Who Are We?

The Drug Control and Access to Medicines (DCAM) Consortium is an international collaboration of experts on drug control regulation, drug treatment, HIV, and pain and palliative care. The participating institutions include:

  • The Center for Health Law, Policy and Practice at Temple University Beasley School of Law
  • The AIDS Projects Management Group, and
  • The Pain and Policy Studies Group, University of Wisconsin

The Consortium has been funded by the U.K. Department for International Development to support and contribute to efforts by a range of stakeholders to reduce policy-related barriers that prevent patients from receiving controlled medicines for pain and drug dependency.

The PROBLEM

Tens of millions suffer annually from severe untreated pain caused by cancer, HIV, accidents and chronic conditions. Fewer than 5% of the estimated 13 million people suffering heroin dependency have access to effective, medication-assisted treatment. On paper, international treaties and national law allow, indeed oblige, access to opioid medicines for pain and drug dependency. BUT IN PRACTICE, cumbersome regulations have combined with training deficits and fear of opioids to perpetuate untreated pain and addiction in most countries of the world.

The International Narcotics Control Board recognizes that "the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol establishes a dual drug control obligation for Governments: to ensure adequate availability of narcotic drugs, including opiates, for medical and scientific purposes, while at the same time preventing the illicit production of, trafficking in and use of such drugs." (INCB. Report of the International Narcotics Control Board for 1995: Availability of opiates for medical needs. New York, NY: United Nations, 1996)

The DCAM Consortium was established in 2008 to assist national governments and international organizations to fulfill these dual drug control obligations.

GLOBAL ASSESSMENT, PLANNING, COORDINATION
  • 2008: Commissioned by the UK Department for International Development (DFID), the DCAM Consortium conducted an ASSESSMENT of past interventions to identify successful models for removing barriers and promoting access to care. The assessment found that pain care advocates had developed AN EFFECTIVE INTERVENTION MODEL built on support of local champions, rigorous assessment of barriers, civil society-government collaboration, training and integration of country work in regional approaches. BUT lack of resources had limited their ability to fully implement and scale up the model, and opioids for drug treatment (medication-assisted treatment or MAT) were not covered by the model. Guided by experienced advocates and experts from PEPFAR, the Consortium designed a Rapid Policy Assessment and Response (RPAR) tool for use in national opioid access interventions.
  • 2009: Funded by DFID, the DCAM Consortium carried out a global consultation of advocacy groups to test messages, to ensure that working on access to opioids for pain relief and drug treatment was appropriate, to identify needs and design an intervention which can help to accelerate policy change in both areas simultaneously. The Consortium also worked with staff at the US President's Emergency Plan for AIDS Relief (PEPFAR) to determine whether this intervention would be suitable for 4 PEPFAR countries.
  • 2010: DCAM has organized an International Coordinating Committee, bringing together a global group of representatives from palliative care, drug treatment, global health, global drug policy and other organizations to work together to accelerate policy change. The DCAM website (coming soon) is being constructed to assist all organizations and individuals interested in accelerating policy change to access the data and guidance materials they need. Where guidance materials are not yet developed, they are being assembled, reviewed by international experts and published, where possible, in collaboration with global organizations. Planning continues for implementation of DCAM activities in 4 countries, to be funded by PEPFAR, with implementation scheduled to begin in the second half of the year.
Planned NATIONAL INTERVENTIONS
  • Year One: Mobilization, Assessment and Action Planning
    In each country, the DCAM Consortium will assist one or two regional partners in national efforts to accelerate policy change on access to controlled medications. Local champions will use the RPAR process to engage stakeholders in collecting, reviewing and acting on the evidence of the ways that regulatory, medical practice and social factors are preventing the delivery of effective care for pain and drug dependence. RPAR proven assessment tools combined with facilitated stakeholder deliberation over 7-10 months to both define problems and identify solutions, building a coalition of champions and allies which will implement steps in the following years. The Consortium will provide tools, training and technical assistance (TA) for these processes.
  • Year Two: Regulatory Change and Implementation Planning
    The coalition forged by the RPAR and led by local champions will work to remove policy barriers and plan implementation, with Technical Assistance (TA) from the DCAM Consortium. Specific TA will be defined based on local needs but will likely include visits to the country from international authorities, national and regional seminars on DCAM issues, study tours, assistance with community and stakeholder education, and provision of local-language versions of key documents. A key aspect of this work will be the expansion of the PPSG's proven Pain and Policy Fellowships program to embrace MAT Policy Fellows, bringing teams from government and health care together to craft and enact new policies. The Consortium TA will also assist the local coalitions to work with WHO, UNODC, UNAIDS, UNICEF and UNFPA country offices to gain access to government at the highest levels and to advocate for statements by each of these bodies on the importance of various aspects of DCAM. Specific attention is paid in Year Two to educating the Drug Regulatory Authority on INCB's position on DCAM and on assisting the authority to understand all steps of supply management and control. Training of medical and nursing staff, peer counselors and law enforcement are scheduled to begin in this year.
  • Year Three: Implementation and Assessment
    The major work of Year Three is the training of health care providers, drug regulators and law enforcement to ensure that the reforms "on the books" can be properly implemented "on the streets." The DCAM Coalition will provide TA in the form of standardized global guidance and training documents, adapted to national needs, as well as expert assistance to carry out training-of trainers. Where possible, training will be institutionalized into ongoing medical, nursing and law enforcement education systems. The Consortium will assist local coalitions to build evaluative mechanisms to continually assess policy barriers and plan activities to address these barriers.