Controlled medicines
Reduction of the HIV transmission among injecting drug users (IDUs) is one of the key issues in HIV prevention. The use of contaminated injection equipment among IDUs contributes 5-10 % to all HIV transmission worldwide. Opioid substitution therapy is an intervention to assist people dependent on opioids with an evidence-based effective treatment and to provide them with opportunities to stop injecting by taking medicines such as methadone or buprenorphine orally. To support the use of opioid substitution therapy, WHO added methadone and buprenorphine to the WHO Model List of Essential Medicines in 2005.
During its clinical course, the HIV infection frequently induces pain to people living with HIV/AIDS. It may be caused by direct infection of the nervous system, immunosuppression, or by adverse effects of HIV/AIDS medication. HIV peripheral neuropathy is a painful condition affecting up to 30% of the people with HIV/AIDS. Morphine is the gold standard for pain relief and the availability of morphine is essential for HIV treatment and care.
However, all these medicines are controlled substances under the international drug control conventions, and are not sufficiently available in many countries, mainly due to:
- Greatly exaggerated fears of dependence,
- Overly restrictive national drug control policies, and
- Problems in procurement, manufacture, storage and distribution of controlled substances.
It is estimated that over 80 % of the world population has no proper access to controlled medications, due to regulatory barriers, prejudice and lack of proper information at national and international levels.
The WHO HIV/AIDS Department, in collaboration with the WHO Department of Mental Health and Substance Abuse and the Department of Medicines Policy and Standards, has developed a database on methadone, buprenorphine, and morphine. The data include available forms and formulations, procurement issues, registration procedures as well as prices. This information is supplied by the pharmaceutical companies producing and distributing these medicines. This database will provide countries and organizations purchasing these essential medicines with necessary information which would help to improve access to these medications.