Network for Evidence & Policy on Access to Controlled Medicines

The International Research Network for Evidence and Policy on Controlled Medicines aims to address critical gaps in research and pharmaceutical policy related to access to controlled essential medicines. Controlled medicines (CM) are those placed under international regulation by the United Nations drug control conventions. These treaties require governments to monitor production, trade, and use because, if taken outside medical supervision, they may cause dependence and serious harm. At the same time, these substances are indispensable for health: opioids such as morphine are vital for pain treatment and palliative care, anaesthetics are essential for surgery, and other controlled medicines are used for managing seizures, neurological disorders, and mental health conditions. Their dual nature—indispensable for health yet potentially harmful if misused—requires careful regulation, while ensuring they remain reliably available for patients in need.Achieving this balance is a major challenge. While some countries face crises of misuse, such as the fentanyl epidemic in the United States, the reality for most of the world is the opposite: millions of patients, particularly in low- and middle-income countries, lack access to essential controlled medicines. According to WHO’s Left Behind in Pain report (2023), more than 95% of all opioids (in morphine-equivalent doses) are consumed in high-income countries, while only 0.03% reach low-income countries. This leads to widespread avoidable suffering, especially among vulnerable groups such as children, people with advanced cancer, and those with chronic neurological conditions. In humanitarian crises and conflict settings, barriers are even greater, as fragile supply chains and regulatory restrictions can prevent urgent deliveries.Barriers to access are multiple. General health system challenges—such as financing, procurement, market dynamics, supply chain reliability, and geographic inequities—are amplified for controlled medicines. Additional obstacles include insufficient training of health professionals, restrictive regulations, and persistent stigma or fear surrounding their use. In 2025, WHO issued revised guidelines on Developing Balanced National Policies on Controlled Medicines, which provide direction for action but also underline the scarcity of scientific evidence and the need for stronger research and cross-country learning.The Institute of Tropical Medicine (ITM), through its work on pharmaceutical policies and access to medicines, including controlled medicines, has observed that research in this area remains fragmented. Experts often focus either on clinical management and patient use, or on pharmaceutical policy and health systems, but rarely integrate the two perspectives. This disconnect limits effective solutions.The Network for Evidence and Policy on Controlled Medicines seeks to bridge these gaps. Over the next five years, it will:•Connect research on controlled medicines with broader pharmaceutical policy, supply chain, and health systems perspectives.•Propose and test policy solutions to address access gaps, thereby contributing to Belgium’s and Flanders’ leadership in this field.•Foster joint research, cross-disciplinary publications, and postgraduate teaching to build capacity and train the next generation of experts.This international network will take a cross-cutting and innovative approach to a pressing but under-researched global health challenge: ensuring equitable access to controlled medicines as both a public health priority and a matter of human dignity and relief of suffering.