1. Controlled medicines are medicines that are listed under the international conventions on narcotic and psychotropic drugs and their precursors. These were established to prevent harm from substance abuse and dependence. However, the international drug treaties state the imperative to make psychotropic and narcotic substances available for medical and scientific use;

2. Some controlled medicines used to treat important health conditions are listed in the WHO Model List of Essential Medicines. Opioid analgesics, such as morphine for the treatment of moderate to severe pain; opioid agonists used for treatment of opioid dependence, such as methadone; ergometrine and ephedrine used in emergency obstetric care; and phenobarbital and benzodiazepine for treatment of epilepsy are essential medicines but they are also classified as controlled medicines;

3. Global morphine consumption – an indicator of access to pain treatment – has increased over the past two decades, but mainly in a small number of developed countries. In 2003, six developed countries accounted for 79% of global morphine consumption. Developing countries, which represent about 80% of the world’s population, accounted for only about 6% of global morphine consumption;

4. Concern about abuse and dependence is a major factor in limiting access to opioids and other controlled medicines that are used in treating important health conditions. In practice, most patients, who are appropriately prescribed controlled medicines, do not become dependent from rational use of these medicines;

5. The cost of opioid medicines at supplier level does not represent a substantial barrier to access. Methadone and morphine unit prices are only a few US cents, although buprenorphine is much more expensive than methadone. However, the retail prices of opioid medicines at country level can be prohibitive;

6. Barriers to access to controlled medicines include lack of medical knowledge, national policies and regulations that are more stringent than is required by the international conventions, and obstacles in the supply of this category of medicines. The provision of reliable annual estimates on opioid medicines’ requirements to the International Narcotics Control Board is also a barrier for several countries. The procurement of narcotic and psychotropic substances can often be a challenge given the complex system of export and import authorizations.