Vallath Nandini, Tandon Tripti, Pastrana Tania, Lohman Diederik, Husain S Asra, Cleary James, Ramanath Ganpati, Rajagopal M R
Trivandrum Institute of Palliative Sciences, World Health Organization Collaborating Centre for Training and Policy on Access to Pain Relief, Arumana Hospital, Thiruvananthapuram, India.
Lawyer's Collective, Bhogal-Jangpura, New Delhi, India.
J Pain Symptom Manage. 2017 Mar;53(3):518-532. doi: 10.1016/j.jpainsymman.2016.10.362. Epub 2016 Dec 30.
The lack of adequate access to opioids in India as analgesics and for agonist therapies, forces millions to live with severe unalleviated pain, or languish with suffering associated with drug dependence. Although India is a major opium exporter, the excessively prohibitive 1985 narcotics law formulated to control harmful use of drugs, impeded the availability and access to opioids for medical and scientific purposes. Amendment of this law in 2014 established a new national regulatory framework for improved access to essential opioid analgesics. This article reflects on key elements and processes that led to this landmark achievement. Unlike quick timelines associated with effecting policy reforms for law enforcement, realizing the 2014 drug policy change primarily to mitigate human suffering, was a 22-year-long process. The most exacting challenges included recognizing the multilayered complexities of the prior policy framework and understanding their adverse impact on field practices to chart an appropriate and viable path for reform. The evolution of an informal civil society movement involving health care professionals, lawyers, media, policy analysts, government officials, and the public was pivotal in addressing these challenges and garnering momentum for reform. The success of the effort for improving access to opioid medications was underpinned by a three-pronged strategy of 1) persuading the executive arm of the government to take interim enabling measures; 2) leveraging judicial intervention through public interest litigation; and 3) crafting a viable policy document for legislative approval and implementation. We hope our findings are useful for realizing drug policy reforms, given the current transformed global policy mandates emphasizing humanitarian, healthcare, and quality-of-life considerations.
在印度，缺乏足够的阿片类药物用于镇痛和激动剂疗法，迫使数百万人忍受着严重的未缓解疼痛，或因药物依赖相关的痛苦而憔悴。尽管印度是主要的鸦片出口国，但1985年制定的旨在控制药物有害使用的过度严格的麻醉品法律，阻碍了用于医疗和科学目的的阿片类药物的供应和获取。2014年对该法律的修订建立了一个新的国家监管框架，以改善基本阿片类镇痛药的获取。本文反思了促成这一具有里程碑意义成就的关键要素和过程。与执法政策改革的快速时间表不同，实现2014年药物政策变革主要是为了减轻人类痛苦，这是一个长达22年的过程。最严峻的挑战包括认识到先前政策框架的多层次复杂性，并理解其对实地实践的不利影响，从而为改革规划一条合适且可行的道路。一个由医疗保健专业人员、律师、媒体、政策分析师、政府官员和公众参与的非正式民间社会运动的演变，对于应对这些挑战和为改革积累动力至关重要。改善阿片类药物获取的努力取得成功，得益于三管齐下的战略：1）说服政府行政部门采取临时扶持措施；2）通过公益诉讼利用司法干预；3）起草一份可行的政策文件以供立法批准和实施。鉴于当前全球政策任务转变为强调人道主义、医疗保健和生活质量考虑，我们希望我们的研究结果对实现药物政策改革有用。
