Examining barriers in accessing paediatric controlled medicines worldwide

For millions of children around the world, medicines that are essential in pain management, palliative care, seizure control and anaesthesia are out of reach — especially for families in low- and middle-income countries.  

A recent two-part series in The Lancet Child & Adolescent Health highlights how the needs of paediatric populations are often left behind in efforts to improve access to controlled medicines. 

• Part one: Controlled medicines for children's medical needs: a review of the scope, determinants, and consequences of inequitable access
• Part two: Children's access to controlled medicines: policy lessons, intervention priorities, and a framework for action

In it, Dr. Brandon Maser — a SickKids resident physician and PhD candidate in the Child Health Evaluative Sciences program — explores the barriers that persist, including regulations, a lack of child-friendly medicine formulations, medical training gaps, and stigma around controlled medicines. 

Here, Dr. Maser reflects on this issue and why it matters for both science and policy.  

Inside the study 

Dr. Maser: As a paediatric resident and as a parent, seeing a child suffering in pain is one of the most distressing things to witness. More than 10 million children in the world are experiencing pain right now who could be treated by affordable, easily administered medicines. Yet, more than 80 per cent of those who need these medicines worldwide lack access to them. 

This gap reflects a failure to protect the health and dignity of some of the world’s most vulnerable, including children, those living in low-resource settings and those with chronic, life-limiting or life-threatening illness. 

Children in low-resource settings face multiple barriers and vulnerabilities accessing medicines in general. And these challenges are compounded by unique regulatory, service-related, and sociocultural factors related specifically to controlled medicines — pointing to the urgent need for focused research and efforts to improve access.  

In The Lancet Child & Adolescent Health series, our team worked to better outline the scope of the problem as well as the causes and consequences of children’s poor access to controlled medicines. We also highlighted successful efforts to improve access in Uganda, India and Costa Rica and proposed a series of priorities for future research and interventions.  

There is a growing global focus on this challenge, as illustrated by political commitments from the UN Commission on Narcotic Drugs, and a recent policy guideline from the WHO. Still, much work is needed to translate these international commitments into tangible reforms in the countries that most need them. 

To support those reforms, we need deeper policy and systems research focused on paediatric controlled medicines — taking place alongside knowledge and resource mobilization. For that, it’s essential that child health experts, health system leaders and policymakers work together enabling cross-disciplinary and intersectoral collaboration.  

We hope our work lays an important foundation for future progress on this urgent topic by highlighting key policy and system gaps and by articulating targets for research and interventions to improve access to paediatric controlled medicines.