Nickerson Jason W, Pettus Katherine, Wheeler Kathleen E, Hallam Christopher, Bewley-Taylor David R, Attaran Amir, Gelb Adrian W
Bruyère Research Institute, 85 Primrose Ave., Ottawa, ON, K1R 6M1, Canada.
International Association for Hospice and Palliative Care, Houston, TX, USA.
Can J Anaesth. 2017 Mar;64(3):296-307. doi: 10.1007/s12630-016-0805-9. Epub 2017 Jan 3.
This article describes the functioning of the international drug control system, its integration into national legislation and policy, and the collective impact on access to medicines.
We conducted a review of the three international drug control conventions, peer-reviewed articles, and grey literature known to the authors that describes national and international drug control systems and their impact on access to controlled medicines. This review was supplemented with literature derived from a structured search of MEDLINE for articles relating to medical uses of ketamine in low- and middle-income countries conducted to strengthen an advocacy campaign. We illustrate the impact of the drug control system on access to medicines through an analysis of current levels of availability of opioids in many countries as well as through a description of the ongoing advocacy work to ensure the availability of ketamine for medical care in low-income countries.
The complexity of the international drug control system, along with health providers' lack of knowledge regarding key provisions, presents a barrier to improving access to safe anesthesia care in low- and middle-income countries. Fifteen of the 46 essential medicines of potential relevance to perioperative care are listed under one or more of the schedules of the three international drug control conventions and, subsequently, are required to be under national controls, potentially decreasing their availability for medical use.
Improving the capacity and quality of anesthesia care in low- and middle-income countries requires attention to improving access to controlled medicines. Anesthesiologists and others involved in global health work should collaborate with policymakers and others to improve national and international drug control legislation to ensure that attempts to thwart illicit drug trafficking and use do not compromise availability of controlled medicines.
本文描述了国际药物管制系统的运作、其融入国家立法和政策的情况，以及对药品可及性的总体影响。
我们对三项国际药物管制公约、同行评审文章以及作者所知的描述国家和国际药物管制系统及其对管制药品可及性影响的灰色文献进行了综述。此次综述还补充了通过对MEDLINE进行结构化检索获得的文献，这些文献与低收入和中等收入国家氯胺酮的医疗用途相关，用于加强一场宣传活动。我们通过分析许多国家目前阿片类药物的可获得水平，以及描述为确保低收入国家医疗护理中氯胺酮的可获得性而正在开展的宣传工作，来说明药物管制系统对药品可及性的影响。
国际药物管制系统的复杂性，以及医疗服务提供者对关键条款缺乏了解，对改善低收入和中等收入国家安全麻醉护理的可及性构成了障碍。与围手术期护理潜在相关的46种基本药物中有15种被列入三项国际药物管制公约的一个或多个附表，随后需要进行国家管制，这可能会减少其医疗用途的可获得性。
提高低收入和中等收入国家麻醉护理的能力和质量需要关注改善管制药品的可及性。麻醉医生和其他参与全球卫生工作的人员应与政策制定者及其他人员合作，改进国家和国际药物管制立法，以确保打击非法药物贩运和使用的努力不会损害管制药品的可获得性。
