New Controls on Pain Relief Medicines in Guatemala Will Spark Public Health Crisis

While many countries have in recent years eased restrictions on access to vital medicines for pain relief, Guatemala has bucked the trend with a new initiative, a move which will lead to the unnecessary suffering of patients in the country. 

Guatemala’s government recently issued an official instruction that will increase restrictions around the access to controlled medicines. This will include morphine, one of the most vital analgesics in treating moderate-to-severe pain.

Controlled medicines are those scheduled under the international drug treaties. Twelve of these medicines – morphine being one of them – are listed by the World Health Organization (WHO) as essential medicines.

Under the new Guatemalan initiative (see below), a number of new bureaucratic hoops have been created for people to jump through when trying to access these medicines. As of July 31, people seeking to obtain a prescription for a controlled medicine on behalf of a patient will have to present a signed and stamped letter of request which must contain a copy of their ID along with the document’s number. Any time there is a change in the person responsible for requesting the prescription – even while the patient in question remains the same – this letter will have to be presented.

This is a particularly regressive move, not only because of the physical and emotional stress it will cause patients who are suffering, but also in light of the fact that just three years ago the country issued its first prescription for oral morphine in an apparent step forward.

Guatemala is by no means alone in its strict regulatory framework for controlled medicines. At present, there are an estimated 5.5 billion people – 75 percent of the global population – who have low to non-existent access to controlled medicines, mainly opioid analgesics. Isolating this to just morphine, 92 percent of the world’s supply is consumed by just 17 percent of the global population primarily concentrated in the global north.

WHO estimates that tens of millions of people suffer each year as a result of a lack of access to controlled medicines, with the main impacted groups being cancer patients, end-stage AIDS patients, women in labor suffering unrelieved pain, and those who have suffered injuries. 

The reasons for limited access are manifold, from weak healthcare systems and poor training of health professionals, to pricing factors and overly burdensome regulations. In addition, the international drug control system has contributed to a climate in which national governments channel resources to a criminal justice approach to controlling narcotics at the expense of providing for their medical and scientific availability when their is a clear need.

What makes Guatemala's recent move all the more surprising is that it goes against the grain of developments witnessed in recent years. A number of countries, among them Ukraine and India, have eased restrictions on accessing pain relief medications either through amending existing drug laws or issuing new decrees. Even Russia, where 11 cancer patients reportedly committed suicide in February because they couldn't access pain relief medicines, recently simplified the process of prescribing of opioids by allowing hospitals to do so. 

Under the international right to the highest attainable standard of health, states have an obligation to ensure access to controlled medicines. With its recent restrictions on access, the Guatemalan government is violating this right and is set to stoke a health crisis that will impact on some of its most vulnerable citizens.