or active pharmaceuticalingredients. (Those names are used in the technical report of the Board on psychotropic substances.) If no INN exists, thesubstances are listed in the schedules under “other non-proprietary or trivial names”.
To most native speakers of English, the INN of many of the substances in Schedule II of the 1971 Convention appear to be
misspellings: amfetamine, dexamfetamine, levamfetamine, metamfetamine, metamfetamine racemate. In the present report, the“other non-proprietary or trivial names” of those substances, which are more common, are used: amphetamine, dexamphetamine,levamphetamine, methamphetamine, methamphetamine racemate.

13

IV

Availability of medicines containing
internationally controlled substances

40. Adequate supply of licitly produced opiate raw materials and of the end products manufactured
using those raw materials, as well as increasing manufacture of psychotropic substances, does
not necessarily lead to adequate supply of medicines containing those substances for the end-user,
the patient. Access to opioid-based medicines, as well as other medicines containing substances
under international control, is limited or almost non-existent in many countries. That
discrepancy has been discussed repeatedly not only by the Board but also by the Commission on
Narcotic Drugs.
41. As mentioned above, the Commission on Narcotic Drugs, in its resolution 53/4, entitled“Promoting adequate availability of internationally controlled licit drugs for medical and scientificpurposes while preventing their diversion and abuse”, recalled the 1961 Convention as amended by
the 1972 Protocol, as well as the 1971 Convention. That resolution reflects the recognition in both
Conventions that internationally controlled substances are indispensable for medical treatment andscientific purposes. In that resolution the Commission recalled that the availability of internationallycontrolled substances should not be unduly restricted and that provision must be made to ensure
their availability for medical and scientific purposes.
42. In the same resolution, the Commission invited the Board to include in its annual report for2010 information on the consumption of narcotic drugs and psychotropic substances used for
medical and scientific purposes worldwide, including an analysis of impediments to their adequate
availability, actions to be taken to overcome those impediments and, when available, specificinformation about the status of and progress made by countries. Pursuant to that resolution, theBoard carried out an analysis of global developments and regional patterns of consumption of opioid
analgesics based on statistics furnished by Governments. It also analysed the global developments andregional patterns of consumption of psychotropic substances.19
43. In order to show discrepancies between regions, as well as between countries within regions,
the Board’s technical publication on narcotic drugs provides regional tables on consumption
levels of opioid analgesics, in addition to the global table on average consumption of narcotic drugs(table XIV of the technical publication on narcotic drugs). Governments are required to provide
to the Board, in their annual statistics on narcotic drugs, data on the consumption of opioid
analgesics. Countries have been collecting such data for many years, but not all of them havedeveloped adequate methods of assessing their requirements. The Board has created the concept of“defined daily doses for statistical purposes (S-DDD) consumed per million inhabitants per day”,__________________
19

Calculated on the basis of statistical data furnished to the Board on manufacture, imports, exports and stocks.

15

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

which it uses when compiling and comparing statistics on the consumption of substances withdifferent potency levels, such as opioid analgesics.
44. In the absence of a universally agreed expert opinion on adequate levels of consumption, theBoard has internally, for administrative purposes, set some minimum standards to use when
examining estimates of annual requirements for narcotic drugs submitted by countries. The Board
has identified levels of consumption that it considers to be inadequate (consumption of opioid
analgesics in quantities between 100 and 200 S-DDD per million inhabitants per day) or very
inadequate (consumption of opioid analgesics in quantities equal to or less than 100 S-DDD). If thoselevels were to be used as a benchmark, 21 countries would have inadequate consumption levels andmore than 100 other countries would have very inadequate consumption levels, most of them inAfrica. In May 2004, the Board adopted an amendment to the rules for establishing estimates, whichallowed for the raising of the estimates of certain essential narcotic drugs by the Board in case theexisting estimates were considered inappropriately low.
45. In its resolution 53/4 the Commission on Narcotic Drugs invited the Board to present to theCommission information on the consumption of psychotropic substances used for medical andscientific purposes worldwide, to promote their adequate availability. However, Governments are notobliged to submit data on the consumption of psychotropic substances. The Board has found it usefulin the past to calculate approximate consumption levels for psychotropic substances based on thestatistical information on those substances that Governments have submitted to the Board in theirannual statistics on psychotropic substances, to show global trends and, when data appear to beconsistent and reliable, to identify unusual consumption patterns. As stated in the technical report ofthe Board on psychotropic substances, caution should be exercised when drawing conclusions on theactual level of consumption of psychotropic substances, at the global level as well as in specificcountries, as data reported by Governments on the manufacture of and trade in psychotropic
substances may not be complete or may not cover all substances. Calculated consumption levels tend
to be particularly inaccurate for manufacturing countries. The calculated consumption levels are
published in table IV of the technical report on psychotropic substances.
46. In the past, the analysis of calculated consumption levels of psychotropic substances often
focused on consistently high levels of consumption that might not be medically justified and mightlead to the diversion and abuse of the substances in question. However, the Board was aware that thevery low levels of consumption of psychotropic substances observed in some countries might reflect
the fact that those substances were almost inaccessible to certain segments of the population and thatthose substances, or counterfeit medicaments allegedly containing those substances, might therefore
appear on unregulated markets to cover the unmet needs. It should also be taken into considerationthat consumption levels for psychotropic substances vary greatly between countries and regions,because of differences in medical practice and related variations in prescription patterns.
Comparisons between countries and regions can be made only with great care, especially since, forcertain psychotropic substances, other psychotropic substances or non-psychotropic substances may
be used as substitutes, which should be taken into account when reviewing the availability of those
psychotropic substances.
47. The Board notes that on numerous occasions Governments have strengthened theinternational control regime for psychotropic substances by agreeing to provide additional data to
16

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

the Board, such as assessments of annual requirements for those substances and details on trade in
substances in Schedules III and IV of the 1971 Convention and on stocks held by manufacturers.
Since such data were not considered essential when the 1971 Convention was adopted, it was the
Economic and Social Council that, in various resolutions,20 introduced the requirement to collect andsubmit to the Board the above-mentioned additional information on psychotropic substances.
Although this additional reporting is not yet universal, the Board appreciates the fact that most
Governments submit the additional information pursuant to the resolutions of the Economic andSocial Council and offers training for the national authorities responsible for completing andreturning the forms.
48. In the opinion of the Board, it is again time for Governments to agree to voluntarily provide itwith information not foreseen under the 1971 Convention but essential for the implementation ofCommission on Narcotic Drugs resolution 53/4 so that the Board will be in a position to analysetrends in the consumption of psychotropic substances. Reliable data on the consumption of
psychotropic substances will also be needed to assess the effectiveness of any measures taken inaccordance with Commission resolution 53/4. The Board therefore strongly recommends that
Governments consider providing it with data on the consumption of psychotropic substances, toenable the Board to comply with Commission resolution 53/4 and, ultimately, to promote theadequate availability of psychotropic substances used for medical and scientific purposes while
preventing the diversion and abuse of those substances.
49. For the reasons mentioned above, the quality of data on the consumption of psychotropic
substances is not comparable with the quality of data on the consumption of narcotic drugs. It istherefore more difficult to provide a meaningful analysis of the consumption levels for psychotropic
substances. Moreover, in most countries psychotropic substances are used much more in medical
treatment than narcotic drugs. To analyse the consumption patterns of psychotropic substances, theBoard therefore uses the concept of S-DDD consumed per thousand inhabitants per day to compareand compile statistics of substances of different potency. Therefore, the information below is divided
into information on consumption levels of opioid analgesics and information on analgesics
controlled under the 1971 Convention, as well as information on other groups of psychotropic
substances.
50. The situation with regard to the adequacy of consumption levels for psychotropic substances issimilar to the situation with regard to the adequacy of consumption levels for narcotic drugs: there isno agreement among experts regarding the level of per capita consumption of any of the groups of
psychotropic substances that is implied by “adequate availability”.
51. The Commission on Narcotic Drugs, in its resolution 53/4, affirmed that the international drug
control conventions sought to achieve a balance between ensuring the availability of narcotic drugs
and psychotropic substances under international control for medical and scientific purposes andpreventing their diversion and abuse. In the same resolution the Commission acknowledged that anincrease in the licit supply of internationally controlled substances might increase the risk ofdiversion and abuse of those substances. The present supplement includes information on the
consumption levels for certain groups of substances that may be considered too high. It is apparent__________________
20

Resolutions 1981/7, 1985/15, 1987/30 and 1991/44.

17

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

that in a few countries with high levels of consumption, narcotic analgesics are the main drug abuseproblem and that the abuse of prescription drugs is increasing.

A. Availability of opioid analgesics controlled under the1961 Convention
52. In the period 1989-2009, global consumption of opioid analgesics used for the treatment ofmoderate and severe pain increased considerably. For example, global consumption of morphineincreased sevenfold. The increase was more dramatic for certain opioids under international control,
such as fentanyl (100-fold) and oxycodone (26-fold). The increase was significantly higher in someregions than in others.21 Within each region, the increase in consumption was greater in somecountries than in others, and there continued to be large differences in the consumption levels ofdifferent countries. Consumption levels in regions, countries and territories are reflected in the tables
in annex I.
Figure 3. All regions: average consumption of opioid analgesics, 1987-1989, 1997-1999
and 2007-2009

250

25 000S-DDD per million inhabitants per day

S-DDD per million inhabitants per day

30 000

20 000

15 000

10 0005 000

0200 S-DDD

200

150

100

50

0
North
America

Oceania

1987-1989
2007-2009

Europe1997-1999

So uthA merica

West
A sia

East and Central A frica
So uth- A merica
East
and theA sia Caribbean

So uthA sia__________________
21

Figures 3-13 provide information on the development in consumption levels of opioid analgesics globally and regionally over thelast 20 years. Due to the significant differences in consumption levels, the scales used in the graphs are different.

18

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

53. The highest levels of consumption for opioid analgesics have been recorded in North Americanand European countries and Australia and New Zealand. In a large proportion of countries in
Europe and North America the levels of consumption for opioid analgesics rose substantiallyin the period 2000-2009. Canada and the United States had the highest levels of consumption
for opioid analgesics in the world. Those two countries recorded a consistent increase in
their consumption of opioid analgesics from 1989 to 2009, when the consumption levels
reached nearly 40,000 S-DDD per million inhabitants per day in the United States and more than
20,000 S-DDD in Canada, compared with 85 S-DDD per million inhabitants per day in Mexico.
54. In Europe, the consumption levels for opioid analgesics used for the treatment of pain also
increased dramatically in the period 2000-2009. However, there continue to be large disparities inthose consumption levels among European countries. The two countries with the highest
consumption levels, Germany and Austria, reported consumption of about 20,000 and
16,000 S-DDD per million inhabitants per day, respectively. Five other countries reported
consumption levels of more than 10,000 S-DDD and 21 countries reported levels between
1,000 and 10,000 S-DDD. In some countries in the region, mostly in Eastern and South-Eastern
Europe, consumption levels increased only slightly or even decreased. Consumption in 3 countries(Belarus, Romania and the Russian Federation) amounted to fewer than 200 S-DDD per million
inhabitants per day.22 Four countries reported consumption levels below 100 S-DDD (Albania,
Republic of Moldova, the former Yugoslav Republic of Macedonia and Ukraine).

Figure 4. North America: average consumption of opioid analgesics, 1997-1999
and 2007-2009

39 487

S-DDD per million inhabitants per day

25 000

20 000

15 000

10 0005 000

200 S-DDD

0
United States

Canada1997-1999

85

Mexico2007-2009__________________
22

Narcotic Drugs: Estimated World Requirements for 2011 — Statistics for 2009 (see footnote 16 above), table XIV.

19

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

Figure 5a. Europe (countries with higher consumption): average consumption of opioid
analgesics, 1997-1999 and 2007-2009

18 000
16 000
14 000
12 000
10 000
8 000
6 000
4 000

1997-1999aAndorraPortugal

PolandCroatia

Italy

Slovakia

Czech RepublicHungary

GreeceUnitedKingdom

Ireland

Slovenia

FranceSwedenLuxembourg

NorwaySpain

Finland

Iceland

Switzerland

Belgium

Denmark

Austria

Germany0

Netherlands

2 000
Gibralter a

S-DDD per million inhabitants per day

20 0002007-2009

Data not available, as the territory did not submit statistical forms for the three consecutive years 1997-1999.

Figure 5b. Europe (countries with lower consumption): average consumption of opioid
analgesics, 1997-1999 and 2007-2009
2 000

1 600
1 400
1 200
1 000
800
600
400

a
b

Data for 1997-1999 not available, as the country was not admitted to membership in the United Nations until 2006.
Data not available, as the country did not submit statistical forms for the three consecutive years 1997-1999.

20

UkraineRepublic ofMoldova

Albania

BelarusRomaniaMalta

2007-2009

The former
Yugoslav Republicof Macedonia

1997-1999

Bulgaria

Bosnia andCyprusEstonia

LatviaMontenegro*

Lithuania

Serbiaa0

RussianFederation

200 S-DDD

200
Herzegovinab

S-DDD per million inhabitants per day

1 800

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

55. Significant increases in the consumption of opioid analgesics also occurred in the
period 2000-2009 in some countries in East and South-East Asia, West Asia, South America andOceania. Despite those increases, the level of consumption of opioid analgesics remained relatively
low in most countries in those regions.
56. In East and South-East Asia, the consumption levels for opioid analgesics in 65 per cent of thecountries in the region amounted to fewer than 100 S-DDD per million inhabitants per day in the
period 2007-2009. The highest levels of consumption were reported in Japan and the Republic ofKorea, the two countries in the region that recorded the most dramatic increase in such consumption
during the past decade (more than 1,000 S-DDD per million inhabitants per day). However, in mostcountries in the region, consumption levels for opioid analgesics increased only slightly. More than
80 per cent of the countries reported consumption levels below 200 S-DDD. In Cambodia, Indonesia,
the Lao People’s Democratic Republic and Myanmar, those consumption levels were below 10 SDDD per million inhabitants per day. No consumption of opioid analgesics was reported by Timor
Leste.

1 023

700
600
500
400
300

200 S-DDD

200

MyanmarLao People's
Democratic Republic

Cambodia

Indonesia

Philippines

Viet Nam

Mongolia

ThailandChina

2007-2009

Democratic
People's Republicof Korea

1997-1999

Brunei
Darussalam

Malaysia

Macao, China

Singapore

Hong Kong,
China

0

Japan

100

Republic of
Korea

S-DDD per million inhabitants per day

800

1 342

Figure 6. East and South-East Asia: average consumption of opioid analgesics, 1997-1999
and 2007-2009

57. In West Asia, the consumption levels for opioid analgesics in more than 60 per cent of thecountries in the region amounted to fewer than 100 S-DDD per million inhabitants per day in the
period 2007-2009. Consumption levels in Israel have been substantially higher than in theother countries in the region and increased steadily over a 20-year period, reaching more than 3,000
S-DDD per million inhabitants per day in the period 2007-2009. The consumption levels for opioid
analgesics used for the treatment of pain increased significantly in the period 2000-2009 in Bahrain
and Turkey. Consumption increased but remained below 200 S-DDD in Jordan, Kuwait, Lebanon,

21

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

Qatar, Saudi Arabia and the United Arab Emirates. In Afghanistan, Iraq, Pakistan, Tajikistan,
Uzbekistan and Yemen, consumption levels were below 10 S-DDD per million inhabitants per day
in 2009.

1 305

500

400

300

200 S-DDD

200

Afghanistan*

Tajikistan*

Pakistan

Iraq

Yemen

Uzbekistan

Kyrgyzstan

Azerbaijan*

Oman
Iran (Islamic
Republic of)Armenia

2007-2009

Turkmenistan*

1997-1999

Kazakhstan

Georgia

Syrian Arab
Republic

LebanonUnited ArabEmirates
Qatar

JordanKuwaitSaudi Arabia

Bahrain0

Turkey100

IsraelS-DDD per million inhabitants per day

600

3 482

Figure 7. West Asia: average consumption of opioid analgesics, 1997-1999 and 2007-2009* Data not available, as the country did not submit statistical forms for the three consecutive years 1997-1999.

58. In South America, the consumption levels for opioid analgesics in more than
50 per cent of the countries in the region amounted to fewer than 100 S-DDD per million inhabitants
per day in the period 2000-2009, although consumption levels in the region
as a whole increased significantly. In about half of the countries in the region, consumption of opioid
analgesics more than doubled during that period. The highest consumption
level in the period 2007-2009 was reported by the Falkland Islands (Malvinas), with
4,283 S-DDD per million inhabitants per day. Argentina and Chile reported consumption levels of
about 400 S-DDD per million inhabitants per day. Bolivia (Plurinational State of) and Guyana
reported consumption of opioid analgesics to be no more than 10 S-DDD per million inhabitants
per day.
59. In Oceania, the situation with regard to consumption levels in the different countries is sharply
divided. Of 15 reporting countries, 6 (40 per cent) have consumption levels below
100 S-DDD per million inhabitants per day. On the other hand, 7 countries (47 per cent) reported
consumption of more than 1,000 S-DDD. The consumption levels for opioid analgesics inAustralia for the period 2007-2009 (more than 8,000 S-DDD) were substantially higher than in theother countries in the region. Despite significant increases in the consumption levels for opioid
analgesics in the Marshall Islands, Nauru, Papua New Guinea, Samoa, Tonga and Vanuatu,
consumption levels remained low (less than 100 S-DDD per million inhabitants per day).

22

0

1997-1999

Samoa

Vanuatu

Papua New
GuineaMarshallIslands

Nauru

400
Bolivia(Plurinational
State of)

GuyanaParaguay

Peru

Suriname

EcuadorVenezuela(Bolivarian
Republic of)

Uruguay

BrazilColombia

Chile

Argentina

200

Tonga

Cook
Islands

2 479

3 403

3 094

1997-1999

Palau

Christmas
IslandFrenchPolynesia

Wallis andFutunaNew
Zealand

New Caledonia

2 400

Norfolk Island

Falkland Islands(Malvinas)

0

8 013

S-DDD per million inhabitants per day

3 591
4 283

700

Australia

S-DDD per million inhabitants per day

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Figure 8. South America: average consumption of opioid analgesics, 1997-1999
and 2007-2009

600

500

400

300

200 S-DDD

100

2007-2009

Figure 9. Oceania: average consumption of opioid analgesics, 1997-1999 and 2007-2009

2 000

1 600

1 200

800

200-S-DDD

2007-200923

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

60. In contrast to the developments in the above-mentioned regions, consumption levels for opioid
analgesics in Africa, Central America and the Caribbean and South Asia did not increase significantlyin the period 2000-2009. Modest increases were recorded in a few countries in each of those
three regions. As a result, in the vast majority of the countries in those regions consumption of opioid
analgesics amounted to fewer than 100 S-DDD per million inhabitants per day, and in a large numberof those countries less than 10 S-DDD or even zero.
61. Africa has continued to be the region with the lowest levels of consumption for opioid
analgesics. Only one country reported consumption above 200 S-DDD per million inhabitants
per day, and four others reported consumption of above 100 S-DDD. In nearly 90 per cent of thecountries in the region, such consumption amounted to fewer than 100 S-DDD per million
inhabitants per day, and nearly half of the countries in the region had levels below 5 S-DDD.
Significant increases in consumption have been limited to a few countries, and it has decreased inseveral others. South Africa currently has the highest consumption level for opioid analgesics in theregion, averaging 600 S-DDD per million inhabitants per day. In six countries in the region(Cameroon, Chad, Mali, Nigeria, Rwanda and United Republic of Tanzania), average consumption of
opioid analgesics amounted to less than 1 S-DDD per million inhabitants per day.
No consumption of opioid analgesics was reported by the Central African Republic,
the Congo, Djibouti, Equatorial Guinea, the Gambia, Guinea, Guinea-Bissau, Liberia, Somalia
or Swaziland.

Figure 10a. Africa (countries with higher consumption): average consumption of opioid
analgesics, 1997-1999 and 2007-2009
650
600

500
450
400
350
300
250

200-S-DDD

200
150
100

1997-1999

2007-2009* Data not available, as the country did not submit statistical forms for the three consecutive years 1997-1999.

24

Ghana*

Kenya

Zimbabwe

UgandaBotswana

MoroccoEgypt

Cape Verde

Namibia

Tristan da
Cunha

Ascension
IslandMauritius

Libyan Arab
Jamahiriya

Seychelles

Tunisia

Algeria0Saint Helena

50South Africa

S-DDD per million inhabitants per day

550

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Figure 10b. Africa (countries with lower consumption): average consumption of opioid
analgesics, 1997-1999 and 2007-2009

20

15

10

1997-1999

RwandaUnited Republic of
Tanzania

Mali*

Nigeria

Chad*

Sudan*

Cameroon*

Comoros*

BurundiBurkina Faso*

Togo

Sierra Leone

Niger

Ethiopia

Eritrea

Benin

Côte d'Ivoire

AngolaSenegal*Mauritania

Democratic Republicof the Congo
Mozambique

Gabon*

Malawi

ZambiaMadagascar

0

Sao Tome and Principe

5

Lesotho

S-DDD per million inhabitants per day

25

2007-2009* Data not available, as the country did not submit statistical forms for the three consecutive years 1997-1999.

62. In Central America and the Caribbean, consumption levels for opioid analgesics remained
relatively low in the period 1989-2009. More than half of the countries in the region reported
levels of fewer than 100 S-DDD of opioid analgesics per million inhabitants per day in the
period 2007-2009. Only the Cayman Islands and the Netherlands Antilles reported consumption
above 1,000 S-DDD per million inhabitants per day. Haiti reported average consumption of
2 S-DDD per million inhabitants per day. No consumption of opioid analgesics was reported by
Anguilla, Antigua and Barbuda, Aruba, Barbados, Belize, the British Virgin Islands, Honduras orSaint Kitts and Nevis.
63. All countries in South Asia reported very low consumption levels of opioid analgesics during
the period 2007-2009. The highest consumption level was reported by Sri Lanka, with 26 S-DDD.
Bhutan was the only other country with a consumption level above 20 S-DDD. Bangladesh and Nepal
reported consumption of less than 10 S-DDD.
64. As indicated in the paragraphs above, there continue to be large disparities among countries
in terms of the consumption of opioids. Opioid analgesics under international control continue
not to be available in sufficient quantities to meet the medical requirements of the population in
many countries throughout the world, including in several countries with very large populations,such as India and Nigeria. In some other countries, however, overprescribing and the availabilityof opioid analgesics in quantities greater than those required for sound medical treatment
may lead to the diversion and abuse of those substances, which some countries are alreadyexperiencing.

25

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

1 200
1 000
800
600
400

1997-1999

2007-2009* Data not available, as the country or territory did not submit statistical forms for the three consecutive years 1997-1999.

Figure 12. South Asia: average consumption of opioid analgesics, 1997-1999
and 2007-2009

S-DDD per million inhabitants per day

30

25

20

15

10

5

0
Sri Lanka

BhutanIndia

Maldives*

1997-1999

2007-2009

Nepal

Bangladesh* Data not available, as the country did not provide consumption data for the three consecutive years 1997-1999.

26

Haiti*

Dominican
Republic

Nicaragua

Dominica

GuatemalaJamaica

Cuba

El Salvador*

Saint Lucia

Costa Rica

PanamaTrinidad andTobago*Montserrat *BahamasTurks andCaicos Islands

Netherlands
Antilles0Saint Vincent
and theGrenadines
Grenada200-S-DDD

200

Cayman Islands

S-DDD per million inhabitants per day

1 400

2 909

Figure 11. Central America and the Caribbean: average consumption of opioid analgesics,
1997-1999 and 2007-2009

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

B. Opioids controlled under the 1971 Convention
65. Buprenorphine, lefetamine and pentazocine are the analgesics controlled under the1971 Convention. The consumption of buprenorphine, an opioid analgesic in Schedule III of
the 1971 Convention, accounted for over 99 per cent of global consumption of such analgesics in2009. Calculated consumption of buprenorphine increased sharply in the period 1990-2009,
although the information available is not accurate enough to allow the level of consumption to be
calculated for each of the major manufacturing and consuming countries. Two decades ago,buprenorphine was used in only 12 countries, none of them in Africa or Oceania. In the period 20072009, buprenorphine was used in about 75 countries or territories, representing every region,or about 35 per cent of all countries and territories. That shift in the use of buprenorphine
is attributable to its increasing use in higher-dosage forms for the treatment of pain and for
substitution treatment. Australia, Belgium, France, Germany, Norway, the United Kingdom of GreatBritain and Northern Ireland and the United States are the countries with the highest consumption
levels for buprenorphine. Europe has consistently been the region with the highest levels of
consumption.
66. From the information available, it is not possible to identify countries withproblematic consumption patterns (consumption levels that are too low or too high), mainly becauseof the reporting problems mentioned above, but also because certain narcotic drugs(for example, any opioid analgesic for the treatment of pain and methadone for substitution
treatment) might be used as a substitute for buprenorphine, and its availability should be
reviewed in connection with the availability of those drugs. The diversion of buprenorphine fromdomestic distribution channels, above all from substitution treatment programmes, continues
to occur.
67. Pentazocine is an opioid analgesic with properties and uses similar to those of morphine; it islisted in Schedule III of the 1971 Convention. In the period 2005-2009, global calculated consumptionof pentazocine showed a slight increase. In contrast to the use of buprenorphine, pentazocine use is
not spreading to other countries; the same 50 countries have been using pentazocine during the last
decade, among which India, Pakistan and the United States together accounted for 80 per cent of the
global total in the period 2007-2009.

C. Anti-epileptics
68. Clonazepam (a benzodiazepine), methylphenobarbital and phenobarbital are theanti-epileptics controlled under the 1971 Convention. All three of them are in Schedule IV ofthat Convention. In addition to being used for the treatment of epilepsy, they are used to induce
sleep. From the data reported to the Board, it is not possible to determine the extent to which the27

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

substances are used to induce sleep and the extent to which they are used to treat epilepsy.
The consumption of phenobarbital accounted for over 99 per cent of global consumption ofanti-epileptics in 2009.

69. Calculated consumption of anti-epileptics increased in the period 1990-2009. In 1990,
the use of those substances was reported in 120 countries throughout the world. Since then, theiruse has spread to virtually every country, and phenobarbital is one of the most widely usedpsychotropic substances. As is the case for all psychotropic substances, calculated consumption levels
for anti-epileptics based on the data reported to the Board are very tentative, as some major
manufacturers and importers submit inaccurate or inconsistent data. The countries with the highest
consumption levels for anti-epileptics are Bulgaria, Latvia and Ukraine. Europe has consistently been
the region with the highest consumption levels for those substances.

70. In Benin, the consumption levels for anti-epileptics (7 S-DDD per million inhabitants
per day in 2008) are much higher than the average for Africa, which could indicate
excessive availability linked to non-implementation of the prescription requirements foreseenby the 1971 Convention, as well as the possibility of related diversion and abuse. The information
available to the Board does not allow conclusions to be drawn as to whether the substances
are available in all countries in sufficient quantities, in particular as anti-epileptics.
Diverted phenobarbital is sometimes found on illicit markets, possibly because the substance is notavailable on licit markets in the quantities required. There have been enquiries from hospitals
indicating that in some countries the quantities of phenobarbital imported for medical purposes are
not sufficient.

D. Stimulants in Schedule II of the 1971 Convention that are used
for the treatment of attention deficit disorder
71. Methylphenidate, amphetamine and dexamphetamine, substances in Schedule II of the1971 Convention, are used mainly for the treatment of attention deficit disorder (ADD)
and narcolepsy. For many years, the most extensive use of those substances for medical
purposes has been in the Americas. In recent years, the highest levels of consumption for
those stimulants have been observed in Canada, Israel, the United States and countries in northern
Europe.

72. Methylphenidate is the most widely used stimulant in Schedule II of the 1971 Convention.
Its manufacture and use continue to increase. In the period 2005-2009, global calculated
consumption of methylphenidate increased by 30 per cent, reaching 40 tons, the majority ofwhich was accounted for by the United States. In that country, the use of methylphenidate for thetreatment of ADD continues to be promoted in advertisements directed at potential consumers,
28

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

contrary to the provisions of the 1971 Convention. The use of methylphenidate for the treatmentof ADD has been growing in many other countries as well, although the use of the substancecontinues to be much greater in the United States than in all the other countries combined. Countries
other than the United States together accounted for less than 20 per cent of global calculated
consumption of methylphenidate in 2000; however, that proportion gradually increased to
30 per cent by 2009.

73. During the period 2007-2009, about 100 countries and territories reported the use of
methylphenidate and about 70 reported the use of amphetamines. Stimulants in Schedule II of the1971 Convention appear not to be available in about 50 per cent of all countries and territories. Since
2007, Iceland, followed by the United States, has been the country with the highest calculated per
capita consumption of methylphenidate. Figure 13 shows the countries with consumption rates ofmethylphenidate above 1 S-DDD per thousand inhabitants per day, ranked by their calculated
consumption levels.

Figure 13. Selected countries: average consumptiona of methylphenidate, 1997-1999
and 2007-2009

S-DDD per 1,000 inhabitants per day

12
11
10
9
8
7
6
5
4
3
2
1

1997-1999aFinlandUnitedKingdom

Australia

AndorraNew Zealand

Belgium

Germany

Netherlands

SwedenDenmark

Switzerland

CanadaIsrael

NorwayUnited States

Iceland0

2007-2009

Approximate consumption calculated by the Board.

29

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

74. As previously noted by the Board, the diversion and abuse of stimulants in Schedule II of the1971 Convention take place in countries with very high levels of consumption of those substances.
The Board reiterates its request to all Governments to ensure that the control measures foreseen in
the 1971 Convention are fully applied to stimulants in Schedule II.

E. Stimulants in Schedule IV of the 1971 Convention that are used
as anorectics

75. The stimulants in Schedule IV of the 1971 Convention are used mainly as anorectics. The mostfrequently used stimulant in Schedule IV is phentermine, followed by fenproporex, amfepramone
and mazindol.

Figure 14. All regions: average consumptiona of central nervous system stimulants in ScheduleIV, 1997-1999 and 2007-2009

11

S-DDD per 1,000 inhabitants per day

10
9
8
7
6
5
4
3
2
1
0
Americas

Oceania

Europe1997-1999aApproximate consumption calculated by the Board.

30

Asia
2007-2009

AfricaAVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Figure 15. Selected countries and territories: average consumptiona of central nervous system
stimulants in Schedule IV, 1997-1999 and 2007-2009
12

S-DDD per 1,000 inhabitants per day

10

8

6

4

2

1997-1999

a

Chile

New Zealand

Netherlands

Malaysia

Paraguay

BelizeAustria

MexicoCzech
Republic

Germany

Hong Kong,
China

Switzerland

Australia

Republic of
Korea

Singapore

BrazilArgentina

United States0

2007-2009

Approximate consumption calculated by the Board.

Figure 16. All regions: number of countries and territories using central nervous system
stimulants in Schedule IV, 2007-2009

60
55

Number of countries/territories

50
45
40
35
23

30

52

36

27

25
20
15

12

5
0

18

21

10

15

4

Africa3

Americas

Countries/territories using substances

Asia

EuropeOceania

Countries/territories not using substances

31

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

76. The highest calculated consumption levels for stimulants in Schedule IV of the1971 Convention have traditionally been recorded in countries in the Americas, in particular
Argentina, Brazil and the United States. In the period 2007-2009, average calculated
consumption in the Americas continued to increase, and the United States remained the country withthe world’s highest calculated per capita consumption levels for those stimulants.
Until 2006, Brazil had similar levels of consumption. Between 2006 and 2009, Brazil succeeded in
reducing per capita consumption of those stimulants by two thirds by strictly enforcing
the prescription requirement and taking action against members of the medical profession who were
found to have acted in an unprofessional manner. The share of global calculated consumption of
stimulants in Schedule IV (expressed in S-DDD) accounted for by the United States increased
from 58 per cent in 2008 to 71 per cent in 2009. The declining demand for stimulants has been
noted by the industry: in 2009 global manufacture of this group of stimulants decreased by 25 percent from the level of previous years, mainly because of a drop in the manufacture of fenproporex
in Brazil.
77. About 75 countries and territories report regular use of stimulants included in Schedule IV of
the 1971 Convention. Figure 15 reflects the fact that consumption levels of those stimulants vary
greatly between countries and regions, whereas figure 16 shows for each region the number ofcountries and territories that reported such use. In about 60 per cent of all the countries andterritories, those stimulants appear not to be available; their availability is particularly limited in
Africa, the island countries of Oceania and much of Asia.
78. In a number of countries, high prescription levels for stimulants in Schedule IV have led to thediversion and abuse of those stimulants. The Board encourages Governments to remain vigilant andidentify consumption levels that are inappropriate and/or not required for sound medical
practice and to take steps to fully apply the control measures foreseen in the1971 Convention.

F. Benzodiazepines
79. For benzodiazepines, global calculated consumption shows a slight increase in the last
decade. During that period, practically all countries and territories that reported to the Board
manufactured or traded in benzodiazepines in quantities of more than 1 kg at least once. Among
anxiolytics, alprazolam and diazepam are the most used substances, whereas triazolam was themost consumed sedative-hypnotic. Reporting obligations for substances included in Schedules III
and IV, such as benzodiazepines, are less stringent than for Schedule II substances. Calculated
consumption levels for these types of substances are therefore more approximate than for Schedule II
substances.23__________________
23

Figures 17 to 28 provide information on global and regional developments in consumption levels of benzodiazepines over the last
10 years. Owing to the significant differences in consumption levels, the scales used in the figures vary.

32

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Benzodiazepine-type anxiolytics

80. As can be seen in figure 17, consumption levels of benzodiazepine-type anxiolytics arehighest in countries in Europe, reflecting the fact that benzodiazepines tend to be prescribedfrequently for the elderly. As reflected in figures 19 to 22, consumption levels of benzodiazepine-type
anxiolytics in countries outside of Europe in the period 2007-2009 tended to be lower than
20 S-DDD per thousand inhabitants per day, although there were a few exceptions.

Figure 17. All regions: average consumptiona of benzodiazepines (anxiolytics), 1997-1999
and 2007-2009

45

S-DDD per 1,000 inhabitants per day

40
35
30
25
20
15
10
5
0
EuropeAmericas

Oceania
1997-1999a

Asia

Africa2007-2009

Approximate consumption calculated by the Board.

81. Consumption of anxiolytics in many countries in Europe during the last decade increased
from an already high level. Between 2007 and 2009, in 12 countries (about 27 per cent of theregion), calculated average consumption levels exceeded 40 S-DDD per thousand inhabitants, and inanother 14 countries (31 per cent) those levels were between 20 and 40 S-DDD per thousand
inhabitants. Countries in Western and South-Eastern Europe have the highest consumption levels in
the region.

33

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

Figure 18. Europe (selected countries): average consumptiona of benzodiazepines (anxiolytics),
1997-1999 and 2007-2009

S-DDD per 1,000 inhabitants per day

110
100
90
80
70
60
50
40
30
20
10

1997-1999

Malta

CyprusLithuania

Luxembourg

AndorraIrelandc

Italy

Montenegrob

FranceHungary

Slovenia

Spain

The former
Yugoslav Republicof Macedonia

Croatia

Portugal

SerbiabBelgium0

2007-2009aApproximate consumption calculated by the Board.
Countries constituted after 1999, therefore, no data are available for the period 1997-1999.
c
Data received do not allow calculation of approximate consumption for the period 1997-1999.
b

82. In Africa, Ghana showed the highest average calculated consumption of anxiolytics(16 S-DDD per thousand inhabitants) in the period 2007-2009. For six countries (Algeria, Benin,
Cape Verde, Democratic Republic of the Congo, Tunisia and South Africa), consumption was
between 5 and 10 S-DDD per thousand inhabitants per day. Eight countries, as shown in figure 19,
had consumption levels between 1 and 5 S-DDD per thousand inhabitants per day, whereas in allother countries and territories (73 per cent of the region) less than 1 S-DDD per thousand inhabitants
per day was consumed.
83. In Asia, seven countries (Islamic Republic of Iran, Iraq, Israel, Japan, Jordan, Pakistan andRepublic of Korea) (15 per cent of the countries and territories) showed an average calculated
consumption level of anxiolytics higher than 10 S-DDD per thousand inhabitants per day between
2007 and 2009, whereas in four countries and two territories (Lebanon, Sri Lanka, Syrian Arab
Republic, Thailand, Hong Kong, China and Macao, China) consumption levels between 5 and
10 S-DDD per thousand inhabitants per day were observed. Ten countries (Bahrain,
Cambodia, China, Georgia, India, Kuwait, Republic of Korea, Singapore, Turkey and Yemen)
consumed between 2 and 5 S-DDD per thousand inhabitants per day. The remaining
44 per cent of the countries and territories in Asia consumed less than 2 S-DDD per thousand
inhabitants per day.

34

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Figure 19. Africa (selected countries): average consumptiona of benzodiazepines (anxiolytics),
1997-1999 and 2007-2009

16
14
12
10
8
6
4

1997-1999a

Mauritania

Togo

Burkina Faso

UnitedRepublic of
Tanzania

Mauritius

MoroccoSouth Africa

Tunisia

Democratic
Republic of
the Congo

Cape Verde

Benin

Algeria

Ghana

0

Egypt

2

Malawi

S-DDD per 1,000 inhabitants per day

18

2007-2009

Approximate consumption calculated by the Board.

Figure 20. Asia (selected countries and territories): average consumptiona of benzodiazepines(anxiolytics), 1997-1999 and 2007-2009

24
20
16
12
8

a

1997-1999

Georgia

India

Singapore

BahrainHong Kong,
China

Macao, China

Sri Lanka

Syrian Arab
Republic

Thailand

Lebanon

Iraq

Pakistan

Republic of Korea

JordanIsrael

0

Japan

4

Iran (Islamic
Republic of)

S-DDD per 1,000 inhabitants per day

28

2007-2009

Approximate consumption calculated by the Board.

35

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

84. In Oceania, two countries and two territories (Australia, New Zealand, French Polynesia and
New Caledonia) consumed on average more than 5 S-DDD of anxiolytics per thousand inhabitants
per day in the period 2007-2009. All other countries and territories consumed considerably less.
85. In the Americas there are significant disparities in consumption levels of anxiolytics, as shownin figure 22. Apart from Argentina, the United States and Uruguay, which consumed on average
more than 20 S-DDD of anxiolytics per thousand inhabitants per day between 2007 and 2009, six
countries (Brazil, Canada, Chile, Cuba, Guyana and Paraguay) consumed between
10 and 20 S-DDD per thousand inhabitants per day, and five countries consumed between 5 and
10 S-DDD per thousand inhabitants per day. The great majority of countries and territories in theregion (70 per cent) consumed less than 5 S-DDD of anxiolytics per thousand inhabitants per day.
The high consumption levels observed for Argentina and Uruguay, which might indicate excessive
availability and non-implementation of the prescription requirements foreseen by the1971 Convention, may be related to the very high consumption of anorectics in the subregion.
Figure 21. Oceania (selected countries and territories): average consumptiona of
benzodiazepines (anxiolytics), 1997-1999 and 2007-2009

S-DDD per 1,000 inhabitants per day

20
18
16
14
12
10
8
6
4
2

1997-1999a

VanuatuFiji

Papua New
GuineaMarshallIslands

Cook Islands
Islands
Cook

Tonga

Palau

WallisWallisandandFutunaFutunaNew ZealandFrenchFrenchPolynesia
Polynesia

New
New Caladonia
Caledonia

Australia

02007-2009

Approximate consumption calculated by the Board.

Benzodiazepine-type sedative-hypnotics
86. Among all the regions, calculated consumption levels of benzodiazepine-type sedativehypnotics were consistently highest in Europe, as shown in figure 23. However, consumption of
benzodiazepine-type sedative-hypnotics decreased in many countries in Europe and elsewhere inmuch more pronounced fashion than in the case of anxiolytics, from the levels observed a decade
before, reflecting changes in the types of benzodiazepines that were prescribed in medical practice.
36

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Figure 22. Americas (selected countries and territories): average consumptiona of
benzodiazepines (anxiolytics), 1997-1999 and 2007-2009

100
90
80
70
60
50
40
30
20

1997-1999a

MexicoNicaragua

Venezuela(Bolivarian
Republic of)

Peru

Suriname

Paraguay

Chile

GuyanaCanadaCuba

United States

Argentina

Uruguay0

Netherlands
Antilles10
BrazilS-DDD per 1,000 inhabitants per day

110

2007-2009

Approximate consumption calculated by the Board.

Figure 23. All regions: average consumptiona of benzodiazepines (sedative-hypnotics),
1997-1999 and 2007-2009

24

S-DDD per 1,000 inhabitants per day

22
20
18
16
14
12
10
8
6
4
2
0
EuropeAsia

Oceania
1997-1999aAmericas

Africa2007-2009

Approximate consumption calculated by the Board.

37

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

87. In Europe, as shown in figure 24, in the period 2007-2009 average consumption levels of
benzodiazepine-type sedative-hypnotics exceeded 10 S-DDD per thousand inhabitants in
13 countries (about 30 per cent of the region), and in another 8 countries (Andorra, Croatia, Greece,
Ireland, Malta, Norway, Serbia and United Kingdom, accounting together for 18 per cent of theregion) the corresponding consumption levels exceeded 5 S-DDD per thousand inhabitants.
Countries in Western Europe showed the highest consumption levels in the region of this group ofbenzodiazepines.

88. In Africa, during the period 2007-2009 only Mauritius and South Africa showed anaverage calculated consumption of sedative-hypnotics higher than 1 S-DDD per thousand
inhabitants. For five other countries (Cape Verde, Libyan Arab Jamahiriya, Namibia, Nigeria
and Seychelles), consumption was between 0.1 and 1 S-DDD per thousand inhabitants per day.
In five countries (Angola, Chad, Côte d’Ivoire, Ghana and Zambia) consumption levels were
between 0.03 and 0.1 S-DDD per thousand inhabitants per day, whereas in all other countries andterritories (82 per cent of the region) less than 0.03 S-DDD per thousand inhabitants per day was
consumed.

Figure 24. Europe (selected countries): average consumptiona of benzodiazepines(sedative-hypnotics), 1997-1999 and 2007-2009

S-DDD per 1,000 inhabitants per day

55
50
45
40
35
30
25
20
15
10
5

1997-1999aApproximate consumption calculated by the Board.

38

2007-2009

Hungary

PolandNetherlands

CyprusAustria

Germany

FrancePortugal

Spain

Luxembourg

Finland

Italy

Belgium

0AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

4.2

Figure 25. Africa (selected countries): average consumptiona of benzodiazepines(sedative-hypnotics), 1997-1999 and 2007-2009

S-DDD per 1,000 inhabitants per day

2.0

1.5

1.0

0.5

1997-1999

a

Ghana

ZambiaChad

Ascension
islandCôte d'Ivoire

AngolaTunisia

Libyan Arab
Jamahiriya

Namibia

Nigeria

Cape Verde

Seychelles

South Africa

Mauritius

0.0

2007-2009

Approximate consumption calculated by the Board.

17.8

45.8

4

3

2

1997-1999

a

Qatar

Lebanon

Nepal

Maldives

Iran (Islamic
Republic of)United ArabEmirates

Macao,
China

Bangladesh

India

Malaysia

Pakistan

Hong Kong,
China

China

Bahrain

Singapore

Japan

0

Republic of
Korea

1

IsraelS-DDD per 1,000 inhabitants per day

5

38.7

Figure 26. Asia (selected countries and territories): average consumptiona of benzodiazepines(sedative-hypnotics), 1997-1999 and 2007-2009

2007-2009

Approximate consumption calculated by the Board.

39

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

89. In Asia, consumption levels of benzodiazepine sedative-hypnotics tend to be very low, except inIsrael and Japan, which are the two countries in Asia with the largest populations of elderly people.
The high consumption levels observed in Japan might also reflect inappropriate prescribing patterns
and associated abuse. In the period 2007-2009, apart from Israel and Japan, four countries (Bahrain,
China, Republic of Korea and Singapore) had consumption levels of more than 1 S-DDD of thisgroup of benzodiazepines per thousand inhabitants per day, whereas the majority of countries andterritories in the region (88 per cent) had levels of less than 1 S-DDD per thousand inhabitants perday.
90. In Oceania, in the period 2007-2009, only Australia and New Zealand had an
average calculated consumption level of benzodiazepine-type sedative-hypnotics above
1 S-DDD per thousand inhabitants per day. Six other countries and territories had consumption
levels of at least 0.01 S-DDD of this group of benzodiazepines per thousand inhabitants per day, as
shown in figure 27. Although Fiji, the Marshall Islands, Papua New Guinea and Vanuatu imported
and used benzodiazepine-type sedative-hypnotics, their calculated consumption levels were less than
0.01 S-DDD per thousand inhabitants per day.

Figure 27. Oceania (selected countries and territories): average consumptiona of
benzodiazepines (sedative-hypnotics), 1997-1999 and 2007-2009

S-DDD per 1,000 inhabitants per day

16
14
12
10
8
6
4
2

a

1997-1999

VanuatuFiji

Papua New
GuineaMarshallIslands

Tonga

Palau

Wallis andFutunaCook
Islands

FrenchPolynesia

New Caledonia

New ZealandAustralia

02007-2009

Approximate consumption calculated by the Board.

91. In the Americas, in the period 2007-2009, Cuba and Uruguay had consumption levels averaging
more than 10 S-DDD of benzodiazepine-type sedative-hypnotics per thousand inhabitants per day.
Three countries (Canada, Paraguay and United States) had levels between 2 and 10 S-DDD per
thousand inhabitants per day, and five countries and one territory (Argentina, Brazil, Chile, Panama,

40

AVAILABILITY OF MEDICINES CONTAINING INTERNATIONALLY CONTROLLED SUBSTANCES

Venezuela (Bolivarian Republic of) and Netherlands Antilles) had levels between 1 and 2 S-DDD per
thousand inhabitants per day. The great majority of countries and territories in the region(80 per cent) had consumption levels of less than 1 S-DDD of benzodiazepine-type sedativehypnotics per thousand inhabitants per day.

Figure 28. Americas (selected countries and territories): average consumptiona of
benzodiazepines, 1997-1999 and 2007-2009

24
22
20
18
16
14
12
10
8
6
4

1997-1999aEcuadorEl Salvador

Colombia

Costa Rica

MexicoChile

PanamaVenezuela(Bolivarian
Republic of)Argentina

Paraguay

United States

CanadaUruguay

Cuba

0

Netherlands
Antilles2
BrazilS-DDD per 1,000 inhabitants per day

26

2007-2009

Approximate consumption calculated by the Board.

41

V

Achieving a balance between ensuring
availability of internationally controlled
substances for medical and scientific purposes
and preventing their diversion and abuse

92. As affirmed in Commission on Narcotic Drugs resolution 53/4, on promoting adequate
availability of internationally controlled licit drugs for medical and scientific purposes while
preventing their diversion and abuse, the balance between adequate availability of these drugs
and prevention of their diversion and abuse is at the core of the international drug control
conventions. While in the absence of indicators of appropriate use it is at present not possible todetermine what appropriate consumption levels would be in individual countries, let alone at the
global level, it is possible to identify consumption levels that appear to be much too low ordisproportionately high.
93. In the case of countries with nil or practically nil consumption levels, such indicators foradequate levels are not required, as there can be no doubt as to the inadequacy of availability. The
Board considers all levels of consumption of narcotic drugs below 200 S-DDD per million inhabitants
per day inadequate. However, this does not imply that levels above 200 S-DDD can be consideredadequate as the determination of whether availability of internationally controlled substances
required for treatment is sufficient depends on the specific morbidity data.
94. It may be of help to compare consumption levels between countries with similar levels of socioeconomic development to determine whether a country’s per capita consumption of certain drugs is
in line with the levels prevalent in comparable countries. However, this method has two
shortcomings. Low levels of consumption of internationally controlled substances are prevalent incertain regions. The fact that the majority of countries in a region record the same inadequately low
levels of consumption does not make those levels adequate, but only indicates that most of thecountries in the region face the same problem. On the other hand, disproportionately high levels of
consumption of certain substances in a number of countries with comparable levels ofsocio-economic development do not make these consumption levels adequate. They could also
indicate that prescription levels in all of those countries may be too high, and there could be a varietyof reasons for this.
95. At present, therefore, circumstantial indicators are used to support other indicators of whether
consumption levels are too low or too high. Reports on untreated patients and on difficulties in
obtaining required medications indicate serious impediments to availability. Reports on diversion ofinternationally controlled substances from domestic distribution channels, on large-scale smugglingof such substances, on trafficking and on significant abuse might indicate availability ofinternationally controlled substances above levels required for sound medical practice.

43

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

A. Impediments to availability of opioid analgesics
96. The level of consumption of opioid analgesics in a country is generally correlated with its levelof socio-economic development. There are a variety of factors determining why specific countries arefound to have the highest levels of consumption of opioid analgesics in their region, including goodreporting to and cooperation with the Board.
97. The Board has on a number of occasions drawn the attention of Governments to the causes oflimited availability of opioids under international control. The causes include regulatory, attitudinal,
knowledge-related, economic and procurement-related problems that adversely affect availability. In
a recent survey conducted by the Board24 on impediments to the availability of opioids for medical
needs,25 a majority of Governments reported that attitude- and knowledge-related impediments —namely, addiction-related concerns among health-care professionals and patients and insufficienttraining for health-care professionals — continued to be the main factors contributing to theunderuse of opioids. Unduly restrictive laws and burdensome regulations were also commonly
perceived as playing a significant role in limiting the availability of opioids. A smaller number ofGovernments reported that difficulties involving distribution and supply and the high cost of opioids
were major obstacles to making opioids adequately available. The most important impediments listed
by countries were concerns about addiction, reluctance to prescribe or stock and insufficient training
for professionals. The ranking of importance of the various impediments as indicated by countries
responding to the survey is shown in figure 29.
Figure 29.

Main factors affecting the availability of opioids for medical needs

Concerns about addiction

67

Reluctance to prescribe or stock

43

Insufficient training for professionals

42

Law restricting activities

37

Administrative burden

25

Cost

19

Difficulties in distribution

13

Insufficient supply

12

Absence of policy

9
0

10

20

30

40

50

60

70

Number of replies

Note: The results shown in the figure are based on replies submitted by countries and territories in response to a specificmultiple-choice question. They could choose one or more responses.
__________________
24
25

The survey was carried out by means of the questionnaire on which figure 29 is based.
Report of the International Narcotics Control Board on Follow-up to the Twentieth Special Session of the General Assembly(United Nations publication, Sales No. E.09.XI.7).

44

ACHIEVING A BALANCE: ENSURING AVAILABILITY OF CONTROLLED SUBSTANCES AND PREVENTING THEIR DIVERSION AND ABUSE

98. In many countries with low consumption levels for opioids, the availability of opioids is
influenced by a combination of regulatory, knowledge-related and economic factors. Those factors
are clearly not independent of one another; for example, it may be more difficult to bring about
regulatory reforms in a country where concerns about drug addiction are pervasive among
policymakers and health-care professionals. Overcoming those impediments therefore requires amultifaceted approach and the participation of a broad range of stakeholders from the relevant
governmental regulatory bodies, health-care professionals and non-governmental organizations
active in the field of health care.
99. France has successfully developed and implemented a multifaceted programme to ensure theadequate availability of opioid analgesics for the treatment of pain. Over the past decade, per capita
consumption of opioid analgesics used in the treatment of moderate and severe pain has increased
more than fivefold in France, making it one of the countries with apparently adequate andappropriate levels of consumption of opioid analgesics under international control.
100. After it was recognized that in France the level of consumption of analgesics was too low andpain was not being adequately treated in the health-care system, legislative and policy changes wereintroduced to promote the implementation of successive national action plans to combat pain,
starting in 1989. Ensuring that health-care professionals are adequately educated about the treatmentof pain has been an important element of each action plan. To that end, modules on pain treatment
and palliative care were introduced into the curricula of medical and nursing schools, andprogrammes about pain treatment were developed to provide continuous training for personnel inhealth-care facilities. At the same time, a number of regulatory reforms made it less difficult for
opioids to be procured, prescribed and dispensed. Examples of such reform measures that have had asignificant impact on the effective treatment of pain include extending the validity of prescriptions
for opioid analgesics from 7 to 28 days and allowing nurses to administer opioids in the absence of a
doctor. While promoting the consumption of opioids for the treatment of pain, the Government ofFrance has, at the same time, established mechanisms to monitor and prevent the abuse and diversionof those substances. All of the above activities remained within the frame of the international
conventions.
101. While increases in consumption levels for opioid analgesics may be easier to achieve incountries that, like France, have adequate resources for health care, such improvements are also
possible in countries with more limited resources, such as Uganda. Over the past 10 years, morphine
consumption in Uganda has increased steadily, as a result of the expansion of a programme thatprovides home-based palliative care to patients throughout the country. In Uganda, as in France, key
factors in the successful implementation of this approach include the commitment of theGovernment to making relief from pain a health-care priority and the education of health-care
professionals about the use of opioids and palliative care. Another important step towards ensuring
access to morphine for patients in a range of health-care settings has been the introduction of legal
reforms allowing nurses to prescribe morphine. That is an example of the kind of task-shifting
recommended by WHO26 to increase access to health-care services in situations where there is a
shortage of health-care workers. Developing systems for the reliable procurement of morphine and__________________
26

World Health Organization, Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams — Global
Recommendations and Guidelines (Geneva, 2008).

45

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

making it available for oral administration, at a low cost, have also been essential to efforts to broaden
access to that drug. Again all of the activities remained within the frame of the international
conventions.
102. The examples of France and Uganda show that increased consumption of opioid analgesics canbe achieved with strong governmental support through a multipronged strategy to remove
impediments to their availability. Although many countries in Europe have consumption levels for
opioids under international control that are comparable to that of France, a number of countries,
including many in Eastern Europe, currently have levels of opioid consumption that are much
lower than the level reported by France 10 years ago. For the majority of the people in many countries
in Africa, access to low-cost oral morphine is practically non-existent. Unfortunately, inadequate
access to opioids remains a reality in a large number of countries not only in Africa andEastern Europe but in all regions. The Board calls upon the Governments of those countries
to take determined steps to ensure adequate access to opioid analgesics and to reinforce theregulatory agencies, which is a key to adequate access to controlled drugs and their appropriateuse. To that end, Governments should consider the recommendations contained in the
1995 special report of the Board on the availability of opiates for medical needs,27 and in chapter I of
the Board’s report for 1999.
103. The Board notes with appreciation that in the past few years, the Governments of a number ofcountries, including Georgia, Guatemala, Panama, Serbia and Viet Nam, have introduced policy
reforms aimed at ensuring adequate access to opioid analgesics. The Governments of those countries
and others that are in the initial stages of developing strategies for improving the availability ofopioids should provide strong support for the implementation of those strategies. Mechanisms
should be in place for monitoring the implementation and the long-term effectiveness of policies toimprove access to opioids.
104. The Board is of the opinion that there is an urgent need for some Governments to take specificmeasures to ensure that their populations have adequate access to opioid-based medications inaccordance with the international drug control conventions. In particular, Governments of countries
in which opioid consumption is below 100 S-DDD per million inhabitants per day and Governmentsof countries with no opioid consumption at all should immediately take appropriate action to ensure
access to such medications. The key element is an effective regulatory body. It is not admissible thatlarge parts of the world remain seriously undersupplied with medicines that are necessary to alleviate
the pain and suffering of patients.
105. The Board calls the attention of Governments to the fact that accurate estimation ofrequirements for internationally controlled substances is essential to ensure the adequate availabilityof those substances for medical and scientific purposes. Poor estimation of those requirements canlead to many problems in the use of controlled substances in the health-care system, such as
shortages, irrational prescribing, distortion of demand and low cost-effectiveness; it can also lead tosurpluses and increased risk of diversion of controlled substances. Proper use of the system of
estimates for narcotic drugs and the system of assessments for psychotropic substances is important
to ensure adequate availability of internationally controlled substances. For this purpose, national__________________
27

Availability of Opiates for Medical Needs (see footnote 8 above).

46

ACHIEVING A BALANCE: ENSURING AVAILABILITY OF CONTROLLED SUBSTANCES AND PREVENTING THEIR DIVERSION AND ABUSE

competent authorities need to ensure that health-service providers can easily communicate theirrequirements to them.

B. Availability of internationally controlled substances above levels
required for sound medical practice106. Lack of availability of narcotic drugs and psychotropic substances may deprive patients of theirfundamental rights and the opportunity to have relief from physical pain and from suffering due tomental illness. On the other hand, excessive availability of these drugs can lead to diversion and abuse
and subsequently to drug dependence. Over recent years the Board has noted with increasing concernthat the abuse of internationally controlled substances, diverted into illicit channels at various stagesof their distribution, continues to be widespread in many countries and has in some countries
reached or overtaken the levels of abuse of illicit drugs.
107. In a number of countries, the abuse of pharmaceuticals containing controlled substances issecond only to the abuse of cannabis. The pharmaceutical preparations diverted and abused containvarious opioids, benzodiazepines and amphetamine-type stimulants. Among opioids, diversion of
preparations containing buprenorphine, codeine, dextropropoxyphene, fentanyl, hydrocodone,
methadone, morphine, oxycodone and trimeperidine account for the largest quantities diverted.
Among the psychotropic substances, alprazolam, buprenorphine, diazepam, flunitrazepam,
phenobarbital and phentermine are the most often diverted and abused substances.
108. Data collected by Governments suggest that abuse patterns are related to excessive overall
availability of the pharmaceutical preparations containing these substances. In particular, countries
with already elevated levels of consumption of narcotic drugs and psychotropic substancesthat experience further significant increases should be vigilant to determine whether these increases
are related to actual medical requirements or to their misuse and abuse. Changing drug prescription
and drug consumption patterns is usually a slow process, and new drug consumption habits develop
over a period of years. New fashions in drug abuse, on the other hand, develop quite fast, in particularwhen the drugs of abuse show the same effect as previously abused illicit drugs but are easier
to obtain. A culture of widespread and excessive availability of pharmaceuticals that have effects
similar to those created by illicit drugs will result in the increasing substitution of thesepharmaceuticals for illicit drugs. Reversing such a trend is difficult and requires efforts, as the abused
pharmaceuticals will remain available. This explains why, in countries with excessive availability, thenon-medical use of pain relievers, tranquillizers, stimulants or sedatives has become the fastestgrowing drug problem.
109. In most countries the problem of abuse of prescription drugs has received less attention
from drug control regulators than abuse of illicit drugs. The systematic collection of data onprescription drug abuse in household surveys is at present carried out only in the United States,
which means that reliable data on the extent of such abuse are limited to that country. The problem
is, however, not restricted to the United States. Abuse of prescription drugs is reported from all
regions in the world.

47

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

110. Abuse of prescription drugs can be as dangerous as abuse of illicit drugs. In particular, the shareof prescription opioids in cases of death related to overdose has significantly increased. This has,
unfortunately, been overlooked by the general public for a long time. Over the last decade the numberof cases of death related to prescription drug abuse has risen significantly, overtaking in somecountries the number of cases of death from overdose related to illicit drugs. However, it was only
because the deaths of several prominent entertainers were related to abuse of prescription drugs thatthe media and the broader public have taken note of the dangers of prescription drug abuse. Action
should be taken, however, before such high levels of abuse of prescription drugs are reached. Since
excessive availability is often the first step towards increasing abuse of prescription drugs, drug
control regulators need to be vigilant with regard to high consumption levels of narcotic drugs andpsychotropic substances.
111. Increasing abuse of prescription drugs has led to rising levels of poly-drug addiction, combining
licitly manufactured medicines and illicit drugs or several medicines containing internationallycontrolled substances. Equally, the abuse of combination products manufactured by thepharmaceutical industry or prescription formulas prepared in pharmacies combining several
internationally controlled substances is increasing.
112. The Board encourages all Governments to identify unusual trends in consumption levels fornarcotic drugs and psychotropic substances and to take remedial action, if required. In the absence of
accepted norms for adequate consumption, Governments may wish to analyse past trends andcompare their national consumption levels with those of other countries at a similar level of socioeconomic development.
113. Such comparisons could be carried out on the basis of the tables on the consumption of opioid
analgesics and the various groups of psychotropic substances published by the Board in its technicalreport on narcotic drugs and its technical report on psychotropic substances. The Governments ofcountries with particularly high or rising levels of consumption of narcotic drugs and psychotropic
substances should monitor the situation closely, determine whether their territories are being used forillegally operating Internet pharmacies, identify possible overprescribing or any other unprofessional
practices among medical professionals and ensure that domestic distribution channels are adequately
controlled. All Governments should implement the recommendations of WHO on the rationalprescribing of drugs and take measures to promote sound medical practices.28
114. To prevent substances under international control from being diverted in one country andsubsequently smuggled into another, Governments should harmonize at the regional and subregional
levels measures taken to reduce excessive consumption levels, so that the efforts made in one country
will not result in problematic consumption patterns shifting to neighbouring countries.
115. However, the use of certain groups of substances may not differ only between countries withcomparable levels of socio-economic development in different regions, but also between countries in__________________
28“Promoting rational use of medicines: core components”, WHO Policy Perspectives on Medicines, No. 5,
September 2002. Available at http://whqlibdoc.who.int/hq/2002/WHO_EDM_2002.3.pdf.

48

ACHIEVING A BALANCE: ENSURING AVAILABILITY OF CONTROLLED SUBSTANCES AND PREVENTING THEIR DIVERSION AND ABUSE

the same region, owing to cultural and demographic factors. For example, significant
cross-national and country-specific variations indicate considerable variances in medical practice
between otherwise similar countries, and sometimes even within countries.
116. A persistent difference in consumption of internationally controlled substances is seen in
the regional preferences for groups of psychotropic substances in Europe and in North America,
two regions with similar levels of socio-economic development. While Europe records theworld’s top use of benzodiazepines, North America records the top consumption of performanceenhancing stimulants. This may imply cultural differences, but may also be related todemographics, as benzodiazepines are taken mostly by the older segments of the population, while
performance- and body shape-enhancing drugs are consumed to a larger extent by adolescents andyounger adults.
117. The channels of supply of abused prescription drugs vary, but, in principle, once they haveleft the officially controlled supply channels they are to be found in a “parallel market” ofsometimes significant dimensions. In many countries, unregulated drug markets called “street
markets” operate in parallel to or often in the absence of licensed pharmacies. The reasons forpurchasing medications on such street markets are often related to economic factors or to an
insufficient supply through official channels. Illegally operating Internet pharmacies are another kindof parallel market. As in street markets, customers can obtain internationally controlled drugs such as
benzodiazepines, opioids, stimulants and barbiturates without a prescription. The supplies for thesemarkets are often diverted or stolen products, or unregistered, substandard or counterfeit
medications.
118. Depending on the country, the reasons for utilizing unregulated markets vary. They include
limited access to health-care facilities, lower cost of drugs, which is often related to the fact that they
are substandard or counterfeit products, overly stringent prescription requirements, the desire toobtain drugs without medical records to preserve privacy or demand for prescription drugs for abusepurposes.
119. All Governments should apply the International Narcotics Control Board guidelines for thecontrol of Internet pharmacies,29 because in some countries such pharmacies represent the principal
channel for the illicit distribution of internationally controlled substances.

C. Ensuring adequate availability in emergency situations
120. Emergency situations in the wake of natural or man-made disasters may lead to a sudden andacute need for medicines containing controlled substances. Such a situation arose following thedevastating earthquake in Haiti in January 2010. Controlled substances such as morphine andpentazocine were urgently required to provide medical care for the large number of people who had
been injured in the earthquake.
__________________
29

Guidelines for Governments on Preventing the Illegal Sale of Internationally Controlled Substances through the Internet (United
Nations publication, Sales No. E.09.XI.6).

49

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

121. Humanitarian relief agencies have often found it difficult to rapidly obtain medicines
containing controlled substances for medical care in emergency situations, in part because of thecontrol measures exerted over the international movement of such medicines. The administrativerequirements that must be fulfilled under normal circumstances to authorize the import and exportof controlled substances slow down the supply of urgently needed medicines to disaster areas. This
problem is compounded if competent national authorities in the importing countries are no longer
functioning.
122. To address that issue, WHO, in consultation with the Board, prepared the Model Guidelines for
the International Provision of Controlled Medicines for Emergency Medical Care.30 The Guidelines
provide a simplified procedure for the export of medicines containing controlled substances to behandled by reputable humanitarian relief agencies. Soon after the earthquake in Haiti, the Board sentletters to all Governments and selected humanitarian relief agencies to remind them about thesimplified procedures contained in the Guidelines.
123. Because emergency situations come about suddenly, competent authorities should be prepared
to use the simplified procedures contained in the Guidelines to expedite the supply of controlled
medicines as soon as the need arises. The Board invites Governments and humanitarian relief
agencies to bring to its attention any problems encountered in making deliveries of controlled
medicines in emergency situations. Governments may wish to include in their special stocks ofnarcotic drugs and psychotropic substances quantities to meet the need for such substances in theevent of an emergency situation.

__________________
30

World Health Organization, document WHO/PSA/96.17.

50

VI

Conclusions and recommendations

124. The International Narcotics Control Board has frequently confirmed that the underlying
principles of the international drug control treaties provide the mechanism to ensure availability ofnarcotic drugs and psychotropic substances for medical and scientific requirements while at the sametime preventing their inappropriate use and abuse. Ensuring availability of narcotic drugs andpsychotropic substances and preventing their diversion are not contradictory goals; in fact, action toachieve these two objectives can be in synergy if measures are correctly and fully implemented. The
proper interpretation of these two complementary aims is accepted by an ever-wider range ofcountries. However, substantial progress is still required in a number of countries.
125. The Board notes that, in response to previous recommendations on availability of narcotic
drugs, a significant number of Governments have increased their estimates to meet medical demand,issued national policies to improve medical use of narcotic drugs, supported educational programmes
and examined their health-care systems, laws and regulations for impediments. There have been
improvements in the adequacy of supply of certain narcotic drugs and psychotropic substances inmany countries, but there have been setbacks in others. While the most significant improvements arerecorded in highly developed countries, the setbacks, unfortunately, have occurred mostly in theregions that 20 years ago had the lowest levels of availability of internationally controlled substances.
126. As shown in the Board’s analysis, a large number of countries in many regions continue torecord inadequate levels of availability of internationally controlled substances. Africa remains theregion with the largest number of countries recording little or no availability. Other regions where thesituation has not improved, and in certain cases worsened, are Central America and the Caribbean
and South Asia. However, even in regions with overall increasing levels of availability, countries
remaining at the lower margin in terms of consumption of controlled substances record inadequately
low levels of availability.
127. Among the countries with particularly low levels of availability are a number of countries withlarge populations; thus, large parts of the world population have no access to narcotic drugs andpsychotropic substances. Also, even if countries have recorded improvements, the improvements
may not have led to levels that could be considered adequate, because of low starting levels. In spite of
the progress made towards meeting treaty objectives, relatively few countries in the world have anadequate drug supply management system and working mechanisms that ensure reliable,
needs-based assessments, equitable availability and cost-effectiveness.
128. According to the analysis of the Board, deficiencies in drug supply management remain
attributable to lack of financial resources, inadequate infrastructure, the low priority given to health51

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

care, weak government authority, inadequate education and professional training, and outdated
knowledge, which together affect the availability of not only controlled drugs but all medicines.
129. Substantial improvement in the availability of narcotic drugs and psychotropic substances islinked to progress in the availability of medicines in general, particularly in countries with limited
resources for health, where growing economic disparities, pressing basic needs and poor
infrastructure are the principal barriers to any lasting improvement. During recent years
international awareness has increased, and efforts to facilitate the supply of licit drugs tounderdeveloped areas are carried out by intergovernmental and non-governmental organizations.
However, despite growing global awareness of the prevailing unsatisfactory situation, a considerable
number of countries continue to show no appreciation of the problem itself or of the relative easewith which efficient treatment can be provided.
130. It appears that a number of countries have not yet recognized that adequate availability of
medicines, including narcotic drugs and psychotropic substances, is an essential part of their
responsibility towards their populations. Negligence towards this responsibility is shown whencountries do not even estimate their requirements and appear to have no knowledge about thequantities of certain drugs their populations would require for medical treatment. In other countries,
where such negligence is not observed, other obstacles continue to prevail, including outdated
restrictive regulations and, more frequently, uninformed interpretations of otherwise correct
regulations, misguided fears and ingrained prejudices about using opioids for medical purposes.
131. The Board has always emphasized that the efforts to limit the use of narcotic drugs andpsychotropic substances to medical and scientific purposes must not adversely affect their availability
for such purposes. On the other hand, increasing the use of certain controlled drugs for legitimate
medical purposes needs thorough monitoring. Careful attention has to be given to ensuring thelegitimate absorption capacity of countries and the proper functioning of safeguard mechanisms inorder to minimize misuse and leaks in the system. The Board is of the opinion that a well-educatedand functioning control-system administration is a prerequisite for ensuring availability, as it will beable to determine the quantities required and will identify shortages and problems in distribution. A
functioning control-system administration will also be a responsible partner for cooperation withprofessional and consumer associations.
132. The overall goal of a well-functioning national and international system for managing theavailability of narcotic drugs and psychotropic substances should be to provide relief from pain andsuffering by ensuring the safe delivery of the best affordable drugs to those patients who need themand, at the same time, to prevent the diversion of drugs for the purpose of abuse. To ensure this,Governments need to fulfil the following essential tasks:

Recommendations on availability of narcotic drugs and psychotropic substances(a) Governments should assess the actual requirements of the national health systems forinternationally controlled substances; calculate their annual requirements for such substances andfurnish the Board with timely estimates for narcotic drugs and assessments for psychotropic

52

CONCLUSIONS AND RECOMMENDATIONS

substances. In case national requirements are at the lower margin of levels of requirements in theregion, Governments may need to critically examine their methods for assessing their medical
requirements for narcotic drugs and psychotropic substances;(b) Governments should identify impediments to availability of narcotic drugs andpsychotropic substances (policy, regulatory, administrative) and take detailed, step-by-step measures
to remove those impediments;(c) Governments should establish a system to collect information from medical facilities thatprovide care for the mentally ill, addicts and surgery, cancer and other patients, from organizations
that are working to improve the appropriate use of narcotic drugs and psychotropic substances, andshould establish groups of knowledgeable individuals to assist in obtaining information aboutchanging medical needs; they should also make use of available guidelines on assessing the actual
requirements for narcotic drugs and psychotropic substances for their country;(d) Once a country has reached an appropriate level of consumption of narcotic drugs andpsychotropic substances, Governments should add to their annual estimates of requirements fornarcotic drugs and assessments for psychotropic substances a margin to allow for the possibility ofincreased consumption from such general causes as population growth, evolution of health services
and trends in the incidence of diseases and their treatment and, if need be, should add an even greater
margin in countries or territories where there is rapid economic and social development or rapid
expansion of the medical use of drugs, including the introduction of new formulations or drugs;(e) Governments that experience interruptions in the supply of narcotic drugs andpsychotropic substances because of delays in importation or for other reasons should examine thesituation and develop a system to accomplish in a timely manner the steps involved, such as issuinglicences, arranging for payment, carrying out paperwork, transporting the drugs, taking the drugs
through customs and distributing the drugs to medical facilities;(f) Governments should determine whether their national narcotics laws contain elements of
the 1961 Convention as amended by the 1972 Protocol that take into account the fact that the medical
use of narcotic drugs continues to be indispensable for the relief of pain and suffering and the factthat adequate provision must be made to ensure the availability of narcotic drugs for such purposes
and to ensure that administrative responsibility has been established and that personnel are available
for the implementation of those laws;(g) Governments should determine whether there are undue restrictions in national narcotics
laws, regulations or administrative policies that impede the prescribing or dispensing of, or needed
medical treatment of patients with, narcotic drugs or psychotropic substances, or their availability
and distribution for such purposes, and, should this be the case, make the necessary adjustments;(h) To promote adequate availability of psychotropic substances globally and in specificcountries pursuant to Commission on Narcotic Drugs resolution 53/4, Governments should collectthe most reliable statistical data on the consumption of psychotropic substances and submit that
information to the Board in timely fashion;

53

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS(i) Governments should fully cooperate with the Board in ensuring adequate availability ofnarcotic drugs and psychotropic substances; they should examine their medical needs for narcotic
drugs and psychotropic substances, as well as the impediments to their availability, advise theBoard of the results of those efforts and inform the Board if it can be of assistance; they should also
inform the Board about progress and needs concerning implementation of the present
recommendations;

Recommendations on appropriate use(j) Governments should ensure the correct education and training of health professionals andshould inform health professionals about the WHO analgesic method for cancer pain relief; theyshould communicate with health professionals about the legal requirements for prescribing anddispensing narcotic drugs and psychotropic substances and should provide an opportunity to discuss
mutual concerns;(k) Governments should ensure that comprehensive curricula on substance abuse andrational use of psychoactive drugs are used in relevant faculties of universities, medical,
pharmaceutical and nursing schools and other health-care institutes;(l) Governments should stimulate, through regulation and monitoring, ethical behaviour indrug marketing; they should ensure high professional standards in therapy (diagnosis, deciding on
therapy, prescribing);(m) Governments should educate the public in the appropriate use of narcotic drugs andpsychotropic substances and in the correct use of pharmacotherapy with other therapeutic options,and should enlist in this effort the active participation of professional organizations and consumer
associations;(n) Governments should establish a comprehensive registration and authorization system andselect carefully and support safer and more cost-effective drugs and reliable alternative treatment
modalities;(o) Governments should also encourage the development and use of better and safer
therapeutic agents (with little or no dependence potential) to replace medicines with limited
efficacy and safety. Countries experiencing abuse problems with regard to combination products orprescription formulas have a responsibility to make sure that action is taken to prevent such abuse;

Recommendations on national control systems(p) Governments should endeavour to keep the supply and consumption of internationallycontrolled substances under close supervision. Experience has shown that particular attention needs
to be given to adequate legislation and correct administrative arrangements, adapted, as required, to
new trends and developments;

54

CONCLUSIONS AND RECOMMENDATIONS(q) Governments should establish a sufficient degree of government authority and regulatory
control over the national drug supply, including the control of narcotic drugs and psychotropic
substances;(r) Governments should conduct inspections of manufacturers, exporters, importers andwholesale and retail distributors, as well as of stocks and records, and take appropriate action against
those who fail to comply with applicable legal requirements and professional codes of conduct.
Activities of market intermediaries such as brokers must be regulated, as appropriate;(s) Governments need to ensure adequate financial and human resources for their drug
regulatory authorities and other agencies and provide capacity-building to their staff;(t) Governments need to implement effective policies to combat counterfeit drugs andprovide a comprehensive legal framework to make trading in counterfeit products a serious criminal
offence; exporting countries must regulate the process with a view to preventing the export of drugs
that are counterfeit or of poor quality;(u) Governments should be aware and make the best use of the Model Guidelines for theInternational Provision of Controlled Medicines for Emergency Medical Care;

Recommendations on prevention of diversion and abuse(v) Governments should enforce existing legislation to ensure that narcotic drugs andpsychotropic substances are not illegally manufactured, imported or exported and are not diverted tothe unregulated market;(w) Governments should collect data on the abuse of prescription drugs in a more systematicmanner and include in their national surveys on drug abuse, as far as possible, pharmaceuticals
containing narcotic drugs and psychotropic substances, by including either specific groups ofsubstances or specific narcotic drugs and psychotropic substances, as required;(x) Considering the international nature of the problem and to complement the efforts of law
enforcement in individual countries in the above-mentioned areas, Governments, as well as regional
and international organizations, should develop intergovernmental agreements for effective joint
operations and arrangements and standards to be applied at the regional level;(y) Governments should take prompt and effective action to implement previous
recommendations of the Board on Internet trading and on the misuse of the mail for smuggling ofinternationally controlled substances.
133. To achieve the goal of adequate availability of narcotic drugs and psychotropic substances
globally, support from the world community is required. Progress in countries with low levels of
consumption of such drugs is usually gradual. Prevailing market conditions and the present supply
system do not make it possible to ensure the availability of needed medicines in low-income

55

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

countries. Economic and financial conditions in such countries and insufficient health-care
infrastructure are impediments that cannot be overcome by those countries alone. Progress can beachieved only on the basis of a more humanitarian approach that is in line with the treaty system.
Such an approach in selected countries may include the provision of assistance in establishing morereliable baseline estimates and assessments of medical needs and consultations with potential
suppliers under preferential conditions.
134. The Board concludes that if the above recommendations are implemented, there will besignificant additional progress towards ensuring adequate availability of narcotic drugs andpsychotropic substances for medical and scientific purposes. The Board will continue its examinationof the situation and will monitor responses to its recommendations. To support progress the Board
will continue to:(a) Monitor annual estimates for narcotic drugs and assessments for psychotropic substances
submitted by Governments and initiate dialogue as necessary to identify unmet needs and ensure thatannual estimates or assessments of requirements for narcotic drugs and psychotropic substances areneither overestimated nor underestimated;(b) Ensure expeditious confirmation of supplementary estimates and processing of modified
assessments for psychotropic substances submitted by Governments to assist them in coping with
unforeseeable needs;(c) Review on a regular basis national and international developments relevant to improving
the availability of narcotic drugs and psychotropic substances for medical purposes, incorporating
updated information and observations into its annual report;(d) Encourage Governments to develop drug distribution systems that are well controlled andthat will ensure availability of narcotic drugs and psychotropic substances to patients in medical
facilities and in the community;(e) Cooperate with UNODC to include in the model national legislation on the control ofnarcotic drugs and psychotropic substances provisions that recognize the obligation to ensure theadequate availability of narcotic drugs and psychotropic substances for medical and scientificpurposes;(f) Respond to the call of the Commission on Narcotic Drugs in the area of availability ofinternationally controlled substances and support the Commission in its efforts to remind parties tothe 1961 Convention and the 1971 Convention of their obligations in this respect;(g) Cooperate with WHO to assist Governments in developing adequately controlled drug
distribution systems that are capable of providing narcotic drugs and psychotropic substances topatients in hospitals and in the community;(h) Alert the international community to new trends in abuse of pharmaceutical preparations
containing narcotic drugs and psychotropic substances;

56

CONCLUSIONS AND RECOMMENDATIONS(i) Alert the international community to emerging new methods of trafficking ofinternationally controlled substances;(j) Support Governments in implementing the provisions of the international drug control
treaties and additional control measures, as requested by the Economic and Social Council, as well as
the relevant guidelines of the Board.

57

Annex ITables on consumption of opioid analgesics in regions
Table 1
Levels of consumption of narcotic drugs: average consumption of narcotic drugs, 2007-2009, byregion per day(Defined daily doses for statistical purposes per million inhabitants per day)CodeineFentanylHydrocodone

Hydromorphone

Morphine

Oxycodone

Pethidine

Others

Total

31

3 781

6 850

337

809

2 217

40

254

14 320

North America

58

7 481

13 738

675

1 564

4 441

72

509

28 536South America

5

120

8

1

68

8

10

2

221

Central America
and the Caribbean

<<

32

4

<<

16

4

8

1

65

Oceania

70

2 727

<<

42

1 050

1 590

28

3

5 510

Europe

32

3 707

6

104

398

288

11

689

5 236

RegionAmericas

2

72

1

<<

14

7

5

4

105

West Asia

2

123

-

<<

8

8

7

7

155

East and South-East
Asia

3

102

<<

1

19

4

11

8

146

South Asia

<<

3

1

-

7

<<

1

4

17

4

22

<<

<<

10

<<

3

11

50

Asia

AfricaNote: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.

59

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

Table 2
Levels of consumption of narcotic drugs

60

Hydrocodone

Hydromorphone

Morphine

Oxycodone

Pethidine

OthersTotal

North America
11
1 United States<<of America
22
2 Canada
783
3
21
91 Mexico a
Regional average:
58
North America
South America
1
3
20 Falkland
369
Islandsa(Malvinas)
2
6
52 Argentina
143
8
55 Chile69
4
957 Colombia
51261 Brazil<<
6
13
71 Uruguay
723
97 Venezuela(Bolivarian
Republic of )8
25 105 Ecuador
9
26 106 Suriname
27
10
27 107 Peru11
31 119 Paraguay
12
33 146 Guyana
213
34 159 Bolivia(Plurinational
State of)Regional average: South5
America
Central America and the Caribbean
1
4
29 Cayman
18
Islands2
541 Netherlands
Antilles3
7
54 Turks and2
Caicos Islands
4
10
58 Bahamas
8
5
11
59 Montserrat
223
614
76 Trinidad andTobago a
715
79 Panama
8
16
83 Costa Rica
917
84 Saint Lucia
29
10
18
85 El Salvador
11
19
87 Cuba-

Fentanyl

CodeineCountry or
non-metropolitan
territoryWorldranking

Average consumption of narcotic drugs in North America, South America and Central
America and the Caribbean, 2007-2009(Defined daily doses for statistical purposes per million inhabitants per day)Ranking in theAmericas

Regional ranking

A.

9 904

20 066

673

2 060

5 962

88

734

39 487

9 432
74

253
-

2 909
1

2 080
9

4 932
1

151
-

92
-

20 63285

7 481

13 738

675

1 564

4 441

72

509

28 536

2 347

-

-

452

-

31

1 084

4 283

103
198
188
139
77
47

42
34
1
-

4
<<

250
108
42
59
76
9

12
5
24
3
14

2
7
1
17
10
1

20
1
-

443
388
295
218
164
71

50
12
26
28
4
<<

-

-

7
18
19
2
3
1

5
9
2

4
4
8
1
-

-

62
61
58
38
10
3

120

8

1

68

8

10

2

221

1 465

181

32

89

714

408

2

2 909

1 080

-

-

82

2

20

45

1 229

133

-

-

10

151

57

39

392

8
<<
17

-

-

40
14
42

96
-

140
35
78

-

292
272
137

104
41
1
48
44

4
3
-

-

7
61
21
4
36

19
-

8
2
36
16
6

2

119
104
91
90
88

Others

Total

Oxycodone

Morphine

Hydromorphone

2

14

-

-

30

-

40

-

86

1

5

-

-

30

-

49

-

85

7
-

4
16
1
30
15

21
-

-

14
4
7
7
8

4
2
1

31
3
38
<<
<<

7
<<
-

63
48
46
39
24

<<
<<

1
32

4

<<

1
16

4

<<
8

1

2
65

31

3 781

6 850

337

809

2 217

40

254

14 320Hydrocodone

Jamaica

91

Pethidine

21

Fentanyl89

Saint Vincent
and theGrenadines
14
24 103 Grenada15
28 114 Guatemala16
29 115 Dominica
17
30 118 Nicaragua18
32 129 Dominican
Republic
19
35 165 Haiti
Regional average:
Central America and the
Caribbean
Average: Americas
13

CodeineCountry or
non-metropolitan
territory

20

World
ranking

12

Ranking in theAmericas

Regional ranking

ANNEX I

Notes: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.
As at 1 November 2010, in North America, the following territory had not submitted any statistical forms for the threeconsecutive years in question: Bermuda; in Central America and the Caribbean, the following eight countries and territories
did either not submit any statistical forms or did not provide any consumption data for the three consecutive years inquestion: Anguilla, Antigua and Barbuda, Aruba, Barbados, Belize, British Virgin Islands, Honduras and Saint Kitts andNevis.
aCalculation is based on data covering two years only.

61

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

38

7

40

8

51

9

81

10

88

Total

6

Others36

Pethidine5

Oxycodone

33

Morphine

4

Hydromorphone32

Hydrocodone

3

Fentanyl

1324

Codeine1
2

Country or
non-metropolitan
territoryWorldranking

Average consumption of narcotic drugs in Oceania, 2007-2009(Defined daily doses for statistical purposes per million inhabitants per day)

Regional
ranking

B.

Australia
Norfolk
IslandNew
Caledonia
New
Zealand
Wallis andFutunaIslands
FrenchPolynesia
Christmas
Island
Palau

108
42

4 058
2 740

<<
-

64
-

1 381
393

2 367
213

31
15

4
-

8 013
3 403

-

2 187

-

17

266

9

-

-

2 479

-

637

-

<<

1 192

479

56

<<

2 364

135

823

-

-

18

-

-

1 161

2 137

-

1 263

-

7

141

6

1

-

1 418

9

818

-

-

12

487

8

-

1 334

34

2

485

-

16

-

27

-

564

Cook
Islandsa
Tonga a

-

-

-

-

41

-

66

-

107

50

3

-

-

15

-

19

-

87

5

13

-

-

14

-

21

-

53

-

7

-

-

15

-

11

-

33

-

15

-

15

-

31

b

11

111

Nauru

12

120

1

<<

-

13

123

MarshallIslandsb
Papua New
Guinea b
Vanuatu b

8

12

-

-

11

-

-

-

31

15

136

Samoa

-

1

-

-

7

-

7

-

15

70

2 727

<<

42

1 050

1 590

28

3

5 510

Regional average: Oceania

Notes: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.
As at 1 November 2010, the following six countries and territories either had not submitted any statistical forms or had notprovided any consumption data for the three consecutive years in question: Cocos (Keeling) Islands, Fiji, Kiribati, Micronesia(Federated States of), Solomon Islands and Tuvalu.
abCalculation is based on data covering two years only.
Calculation is based on data covering one year only.

62

ANNEX I

Hydromorphone

12 77210 252

41
-

615
932

3

5

Belgium

22

10 613

42

126

4

6

Denmark

-

8 078

6

74

5

7

Switzerland

6

8

Iceland

7

9

8

Total

Hydrocodone

1
17

OthersFentanyl

Germany
Austria

Pethidine

Codeine34

OxycodoneCountry or
non-metropolitan
territory

1
2

Morphine

World ranking

Average consumption of narcotic drugs in Europe, 2007-2009(Defined daily doses for statistical purposes per million inhabitants per day)
Regional ranking

C.

619
4 593

836
200

14
6

4 421
160

19 31916 160

366

72

13

3 460

14 714

1 523

2 298

75

992

13 046

98

7 649

67

232

1 238

717

80

2 963

13 044

4 818

5 607

-

48

919

249

8

841

12 490Gibraltar-

10 714

-

-

325

37

15

44

11 13510Netherlands

-

6 460

-

31

377

470

9

839

8 186

9

11

Spain

-

7 702

-

53

180

107

22

8

8 072

10

12

Finland

35

6 861

-

17

107

1 023

3

12

8 058

11

14

Norway

16

5 284

6

12

810

1 225

32

241

7 626

12

15

Luxembourg

3

5 266

<<

120

197

2

4

1 431

7 023

13

16

Sweden

-

4 763

<<

200

584

1 074

3

192

6 816

14

17

France

129

5 055

-

43

1 024

328

1

184

6 764

15

18

Slovenia

59

4 726

-

172

761

308

6

236

6 268

16

19

Ireland

-

4 413

2

111

269

525

24

<<

5 344

17

21

Greece

<<

4 217

-

<<

14

<<

18

21

4 270

18

22

1

1 281

<<

36

1 114

914

33

276

3 655

19

25

UnitedKingdom
Hungary

24

2 925

<<

57

36

19

5

300

3 366

20

26

Czech Republic

60

2 444

-

117

142

193

37

64

3 057

21

27

Slovakia

3

2 884

-

32

37

51

8

6

3 021

22

28

Italy

-

2 479

-

26

78

118

5

220

2 926

23

30

Croatia

397

2 121

-

9

51

30

4

<<

2 612

24

31

Poland

221

2 055

-

<<

171

1

20

23

2 491

25

34

Andorra

-

2 203

-

-

74

71

13

-

2 361

26

35

Portugal

89

1 454

-

6

601

-

11

5

2 166

27

37

Serbia

<<

1 285

-

21

21

<<

2

494

1 823

28

42

Lithuania

<<

999

-

-

75

<<

19

<<

1 093

29

44

Montenegro

-

919

-

-

3

-

2

3

927

30

45

Latvia

2

734

-

-

57

7

6

14

820

31

46

Estonia

<<

555

-

-

112

113

24

1

805

32

47

Cyprus

-

474

-

-

72

81

39

-

666

33

48

1

460

-

-

17

-

<<

140

618

34

53

Bosnia andHerzegovina
Bulgaria

-

95

-

-

197

31

8

81

412

35

56

Malta

<<

67

-

<<

239

-

53

2

361

36

69

Romania

-

93

-

1

34

40

5

-

173

37

74

Belarus

-

118

-

-

14

-

-

24

156

38

81

RussianFederation

<<

75

-

-

12

-

-

20

107

63

Regional ranking

World ranking

Country or
non-metropolitan
territory

CodeineFentanylHydrocodone

Hydromorphone

Morphine

Oxycodone

Pethidine

OthersTotal

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

39

98

Albania

-

28

-

-

20

-

3

18

69

40

101

Republic ofMoldova
Ukraine

-

30

-

-

27

-

-

9

66

13

11

-

-

6

-

-

2

32

The former
Yugoslav
Republic ofMacedonia

-

25

-

-

1

-

-

-

26

Regional average: Europe

32

3 707

6

104

398

288

11

689

5 236

41

122

42

127

Note: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.

64

ANNEX I

FentanylHydrocodone

Hydromorphone

Morphine

Oxycodone

Pethidine

Others

Total

2

39

Republic of
Korea

15

1 079

16

26

50

128

15

13

1 342

2

3

43

Japan

25

805

-

-

76

98

3

16

1 023

3

6

62

Hong Kong,
China

<<

89

2

<<

86

<<

20

11

208

4

7

63

Singapore

<<

127

<<

-

31

20

19

<<

197

5

13

73

Macao, China

-

100

-

-

42

<<

16

<<

158

6

15

80

Malaysia

-

60

-

-

33

5

18

<<

116

7

16

86

Brunei
Darussalam

-

34

-

-

33

-

20

2

89

8

19

99

China

2

37

<<

<<

17

2

10

<<

68

World ranking

1Ranking in Asia

CodeineCountry or
non-metropolitan
territory

Average consumption of narcotic drugs in East and South-East Asia, South Asia and West
Asia, 2007-2009(Defined daily doses for statistical purposes per million inhabitants per day)
Regional ranking

D.

East and South-East Asia

9

20

100

Thailand

<<

36

-

-

23

-

8

-

67

10

23

110

Mongolia

2

6

-

-

47

-

-

1

56

11

26

125

Democratic
People’sRepublic of
Korea

7

-

-

-

23

-

-

-

30

12

27

126

Viet Nam

-

17

-

-

8

-

4

-

29

13

35

145

Philippines

-

4

-

<<

4

2

1

-

11

14

36

148

Indonesia

-

6

-

-

1

-

2

-

9

15

41

157

Cambodia

1

3

-

-

2

-

<<

-

6

16

43

159

Lao People’s
Democratic
Republic a

-

1

<<

-

<<

-

2

-

3

17

47

179

Myanmar

<<

<<

-

-

<<

-

<<

<<

<<

3

102

<<

1

19

4

11

8

146

Regional average: East andSouth-East Asia
South Asia
1

28

127

Sri Lanka

-

3

-

-

16

-

7

-

26

2

29

130

Bhutan b

7

1

-

-

3

-

10

-

21

3

30

134

India

-

4

1

-

8

<<

<<

4

17

4

34

144

Maldivesa

-

3

-

-

4

-

5

-

12

5

36

148

Nepal

-

1

-

-

6

-

2

-

9

6

40

153

Bangladesh a

-

1

-

-

1

-

5

-

7

<<

3

1

-

7

<<

1

4

17

Regional average: South Asia
West Asia1123

Israel

86

2 719

-

2

140

500

26

9

3 482

2

4

50

Turkey

-

513

-

-

23

-

15

44

595

3

5

60

Bahrain

2

131

-

-

47

-

51

-

231

4

8

64

Saudi Arabia a

22

132

-

1

16

2

22

<<

195

65

66

Jordan-11

67

Lebanon

-

8

12

68

United ArabEmirates

<<

<<

13

5

111

-

<<

43

-

125

-

-

35

-

143

-

4

14

3

Total

10

7

-

Others6

126

Pethidine6

Oxycodone

Codeine

KuwaitMorphine

Country or
non-metropolitan
territory

65

Hydromorphone

World ranking

9

Hydrocodone

Ranking in Asia

5

Fentanyl

Regional ranking

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

41

-

191

32

-

186

24

1

185

11

4

179

9

14

75

Qatar

1

100

-

-

27

1

22

2

153

10

17

94

Georgia

<<

33

-

-

39

-

-

2

74

11

18

96

Syrian Arab
Republic

-

23

-

-

3

35

11

-

72

12

21

102

Kazakhstan

<<

40

-

-

4

-

-

20

64

13

22

103

Oman

1

33

-

-

19

-

10

<<

63

14

24

115

Iran (Islamic
Republic of )

-

28

-

-

-

-

18

-

46

15

25

117

Armenia

-

14

-

-

26

-

-

2

42

16

31

136

Azerbaijan

-

11

-

-

2

-

-

2

15

Turkmenistan

<<

3

-

-

6

-

-

6

15

18

33

140

Kyrgyzstan

<<

9

-

-

2

-

-

3

14

19

36

148

Yemen

-

7

-

<<

1

-

1

-

9

20

39

151

Uzbekistan

<<

3

-

-

3

-

-

2

8

b

21

41

157

Iraq

-

1

-

-

1

-

4

-

6

22

43

159

Pakistan

-

2

-

-

1

-

<<

-

3

Tajikistan

<<

2

-

-

<<

-

-

1

3

24

-

<<

-

-

1

-

<<

-

1

Regional average: West Asia

2

123

-

<<

8

8

7

7

155

Average: Asia

2

72

1

<<

14

7

5

4

105

46

174

AfghanistanbNotes: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.
As at 1 November 2010, in East and South-East Asia, the following country had not submitted any statistical forms for thethree consecutive years in question: Timor-Leste.
abCalculation is based on data covering two years only.
Calculation is based on data covering one year only.

66

ANNEX I

78

Seychelles

689

Libyan Arab
Jamahiriya a
Mauritiusa

Total

5

OthersTunisia

Pethidine

Algeria77

Oxycodone

72

4Morphine

3

Hydromorphone

South AfricaSaint Helena

-

125
38

<<
-

32
26

106
-

600
167

-

3

-

<<

133

162

-

59

-

3

-

123

-

-

85

-

15

-

120

-

-

1

-

23

-

86

15

-

-

24

-

36

-

75

21

-

-

14

-

38

-

73

-

-

-

-

55

-

3

-

58

Hydrocodone

49
70

FentanylCountry or
non-metropolitan
territory

1
2

CodeineWorld ranking

Average consumption of narcotic drugs in Africa, 2007-2009(Defined daily doses for statistical purposes per million inhabitants per day)
Regional ranking

E.

63
77

274
26

-

-

26

-

-

61

-

4

16

<<

62

-

7

93

8

95

9

107

10

109

Ascension
Island a
Tristan da
CunhaaNamibia

<<

22

-

-

27

-

7

1

57

11

112

Cape Verde

-

37

-

-

9

-

3

-

49

Egypt

-

41

<<

<<

4

<<

4

-

49

-

26

-

-

7

-

-

-

33

13

120

Morocco14

130

Botswana

-

1

-

-

15

-

5

<<

21

15

132

Uganda a

5

-

-

-

13

-

1

-

19

16

133

Zimbabwea

-

1

-

-

6

-

8

3

18

17

135

Kenya

-

1

-

-

6

-

6

3

16

18

136

Ghana

-

<<

-

-

1

-

14

-

15

19

140

Zambia

-

<<

-

-

4

-

10

-

14

Madagascar

-

1

-

-

<<

-

-

12

13

Malawi

<<

<<

-

-

5

-

8

-

13

b

20

142

22

146

Gabon

-

10

-

-

<<

-

<<

-

10

23

151

Lesotho a

-

1

-

-

<<

-

7

-

8

Democratic
Republic of the
Congo
Mozambique
Sao Tome andPrincipe
Mauritaniaa

4

<<

-

-

2

-

<<

-

7

-

2
7

-

-

4
<<

-

1
-

-

7
7

-

3

-

-

<<

-

-

-

3

a

-

1

-

-

2

-

-

-

3

Angola a

-

1

-

-

<<

-

<<

-

2

Benin

-

1

-

-

<<

-

1

-

2

Côte d’Ivoire

-

2

-

-

<<

-

-

-

2

24

153

27

159

29

165

SenegalEritrea

1

-

-

-

<<

-

1

-

2

Ethiopia a

<<

<<

-

-

1

-

1

-

2

Niger

<<

2

-

-

<<

-

<<

-

2

Sierra Leoneb

2

<<

-

-

<<

-

<<

-

2

Togo

-

1

-

-

<<

-

1

-

2

67

179

Morphine

Oxycodone

Pethidine

Others

Total

1

-

-

<<

-

<<

-

1

<<

-

-

<<

-

1

-

b

1
1

-

-

-

-

<<

-

1

-

Sudan

-

<<

-

-

<<

-

1

-

1

Cameroon a

-

<<

-

-

<<

-

<<

<<

<<

Chadb

-

<<

-

-

<<

-

<<

-

<<

Mali
41

Hydromorphone

Burundi a
Comoros

Hydrocodone

174

Fentanyl

Burkina Faso
37<<

CodeineCountry or
non-metropolitan
territory

World ranking

Regional ranking

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

a

-

<<

-

-

<<

-

-

-

<<

Nigeria

-

<<

-

-

<<

-

<<

-

<<

Rwanda

-

<<

-

-

<<

-

<<

-

<<

United Republicof Tanzania

-

-

-

-

<<

-

-

<<

<<

4

22

<<

<<

10

<<

3

11

50

Regional average: Africa

Notes: The symbol “<<” indicates an amount less than 1 defined daily dose for statistical purposes per million inhabitants
per day.
As at 1 November 2010, the following 10 countries either had not submitted any statistical forms or had not provided any
consumption data for the three consecutive years in question: Central African Republic, Congo, Djibouti, Equatorial Guinea,
Gambia, Guinea, Guinea-Bissau, Liberia, Somalia and Swaziland.
abCalculation is based on data covering two years only.
Calculation is based on data covering one year only.

68Annex II
Joint letter from the President of the International Narcotics
Control Board and the Chair of the United Nations
Development Group

UNITED NATIONSNATIONS UNIES
24 August 2001

Dear Colleagues,
As Resident Coordinator of the UN system at the country level, you are called upon, from time totime, to support the work and raise the concerns of UN bodies and organizations. We are writing to you toseek your support and assistance with regard to some of the issues and concerns important to theInternational Narcotics Control Board (INCB).
The INCB is the independent and quasi-judicial organ that monitors the implementation of theinternational drug control treaties. The Board is a treaty body established by the Single Convention on
Narcotic Drugs of 1961, and its thirteen members are elected by ECOSOC to serve in their personal
capacities, and not as representatives of their respective governments. The members of the Board come fromdifferent fields of expertise in dealing with the drug problem, and currently include senior police/law
enforcement officials, former diplomats, veteran medical practitioners, noted researchers and the like. The
1961 Convention requires the UN Secretary-General to provide the Board with a secretariat, and theSecretary of the Board and his staff are therefore administratively part of the United Nations International
Drug Control Programme (UNDCP) based in Vienna, Austria and report to the Board on all substantive
issues. The Board’s mandate under the Conventions is to limit to medical and scientific purposes the
manufacture of, trade in and use of drugs. The Board is accordingly endowed with regulatory and quasijudicial powers concerning the manufacture of, and trade in, medicaments containing internationallyscheduled substances. The Board and its staff also monitor the international trade in chemicals frequently
used in the illicit manufacture of drugs.
The Board’s annual report for 1999 highlighted the under-consumption and the lack of medicaments
available for the treatment of severe pain in many developing countries. Countries with a high incidence ofcancer and AIDS, for example, are directly affected as essential medicines for the treatment of severe pain
associated with such conditions are often not available. We therefore urge you to be aware of these issues
when you establish your future priorities in programmes for the development of the health sector. We also
urge you to raise this issue when you discuss health and development with government, the donor
community and non-governmental organizations in your country of operation.
Further, the INCB undertakes periodic missions to our programme countries. The purpose of themissions, which generally comprise one or two Board members and a member of the Vienna-based
secretariat, varies from country to country, and could range from encouraging accession to one or more of theinternational drug control treaties to close examination of the implementation of the treaties and fact finding.
We urge each one of you to provide your full support to these missions, and to meet with the missions to
discuss drug issues in your country of operation.
Finally, the Board launches an annual report, usually in late February, assessing the world drug
situation in relation to the international drug control conventions and reporting on the activities of thepreceding year. Your support for this event will be very much appreciated.
We look forward to your cooperation and participation, as the Resident Coordinator of the UN systemat the country level, in these areas where our mutual expertise in development work and the international
drug conventions can make a difference.

Mark Malloch Brown
Chair
United Nations Development Group

Hamid Ghodse
PresidentInternational Narcotics Control Board

69

Annex III
Follow-up joint letter from the President of the International
Narcotics Control Board and the Chair of the United Nations
Development Group
UNITED NATIONSNATIONS UNIES

24 February 2005
Dear Resident Coordinators,
As Resident Coordinators of the UN system at the country level, you are called upon to support thework as well as raise the concerns of UN bodies and organizations. As was the case in 2001, we are again
pleased to introduce the International Narcotics Control Board to you and to renew our call for your support
and assistance with regard to the issues and concerns the Board addresses.
The INCB is a treaty body established by the Single Convention on Narcotic Drugs of 1961 thatmonitors the implementation of the international drug control treaties. It is an independent and quasi-judicial
body composed of 13 members elected by ECOSOC to serve in their personal capacities, and not as
representatives of their respective governments. The members of the Board are renowned experts of thedifferent control fields. The present Board comprises senior law enforcement officials, former diplomats,veteran medical practitioners and pharmacists, demand reduction specialists, and noted academics andresearchers.
The Board is assisted in its work by a secretariat provided by the UN Secretary-General, and headed
by a Secretary. The Secretariat and the Secretary of the Board and his colleagues are administratively part of
the United Nations Office on Drugs and Crime (UNODC) based in Vienna. However, the Secretary reports
to the Board on all substantive issues.
The Board’s mandate under the Convention is to limit to medical and scientific purposes the
manufacture of, trade in and use of drugs. The Board is accordingly endowed with regulatory and quasijudicial powers concerning the manufacture of, and trade in, medicaments containing internationallyscheduled substances. Since the coming into force of the 1988 Convention, the Board also monitors theinternational trade in chemicals frequently used in the illicit manufacture of drugs.
The specific areas of cooperation we would request of you, as Resident Coordinators, include:
Field missions: To maintain dialogue at country level, the Board undertakes annually about 20
missions to different regions of the world. The purpose of the missions, which generally comprise one or two
Board members accompanied by a staff of its Vienna-based secretariat, varies from country to country, but
usually ranges from encouraging member States to accede to the international drug control treaties to close
examination of the implementation of the treaties by governments.
The missions are generally prepared and organized from the logistical point of view in cooperation
with governments and UNODC. However, in many places, your assistance is required either for arranging
the mission or providing substantive briefing to INCB mission members on the drug situation in your countryof operation.
Launch of INCB annual reports: The Board publishes an annual report on its work, which islaunched usually in February. While this is done in cooperation with UNIS, you may be called upon to assist
either at the request of the INCB or a government.
Dissemination of the findings of the Board: The findings in the Board reports are disseminatedworldwide to the general public through national and international channels. You may be called upon by
INCB to assist in this process.

71

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGS

Action-oriented programmes: The issues addressed by the Board serve as the basis for policy andaction-oriented programmes in drug control and related matters. Examples of issues dealt with by the Board
recently include the access and availability of drugs for medical use, especially in developing countries;
illicit drugs and economic development and the complex relationship between drug abuse, crime andviolence at the community level. As you can see, these issues are of direct relevance to UNDP’s mandate. As
Resident Representatives of UNDP and UN Resident Coordinators, we request you to consider their
inclusion in your future priorities in development programmes, and to raise them when you discuss withgovernment, the donor community and non-governmental organizations in your country of operation.
We look forward to your cooperation and participation, as the Resident Coordinator of the UN systemat the country level, in these areas where our mutual expertise in development work and international drug
control can make a difference.

Mark Malloch Brown
Chair
United Nations Development Group72

Hamid Ghodse
PresidentInternational Narcotics Control Board

Annex IV
Letter from the President of the International Narcotics Control
Board to all countries
UNITED NATIONSINTERNATIONAL
NARCOTICS
CONTROL BOARD

INCB

NATIONS UNIES ORGANE
INTERNATIONAL DE
OICS
CONTRÔLE DESSTUPÉFIANTS

Vienna International Centre, P.O. Box 500, A-1400 Vienna, Austria
Telephone: +43-1-26060, Telefax: +43-1-26060-5867/5868, Telex: 135612 uno a
E-Mail: secretariat@incb.org Internet Address: http://www.incb.org/

Reference: INCB 114 (3) & 121 & 141
Decision: 84/53

24 April 2006
CU 2006/74

Excellency,
On behalf of the United Nations International Narcotics Control Board (INCB), I have the honour torefer to the responsibilities of the Board under the international drug control treaties, which are to promote
Government compliance with those treaties and to monitor the functioning of the international control
system.
With a history of nearly a century, the international drug control conventions are among the oldest
international conventions ratified by most countries. National legislations are guided by these international
obligations. The purpose of the conventions was to secure a balance between the appropriate use of narcotic
drugs and psychotropic substances and their undesirable effects such as abuse and dependence. The
cornerstone of the conventions is therefore to limit the use of these drugs and substances to medical andscientific purposes. Over recent years, the Board has brought to the attention of the governments that, in
addition to international control of production/manufacture and international trade, there is a need for otheraspects of prevention, particularly demand reduction, to be promoted and advanced, if substance abuse anddependence are going to be prevented.
Health care professionals can play an important role in these efforts by ensuring that the balance
between benefit and risk is kept in mind and that the use of narcotic drugs and psychotropic substances isappropriate and in line with the pertinent recommendations of the World Health Organization (WHO) on therational use of drugs. However, there are problems of access to these very effective drugs for needy patients
due to a variety of reasons which were discussed in the Board’s Report for 1999. Overuse of drugs in somecountries creates other problems and this aspect was covered comprehensively in the Board’s Report for2000. For example, just six countries account for the use of 80% of licitly produced narcotic analgesics while
80% of the world’s population have very little or no access to these drugs.
Universities are well placed to understand the different factors that affect health in relation to humandevelopment and to monitor ways in which such development can be used to enhance the quality of life. The
Board therefore believes that the education and training of professionals involved in the caring professions
and, as appropriate, of those in law and regulatory disciplines as well as social and behavioural sciences, is of
the utmost importance. Universities clearly have a prominent role in leadership in this area, not only inresearch and advocacy, but also by ensuring that the relevant topics are included in undergraduate andpostgraduate curricula.

73

REPORT ON THE AVAILABILITY OF INTERNATIONALLY CONTROLLED DRUGSThe Board has requested me to bring these views to the attention of your Government. In particular,
the Board wishes to encourage your Government to take measures to ensure the inclusion of the subject of
the rational use of drugs for medical purposes and the risks associated with substance abuse and addictions to
drugs in the curricula of the appropriate faculties in the universities, taking into account the need for coherent
programmes in the various fields of study. Concerted action in this field could also cover misuse and abuseof alcohol and tobacco, although the Board has no mandate in these areas. The Board would respectfully
request you to bring this to the attention of ministers of higher education, chancellors of the universities andother appropriate ministries, for their consideration.
The Board and its secretariat are happy to provide your Government and universities, with copies of
INCB annual reports and publications to facilitate the development of such curricula.
I am attaching a brochure presenting the Board and its functions for your information.
Accept, Excellency, the assurance of my highest consideration.

Hamid Ghodse
PresidentInternational Narcotics Control Board

74

About the International Narcotics Control Board
The International Narcotics Control Board (INCB) is an independent and quasi-judicial control organ,
established by treaty, for monitoring the implementation of the international drug control treaties. It had predecessors
under the former drug control treaties as far back as the time of the League of Nations.

Composition
INCB consists of 13 members who are elected by the Economic and Social Council and who serve in theirpersonal capacity, not as Government representatives. Three members with medical, pharmacological or
pharmaceutical experience are elected from a list of persons nominated by the World Health Organization (WHO) and
10 members are elected from a list of persons nominated by Governments. Members of the Board are persons who, by
their competence, impartiality and disinterestedness, command general confidence. The Council, in consultation with
INCB, makes all arrangements necessary to ensure the full technical independence of the Board in carrying out its
functions. INCB has a secretariat that assists it in the exercise of its treaty-related functions. The INCB secretariat is anadministrative entity of the United Nations Office on Drugs and Crime, but it reports solely to the Board on matters of
substance. INCB closely collaborates with the Office in the framework of arrangements approved by the Council in its
resolution 1991/48. INCB also cooperates with other international bodies concerned with drug control, including not
only the Council and its Commission on Narcotic Drugs, but also the relevant specialized agencies of the United
Nations, particularly WHO. It also cooperates with bodies outside the United Nations system, especially theInternational Criminal Police Organization (INTERPOL) and the World Customs Organization.

Functions
The functions of INCB are laid down in the following treaties: the Single Convention on Narcotic Drugs of 1961
as amended by the 1972 Protocol; the Convention on Psychotropic Substances of 1971; and the United Nations
Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988. Broadly speaking, INCB
deals with the following:(a)
As regards the licit manufacture of, trade in and use of drugs, INCB endeavours, in cooperation with
Governments, to ensure that adequate supplies of drugs are available for medical and scientific uses and that thediversion of drugs from licit sources to illicit channels does not occur. INCB also monitors Governments’ control overchemicals used in the illicit manufacture of drugs and assists them in preventing the diversion of those chemicals into
the illicit traffic;(b) As regards the illicit manufacture of, trafficking in and use of drugs, INCB identifies weaknesses innational and international control systems and contributes to correcting such situations. INCB is also responsible forassessing chemicals used in the illicit manufacture of drugs, in order to determine whether they should be placed
under international control.
In the discharge of its responsibilities, INCB:(a)
Administers a system of estimates for narcotic drugs and a voluntary assessment system for psychotropic
substances and monitors licit activities involving drugs through a statistical returns system, with a view to assisting
Governments in achieving, inter alia, a balance between supply and demand;(b) Monitors and promotes measures taken by Governments to prevent the diversion of substances frequently
used in the illicit manufacture of narcotic drugs and psychotropic substances and assesses such substances todetermine whether there is a need for changes in the scope of control of Tables I and II of the 1988 Convention;(c)Analyses information provided by Governments, United Nations bodies, specialized agencies or othercompetent international organizations, with a view to ensuring that the provisions of the international drug control
treaties are adequately carried out by Governments, and recommends remedial measures;(d) Maintains a permanent dialogue with Governments to assist them in complying with their obligations
under the international drug control treaties and, to that end, recommends, where appropriate, technical or financial
assistance to be provided.
INCB is called upon to ask for explanations in the event of apparent violations of the treaties, to propose
appropriate remedial measures to Governments that are not fully applying the provisions of the treaties or are
encountering difficulties in applying them and, where necessary, to assist Governments in overcoming such difficulties.
If, however, INCB notes that the measures necessary to remedy a serious situation have not been taken, it may call thematter to the attention of the parties concerned, the Commission on Narcotic Drugs and the Economic and Social

Council. As a last resort, the treaties empower INCB to recommend to parties that they stop importing drugs from adefaulting country, exporting drugs to it or both. In all cases, INCB acts in close cooperation with Governments.
INCB assists national administrations in meeting their obligations under the conventions. To that end, it
proposes and participates in regional training seminars and programmes for drug control administrators.

Reports
The international drug control treaties require INCB to prepare an annual report on its work. The annual reportcontains an analysis of the drug control situation worldwide so that Governments are kept aware of existing andpotential situations that may endanger the objectives of the international drug control treaties. INCB draws theattention of Governments to gaps and weaknesses in national control and in treaty compliance; it also makessuggestions and recommendations for improvements at both the national and international levels. The annual report isbased on information provided by Governments to INCB, United Nations entities and other organizations. It also uses
information provided through other international organizations, such as INTERPOL and the World Customs
Organization, as well as regional organizations.
The annual report of INCB is supplemented by detailed technical reports. They contain data on the licit
movement of narcotic drugs and psychotropic substances required for medical and scientific purposes, together withan analysis of those data by INCB. Those data are required for the proper functioning of the system of control over the
licit movement of narcotic drugs and psychotropic substances, including preventing their diversion to illicit channels.
Moreover, under the provisions of article 12 of the 1988 Convention, INCB reports annually to the Commission on
Narcotic Drugs on the implementation of that article. That report, which gives an account of the results of themonitoring of precursors and of the chemicals frequently used in the illicit manufacture of narcotic drugs andpsychotropic substances, is also published as a supplement to the annual report.
Since 1992, the first chapter of the annual report has been devoted to a specific drug control issue on which
INCB presents its conclusions and recommendations in order to contribute to policy-related discussions and decisions
in national, regional and international drug control. The following topics were covered in past annual reports:
1992: Legalization of the non-medical use of drugs
1993: The importance of demand reduction
1994: Evaluation of the effectiveness of the international drug control treaties
1995: Giving more priority to combating money-laundering
1996: Drug abuse and the criminal justice system
1997: Preventing drug abuse in an environment of illicit drug promotion
1998: International control of drugs: past, present and future
1999: Freedom from pain and suffering
2000: Overconsumption of internationally controlled drugs
2001: Globalization and new technologies: challenges to drug law enforcement in the twenty-first century
2002: Illicit drugs and economic development
2003: Drugs, crime and violence: the microlevel impact
2004: Integration of supply and demand reduction strategies: moving beyond a balanced approach
2005: Alternative development and legitimate livelihoods
2006: Internationally controlled drugs and the unregulated market
2007: The principle of proportionality and drug-related offences
2008: The international drug control conventions: history, achievements and challenges
2009: Primary prevention of drug abuse
Chapter I of the report of the International Narcotics Control Board for 2010 is entitled “Drugs and corruption”.
Chapter II presents an analysis of the operation of the international drug control system based primarily on
information that Governments are required to submit directly to INCB in accordance with the international drug
control treaties. Its focus is on the worldwide control of all licit activities related to narcotic drugs and psychotropic
substances, as well as chemicals used in the illicit manufacture of such drugs.
Chapter III presents some of the major developments in drug abuse and trafficking and measures by
Governments to implement the international drug control treaties by addressing those problems.
Chapter IV presents the main recommendations addressed by INCB to Governments, the United Nations Officeon Drugs and Crime, WHO and other relevant international and regional organizations.

United Nations system and drug control organs and their secretariat

General Assembly

Economic and Social
CouncilCommission on
Narcotic Drugs

INCB

UNODCa/INCB secretariatb

Key:
Direct connection (administrative or constitutional)
Reporting, cooperating and advising relationshipa

United Nations Office on Drugs and Crime.
The INCB secretariat reports on substantive matters to INCB only.

bINTERNATIONAL NARCOTICS CONTROL BOARD

2010

Report of theInternational Narcotics Control Board on the
Availability ofInternationally Controlled Drugs:
Ensuring Adequate Access for
Medical and Scientific Purposes

United Nations publication
Printed in Austria

USD 12
ISBN 978-92-1-148260-7

Sales No. E.11.XI.7
E/INCB/2010/1/Supp.1

UNITED NATIONS*1058065*
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