Two groundbreaking articles have been published in The Lancet, authored by a group of pediatricians, physicians, palliative care specialists, scientists, and young professionals, shedding light on one of the most overlooked issues in global health: the profound inequality in children’s access to pharmaceuticals containing controlled substances (hereafter “controlled medicines”).
A response to global attention
In 2024, the Commission on Narcotic Drugs adopted Resolution 67/2, with the aim of strengthening global efforts to improve access to controlled substances for medical and scientific purposes. The resolution called for increased awareness, expanded education and training, and stronger data collection as part of a comprehensive strategy to ensure these medicines are available, including and in particular for children, promoting their rational use, while preventing diversion and non-medical use. The move reflects growing international recognition of the urgent need to address persistent gaps in access to essential controlled medicines.
A silent crisis in pediatric care
For children living with cancer, life-limiting illnesses, and those in need of palliative care, opioids are not optional, they are essential. When used appropriately, these medicines relieve severe pain, restore dignity, and ease suffering during the most vulnerable moments of a child’s life.
Yet across much of the world, these medications remain out of reach.
In many low- and middle-income countries, opioids are unavailable in appropriate pediatric dosages or child-friendly formulations. Also, essential medicines that are critical for treating emergencies like seizures, such as psychotropic drugs and basic barbiturates, are often inaccessible or unaffordable. The result is a silent crisis where children in need are enduring preventable pain and distress because the medicines they need are not available.
Inequality that demands action
The newly published articles expose the structural, regulatory, and economic barriers that perpetuate these disparities. While high-income countries have systems that ensure access to controlled medicines under proper safeguards, vast regions of the world continue to struggle with limited supply chains, restrictive policies and lack of training.
Children cannot advocate for themselves
Children rely on healthcare professionals, policymakers, and global health leaders to protect their rights and ensure equitable access to essential care. These publications call for urgent reforms to improve availability, affordability, and appropriate regulation of controlled medicines for pediatric patients worldwide, while preventing diversion and non-medical use.
Collective Effort Rooted in Compassion
These publications in The Lancet are more than an academic milestone. They are a reminder that equitable access to essential medicines, including controlled medicines, is not a privilege. It is a fundamental component of children’s right to the highest attainable level of health, dignity, and relief from suffering.
To read the articles:
Children’s access to controlled medicines: policy lessons, intervention priorities, and a framework for action:
https://authors.elsevier.com/c/1me57_rVIJSgGN
Controlled medicines for children’s medical needs: a review of the scope, determinants, and consequences of inequitable access
https://authors.elsevier.com/c/1me578Mut2UcZa
