Legislation analysis according to WHO and INCB criteria on opioid availability: a comparative study of 5 countries and the state of Texas

Opioids are not always available in many developing countries, including th ose in Latin America. In this study we analyzed the national laws on opioid s and other controlled substances from Argentina, Colombia, Costa Rica, Per u, Mexico, and the state of Texas, according to the principles set by the W orld Health Organization (WHO) and the International Narcotics Control Boar d (INCB), as well as to the presence of over-regulations regarding their me dical and scientific use. The six main principles outlined by WHO and INCB for opioid availability were analyzed by using a total of 17 criteria as sh own in Table 3. The result scores ranged from 17/17 (full compliance with a ll criteria) to 0/17 (non-compliance). Results showed that with the excepti on of the state of Texas 16/17 (94%), the countries failed to adequately me et the INCB and WHO criteria: Argentina: 7/17 (41%); Colombia: 9 /17 (53%); Costa Rica: 9/17 (53%); Mexico: 4/17 (24%); and Peru: 7/17 (41%). In all 5 Latin American countries, national laws and regulations imposed limits on the number of days allowed for prescription, the potency of the dosage, and the number of doses allowed per day. In all cases, including Texas, there was confusion on the meaning and utilization of the terms physical dependen ce, psychological dependence, addiction, tolerance and abuse. In total, com bining all cases, only 51% of the criteria were met. Additionally, all laws and regulations, especially in Argentina, include over regulations and sta tements that may further interfere with patient access to opioids. The pres cription criteria were fully met by the stale of Texas and all five countri es. These results indicate that there is need to revise the existing laws a nd regulations in countries with opioid availability problems, and identify the potential barriers, which may be playing a significant role in the acc ess to adequate treatment. Such review seeks to carefully consider all poss ible criteria, since partial resolution of legislative articles will not re sult in increased opioid availability. (C) 2001 Elsevier Science Ireland Lt d. All rights reserved.