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Achieving Balance Opioids Ar

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Al-Sadeel Society
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‫4.0002/‪WHO/EDM/QSM‬‬ ‫اﻟﺘﻮزﻳﻊ: ﻋﺎم‬ ‫‪WORLD HEALTH ORGANIZATION‬‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة وذات اﻟﺘﺄﺛﻴﺮ اﻟﻨﻔﺴﻲ‬ ‫ﺪ‬ ‫ﺗﺤﻘﻴﻖ اﻟﺘﻮازن‬ ‫ﻓﻲ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫ﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤ ﱢﺪرة‬ ‫ﺨ‬ ‫ﻣﺒﺎدئ ﺗﻮﺟﻴﻬﻴﺔ ﻟﻠﺘﻘﻴﻴﻢ‬ ‫‪WORLD HEALTH ORGANIZATION‬‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬
‫ﺣﻘﻮق اﻟﻨﺸﺮ © 0002 ﻣﺤﻔﻮﻇﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫ﻟﻴﺴﺖ هﺬﻩ اﻟﻮﺛﻴﻘﺔ إﺻﺪا ًا رﺳﻤ ًﺎ ﻣﻦ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ‬ ‫ﻴ‬ ‫ر‬ Ce document n'est pas une publication officielle ‫(، وآﺎﻓﺔ اﻟﺤﻘﻮق ﻣﺤﻔﻮﻇﺔ ﻟﻠﻤﻨﻈﻤﺔ. وﻣﻊ‬WHO) ‫اﻟﻌﺎﻟﻤﻴﺔ‬ de l'Organisation mondiale de la Santé (OMS) et tous les droits y afférents sont réservés par ‫ذﻟﻚ، ﻳﺠﻮز أن ﺗﺘﻢ ﻣﺮاﺟﻌﺔ اﻟﻮﺛﻴﻘﺔ أو اﻻﻗﺘﺒﺎس ﻣﻨﻬﺎ أو‬ l'Organisation. S'il peut être commenté, resumé ‫إﻋﺎدة إﻧﺘﺎﺟﻬﺎ أو ﺗﺮﺟﻤﺘﻬﺎ، ﺟﺰﺋ ًﺎ أو آﻠ ًﺎ، دون ﻗﻴﺪ، وﻟﻜﻦ ﻻ‬ ‫ﻴ‬ ‫ﻴ‬ ou cité sans aucune restriction, il ne saurait ‫ﻳﺠﻮز أن ﻳﺘﻢ ذﻟﻚ ﺑﻬﺪف اﻟﺒﻴﻊ أو اﻻﺳﺘﺨﺪام ﻷﻏﺮاض‬ cependant être reproduit ni traduit, partiellement .‫ﺗﺠﺎرﻳﺔ‬ ou en totalité, pour la vente ou à des fins commerciales. ‫اﻵراء اﻟﻮاردة ﻓﻲ اﻟﻮﺛﺎﺋﻖ ﻣﻦ ﻗﺒﻞ اﻟﻜﺘﺎب اﻟﻤﺬآﻮرة‬ Les opinions exprimées dans les documents par .‫أﺳﻤﺎؤهﻢ ﺗﻘﻊ ﻣﺴﺌﻮﻟﻴﺘﻬﺎ ﻋﻠﻰ هﺆﻻء اﻟﻜﺘﺎب وﺣﺪهﻢ‬ des auteurs cités nommément n'engagent que lesdits auteurs, ‫ﺟﺪول اﻟﻤﺤﺘﻮﻳﺎت‬
‫اﻟﺼﻔﺤﺔ‬ ‫اﻟﻤﻠﺨﺺ اﻟﺘﻨﻔﻴﺬي ..............................................................................................................1‬ ‫اﻟﻐﺮض واﻟﺠﻤﻬﻮر.....................................................................................2‬ ‫اﻟﻘﺴﻢ 1‬ ‫ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ..............................................................................3‬ ‫اﻟﻘﺴﻢ 2‬ ‫اﻟﺤﺎﺟﺔ اﻟﻄﺒﻴﺔ إﻟﻰ ﺗﻨﺎول اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ......................................................4‬ ‫اﻟﻘﺴﻢ 3‬ ‫اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ......................................................5‬ ‫ﺪ‬ ‫اﻟﻘﺴﻢ 4‬ ‫ﻋﻮاﺋﻖ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪ ﱢة ..............................................................7‬ ‫ر‬ ‫اﻟﻘﺴﻢ 5‬ ‫اﻟﻀﺮورة اﻟﺤﺘﻤﻴﺔ ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ......................................01‬ ‫اﻟﻘﺴﻢ 6‬ ‫أﺳﻠﻮب إﻋﺪاد اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ .....................................................................31‬ ‫اﻟﻘﺴﻢ 7‬ ‫اﺳﺘﺨﺪام اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ...........................................................................41‬ ‫اﻟﻘﺴﻢ 8‬ ‫اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ .....................................................................................51‬ ‫اﻟﻘﺴﻢ 9‬ ‫ﻗﺎﺋﻤﺔ ﺗﺪﻗﻴﻖ اﻟﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ..............................................................................13‬ ‫اﻟﻘﺴﻢ 01‬ ‫ﺷﻜﺮ وﺗﻘﺪﻳﺮ ....................................................................................................................43‬ ‫اﻟﻤﺮاﺟﻊ .........................................................................................................................53‬ ‫اﺳﺘﺨﺪام اﻟﻤﺼﻄﻠﺤﺎت ﻓﻲ هﺬا اﻹﺻﺪار ...........................................................83‬ ‫اﻟﻤﻠﺤﻖ 1‬ ‫ﻣﻌﻠﻮﻣﺎت اﻟﻄﻠﺐ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺼﺎدر اﻟﺮﺋﻴﺴﻴﺔ ....................................................04‬ ‫اﻟﻤﻠﺤﻖ 2‬ ‫ﻣﻠﺨﺺ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ............................................................................34‬ ‫اﻟﻤﻠﺤﻖ 3‬ ‫اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة اﻟﺮﺋﻴﺴﻴﺔ .....................................................44‬ ‫ﺪ‬ ‫اﻟﻤﻠﺤﻖ 4‬ ‫‪ii‬‬
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‫اﻟﻤﻠﺨﺺ اﻟﺘﻨﻔﻴﺬي‬ ‫ﻗﺮرت ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ )‪ (WHO‬أن اﻟﺘﻌﺎﻣﻞ ﻏﻴﺮ اﻟﻤﻼﺋﻢ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ ﻣﺮض اﻟﺴﺮﻃﺎن‬ ‫ﻳﻌﺪ ﺑﻤﺜﺎﺑﺔ ﻣﺸﻜﻠﺔ ﺻﺤﻴﺔ ﻋﺎﻣﺔ ﻋﻠﻰ ﺟﺎﻧﺐ آﺒﻴﺮ ﻣﻦ اﻟﺨﻄﻮرة ﻓﻲ اﻟﻌﺎﻟﻢ. ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ، هﻨﺎك 01‬ ‫ﻣﻼﻳﻴﻦ ﺣﺎﻟﺔ ﺟﺪﻳﺪة ﻟﻺﺻﺎﺑﺔ ﺑﻤﺮض اﻟﺴﺮﻃﺎن و6 ﻣﻼﻳﻴﻦ ﺣﺎﻟﺔ وﻓﺎة ﺳﻨﻮ ًﺎ ﻳﺘﺴﺒﺐ ﻓﻴﻬﺎ هﺬا اﻟﻤﺮض ﻏﻴﺮ‬ ‫ﻳ‬ ‫اﻟﻤﻌﺪي )1(. وﺳﻮف ﻳﺘﻀﺎﻋﻒ اﻟﻌﺐء اﻟﻌﺎﻟﻤﻲ اﻟﻤﺘﺮﺗﺐ ﻋﻠﻰ اﻟﺴﺮﻃﺎن، ﺑﻌﺪ اﺛﻨﻲ ﻋﺸﺮ ﻋﺎ ًﺎ ﻣﻦ اﻵن.‬ ‫ﻣ‬ ‫ﺳﻴﺘﺰاﻳﺪ ﻣﻌﺪل اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﺮﻃﺎن ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ أآﺜﺮ ﻣﻨﻪ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ، واﻟﺘﻲ ﺗﺸﻬﺪ ﻣﻌﺪﻻ أﻋﻠﻰ‬ ‫ً‬ ‫ﻟﻺﺻﺎﺑﺔ ﻋﻦ اﻟﻤﻮﺟﻮد ﺑﺎﻟﺪول اﻟﻨﺎﻣﻴﺔ ﻓﻲ اﻟﻮﻗﺖ اﻟﺤﺎﻟﻲ، ﻣﻤﺎ ﻳﻌﻜﺲ إﺳﺘﺮاﺗﻴﺠﻴﺎت أﻓﻀﻞ ﻟﻠﻮﻗﺎﻳﺔ ﻓﻲ اﻟﻌﺎﻟﻢ‬ ‫اﻟﻤﺘﻘﺪم. وﻟﻘﺪ ﻗ ﱠر ﺑﺮﻧﺎﻣﺞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﻤﻌﻨﻲ ﺑﺎﻟﺴﻴﻄﺮة ﻋﻠﻰ ﻣﺮض اﻟﺴﺮﻃﺎن أﻧﻪ ﺑﺤﻠﻮل ﻋﺎم‬ ‫ﺪ‬ ‫0202 ﺳﻮف ﻳﺤﺪث ﻧﺤﻮ 07% ﻣﻦ ﺣﺎﻻت اﻹﺻﺎﺑﺔ اﻟﺴﻨﻮﻳﺔ ﺑﺎﻟﺴﺮﻃﺎن واﻟﺘﻲ ﺗﺼﻞ إﻟﻰ ﻋﺸﺮﻳﻦ ﻣﻠﻴﻮن‬ ‫ﺣﺎﻟﺔ ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ )1(، واﻟﺘﻲ ﻳﺘﻢ ﺗﺸﺨﻴﺺ اﻟﻤﺮض ﻓﻴﻬﺎ ﻟﺪى ﻣﻌﻈﻢ اﻟﻤﺮﺿﻰ ﺑﻌﺪ وﺻﻮل اﻟﻤﺮض‬ ‫إﻟﻰ ﻣﺮاﺣﻞ ﻣﺘﺄﺧﺮة. وﻳﺘﻔﺸﻰ اﻷﻟﻢ ﻓﻲ ﺣﺎﻟﺔ اﻹﺻﺎﺑﺔ ﺑﻤﺮض اﻟﺴﺮﻃﺎن، وإن آﺎن ذﻟﻚ ﻳﺤﺪث ﻓﻲ اﻟﻤﺮاﺣﻞ‬ ‫اﻷﺧﻴﺮة ﻣﻦ اﻟﻤﺮض ﻋﻠﻰ وﺟﻪ اﻟﺨﺼﻮص، ﻋﻨﺪ دﻧﻮ اﻟﻤﻮت.‬ ‫وﻣﻦ اﻟﻤﺆﺳﻒ أن اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻻ ﺗﺘﻢ ﻣﻌﺎﻟﺠﺘﻪ ﺑﺸﻜﻞ ﻣﺘﻜﺮر، وﻋﻨﺪﻣﺎ ﺗﺘﻢ ﻣﻌﺎﻟﺠﺘﻪ ﻏﺎﻟ ًﺎ ﻣﺎ‬ ‫ﺒ‬ ‫ﻳﻜﻮن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻏﻴﺮ آﺎف. وﻣﻊ ذﻟﻚ ﻓﻘﺪ أوﺿﺤﺖ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ أن أﻏﻠﺐ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ‬ ‫ٍ‬ ‫اﻟﺴﺮﻃﺎن، إن ﻟﻢ ﻳﻜﻦ آﻠﻪ، ﻳﺘﻌﺬر ﺗﺨﻔﻴﻔﻪ ﻓﻲ ﺣﺎﻟﺔ ﺗﻄﺒﻴﻖ اﻟﻌﻼﺟﺎت واﻟﻤﻌﻠﻮﻣﺎت اﻟﻄﺒﻴﺔ اﻟﺤﺎﻟﻴﺔ. ﺛﻤﺔ هﻮة‬ ‫ﻋﻼﺟﻴﺔ: وهﻲ ﺗﺘﻤﺜﻞ ﻓﻲ اﻟﻔﺎرق ﺑﻴﻦ ﻣﺎ ﻳﻤﻜﻦ ﻓﻌﻠﻪ وﻣﺎ ﻳﺘﻢ ﻓﻌﻠﻪ إزاء اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻳﻤﻜﻦ‬ ‫ﺗﻀﻴﻴﻖ اﻟﻬﻮة اﻟﻌﻼﺟﻴﺔ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﻘﻴﻒ وﺗﺪرﻳﺐ اﻟﻌﺎﻣﻠﻴﻦ ﻓﻲ ﻣﺠﺎل اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ وإﺗﺎﺣﺔ اﻟﻤﺰﻳﺪ‬ ‫ﻣﻦ ﺧﺪﻣﺎت ﺗﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻌﻼج ﺑﺘﻘﺪﻳﻢ اﻟﻤﺴﻜﻨﺎت. وﻣﻊ ذﻟﻚ، ﻓﻘﺪ ﺗﻢ ﺗﺤﺪﻳﺪ ﻗﺪر آﺒﻴﺮ ﻣﻦ اﻟﻬﻮة اﻟﻌﻼﺟﻴﺔ،‬ ‫وﺑﺨﺎﺻﺔ ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ، ﻋﻠﻰ أﻧﻬﺎ ﺗﺘﻤﺜﻞ ﻓﻲ اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻷدوﻳﺔ ﺗﺨﻔﻴﻒ اﻷﻟﻢ، وﻋﻠﻰ اﻷﺧﺺ‬ ‫اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ.‬ ‫وﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ وﺟﻮد اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻼﺟﺎت اﻟﺪواﺋﻴﺔ وﻏﻴﺮ اﻟﺪواﺋﻴﺔ، ﻓﺈن اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ﻣﻦ ﻗﺒﻴﻞ‬ ‫اﻟﻜﻮداﻳﻴﻦ واﻟﻤﻮرﻓﻴﻦ ﺗﻌﺪ ﺿﺮورﻳﺔ ﺣﺘ ًﺎ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻋﻨﺪﻣﺎ ﻳﻜﻮن اﻷﻟﻢ‬ ‫ﻤ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻣﺘﻮﺳ ًﺎ أو ﺣﺎ ًا، ﻻ ﻳﻜﻮن ﺑﺪﻳﻼ ﻻﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ‬ ‫ﺪ‬ ‫ً‬ ‫د‬ ‫ﻄ‬ ‫اﻟﻌﻼﺟﻴﺔ ﻟﻠﻤﻮرﻓﻴﻦ. وﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )‪ ،1(INCB‬ﺑﻮﺻﻔﻬﺎ‬ ‫اﻟﺠﻬﺔ اﻟﺪوﻟﻴﺔ اﻟﺘﻲ ُﻌﻨﻰ، ﻣﻦ ﺑﻴﻦ أﺷﻴﺎء أﺧﺮى، ﺑﻤﺮاﻗﺒﺔ اﻟﺘﻮﻓﺮ اﻟﻌﺎﻟﻤﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة، ﺗﺸ ﱢد ﻋﻠﻰ‬ ‫ﺪ‬ ‫ﺪ‬ ‫ﺗ‬ ‫ﺿﺮورة إﺗﺎﺣﺔ هﺬﻩ اﻟﻌﻘﺎﻗﻴﺮ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ.‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻣﺼﻨﻔﺔ آﻌﻘﺎﻗﻴﺮ ﻣﺨ ﱢرة ﻧﻈ ًا ﻻﺣﺘﻤﺎﻟﻴﺔ إﺳﺎءة اﺳﺘﺨﺪاﻣﻬﺎ. وآﻨﺘﻴﺠﺔ ﻟﺬﻟﻚ، ﻳﺘﻢ‬ ‫ﺮ‬ ‫ﺪ‬ ‫ﺪ‬ ‫ﺗﻨﻈﻴﻢ ﺗﻌﺎﻃﻲ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺗﺒ ًﺎ ﻟﻠﻤﻌﺎهﺪات اﻟﺪوﻟﻴﺔ واﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻤﺮاﻗﺒﺔ‬ ‫ﻌ‬ ‫ﺪ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ. أﻓﺎدت آﻞ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ‬ ‫ﺑﺄن اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻴﺴﺖ ﻣﺘﻮﻓﺮة ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ ﺑﺸﻜﻞ آﺎف. وﻳﺮﺟﻊ ذﻟﻚ إﻟﻰ ﻋﺪد ﻣﻦ‬ ‫ٍ‬ ‫ﺪ‬ ‫اﻷﺳﺒﺎب، ﻣﻦ ﺑﻴﻨﻬﺎ اﻷوﻟﻮﻳﺔ اﻟﻤﻨﺨﻔﻀﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﻓﻲ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ، واﻟﻤﺨﺎوف اﻟﻤﺒﺎﻟﻎ‬ ‫ﻓﻴﻬﺎ ﺑﺸﻜﻞ آﺒﻴﺮ إزاء اﻹدﻣﺎن، واﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﺘﺴﻢ ﺑﺎﻟﺘﻘﻴﻴﺪ اﻟﻤﻔﺮط، وآﺬا‬ ‫اﻟﻤﺸﻜﻼت اﻟﺨﺎﺻﺔ ﺑﺎﻟﺤﺼﻮل ﻋﻠﻰ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة وﺗﺼﻨﻴﻌﻬﺎ وﺗﻮزﻳﻌﻬﺎ.‬ ‫ﺪ‬ ‫ﻓﻲ ﺑﻌﺾ اﻟﺪول، ﻗﺎﻣﺖ اﻟﺤﻜﻮﻣﺎت وأﺧﺼﺎﺋﻴﻮ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﺑﺎﻟﻌﻤﻞ ﻣ ًﺎ ﻟﺘﺤﺴﻴﻦ ﻃﺮﻳﻘﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ‬ ‫ﻌ‬ ‫اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت، وﻗﺪ ﺑﺪأت ﺑﻌﺾ اﻟﺪول ﻓﻲ ﺗﺤﺪﻳﺪ وﺗﺼﺤﻴﺢ اﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ ﺗﻔﺮط ﻓﻲ ﺗﻘﻴﻴﺪ اﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻟﻠﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ. أﻣﺎ ﺑﺎﻗﻲ اﻟﺪول ﻓﻤﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻴﻬﺎ‬ ‫ﻣﻌﺎﻟﺠﺔ هﺬﻩ اﻷﻣﻮر. وﻳﻤﻜﻦ ﻟﻠﺤﻜﻮﻣﺎت اﺳﺘﺨﺪام هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﺘﺤﺪﻳﺪ ﻣﺎ إذا آﺎﻧﺖ اﻟﺴﻴﺎﺳﺎت‬ ‫اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻗﺪ وﺿﻌﺖ اﻹﻃﺎر اﻟﻘﺎﻧﻮﻧﻲ واﻹداري، اﻟﺬي ﻳﻀﻤﻦ اﻟﺘﻮﻓﺮ اﻟﻄﺒﻲ ﻟﻠﻤﺴﻜﻨﺎت‬ ‫اﻷﻓﻴﻮﻧﻴﺔ، ﻃﺒ ًﺎ ﻟﻼﺗﻔﺎﻗﻴﺎت اﻟﺪوﻟﻴﺔ واﻟﺘﻮﺻﻴﺎت اﻟﻤﻘﺪﻣﺔ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ‬ ‫ﻘ‬ ‫اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ.‬ ‫1ﺗﻌﺪ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﺟﻬﺔ ﻣﺴﺘﻘﻠﺔ ﻣﺴﺘﻨﺪة إﻟﻰ اﺗﻔﺎﻗﻴﺔ ُﻌﻨﻰ ﺑﻤﺮاﻗﺒﺔ ﺗﻨﻔﻴﺬ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات‬ ‫ﺗ‬ ‫ﻟﺴﻨﺔ 1691، واﻻﺗﻔﺎﻗﻴﺎت ذات اﻟﺼﻠﺔ اﻷﺧﺮى. ﻟﻠﺤﺼﻮل ﻋﻠﻰ وﺻﻒ ﻟﻠﻬﻴﺌﺔ وأﻧﺸﻄﺘﻬﺎ، راﺟﻊ: ‪.(2) 1999 ،INCB‬‬ ‫-1-‬
‫ذآﺮ ﺗﻘﺮﻳﺮ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻟﻌﺎم 5991 )3( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“...an efficient national drug control regime must involve not only a programme to‬‬ ‫‪prevent illicit trafficking and diversion, but also a programme to ensure the adequate‬‬ ‫”‪...] ."availability of narcotic drugs for medical and scientific purposes‬ﻳﺠﺐ أﻻ‬ ‫ﻳﻨﻄﻮي اﻟﻨﻈﺎم اﻟﻮﻃﻨﻲ اﻟﻔﻌﺎل ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻋﻠﻰ ﺑﺮﻧﺎﻣﺞ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ ﻓﻲ ﻏﻴﺮ‬ ‫اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ واﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع ﻓﻴﻬﺎ وﺣﺴﺐ، وإﻧﻤﺎ أﻳ ًﺎ ﻋﻠﻰ ﺑﺮﻧﺎﻣﺞ‬ ‫ﻀ‬ ‫ﻟﻀﻤﺎن اﻟﺘﻮﻓﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ[. )ﺻﻔﺤﺔ 41(.‬ ‫ﺪ‬ ‫اﻟﻘﺴﻢ 1 – اﻟﻐﺮض واﻟﺠﻤﻬﻮر‬ ‫ﻳﺘﻤﺜﻞ اﻟﻐﺮض ﻣﻦ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﻠﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ ﻓﻲ ﺗﺸﺠﻴﻊ اﻟﺤﻜﻮﻣﺎت ﻋﻠﻰ ﺗﺤﻘﻴﻖ ﺗﻌﺎﻣﻞ أﻓﻀﻞ‬ ‫2‬ ‫ﻣﻊ اﻷﻟﻢ وذﻟﻚ ﻋﻦ ﻃﺮﻳﻖ اﻟﺘﻌﺮف واﻟﺘﻐﻠﺐ ﻋﻠﻰ اﻟﻌﻘﺒﺎت اﻟﺘﻨﻈﻴﻤﻴﺔ أﻣﺎم ﺗﻮﻓﻴﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة.‬ ‫ﺪ‬ ‫وﻳﻤﻜﻦ اﺳﺘﺨﺪام هﺬﻩ اﻹرﺷﺎدات أﻳ ًﺎ ﻟﻮﺿﻊ ﺳﻴﺎﺳﺎت وﻃﻨﻴﺔ ﻣﺘﻮازﻧﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ )ﺑﻤﺎ ﻓﻲ ذﻟﻚ‬ ‫ﻀ‬ ‫ﺳﻠﻄﺎت اﻟﻮﻻﻳﺔ أو اﻟﻤﻘﺎﻃﻌﺔ أو اﻟﻤﻨﻄﻘﺔ آﻠﻤﺎ أﻣﻜﻦ( ﻓﻲ ﺣﺎﻟﺔ ﻋﺪم وﺟﻮدهﺎ ﺑﺎﻟﻔﻌﻞ. )اﻧﻈﺮ اﻟﻤﻠﺤﻖ 1‬ ‫ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟـ "اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ"(. ﻳﺸﻴﺮ "اﻟﺘﻮازن" إﻟﻰ اﻟﻐﺮض اﻟﻤﺰدوج ﻟﻤﻨﻊ اﺳﺘﻐﻼل‬ ‫اﻟﻌﻘﺎﻗﻴﺮ ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ واﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع، ﻣﻊ ﺿﻤﺎن ﺗﻮﻓﺮهﺎ ﻟﻸﻏﺮاض‬ ‫اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ، وﺧﺼﻮ ًﺎ ﻟﻌﻼج اﻷﻟﻢ واﻟﻤﻌﺎﻧﺎة )اﻧﻈﺮ اﻟﻘﺴﻢ 7 ﻟﻼﻃﻼع ﻋﻠﻰ ﻣﺰﻳﺪ ﻣﻦ اﻟﻨﻘﺎش(.‬ ‫ﺻ‬ ‫هﺬﻩ اﻟﻮﺛﻴﻘﺔ ﻣﺨﺼﺼﺔ ﻟﻸﻓﺮاد اﻟﺬﻳﻦ ﻳﻘﻮﻣﻮن ﺑﻮﺿﻊ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ، ﻓﻀﻼ ﻋﻦ اﻷﻓﺮاد‬ ‫ً‬ ‫اﻟﺬﻳﻦ ﻳﻘﻮﻣﻮن ﺑﺘﻨﻔﻴﺬهﺎ. وﻳﺠﻮز ﻷﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ واﻟﻤﺆﺳﺴﺎت اﻟﺨﺎﺻﺔ ﺑﻬﻢ اﺳﺘﺨﺪام اﻟﻮﺛﻴﻘﺔ‬ ‫أﻳ ًﺎ وذﻟﻚ ﻟﺘﺸﺠﻴﻊ اﻟﺘﻌﺎون ﻣﻊ اﻟﺤﻜﻮﻣﺎت وﻟﺘﻮﻓﻴﺮ ﻗﺪر أآﺒﺮ ﻣﻦ اﻟﺘﺜﻘﻴﻒ.‬ ‫ﻀ‬ ‫ﺗﺤ ﱢﻖ هﺬﻩ اﻟﻮﺛﻴﻘﺔ ﻏﺮﺿﻬﺎ ﺑﻌﺪة ﻃﺮق:‬ ‫ﻘ‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ ﻣﻌﻠﻮﻣﺎت ﻣﺮﺟﻌﻴﺔ ﺣﻮل اﻟﻤﺸﻜﻠﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺗﺞ ﻋﻦ ﻣﺮض‬ ‫1.‬ ‫اﻟﺴﺮﻃﺎن ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف )اﻟﻘﺴﻢ 2(؛‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت ﺣﻮل ﺳﺒﺐ اﻻﺣﺘﻴﺎج إﻟﻰ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة )أي اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺪ‬ ‫2.‬ ‫3‬ ‫واﻷﻓﻴﻮن( ﺑﻐﺮض اﻟﺘﻌﺎﻣﻞ اﻟﻄﺒﻲ ﻣﻊ اﻷﻟﻢ )اﻟﻘﺴﻢ 3(.‬ ‫ﻳﺘﻢ إﻋﻄﺎء ﻣﻌﻠﻮﻣﺎت ﺣﻮل اﻟﺘﻮﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ﻓﻲ ﻣﻌﻈﻢ اﻟﺪول‬ ‫3.‬ ‫)اﻟﻘﺴﻢ 4(.‬ ‫2ﺗﻮﺟﺪ ﺛﻼﺛﺔ ﻣﺴﺘﻮﻳﺎت ﻟﻠﻌﻘﺒﺎت اﻟﺘﻲ ﺗﺤﻮل دون اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﺑﺸﻜﻞ آﺎف: ﻣﺴﺘﻮى اﻗﺘﺼﺎدي، وﺁﺧﺮ ﻃﺒﻲ، وﺛﺎﻟﺚ‬ ‫ﺗﻨﻈﻴﻤﻲ. وﺑﻴﻨﻤﺎ ﺗﺮآﺰ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻋﻠﻰ اﻟﻤﺸﻜﻼت اﻟﺘﻨﻈﻴﻤﻴﺔ وﺣﺪهﺎ، إﻻ أﻧﻪ ﻣﻦ اﻟﻤﻔﻬﻮم ﺟﻴ ًا أن اﻟﻌﻘﺒﺎت‬ ‫ﺪ‬ ‫اﻻﻗﺘﺼﺎدﻳﺔ واﻟﻄﺒﻴﺔ ﺗﻠﻌﺐ أدوا ًا رﺋﻴﺴﻴﺔ ﻓﻲ ﻣﻌﺎﻟﺠﺔ اﻷﻟﻢ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف. ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل، ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﺳﺒﺎب‬ ‫ر‬ ‫اﻻﻗﺘﺼﺎدﻳﺔ، ﻳﺘﻢ ﺗﺸﺠﻴﻊ أﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻠﻰ اﺳﺘﺨﺪام ﻣﻨﺘﺠﺎت دواﺋﻴﺔ أﻋﻠﻰ آﻠﻔﺔ وأﻗﻞ ﻓﻌﺎﻟﻴﺔ. وﻗﺪ ﻳﺘﺴﺒﺐ هﺬا‬ ‫ﻓﻲ ﺗﻔﺎﻗﻢ ﺣﺎﻟﺔ ﺗﻮاﻓﺮ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف، ﺑﺎﻟﻨﺴﺒﺔ ﻟﻨﻈﺎم اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻤﻮ ًﺎ وﻟﻠﻤﺮﻳﺾ اﻟﻔﺮد ﻋﻠﻰ ﺣﺪ ﺳﻮاء.‬ ‫ﻣ‬ ‫وﻓﻲ ﺑﻌﺾ اﻟﺪول، ﻳﺘﻢ إﻧﻔﺎق اﻟﻤﻮارد اﻟﻄﺒﻴﺔ اﻟﻨﺎدرة ﻋﻠﻰ اﻟﻌﻼﺟﺎت اﻟﻤﻜﻠﻔﺔ اﻟﺘﻲ ﺗﻜﻮن ﻋﺪﻳﻤﺔ اﻟﺠﺪوى ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ‬ ‫اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ ﻣﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ ﻣﺮض اﻟﺴﺮﻃﺎن )4(. ﺗﺤﻮل هﺬﻩ اﻟﺴﻴﺎﺳﺎت دون ﺗﻮﻓﻴﺮ اﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت.‬ ‫وأﺧﻴ ًا، ﻓﺈن اﻟﺘﺜﻘﻴﻒ اﻟﻄﺒﻲ اﻟﺬي ﻻ ﻳﻌﺎﻟﺞ اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﻳﺴﻬﻢ ﻓﻲ اﻟﺘﻌﺎﻣﻞ ﻏﻴﺮ اﻟﻤﻼﺋﻢ ﻣﻊ اﻷﻟﻢ.‬ ‫ﺮ‬ ‫3راﺟﻊ اﻟﻤﻠﺤﻖ 3 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺷﺮح ﻟـ "اﻷﻓﻴﻮن" و"اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة" وﻟﻠﻤﺼﻄﻠﺤﺎت اﻟﺮﺋﻴﺴﻴﺔ اﻷﺧﺮى‬ ‫ﺪ‬ ‫اﻟﻮارد ذآﺮهﺎ ﻓﻲ هﺬا اﻹﺻﺪار.‬ ‫-2-‬
‫ﻳﺘﻢ إﺑﺪاء اﻷﺳﺒﺎب اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺘﻮﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ، ﻣﻊ إﺷﺎرة ﺧﺎﺻﺔ إﻟﻰ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ‬ ‫4.‬ ‫ﺗﺘﺴﻢ ﺑﺎﻟﺘﻘﻴﻴﺪ اﻟﻤﻔﺮط إزاء أدوﻳﺔ ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﻤﻮﺟﺐ ﺑﻌﺾ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫)اﻟﻘﺴﻢ 5(.‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ أﺳﺎس ﻣﻨﻄﻘﻲ ﻟﻠﺤﻜﻮﻣﺎت ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﺑﻬﺪف ﺗﺤﻘﻴﻖ اﻟﺘﻮازن )اﻟﻘﺴﻢ 6(.‬ ‫5.‬ ‫ﻳﺘﻢ وﺻﻒ اﻟﻄﺮﻳﻘﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ وﺿﻊ ﻣﺒﺎدئ ﺗﻮﺟﻴﻬﻴﺔ ﻹﺟﺮاء ﺗﻘﻴﻴﻢ ذاﺗﻲ )اﻟﻘﺴﻢ 7(.‬ ‫6.‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﺤﺚ اﻟﺮأي اﻟﺠﻤﺎﻋﻲ ﻋﻠﻰ اﺗﺨﺎذ ﺳﻴﺎﺳﺔ وﻃﻨﻴﺔ ﻣﺘﻮازﻧﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ.‬ ‫7.‬ ‫وﺗﺴﺘﻨﺪ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ إﻟﻰ اﻟﺮأي اﻟﺠﻤﺎﻋﻲ اﻟﻄﺒﻲ واﻟﺘﻨﻈﻴﻤﻲ اﻟﺪوﻟﻲ واﻟﺬي ﻳﻔﻴﺪ ﺏﻮﺟﻮب إﺡﺪاث ﺗﻮازن‬ ‫ﻟﺴﻴﺎﺳﺔ ﻣﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ )اﻟﻘﺴﻢ 9(.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻗﺎﺋﻤﺔ ﺗﺪﻗﻴﻖ ﻟﻸﺳﺌﻠﺔ وذﻟﻚ ﻟﺘﻮﺟﻴﻪ اﻟﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ )اﻟﻘﺴﻢ 01(.‬ ‫8.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت ﻟﻠﻤﺮاﺟﻊ ﻓﻲ اﻟﺼﻔﺤﺘﻴﻦ 43-53.‬ ‫9.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت اﻟﻄﻠﺐ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺼﺎدر اﻟﺮﺋﻴﺴﻴﺔ ﻓﻲ اﻟﻤﻠﺤﻖ 2.‬ ‫01.‬ ‫ﻳﺘﻮﻓﺮ دﻟﻴﻞ ﺑﺎﻟﻤﻜﺎﺗﺐ اﻟﺤﻜﻮﻣﻴﺔ اﻟﻤﻌﻨﻴﺔ ﺑﺘﻨﻈﻴﻢ اﻟﻤﺨﺪرات )اﻟﺴﻠﻄﺎت اﻟﻮﻃﻨﻴﺔ‬ ‫11.‬ ‫اﻟﻤﺨﺘﺼﺔ( ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻋﺒﺮ اﻟﻮﺳﺎﺋﻞ اﻟﺘﺎﻟﻴﺔ:‬ ‫ﻣﻮﻗﻊ اﻟﻮﻳﺐ: ‪،http://www.incb.org‬‬ ‫أو اﻟﻬﺎﺗﻒ: 7724-06062-1-34+، أو اﻟﻔﺎآﺲ: 8685/7685-06062-1-34+‬ ‫اﻟﻘﺴﻢ 2 - ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف‬ ‫ﻳﻌﺎﻧﻲ آﺎﻓﺔ اﻟﻤﺼﺎﺑﻴﻦ ﺑﺎﻟﺴﺮﻃﺎن ﻣﻦ اﻷﻟﻢ. وﻗﺪ ﻳﺤﺘﺎج ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن إﻟﻰ ﺗﺨﻔﻴﻒ ﻟﻸﻟﻢ ﻓﻲ آﻞ ﻣﺮﺣﻠﺔ‬ ‫ﻣﻦ اﻟﻤﺮض. واﻟﺠﺪﻳﺮ ﺑﺎﻟﺬآﺮ أن ﺛﻠﺜﻲ ﻋﺪد اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ وﺻﻠﻮا ﻟﻤﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ اﻟﺴﺮﻃﺎن ﻳﻌﺎﻧﻮن‬ ‫ﻣﻦ أﻟﻢ ﺣﺎد )5(. ﺑﺎﻟﻨﺴﺒﺔ ﻟﻬﺆﻻء اﻟﻤﺮﺿﻰ، ﻳﻨﺒﻐﻲ أن ﻳﻜﻮن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺟﺰ ًا ﻣﻦ اﻟﻌﻼج اﻹﺟﻤﺎﻟﻲ اﻟﺬي‬ ‫ء‬ ‫ﻳﺨﻀﻌﻮن ﻟﻪ. أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ اﻟﺬﻳﻦ وﺻﻠﻮا ﻟﻤﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ اﻟﺴﺮﻃﺎن، ﻓﺈن اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ‬ ‫واﻷﻋﺮاض اﻟﻤﺮﺿﻴﺔ اﻷﺧﺮى ﻳﻨﺒﻐﻲ أن ﻳﻤﺜﻞ اﻟﻬﺪف اﻟﺮﺋﻴﺴﻲ ﻟﻠﺒﺮاﻣﺞ اﻟﻮﻃﻨﻴﺔ ﻟﻠﺴﻴﻄﺮة ﻋﻠﻰ ﻣﺮض‬ ‫اﻟﺴﺮﻃﺎن.‬ ‫ﻓﻲ ﻋﺎم 6991، ذآﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ‬ ‫ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )5(:‬ ‫‪“In most parts of the world, the majority of cancer patients present with advanced‬‬ ‫‪disease. For them, the only realistic treatment option is pain relief and palliative‬‬ ‫”‪].care‬ﻓﻲ ﻣﻌﻈﻢ أﻧﺤﺎء اﻟﻌﺎﻟﻢ، ﻳﺘﺴﻢ أﻏﻠﺐ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﻤﺮﺣﻠﺔ ﻣﺘﻘﺪﻣﺔ ﻣﻦ اﻟﻤﺮض.‬ ‫وﺑﺎﻟﻨﺴﺒﺔ ﻟﻬﻢ، ﻳﺘﻤﺜﻞ ﺧﻴﺎر اﻟﻌﻼج اﻟﻮاﻗﻌﻲ اﻟﻮﺣﻴﺪ ﻓﻲ ﺗﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت[‬ ‫)ص ‪.(v‬‬ ‫ﺗﻘﺘﺮح اﻟﺪراﺳﺎت اﻻﺳﺘﻘﺼﺎﺋﻴﺔ أن أآﺜﺮ ﻣﻦ 05% ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻳﻌﺎﻧﻮن ﻣﻦ أﻟﻢ ﻣﺘﻮاﺻﻞ )6(.‬ ‫ﻳﻤﻜﻦ ﻟﻸﻟﻢ اﻟﻤﺘﻮاﺻﻞ أن ﻳﺆﺛﺮ ﺑﺎﻟﺴﻠﺐ ﻋﻠﻰ آﺎﻓﺔ ﺟﻮاﻧﺐ ﺣﻴﺎة اﻹﻧﺴﺎن، ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺸﻬﻴﺔ واﻟﺤﺎﻟﺔ‬ ‫اﻟﻤﺰاﺟﻴﺔ واﻻﻋﺘﺪاد ﺑﺎﻟﻨﻔﺲ واﻟﻌﻼﻗﺎت ﻣﻊ اﻵﺧﺮﻳﻦ ﺑﻞ وﺣﺘﻰ اﻟﻘﺪرة ﻋﻠﻰ اﻟﺤﺮآﺔ. ﻓﻲ ﺑﻌﺾ اﻟﺪول، ﺗﺒﻴﻦ‬ ‫أن اﻷﻟﻢ اﻟﻤﺘﻮاﺻﻞ ﻳﻤﻜﻦ أن ﻳﺆدي إﻟﻰ اﻟﺮﻏﺒﺔ ﻓﻲ اﻟﻤﻮت ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ وﺟﻮد ﺟﺪل ﺣﻮل اﻟﻘﺘﻞ اﻟﺮﺣﻴﻢ‬ ‫واﻻﻧﺘﺤﺎر ﺑﻤﺴﺎﻋﺪة اﻟﻐﻴﺮ. آﻤﺎ ﺛﺒﺖ أن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻳﺆدي إﻟﻰ ﺗﺤﺴﻴﻦ ﻃﺒﻴﻌﺔ اﻟﺤﻴﺎة.‬ ‫-3-‬
‫اﻟﻘﺴﻢ 3 -‬ ‫اﻟﺤﺎﺟﺔ اﻟﻄﺒﻴﺔ إﻟﻰ ﺗﻨﺎول اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻦ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺬي ﺗﻨﺎول آﻴﻔﻴﺔ اﻟﺘﻌﺎﻣﻞ‬ ‫اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“In patients with severe pain, morphine -- a strong opioid -- is the drug of‬‬ ‫”‪].choice‬ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﻜﺎﺑﺪون أﻟ ًﺎ ﻣﺒﺮ ًﺎ، ﻳﻌﺪ اﻟﻤﻮرﻓﻴﻦ – وهﻮ ﻣﺎدة‬ ‫ﺣ‬ ‫ﻤ‬ ‫أﻓﻴﻮﻧﻴﺔ ﻣﺨ ﱢرة – ﺑﻤﺜﺎﺑﺔ اﻟﻌﻘﺎر اﻷﻣﺜﻞ[ )ص 81(.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻨﺖ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻠﻌﺎﻟﻢ أن أﻏﻠﺐ، إن ﻟﻢ ﻳﻜﻦ آﻞ، اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫ﻳﻤﻜﻦ ﺗﺨﻔﻴﻔﻪ ﻓﻲ ﺣﺎﻟﺔ ﺗﻄﺒﻴﻖ اﻟﻤﻌﺮﻓﺔ اﻟﻄﺒﻴﺔ اﻟﻤﺘﻮﻓﺮة ﺣﺎﻟ ًﺎ )6(. ﻳﻤﻜﻦ ﺗﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫ﻴ‬ ‫ﺑﺎﺳﺘﺨﺪام ﻣﺠﻤﻮﻋﺔ ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﺘﺪاﺑﻴﺮ اﻟﺪواﺋﻴﺔ وﻏﻴﺮ اﻟﺪواﺋﻴﺔ، ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ. وﻣﻊ ذﻟﻚ‬ ‫ﻓﺈن اﻟﻤﻮرﻓﻴﻦ واﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ اﻟﻌﻼﺟﻴﺔ ﻟﻠﻤﻮرﻓﻴﻦ ﺗﻌﺪ أﻣ ًا ﺿﺮور ًﺎ‬ ‫ﻳ‬ ‫ﺮ‬ ‫ﺪ‬ ‫ﻋﻨﺪﻣﺎ ﻳﻜﻮن اﻷﻟﻢ ﻣﺘﻮﺳ َﺎ أو ﺣﺎ ًا )4، 5، 6(. ﺗﻢ ﺗﺸﺠﻴﻊ أﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻠﻰ اﺳﺘﺨﺪام‬ ‫د‬ ‫ﻄ‬ ‫ً‬ ‫اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﻤﺆآﺪة اﻟﻤﻜﻮﻧﺔ ﻣﻦ ﺛﻼث ﺧﻄﻮات )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( واﻟﺘﻲ ﺗﻢ‬ ‫ﺗﻄﻮﻳﺮهﺎ ﻣﻦ ﻗﺒﻞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ آﻄﺮﻳﻘﺔ ﻓﻌﺎﻟﺔ ﻟﻌﻼج اﻷﻟﻢ.‬ ‫ذآﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )4( ﻓﻲ ﻋﺎم 0991 أن:‬ ‫‪“Freedom from pain should be seen as a right of every cancer patient and access to‬‬ ‫”‪] pain therapy as a measure of respect for this right‬ﻳﻨﺒﻐﻲ اﻋﺘﺒﺎر اﻟﺘﺨﻠﺺ ﻣﻦ اﻷﻟﻢ‬ ‫ﺑﻤﺜﺎﺑﺔ ﺣﻖ ﻟﻜﻞ ﻣﺼﺎب ﺑﺎﻟﺴﺮﻃﺎن آﻤﺎ ﻳﻨﺒﻐﻲ اﻋﺘﺒﺎر اﻟﺤﺼﻮل ﻋﻠﻰ ﻋﻼج اﻷﻟﻢ ﻳﻌﺪ ﻣﻘﻴﺎ ًﺎ ﻟﻤﺪى‬ ‫ﺳ‬ ‫اﺣﺘﺮام هﺬا اﻟﺤﻖ [ )ص 01(.‬ ‫ﻳﻌﺘﻤﺪ ﺗﺨﻔﻴﻒ اﻷﻟﻢ اﻟﺤﺎد اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻋﻠﻰ ﺗﻮﻓﺮ واﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ‬ ‫ﺪ‬ ‫اﻟﻌﻼﺟﻴﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﻤﻮرﻓﻴﻦ. ﻟﻴﺲ ﻟﺪى هﺬﻩ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة أي "ﺳﻘﻒ ﺗﺴﻜﻴﻨﻲ" )أي ﺳﻤﺔ‬ ‫ﺪ‬ ‫دواﺋﻴﺔ ﻟﻌﻘﺎر ﻋﻨﺪﻣﺎ ﻻ ﺗﻮﻓﺮ ﺟﺮﻋﺔ ﻣﺘﺰاﻳﺪة ﻣﻨﻪ ﻗﺪ ًا إﺿﺎﻓ ًﺎ ﻣﻦ اﻟﺘﺴﻜﻴﻦ(. وﻳﻤﻜﻦ إﻋﻄﺎؤهﺎ ﺑﺄﻣﺎن ﻓﻲ‬ ‫ﻴ‬ ‫ر‬ ‫ﺷﻜﻞ ﺟﺮﻋﺎت ﻣﺘﺰاﻳﺪة إﻟﻰ أن ﻳﺘﻢ ﺗﺨﻔﻴﻒ اﻷﻟﻢ، ﻃﺎﻟﻤﺎ ﻳﻤﻜﻦ ﺗﺤﻤﻞ اﻷﻋﺮاض اﻟﺠﺎﻧﺒﻴﺔ )5(. وﻻ ﺗﻮﺟﺪ‬ ‫ﺟﺮﻋﺔ ﻋﻼﺟﻴﺔ ﻗﻴﺎﺳﻴﺔ ﻣﻦ هﺬﻩ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة. وﻳﻨﺒﻐﻲ ﺗﺤﺪﻳﺪ اﻟﺠﺮﻋﺔ اﻟﻤﻨﺎﺳﺒﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ ﻋﻦ‬ ‫ﺪ‬ ‫4‬ ‫ﻃﺮﻳﻖ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻔﺮدﻳﺔ ﻟﻠﻤﺮﻳﺾ.‬ ‫ﻳﺠﺐ ﺗﻮﻓﻴﺮ ﻣﻘﺎدﻳﺮ آﺎﻓﻴﺔ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ ودواء واﺣﺪ أو أآﺜﺮ ﻣﻦ اﻷدوﻳﺔ اﻷﻓﻴﻮﻧﻴﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ، ﻓﻀﻼ ﻋﻦ‬ ‫ً‬ ‫اﻷدوﻳﺔ اﻷﺧﺮى اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ واﻷﻋﺮاض اﻟﻤﺮﺿﻴﺔ، ﻋﻨﺪﻣﺎ ﻳﺤﺘﺎج اﻟﻤﺮﺿﻰ إﻟﻴﻬﺎ وﻓﻲ‬ ‫اﻷﻣﺎآﻦ اﻟﺘﻲ ﻳﻌﻴﺸﻮن ﻓﻴﻬﺎ )4(.‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻦ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل آﻴﻔﻴﺔ اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﻣﺎ ﻳﻠﻲ:‬ ‫1691 ‪“Of 22 drugs commonly used for cancer pain relief, eight are covered by the‬‬ ‫‪Single Convention on Narcotic Drugs and one by the 1971 Convention on‬‬ ‫”...‪] Psychotropic Substances‬ﻣﻦ ﺑﻴﻦ اﻟـ 22 دواء ﻣﺴﺘﺨﺪ ًﺎ ﺑﺸﻜﻞ ﺷﺎﺋﻊ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ‬ ‫ﻣ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن، ﺗﻐﻄﻲ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691 ﺛﻤﺎﻧﻴﺔ أدوﻳﺔ ﻣﻨﻬﺎ، آﻤﺎ‬ ‫ﺗﻐﻄﻲ إﺣﺪاهﺎ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻤﺆﺛﺮات اﻟﻌﻘﻠﻴﺔ ﻟﺴﻨﺔ 1791... [)ص 72(.‬ ‫آﺎﻧﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ اﻷﺳﺎﺳﻴﺔ )7( ﻗﺪ ﺻﻨﻔﺖ ﻷﻋﻮام‬ ‫4ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎت إآﻠﻴﻨﻴﻜﻴﺔ ﺣﻮل آﻴﻔﻴﺔ اﺧﺘﻴﺎر اﻟﻤﺴﻜﻨﺎت واﺳﺘﺨﺪاﻣﻬﺎ، راﺟﻊ: ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، 6991 )5(.‬ ‫-4-‬
‫ﻋﺪﻳﺪة اﻟﻤﻮرﻓﻴﻦ واﻟﻜﻮداﻳﻴﻦ وﻏﻴﺮهﺎ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة آـ "ﻋﻘﺎﻗﻴﺮ أﺳﺎﺳﻴﺔ" وﻋﺮﻓﺘﻬﺎ ﻋﻠﻰ‬ ‫ﺪ‬ ‫اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫‪“those that satisfy the health care needs of the majority of the population; they‬‬ ‫‪should therefore be available at all times in adequate amounts and in the‬‬ ‫”...‪] appropriate dosage forms‬هﻲ ﺗﻠﻚ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﻠﺒﻲ اﺣﺘﻴﺎﺟﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫ﻷﻏﻠﺐ اﻟﺴﻜﺎن؛ وﻳﻨﺒﻐﻲ إﺗﺎﺣﺘﻬﺎ داﺋ ًﺎ ﺑﺎﻟﻤﻘﺎدﻳﺮ اﻟﻜﺎﻓﻴﺔ وﺑﺄﺷﻜﺎل اﻟﺠﺮﻋﺎت اﻟﻤﻼﺋﻤﺔ... [‬ ‫ﻤ‬ ‫)ص 2(.‬ ‫ﺗﺰاﻳﺪ اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻤﻮرﻓﻴﻦ ﺑﺼﻮرة آﺒﻴﺮة ﺣﻴﺚ ﺗﺒﻨﺖ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت وأﺧﺼﺎﺋﻴﻮ اﻟﺼﺤﺔ‬ ‫اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻣﻊ ذﻟﻚ‬ ‫ﻓﺈن ﻣﻌﻈﻢ اﻻﺳﺘﻬﻼك اﻟﻤﺘﺰاﻳﺪ ﻟﻠﻤﻮرﻓﻴﻦ ﻗﺪ ﺣﺪث ﻓﻲ ﻋﺪد ﻗﻠﻴﻞ ﻣﻦ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ اﻟﺘﻲ ﺗﻤﺜﻞ ﺟﺰ ًا‬ ‫ء‬ ‫ﺿﺌﻴﻼ ﻣﻦ ﺗﻌﺪاد ﺳﻜﺎن اﻟﻌﺎﻟﻢ )3(. وﻓﻲ اﻵوﻧﺔ اﻷﺧﻴﺮة، ﺑﺪأ اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ ﻓﻲ اﻟﺘﺰاﻳﺪ ﻓﻲ دول‬ ‫ً‬ ‫أﺧﺮى، وﻣﻦ ﺑﻴﻨﻬﺎ ﻋﺪد ﻣﻦ اﻟﺪول اﻟﻨﺎﻣﻴﺔ. وﺗﻮﺿﺢ اﻟﺒﻴﺎﻧﺎت اﻹﺣﺼﺎﺋﻴﺔ ﻟﻠﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻋﻦ اﻟﻔﺘﺮة ﻣﻦ 0991 إﻟﻰ 8991 ﺣﺪوث ﺗﺰاﻳﺪات آﺒﻴﺮة ﻓﻲ آﻞ ﻣﻦ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ واﻟﻨﺎﻣﻴﺔ ﻋﻠﻰ ﺣﺪ‬ ‫ﺳﻮاء، ﺑﻴﻨﻤﺎ ﺑﻘﻰ ﻣﻌﺪل اﻻﺳﺘﻬﻼك ﺛﺎﺑ ًﺎ أو ﺣﺘﻰ ﺗﻨﺎﻗﺺ ﻓﻲ دول أﺧﺮى. وﺗﺴﺘﺨﺪم أﻏﻠﺐ اﻟﺪول ﻗﺪ ًا‬ ‫ر‬ ‫ﺘ‬ ‫ﺿﺌﻴﻼ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ.‬ ‫ً‬ ‫ﻳﻘﺪم اﻟﻤﻠﺤﻖ 4 ﺑﻴﺎﻧﺎت ﺣﻮل اﺳﺘﻬﻼك ﻧﻄﺎق واﺳﻊ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻤﺤﺪدة ﻓﻲ ﺷﻜﻞ ﺟﺮﻋﺔ‬ ‫ﺪ‬ ‫ﻳﻮﻣﻴﺔ ﻣﻘﺮرة )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻟﻜﻞ ﻣﻠﻴﻮن ﻧﺴﻤﺔ، وﻳﻤﺜﻞ اﻟﻤﺘﻮﺳﻂ ﻓﻲ ﺧﻤﺴﺔ‬ ‫أﻋﻮام. وﻳﺘﻴﺢ اﻟﻤﻠﺤﻖ 4 إﻣﻜﺎﻧﻴﺔ اﻟﻤﻘﺎرﻧﺔ ﺑﻴﻦ اﺳﺘﻬﻼك ﻋﺪد ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة داﺧﻞ اﻟﺪول‬ ‫ﺪ‬ ‫وﻓﻴﻤﺎ ﺑﻴﻨﻬﺎ. وﻓﻲ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺪول، ﻳﻈﻞ ﻣﻌﺪل اﻻﺳﺘﻬﻼك ﻣﻨﺨﻔ ًﺎ ﻟﻠﻐﺎﻳﺔ ﻣﻘﺎرﻧﺔ ﺑﺎﻻﺣﺘﻴﺎج اﻟﻄﺒﻲ،‬ ‫ﻀ‬ ‫وﻣﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻰ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ ﺳﺪ هﺬا اﻟﻨﻘﺺ اﻟﺒﺎﻟﻎ )3(.‬ ‫اﻟﻘﺴﻢ 4‬ ‫اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻓﻲ أﻏﻠﺐ اﻟﺪول، ﻻ ﻳﺘﻮﻓﺮ اﻟﻤﻮرﻓﻴﻦ واﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻷﺧﺮى اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ اﻟﻌﻼﺟﻴﺔ‬ ‫ﺪ‬ ‫اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﻤﻮرﻓﻴﻦ، أو ﺗﻜﻮن ﻣﺘﻮﻓﺮة ﺑﻜﻤﻴﺎت ﻣﺤﺪودة أو ﻓﻲ أﻣﺎآﻦ ﻣﺤﺪودة، أو ﺗﻜﻮن ﻣﺘﻮﻓﺮة ﻣﻊ‬ ‫اﺳﺘﺨﺪاﻣﻬﺎ ﺑﺸﻜﻞ ﻧﺎﻗﺺ )4( .وﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن ﻣﻨﺸﻮر اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﻤﻜﻮﻧﺔ ﻣﻦ ﺛﻼث‬ ‫ﺧﻄﻮات واﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺬي ﻧﺸﺮﺗﻪ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻓﻲ ﻋﺎم‬ ‫6891 ﻗﺪ ﺳﺎهﻢ ﻓﻲ ﺗﺰاﻳﺪ ﻣﻌﺪل اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ. وﻗﺒﻞ ﻣﻄﻠﻊ اﻟﺜﻤﺎﻧﻴﻨﻴﺎت ﻣﻦ‬ ‫اﻟﻘﺮن اﻟﻌﺸﺮﻳﻦ، آﺎن ﻣﻌﺪل اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ )راﺟﻊ اﻟﻤﺮاﻓﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻣﻨﺨﻔ ًﺎ وﺛﺎﺑ ًﺎ‬ ‫ﺘ‬ ‫ﻀ‬ ‫)راﺟﻊ اﻟﺸﻜﻞ اﻟﺘﻮﺿﻴﺤﻲ اﻟﺘﺎﻟﻲ(.‬ ‫-5-‬
‫اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻤﻮرﻓﻴﻦ‬ ‫8991-2791‬ ‫آﻴﻠﻮﺟﺮام‬ ‫8991 7991 6991 5991 4991 3991 2991 1991 0991 9891 8891 7891 6891 5891 4891 3891 2891 1891 0891 9791 8791 7791 6791 5791 4791 3791 2791‬ ‫اﻟﻤﺼﺪر: اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻓﻲ ﻋﺎم 3991، أﻗﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ )8(:‬ ‫‪“...that there was a great need to ensure, in seeking to reduce the non-medical use‬‬ ‫‪of therapeutic psychoactive drugs, that patients with legitimate medical needs are‬‬ ‫‪not prevented from being treated with adequate amounts of appropriate‬‬ ‫‪medications. Evidence suggests that medical needs for opioids are not being fully‬‬ ‫‪satisfied, particularly among patients with cancer, who may require large doses of‬‬ ‫”‪...] opioids to obtain optimal pain relief‬آﺎﻧﺖ هﻨﺎك ﺣﺎﺟﺔ ﻣﺎﺳﺔ ﻟﻀﻤﺎن أﻧﻪ ﻻ ﻳﺘﻢ ﻣﻨﻊ‬ ‫اﻟﻤﺮﺿﻰ ذوي اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ اﻟﻤﺸﺮوﻋﺔ ﻣﻦ ﺗﻠﻘﻲ اﻟﻌﻼج ﺑﻤﻘﺎدﻳﺮ آﺎﻓﻴﺔ ﻣﻦ اﻷدوﻳﺔ‬ ‫اﻟﻤﻼﺋﻤﺔ، وذﻟﻚ ﻓﻲ إﻃﺎر اﻟﺴﻌﻲ إﻟﻰ ﺧﻔﺾ اﻻﺳﺘﺨﺪام ﻏﻴﺮ اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻌﻼﺟﻴﺔ اﻟﻨﻔﺴﻴﺔ.‬ ‫وﺗﺸﻴﺮ اﻷدﻟﺔ إﻟﻰ ﻋﺪم ﺗﻠﺒﻴﺔ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺑﺸﻜﻞ آﺎﻣﻞ،‬ ‫ﺪ‬ ‫ﺧﺎﺻﺔ ﺑﻴﻦ اﻟﻤﺮﺿﻰ اﻟﻤﺼﺎﺑﻴﻦ ﺑﺎﻟﺴﺮﻃﺎن، واﻟﺬﻳﻦ ﻗﺪ ﻳﺘﻄﻠﺒﻮن ﺟﺮﻋﺎت آﺒﻴﺮة ﻣﻦ اﻟﻤﻮاد‬ ‫اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﺤﺪ اﻷﻗﺼﻰ ﻣﻦ ﺗﺨﻔﻴﻒ اﻷﻟﻢ[ )ص 02(.‬ ‫ﺪ‬ ‫ﻃﺒ ًﺎ ﻟﺪراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ أﺟﺮﻳﺖ ﻋﺎم 5991 ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت ﻣﻦ ﻗﺒﻞ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻘ‬ ‫)3(، ﻻ ﺗﺰال اﻷﺷﻜﺎل اﻟﻘﺎﺑﻠﺔ ﻟﻠﺤﻘﻦ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ أآﺜﺮ ﺗﻮﻓ ًا ﻣﻦ اﻟﺸﻜﻞ اﻟﺬي ﻳﺘﻢ ﺗﻌﺎﻃﻴﻪ ﻋﻦ ﻃﺮﻳﻖ اﻟﻔﻢ‬ ‫ﺮ‬ ‫واﻟﺬي ﺗﻮﺻﻲ ﺑﻪ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ. وﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن 06% ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﺧﻀﻌﺖ‬ ‫ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ ﻗﺪ أﻗﺮت اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، ﻓﺈن ﻧﺤﻮ ﻧﺼﻒ‬ ‫اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ اﺳﺘﺠﺎﺑﺖ ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ أﺑﻠﻐﺖ ﻋﻦ ﻋﺪم ﺗﻮاﻓﺮ اﻟﻤﻮرﻓﻴﻦ ﻓﻲ آﺎﻓﺔ اﻟﻤﺴﺘﺸﻔﻴﺎت اﻟﺘﻲ‬ ‫ﺗﺤﺘﻮي ﻋﻠﻰ ﺑﺮاﻣﺞ ﻟﻌﻼج اﻟﺴﺮﻃﺎن. وﻟﻘﺪ أﺻﺒﺢ اﻟﻨﺠﺎح اﻟﻤﺤﺮز ﻓﻲ ﺗﻄﺒﻴﻖ اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ‬ ‫ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻣﺤﺪو ًا ﻣﻦ ﺟﺮاء ﻧﻘﺺ اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ؛ وﺳﻮف ﻳﻌﺘﻤﺪ اﻟﻨﺠﺎح ﻓﻲ اﻟﻤﺴﺘﻘﺒﻞ‬ ‫د‬ ‫ﻋﻠﻰ ﺟﻬﻮد اﻟﺤﻜﻮﻣﺎت ﻧﺤﻮ ﺗﺤﺪﻳﺪ وﻣﺠﺎﺑﻬﺔ اﻟﻌﻘﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ ﻧﻈﻢ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ واﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫اﻟﺨﺎﺻﺔ ﺑﻬﻢ.‬ ‫-6-‬
‫اﻟﻘﺴﻢ 5‬ ‫ﻋﻮاﺋﻖ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻟﻤﺨﺪ ﱢة‬ ‫ر‬ ‫دﻋﺖ آﻞ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ إﻟﻰ اﻻهﺘﻤﺎم ﺑﺎﻟﻌﻼج ﻏﻴﺮ اﻟﻜﺎﻓﻲ‬ ‫ﻟﻸﻟﻢ، وﻗﺪ ﺗﻮﺻﻠﺘﺎ إﻟﻰ أن هﺬا اﻷﻣﺮ ﻳﺮﺟﻊ ﺟﺰﺋ ًﺎ إﻟﻰ اﻟﻘﻮاﻧﻴﻦ واﻟﺘﺸﺮﻳﻌﺎت اﻟﻤﻘ ﱢﺪة ﻋﻠﻰ ﻧﺤﻮ ﻣﺒﺎﻟﻎ ﻓﻴﻪ‬ ‫ﻴ‬ ‫ﻴ‬ ‫واﻟﺘﻲ ﺗﻌﻮق اﻟﺘﻮاﻓﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة واﺳﺘﺨﺪاﻣﻬﺎ اﻟﻄﺒﻲ )3، 4، 5، 9،‬ ‫ﺪ‬ ‫5‬ ‫01، 11(.‬ ‫ﻓﻲ وﻗﺖ ﻣﺒﻜﺮ وﺗﺤﺪﻳ ًا ﻓﻲ ﻋﺎم 6891، اﻋﺘﺮف اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل‬ ‫ﺪ‬ ‫اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﺑﺎﻟﺤﺎﺟﺔ إﻟﻰ ﺗﺤﺪﻳﺚ ﻧﻈﻢ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ وذﻟﻚ ﻟﺘﻠﺒﻴﺔ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ اﻟﻤﺘﻐﻴﺮة: :‬ ‫‪“Systems regulating the distribution and prescription of opioid drugs were designed‬‬ ‫‪before the value of the oral use of opioid drugs for cancer pain management was‬‬ ‫‪recognized. These systems were developed to prevent the social misuse of strong‬‬ ‫”‪opioids; there was no intention to prevent the use of opioids for pain relief in cancer‬‬ ‫]ﺗﻢ ﺗﺼﻤﻴﻢ اﻟﻨﻈﻢ اﻟﺘﻲ ﺗﻨﻈﻢ ﺗﻮزﻳﻊ ووﺻﻒ اﻟﻌﻘﺎﻗﻴﺮ اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻗﺒﻞ اﻟﺘﻌﺮف ﻋﻠﻰ ﻗﻴﻤﺔ‬ ‫ﺪ‬ ‫اﻟﺘﻌﺎﻃﻲ ﺑﺎﻟﻔﻢ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻗﺪ ﺗﻢ وﺿﻊ هﺬﻩ‬ ‫ﺪ‬ ‫اﻟﻨﻈﻢ ﻟﻠﺤﻴﻠﻮﻟﺔ دون ﺳﻮء اﻻﺳﺘﺨﺪام اﻻﺟﺘﻤﺎﻋﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻘﻮﻳﺔ؛ وﻟﻢ ﻳﻜﻦ هﻨﺎك‬ ‫ﺪ‬ ‫ﻋﺰم ﻟﻤﻨﻊ اﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن[‬ ‫ﺪ‬ ‫)ص 72(.‬ ‫آﻤﺎ أوﺿﺢ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ‬ ‫اﻟﺴﺮﻃﺎن ﻋﺎم 6891 )6( أهﺪاف اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691، واﻟﻤﻌﺪﻟﺔ ﺑﺒﺮوﺗﻮآﻮل‬ ‫2791 اﻟﻤﻌﺪل ﻟﻼﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691 )واﻟﻤﺸﺎر إﻟﻴﻬﺎ ﻓﻴﻤﺎ ﻳﻠﻲ ﺑﺎﺳﻢ‬ ‫” اﺗﻔﺎﻗﻴﺔ 1691“، راﺟﻊ اﻟﻤﻠﺤﻖ 1(، واﺗﻔﺎﻗﻴﺔ اﻟﻤﺆﺛﺮات اﻟﻌﻘﻠﻴﺔ ﻟﺴﻨﺔ 1791:‬ ‫,‪“...The principal object of these two conventions is to stop trade in, and use of‬‬ ‫‪controlled drugs, except for medical and scientific purposes. The conventions are‬‬ ‫‪not intended to be an impediment to the use of necessary drugs for the relief of‬‬ ‫,‪cancer pain. It is therefore important that, by complying with the conventions‬‬ ‫‪national laws should not, at the same time, impede the use of these drugs in cancer‬‬ ‫‪patients. Some countries have gone beyond the minimal control measures laid down‬‬ ‫‪in the conventions. Some have established stringent controls, especially in relation to‬‬ ‫”‪...] drug prescription and distribution‬ﻳﺘﻤﺜﻞ اﻟﻐﺮض اﻟﺮﺋﻴﺴﻲ ﻣﻦ هﺎﺗﻴﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ ﻓﻲ ﻣﻨﻊ‬ ‫اﻻﺗﺠﺎر ﻓﻲ اﻟﻌﻘﺎﻗﻴﺮ اﻟ ُﺮا َﺒﺔ، إﻻ ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ. وﻻ ﻳﻘﺼﺪ ﻣﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ أن‬ ‫ﻤ ﻗ‬ ‫ﺗﺸﻜﻼ ﻋﺎﺋ ًﺎ أﻣﺎم اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ اﻟﻀﺮورﻳﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. ﻟﺬا ﻣﻦ‬ ‫ﻘ‬ ‫اﻷهﻤﻴﺔ ﺑﻤﻜﺎن أن ﺗﻠﺘﺰم اﻟﻘﻮاﻧﻴﻦ اﻟﻮﻃﻨﻴﺔ ﺑﺎﻻﺗﻔﺎﻗﻴﺘﻴﻦ وﻳﻨﺒﻐﻲ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ أﻻ ﺗﻌﻮق اﺳﺘﺨﺪام‬ ‫هﺬﻩ اﻟﻌﻘﺎﻗﻴﺮ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن. وﻟﻘﺪ ﺗﺠﺎوزت ﺑﻌﺾ اﻟﺪول اﻟﺤﺪ اﻷدﻧﻰ ﻣﻦ ﺗﺪاﺑﻴﺮ اﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﻮاردة ﻓﻲ هﺎﺗﻴﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ. إذ أﻗﺮت ﺑﻌﺾ اﻟﺪول ﺿﻮاﺑﻂ ﺻﺎرﻣﺔ، وﻋﻠﻰ اﻷﺧﺺ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ‬ ‫ﺑﺎﻟﻮﺻﻒ اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ وﺗﻮزﻳﻌﻬﺎ )ﺗﻤﺖ إﺿﺎﻓﺔ ﺗﺸﺪﻳﺪ([ )ص 72(.‬ ‫ﻓﻲ ﻋﺎم 9891، ﺟﺬﺑﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( اﻻﻧﺘﺒﺎﻩ إﻟﻰ رد اﻟﻔﻌﻞ اﻟﻤﻔﺮط ﻟﺒﻌﺾ‬ ‫اﻟﺤﻜﻮﻣﺎت إزاء ﻣﺸﻜﻠﺔ إﺳﺎءة اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ ﻋﻨﺪﻣﺎ:‬ ‫‪“...the reaction of some legislators and administrators to the fear of drug‬‬ ‫5ﻟﻤﺰﻳﺪ ﻣﻦ اﻟﻨﻘﺎش ﺣﻮل آﺎﻓﺔ اﻟﻌﻘﺒﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﻌﻼج اﻟﺘﺴﻜﻴﻨﻲ وﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪرة،‬ ‫ﱢ‬ ‫راﺟﻊ: ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، 0991 )4(؛ 6991 )5(.‬ ‫-7-‬
‫‪abuse developing or spreading has led to the enactment of laws and‬‬ ‫‪regulations that may, in some cases, unduly impede the availability of‬‬ ‫‪opiates. The problem may also arise as a result of the manner in which‬‬ ‫”‪drug control laws and regulations are interpreted or implemented‬‬ ‫]...أﻓﻀﻰ رد ﻓﻌﻞ ﺑﻌﺾ اﻟﻤﺴﺌﻮﻟﻴﻦ واﻟﻤﺸﺮﻋﻴﻦ إزاء اﻟﺨﻮف ﻣﻦ ﺗﻄﻮر أو اﻧﺘﺸﺎر‬ ‫إﺳﺎءة اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ إﻟﻰ ﺳﻦ اﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ ﻗﺪ ﺗﻌﻮق ﺑﺸﻜﻞ‬ ‫ﻣﻔﺮط ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﺗﻮاﻓﺮ اﻷﻓﻴﻮن. وﻗﺪ ﺗﻨﺸﺄ اﻟﻤﺸﻜﻠﺔ أﻳ ًﺎ آﻨﺘﻴﺠﺔ ﻟﻠﻄﺮﻳﻘﺔ‬ ‫ﻀ‬ ‫اﻟﺘﻲ ﻳﺘﻢ ﺑﻬﺎ ﺗﻔﺴﻴﺮ أو ﺗﻄﺒﻴﻖ اﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﻤﺘﻌﻠﻘﺔ ﺑﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ[‬ ‫)ص 1(.‬ ‫,‪“...legislators sometimes enact laws which not only deal with the illicit traffic itself‬‬ ‫‪but also impinge on some aspects of licit trade and use, without first having‬‬ ‫‪adequately assessed the impact of the new laws on such licit activity. Heightened‬‬ ‫‪concern with the possibility of abuse may also lead to the adoption of overly‬‬ ‫‪restrictive regulations which have the practical effect of reducing availability‬‬ ‫”‪...] for licit purposes‬أﺣﻴﺎ ًﺎ ﻣﺎ ﻳﻘﻮم اﻟﻤﺸ ﱢﻋﻮن ﺑﺴﻦ اﻟﻘﻮاﻧﻴﻦ اﻟﺘﻲ ﻻ ﺗﺘﻨﺎول ﻓﻘﻂ‬ ‫ﺮ‬ ‫ﻧ‬ ‫اﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع ﻓﻲ ﺣﺪ ذاﺗﻪ، وإﻧﻤﺎ ﺗﺼﻄﺪم أﻳ ًﺎ ﺑﺒﻌﺾ ﻧﻮاﺣﻲ اﻟﺘﺠﺎرة‬ ‫ﻀ‬ ‫واﻻﺳﺘﺨﺪام اﻟﻤﺸﺮوﻋﻴﻦ، دون إﺟﺮاء ﺗﻘﻴﻴﻢ آﺎف أوﻻ ﻟﺘﺄﺛﻴﺮ اﻟﻘﻮاﻧﻴﻦ اﻟﺠﺪﻳﺪة ﻋﻠﻰ هﺬا‬ ‫ٍ ً‬ ‫اﻟﻨﺸﺎط ﻏﻴﺮ اﻟﻤﺸﺮوع. وﻗﺪ ﻳﺆدي أﻳ ًﺎ اﻟﻘﻠﻖ اﻟﻤﻀﺎﻋﻒ إزاء اﺣﺘﻤﺎﻟﻴﺔ إﺳﺎءة اﻻﺳﺘﺨﺪام‬ ‫ﻀ‬ ‫إﻟﻰ اﺗﺨﺎذ ﻟﻮاﺋﺢ ﺗﻨﻈﻴﻤﻴﺔ ﻣﻘﻴﺪة ﺑﺸﻜﻞ ﻣﻔﺮط ﺗﻨﻄﻮي ﻋﻠﻰ ﺗﺄﺛﻴﺮ ﺧﻔﺾ ﻣﻌﺪﻻت اﻟﺘﻮاﻓﺮ‬ ‫ﻟﻸﻏﺮاض اﻟﻤﺸﺮوﻋﺔ[ )ص 51(.‬ ‫ﻓﻲ واﻗﻊ اﻷﻣﺮ، ﻟﻢ ﻳﺤﻆ اﻻﺳﺘﺨﺪام ﻃﻮﻳﻞ اﻟﻤﺪى ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺑﻐﺮض ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﺎﻟﺘﺸﺠﻴﻊ،‬ ‫ﺪ‬ ‫وذﻟﻚ ﻟﻮﺟﻮد ﺧﻄﺮ ﻧﺎﺟﻢ ﻋﻦ "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ". اﻻﺳﺘﺨﺪام اﻟﺪﻗﻴﻖ ﻟﻠﻤﺼﻄﻠﺤﺎت هﻮ ﻣﺎ ﻳﻔﺼﻞ‬ ‫اﻟﺘﺼﻮرات واﻟﺨﺮاﻓﺎت ﻋﻦ اﻟﻮاﻗﻊ.‬ ‫ﻳﻤﻜﻦ أن ﻳﺤﻮل اﻻﻟﺘﺒﺎس ﻓﻲ اﻟﻤﺼﻄﻠﺤﺎت دون اﺳﺘﺨﺪام آﻞ ﻣﻦ اﻷﻃﺒﺎء واﻟﻤﺮﺿﻰ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ‬ ‫اﻟﻤﺨ ﱢرة ﻋﻨﺪ ﺗﻮاﻓﺮ ﻣﺒﺮر ﻃﺒﻲ ﻗﻮي ﻻﺳﺘﺨﺪاﻣﻬﺎ. وﻗﺪ ﻳﺤﺪث ﻧﻮﻋﺎن ﻣﺮﺗﺒﻄﺎن ﻣﻦ اﻻﻟﺘﺒﺎس: )1( اﻟﺘﺨﺒﻂ‬ ‫ﺪ‬ ‫ﺑﻴﻦ "اﻟﺘﻌﺎﻃﻲ" )أو "إﺳﺎءة اﻻﺳﺘﺨﺪام"( واﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻃﻮﻳﻞ اﻟﻤﺪى، و)2( اﻟﺘﺨﺒﻂ ﺑﻴﻦ "اﻹدﻣﺎن"‬ ‫و"اﻻﺗﻜﺎل".‬ ‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻨﻮع اﻷول ﻣﻦ اﻻﻟﺘﺒﺎس، ﻳﺘﻤﺜﻞ اﻟﻬﺪف اﻟﺮﺋﻴﺴﻲ ﻻﺗﻔﺎﻗﻴﺔ 1691 ﻓﻲ ﻣﻨﻊ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻣﻊ ﺿﻤﺎن ﺗﻮاﻓﺮهﺎ ﻟﻼﺳﺘﺨﺪام اﻟﻄﺒﻲ. ﻟﺬا ﻓﻤﻦ اﻷهﻤﻴﺔ ﺑﻤﻜﺎن إﺟﺮاء ﺗﻤﻴﻴﺰ واﺿﺢ ﺑﻴﻦ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫اﻟﻤﺨ ﱢرة واﺳﺘﺨﺪاﻣﻬﺎ ﻃﺒ ًﺎ.‬ ‫ﻴ‬ ‫ﺪ‬ ‫ﻻ ﺗﻘﻮم اﺗﻔﺎﻗﻴﺔ 1691 ﺑﺘﻌﺮﻳﻒ ﻣﺼﻄﻠﺤﻲ "إﺳﺎءة اﻻﺳﺘﺨﺪام" أو "اﻟﺘﻌﺎﻃﻲ". وﻣﻊ ذﻟﻚ ﻓﺈن‬ ‫ﻣﺼﻄﻠﺢ "اﻟﺘﻌﺎﻃﻲ" ﻣﻌﺮف ﻣﻦ ﻗﺒﻞ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ‬ ‫ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ )91( ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫‪“persistent or sporadic excessive drug use inconsistent with or unrelated to‬‬ ‫”‪] acceptable medical practice‬اﻻﺳﺘﺨﺪام اﻟﺰاﺋﺪ ﻋﻦ اﻟﺤﺪ ﻟﻠﻌﻘﺎﻗﻴﺮ ﺑﺸﻜﻞ ﻣﻨﺘﻈﻢ أو‬ ‫ﻏﻴﺮ ﻣﻨﺘﻈﻢ ﺑﻤﺎ ﻻ ﻳﺘﻔﻖ أو ﻳﺘﺼﻞ ﺑﺎﻟﻤﻤﺎرﺳﺔ اﻟﻄﺒﻴﺔ اﻟﻤﻘﺒﻮﻟﺔ[ )ص 6(.‬ ‫اﻧﻄﻼ ًﺎ ﻣﻦ هﺬا اﻟﺘﻌﺮﻳﻒ، ﻳﺘﻀﺢ أن اﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ، ﺳﻮاء ﻋﻠﻰ اﻟﻤﺪى اﻟﻄﻮﻳﻞ أم ﻻ،‬‫ﻗ‬ ‫وﺳﻮاء ﺣﺪﺛﺖ ردود ﻓﻌﻞ ﺳﻴﺌﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ )ﺑﻤﺎ ﻓﻲ ذﻟﻚ "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ"( أم ﻻ، ﻓﻼ ﻳﻤﺜﻞ "إﺳﺎءة‬ ‫اﺳﺘﺨﺪام ﻟﻠﻌﻘﺎﻗﻴﺮ".‬ ‫أﻣﺎ اﻟﻨﻮع اﻵﺧﺮ ﻣﻦ اﻻﻟﺘﺒﺎس ﺑﻴﻦ "اﻹدﻣﺎن" و"اﻻﺗﻜﺎل" ﻓﻴﺼﻌﺐ ﺗﻮﺿﻴﺤﻪ ﺑﺼﻮرة أآﺒﺮ ﻧﻈ ًا ﻷن‬ ‫ﺮ‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻢ ﺗﻌﺪ ﺗﺴﺘﺨﺪم ﻣﺼﻄﻠﺢ "اﻹدﻣﺎن". وﺑﻨﺎء ﻋﻠﻴﻪ، ﻻ ﻳﻮﺟﺪ ﺗﻌﺮﻳﻒ رﺳﻤﻲ ﻣﻦ‬ ‫ً‬ ‫-8-‬
‫6‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻤﺼﻄﻠﺢ "اﻹدﻣﺎن" ﺑﺤﻴﺚ ﻳﻤﻜﻦ ﻣﻘﺎرﻧﺘﻪ ﻣﻊ ﺗﻌﺮﻳﻒ ﻣﺼﻄﻠﺢ "اﻻﺗﻜﺎل".‬ ‫اﻟﺘﻌﺮﻳﻒ اﻟﺤﺎﻟﻲ ﻟﻤﺼﻄﻠﺢ "اﻻﺗﻜﺎل" 7 ﺣﺴﺐ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫واﻟﻤﻌﻨﻴﺔ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ )8( هﻮ:‬ ‫‪“A cluster of physiological, behavioural and cognitive phenomena of variable‬‬ ‫‪intensity, in which the use of a psychoactive drug (or drugs) takes on a high‬‬ ‫‪priority. The necessary descriptive characteristics are preoccupation with a‬‬ ‫.‪desire to obtain and take the drug and persistent drug-seeking behaviour‬‬ ‫‪Determinants and problematic consequences of drug dependence may be‬‬ ‫”‪] biological, psychological or social, and usually interact‬ﻣﺠﻤﻮﻋﺔ ﻇﻮاهﺮ‬ ‫ﻓﺴﻴﻮﻟﻮﺟﻴﺔ وﺳﻠﻮآﻴﺔ وﻣﻌﺮﻓﻴﺔ ذات ﺷﺪة ﻣﺘﻔﺎوﺗﺔ، ﻳﻜﻮن ﻓﻴﻬﺎ اﺳﺘﺨﺪام ﻋﻘﺎر )أو ﻋﻘﺎﻗﻴﺮ(‬ ‫ﻧﻔﺴﻴﺔ ذا أوﻟﻮﻳﺔ ﻋﺎﻟﻴﺔ. ﺗﺘﻤﺜﻞ اﻟﺴﻤﺎت اﻟﻮﺻﻔﻴﺔ اﻟﻼزﻣﺔ ﻓﻲ وﺟﻮد رﻏﺒﺔ ﻋﺎرﻣﺔ ﻓﻲ‬ ‫اﻟﺤﺼﻮل ﻋﻠﻰ اﻟﻌﻘﺎر وﺗﻌﺎﻃﻴﻪ وآﺬا ﺳﻠﻮك ﻣﻨﺘﻈﻢ ﻟﻄﻠﺐ اﻟﻌﻘﺎر. وﻗﺪ ﺗﻜﻮن اﻟﻤﺤﺪدات‬ ‫واﻟﻌﻮاﻗﺐ اﻹﺷﻜﺎﻟﻴﺔ ﻟﻼﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎر ﺑﻴﻮﻟﻮﺟﻴﺔ أو ﻧﻔﺴﻴﺔ أو اﺟﺘﻤﺎﻋﻴﺔ وﻋﺎدة ﻣﺎ ﺗﺘﺪاﺧﻞ‬ ‫ﺑﻌﻀﻬﺎ ﻣﻊ اﻟﺒﻌﺾ[ )ص 5(.‬ ‫ﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن اﻟﻤﻔﻬﻮم اﻷﺳﺎﺳﻲ ﻟﺘﻌﺮﻳﻒ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺨﺎص ﺑﻤﺼﻄﻠﺢ "اﻻﺗﻜﺎل ﻋﻠﻰ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ" ﻳﺘﻄﻠﺐ ﺗﻮاﻓﺮ رﻏﺒﺔ ﻗﻮﻳﺔ أو إﺣﺴﺎس ﺑﺎﻹﻟﺰام ﻟﺘﻌﺎﻃﻲ اﻟﻌﻘﺎر.‬ ‫آﻤﺎ أن اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ اﻹآﻠﻴﻨﻴﻜﻴﺔ )01-‪ (ICD‬اﻟﺨﺎﺻﺔ ﺑﺘﺸﺨﻴﺺ ﻣﺤﺪد ﻟـ "اﻻﺗﻜﺎل" واﻟﺘﻲ وﺿﻌﺘﻬﺎ‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺗﺘﻄﻠﺐ ﻇﻬﻮر ﺛﻼث أو أآﺜﺮ ﻣﻦ اﻟﺴﻤﺎت اﻟﻤﻤﻴﺰة اﻟﺴﺖ اﻟﺘﺎﻟﻴﺔ أو اﻟﺘﻌﺮض ﻟﻬﺎ‬ ‫)12(:‬ ‫)أ( رﻏﺒﺔ ﻗﻮﻳﺔ أو إﺣﺴﺎس ﺑﺎﻻﺿﻄﺮار ﻟﺘﻌﺎﻃﻲ اﻟﻌﻘﺎر؛‬ ‫)ب( ﺻﻌﻮﺑﺎت ﻓﻲ اﻟﺘﺤﻜﻢ ﻓﻲ ﺳﻠﻮك ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺒﺪﺋﻪ أو إﻧﻬﺎﺋﻪ أو ﻣﺴﺘﻮﻳﺎت‬ ‫اﺳﺘﺨﺪاﻣﻪ؛‬ ‫)ج( ﺣﺎﻟﺔ ﺳﺤﺐ ﺑﻴﻮﻟﻮﺟﻴﺔ ﻋﻨﺪ اﻟﺘﻮﻗﻒ ﻋﻦ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر أو ﺧﻔﺾ ﻣﻌﺪﻟﻪ، ﺣﺴﺒﻤﺎ ﻳﺘﻀﺢ ﻣﻦ‬ ‫ﺧﻼل: أﻋﺮاض اﻟﺴﺤﺐ اﻟﻤﻤﻴﺰة ﻟﻠﻌﻘﺎر؛ أو اﺳﺘﺨﺪام ﻧﻔﺲ اﻟﻌﻘﺎر )أو ﻋﻘﺎر ﻣﺮﺗﺒﻂ ﺑﺸﺪة(‬ ‫ﺑﻘﺼﺪ ﺗﺨﻔﻴﻒ أﻋﺮاض اﻟﺴﺤﺐ أو ﺗﺠﻨﺒﻬﺎ؛‬ ‫)د( دﻟﻴﻞ اﻟﺘﺤﻤﻞ، ﺣﻴﺚ إن اﻟﺠﺮﻋﺎت اﻟﻤﺘﺰاﻳﺪة ﻟﻠﻌﻘﺎر اﻟﻨﻔﺴﻲ ﺗﻜﻮن ﺿﺮورﻳﺔ ﻟﺘﺤﻘﻴﻖ‬ ‫اﻟﺘﺄﺛﻴﺮات اﻟﺘﻲ ﺗُﺤﺪﺛﻬﺎ اﻟﺠﺮﻋﺎت اﻷﻗﻞ؛‬ ‫)هـ( إهﻤﺎل ﻣﺘﺰاﻳﺪ ﺑﺎﻟﻤﺘﻊ أو اﻻهﺘﻤﺎﻣﺎت اﻟﺒﺪﻳﻠﺔ ﻣﻦ ﺟﺮاء ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر اﻟﻨﻔﺴﻲ، وﻗﺪر ﻣﺘﺰاﻳﺪ‬ ‫ﻣﻦ اﻟﻮﻗﺖ اﻟﻼزم ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﻌﻘﺎر أو ﺗﻌﺎﻃﻴﻪ أو ﻟﻠﺘﻌﺎﻓﻲ ﻣﻦ ﺁﺛﺎرﻩ؛‬ ‫6ﻟﻔﻬﻢ اﻟﻔﺎرق ﺑﻴﻦ "اﻟﺘﻌﺎﻃﻲ" و"اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ"، ﻣﻦ اﻟﻀﺮوري ﻣﺮاﺟﻌﺔ ﺗﺎرﻳﺦ ﺗﻄﻮر ﻣﻔﻬﻮم "اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻤﺨﺪرات"‬ ‫ﺑﺈﻳﺠﺎز. إﺑﺎن اﻟﺴﺘﻴﻨﻴﺎت ﻣﻦ اﻟﻘﺮن اﻟﻌﺸﺮﻳﻦ، ﻗﺎﻣﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﻮﻟﺪة ﻟﻺدﻣﺎن )02(‬ ‫ﺑﻤﺤﺎوﻻت ﺟﺎدة ﻟﺒﻴﺎن اﻟﻔﺎرق ﺑﻴﻦ "اﻹدﻣﺎن" و"اﻟﺘﻌﻮد"، وﻗﺪ ﺗﻮﻗﻔﺖ ﻋﻦ هﺬا اﻟﺠﻬﺪ واﻗﺘﺮﺣﺖ ﻋﻮ ًﺎ ﻋﻨﻪ اﺳﺘﺨﺪام ﻣﺼﻄﻠﺢ "اﻻﻋﺘﻤﺎد‬ ‫ﺿ‬ ‫ﻋﻠﻰ اﻟﻤﺨﺪرات". وﻓﻲ ﻋﻘﻮل ﺑﻌﺾ اﻟﺨﺒﺮاء، أدى هﺬا إﻟﻰ ﺣﺪوث ﺳﻮء ﻓﻬﻢ ﻣﻔﺎدﻩ أن ﻣﻌﻨﻰ اﻟﻤﺼﻄﻠﺢ اﻟﺠﺪﻳﺪ ﺁﻧﺬاك "اﻻﻋﺘﻤﺎد" ﻳﻤﺎﺛﻞ‬ ‫"اﻹدﻣﺎن" أو "اﻟﺘﻌﻮد" أو آﻠﻴﻬﻤﺎ ﻣ ًﺎ. ﻏﻴﺮ أن هﺬا ﻟﻢ ﻳﻜﻦ ﺻﺤﻴ ًﺎ. وﺣﺴﺒﻤﺎ ﺷﺪدت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء ﺳﺎﻟﻔﺔ اﻟﺬآﺮ، ﻻ ﻳﻨﻄﻮي ﻣﺼﻄﻠﺢ‬ ‫ﺤ‬ ‫ﻌ‬ ‫"اﻻﻋﺘﻤﺎد" ﻋﻠﻰ أﻳﺔ دﻻﻟﺔ ﻟﺪرﺟﺔ اﻟﺨﻄﻮرة ﻋﻠﻰ اﻟﺼﺤﺔ اﻟﻌﺎﻣﺔ. وﻗﺪ آﺎن هﺬا ﺑﻤﺜﺎﺑﺔ ﻓﺎرق آﺒﻴﺮ ﻋﻦ ﻣﺼﻄﻠﺢ "اﻹدﻣﺎن"‬ ‫واﻟﺬي آﺎن ﻳﻨﻄﻮي ﻋﻠﻰ هﺬﻩ اﻟﺪﻻﻟﺔ.‬ ‫7ﻗﺪﻣﺖ ﻧﻔﺲ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء )8( أﻳ ًﺎ ﺗﻮﺻﻴﺎت ﻓﻲ ﻣﻘﺎﺑﻞ اﻟﺠﻬﻮد اﻟﻤﺒﺬوﻟﺔ ﻟﻠﺘﻤﻴﻴﺰ ﺑﻴﻦ "اﻻﺗﻜﺎل اﻟﻌﻀﻮي" و"اﻻﺗﻜﺎل اﻟﻨﻔﺴﻲ"، ﻧﻈ ًا‬ ‫ﺮ‬ ‫ﻀ‬ ‫ﻷﻧﻬﺎ رأت أﻧﻪ ﻣﻦ اﻟﻤﻤﻜﻦ ﻓﻬﻢ ﺗﺄﺛﻴﺮات اﻟﻌﻘﺎﻗﻴﺮ ﻋﻠﻰ اﻷﻓﺮاد ﺑﺎﺳﺘﺨﺪام ﻣﺼﻄﻠﺤﺎت ﺑﻴﻮﻟﻮﺟﻴﺔ. وﻓﻀﻼ ﻋﻦ ذﻟﻚ، ﻻﺣﻈﺖ اﻟﻠﺠﻨﺔ أن‬ ‫ً‬ ‫"اﻻﺗﻜﺎل اﻟﻌﻀﻮي" آﺎن ﻣﺮﺑ ًﺎ ﻟﺒﻌﺾ اﻷﻃﺒﺎء اﻹآﻠﻴﻨﻴﻜﻴﻴﻦ ﻧﻈ ًا ﻷﻧﻪ ﻗﺪ ﺗﻢ ﺗﻔﺴﻴﺮ ﻇﻬﻮر أﻋﺮاض اﻟﺴﺤﺐ )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل‬ ‫ﺮ‬ ‫ﻜ‬ ‫ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻋﻠﻰ أﻧﻪ دﻟﻴﻞ ﻋﻠﻰ "اﻻﺗﻜﺎل اﻟﻌﻀﻮي" و"اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ" ﻓﻲ ﺁن واﺣﺪ.‬ ‫-9-‬
‫)و( اﻹﺻﺮار ﻋﻠﻰ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر ﺑﺮﻏﻢ اﻟﺪﻟﻴﻞ اﻟﻮاﺿﺢ ﻋﻠﻰ ﻋﻮاﻗﺒﻪ اﻟﻀﺎرة ﺑﺸﻜﻞ ﻣﻔﺮط، ﻣﺜﻞ‬ ‫اﻟﻀﺮر اﻟﺬي ﻳﻠﺤﻖ ﺑﺎﻟﻜﺒﺪ ﻋﻦ ﻃﺮﻳﻖ اﺣﺘﺴﺎء اﻟﻜﺤﻮﻟﻴﺎت ﺑﺸﻜﻞ ﻣﻔﺮط، واﻟﺤﺎﻻت اﻟﻤﺰاﺟﻴﺔ‬ ‫اﻟﻤُﻜﺘﺌﺒﺔ اﻟﺘﻲ ﺗﻌﻘﺐ ﻓﺘﺮات اﻟﺘﻌﺎﻃﻲ اﻟﻜﺜﻴﻒ ﻟﻠﻌﻘﺎر، أو ﻗﺼﻮر اﻟﻮﻇﺎﺋﻒ اﻹدراآﻴﺔ ﺑﺴﺒﺐ‬ ‫اﻟﻌﻘﺎر؛ ﻳﺠﺐ ﺑﺬل اﻟﺠﻬﻮد ﻟﺘﺤﺪﻳﺪ أن اﻟﻤﺘﻌﺎﻃﻲ آﺎن ﺑﺎﻟﻔﻌﻞ أو ﻳﻤﻜﻦ ﺗﻮﻗﻊ آﻮﻧﻪ ﻋﻠﻰ دراﻳﺔ‬ ‫ﺑﻄﺒﻴﻌﺔ اﻟﻀﺮر وﻣﺪاﻩ )ص 57 - 67(.‬ ‫ﻣﻦ اﻟﻮاﺿﺢ أن اﻟﻤﺼﺎب ﺑﻤﺮض اﻟﺴﺮﻃﺎن اﻟﺬي ﻳﺘﻄﻠﺐ ﺟﺮﻋﺎت ﻣﺘﺰاﻳﺪة ﻣﻦ ﻣﺎدة أﻓﻴﻮﻧﻴﺔ ﻣﺨ ﱢرة ﻟﺘﺨﻔﻴﻒ‬ ‫ﺪ‬ ‫اﻷﻟﻢ )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟﻤﺼﻄﻠﺢ "اﻟﺘﺤﻤﻞ"( واﻟﺬي ﻳﻌﺎﻧﻲ أﻳ ًﺎ ﻣﻦ أﻋﺮاض ﺳﺤﺐ‬ ‫ﻀ‬ ‫)راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟﻤﺼﻄﻠﺢ "أﻋﺮاض اﻟﺴﺤﺐ"( ﻋﻨﺪ وﻗﻒ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر، ﻳﻄﺎﺑﻖ‬ ‫ﺷﺮﻃﻴﻦ ﻓﻘﻂ ﻣﻦ اﻟﺸﺮوط اﻟﻤﻄﻠﻮﺑﺔ ﻟﻠﺘﺸﺨﻴﺺ اﻹﻳﺠﺎﺑﻲ ﻷﻋﺮاض اﻻﺗﻜﺎل. وﻣﻦ ﺛﻢ ﻻ ﻳﻜﻮن اﻟﻤﺮﻳﺾ‬ ‫ﻣﺼﺎ ًﺎ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻤﺎدة اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة، إﻻ إذا ﻃﺎﺑﻖ ﺷﺮ ًﺎ واﺣ ًا ﻋﻠﻰ اﻷﻗﻞ ﻣﻦ اﻟﺸﺮوط اﻷرﺑﻌﺔ‬ ‫ﺪ‬ ‫ﻃ‬ ‫ﺪ‬ ‫ﺑ‬ ‫اﻟﻤﺘﺒﻘﻴﺔ اﻟﻮاردة أﻋﻼﻩ )أ أو ب أو هـ أو و(.‬ ‫ﺗﺸﻴﺮ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )5( إﻟﻰ أن "اﻻﺗﻜﺎل" ﻳﺤﺪث ﺑﺸﻜﻞ ﻧﺎدر ﻟﺪى ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن:‬ ‫‪“Studies have shown that, while withdrawal syndrome and tolerance do occur in‬‬ ‫.‪patients who take opioids over a long period, [drug] dependence is extremely rare‬‬ ‫‪Consequently, the risk of [drug] dependence should not be a factor in deciding‬‬ ‫”‪] whether to use opioids to treat the cancer patient with pain‬أوﺿﺤﺖ اﻟﺪراﺳﺎت أﻧﻪ‬ ‫ﺑﺮﻏﻢ ﺣﺪوث أﻋﺮاض اﻟﺴﺤﺐ واﻟﺘﺤﻤﻞ ﻟﺪى اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﺘﻌﺎﻃﻮن اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪرة‬ ‫ﻋﻠﻰ ﻣﺪار ﻓﺘﺮة زﻣﻨﻴﺔ ﻃﻮﻳﻠﺔ، ﻳﻜﻮن اﻻﺗﻜﺎل )ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ( ﻧﺎدر اﻟﺤﺪوث إﻟﻰ ﺣﺪ آﺒﻴﺮ. وﺑﺎﻟﺘﺎﻟﻲ‬ ‫ﻳﻨﺒﻐﻲ أﻻ ﻳﻜﻮن ﺧﻄﺮ اﻻﺗﻜﺎل )ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ( ﺑﻤﺜﺎﺑﺔ ﻋﺎﻣﻞ ﻓﻲ ﺗﺤﺪﻳﺪ ﻣﺎ إذا آﺎن ﻳﻨﺒﻐﻲ اﺳﺘﺨﺪم‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ ﻋﻼج ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ اﻷﻟﻢ أم ﻻ[ )ص 85(.‬ ‫ﺪ‬ ‫ﺗﺪﻋﻢ هﺬﻩ اﻟﻤﻼﺣﻈﺔ ﺗﻘﺎرﻳﺮ ردود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﺼﺎدرة ﻋﻦ اﻟﻤﺮآﺰ اﻟﻤﺘﻌﺎون ﻣﻊ ﻣﻨﻈﻤﺔ‬ ‫اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻠﻤﺮاﻗﺒﺔ اﻟﺪوﻟﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ ﻓﻲ أﺑﺴﺎﻻ ﺑﺎﻟﺴﻮﻳﺪ. ﻓﻲ إﻃﺎر ﺑﺮﻧﺎﻣﺞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫ﻟﻠﻤﺮاﻗﺒﺔ اﻟﺪوﻟﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ، ُﻌ ّف "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ" ﻋﻠﻰ أﻧﻪ أﺣﺪ ردود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ واﻟﺘﻲ‬ ‫ﻳﺮ‬ ‫ﺗﺘﻢ ﻣﺮاﻗﺒﺘﻬﺎ واﻹﺑﻼغ ﻋﻨﻬﺎ إﻟﻰ اﻟﻤﺮآﺰ اﻟﻤﺘﻌﺎون وذﻟﻚ ﻋﻦ ﻃﺮﻳﻖ ﻣﺮاآﺰ اﻟﻤﺮاﻗﺒﺔ اﻟﻮﻃﻨﻴﺔ. واﻋﺘﺒﺎ ًا ﻣﻦ‬ ‫ر‬ ‫ﻋﺎم 9991، ﺗﺸﺎرك 65 دوﻟﺔ ﻓﻲ هﺬا اﻟﺒﺮﻧﺎﻣﺞ اﻟﺪوﻟﻲ، وﺗﺤﺘﻮي ﻗﺎﻋﺪة اﻟﺒﻴﺎﻧﺎت ﻋﻠﻰ أآﺜﺮ ﻣﻦ ﻣﻠﻴﻮﻧﻲ‬ ‫ﺗﻘﺮﻳﺮ ﺣﺎﻟﺔ ﻟﺮدود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ. ﺗﺸﻴﺮ ﻗﺎﺋﻤﺔ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﻢ إﺑﻼغ هﺬا اﻟﻨﻈﺎم ﺑﻮﻗﻮع ﺣﺎﻻت‬ ‫"اﺗﻜﺎل ﻋﻠﻴﻬﺎ" ﻋﻠﻰ اﻗﺘﺮان أﻋﺪاد ﻣﺘﻮاﺿﻌﺔ ﻓﻘﻂ ﻣﻦ ﺣﺎﻻت اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺎﺳﺘﺨﺪام اﻟﻤﺴﻜﻨﺎت‬ ‫اﻷﻓﻴﻮﻧﻴﺔ وأﻧﻪ ﻗﺪ ﺗﻢ اﻹﺑﻼغ ﻋﻦ ﺣﺎﻻت "اﺗﻜﺎل" ﻋﻠﻰ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻘﺎﻗﻴﺮ اﻷﺧﺮى، ﺳﻮاء آﺎﻧﺖ ﻋﻘﺎﻗﻴﺮ‬ ‫ﺗﺨﻀﻊ ﻟﻠﻤﺮاﻗﺒﺔ أم ﻻ )22(.‬ ‫اﻟﻘﺴﻢ 6‬ ‫اﻟﻀﺮورة اﻟﺤﺘﻤﻴﺔ ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫ﻃﺎﻟﺒﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺤﻜﻮﻣﺎت ﺑﺘﻘﻴﻴﻢ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫واﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﺸﺮﻳﻌﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻬﺎ، وﺗﺤﺪﻳﺪ وإزاﻟﺔ اﻟﻌﻘﺒﺎت أﻣﺎم ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻟﻼﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ )3، 4، 5، 9، 01، 11(. وإذ ﻳﺘﻤﺘﻊ ﺑﻨﻔﺲ اﻟﻘﺪر ﻣﻦ اﻷهﻤﻴﺔ ﺗﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻋﻦ ﻗﺪرﺗﻬﺎ اﻟﻤﺤﺘﻤﻠﺔ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟ ُﺮاﻗﺒﺔ ﻓﻲ أﻏﺮاض ﻏﻴﺮ ﻣﺨﺼﺼﺔ ﻟﻬﺎ‬ ‫ﻤ‬ ‫واﻻﺗﺠﺎر ﻓﻴﻬﺎ وﺗﻌﺎﻃﻴﻬﺎ، ﺗﺘﻮاﻓﺮ ﻣﻌﻠﻮﻣﺎت وإرﺷﺎدات ﻟﻬﺬا اﻟﺘﻘﻴﻴﻢ )21(.‬ ‫وﻗﺪ ﻋﻠﻖ ﺗﻘﺮﻳﺮ ﺻﺎدر ﻋﺎم 5991 ﻋﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )3( ﻋﻠﻰ ﻣﺪى اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ‬ ‫اﻟﻤﺨﺪرة ﻓﻲ أﻏﺮاض ﻏﻴﺮ ﻣﺨﺼﺼﺔ ﻟﻬﺎ ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫- 01 -‬
‫.‪“The international system to prevent diversion of narcotic drugs is working well‬‬ ‫‪The number of incidents involving diversion of narcotic drugs is small considering‬‬ ‫”‪] the large number of transactions at the international and national level‬ﻳﺆدي‬ ‫اﻟﻨﻈﺎم اﻟﺪوﻟﻲ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ دورﻩ ﺟﻴ ًا.‬ ‫ﺪ‬ ‫ﺪ‬ ‫آﻤﺎ أن ﻋﺪد اﻟﺤﻮادث اﻟﺘﻲ ﺗﺘﻀﻤﻦ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ‬ ‫ﺪ‬ ‫ﻟﻬﺎ ﻳﻌﺪ ﻋﺪ ًا ﻗﻠﻴﻼ ﻣﻊ اﻟﻮﺿﻊ ﻓﻲ اﻻﻋﺘﺒﺎر اﻟﻌﺪد اﻟﻜﺒﻴﺮ ﻟﻠﺼﻔﻘﺎت اﻟﺘﻲ ﺗﺘﻢ ﻋﻠﻰ اﻟﻤﺴﺘﻮﻳﻴﻦ‬ ‫ً‬ ‫د‬ ‫اﻟﺪوﻟﻲ واﻟﻤﺤﻠﻲ[ )ص 1(.‬ ‫وﺑﺎﻟﺘﺎﻟﻲ ﻳﺮآﺰ هﺬا اﻟﻤﺒﺪأ اﻟﺘﻮﺟﻴﻬﻲ ﺑﺸﻜﻞ ﺧﺎص ﻋﻠﻰ ﺗﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ واﻟﺘﻲ ﺗﺆﺛﺮ‬ ‫ﻋﻠﻰ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 9891، أوردت اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“One of the objectives of the Single Convention on Narcotic Drugs, 1961, and of that‬‬ ‫‪Convention as amended by the 1972 Protocol amending the Single Convention on‬‬ ‫‪Narcotic Drugs, 1961, is to ensure the availability of opiates, such as codeine and‬‬ ‫‪morphine, that are indispensable for the relief of pain and suffering, while minimizing‬‬ ‫”‪] the possibility of their abuse or diversion‬أﺣﺪ أهﺪاف اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ‬ ‫1691 وﺗﻠﻚ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻤﻌﺪﻟﺔ ﺑﺒﺮوﺗﻮآﻮل 2791 اﻟﻤﻌﺪل ﻟﻼﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ‬ ‫1691 هﻮ ﺿﻤﺎن ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻣﻦ ﻗﺒﻴﻞ اﻟﻜﻮداﻳﻴﻦ واﻟﻤﻮرﻓﻴﻦ واﻟﺘﻲ ﺗﻌﺪ‬ ‫ﺪ‬ ‫ﺿﺮورﻳﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻤﻌﺎﻧﺎة، ﻣﻊ ﺗﻘﻠﻴﻞ إﻣﻜﺎﻧﻴﺔ ﺗﻌﺎﻃﻴﻬﺎ أو ﺗﺤﻮﻳﻠﻬﺎ إﻟﻰ اﻟﺤﺪ اﻷدﻧﻰ[‬ ‫)ص 3(.‬ ‫ﻓﻲ 9891، راﺟﻌﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( أﺳﺒﺎب ﻋﺪم آﻔﺎﻳﺔ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺑﺎﻟﺘﻌﺎون ﻣﻊ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، وﻃﺎﻟﺒﺖ اﻟﺤﻜﻮﻣﺎت ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ ﺑـ :‬ ‫‪“...examine the extent to which their health-care systems and laws and regulations‬‬ ‫‪permit the use of opiates for medical purposes, identify possible impediments to‬‬ ‫‪such use and develop plans of action to facilitate the supply and availability of‬‬ ‫”‪...] opiates for all appropriate indications‬ﻓﺤﺺ اﻟﻤﺪى اﻟﺬي ﺗﺴﻤﺢ ﺑﻪ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ‬ ‫اﻟﺼﺤﻴﺔ واﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻬﺎ ﻻﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ‬ ‫ﺪ‬ ‫اﻷﻏﺮاض اﻟﻄﺒﻴﺔ، واﻟﺘﻌﺮف ﻋﻠﻰ اﻟﻌﻘﺒﺎت اﻟﻤﺤﺘﻤﻠﺔ ﻻﺳﺘﺨﺪاﻣﻬﺎ ووﺿﻊ ﺧﻄﻂ ﻋﻤﻞ ﻟﺘﻴﺴﻴﺮ‬ ‫إﻣﺪاد اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة وﺗﻮﻓﻴﺮهﺎ ﻟﻜﺎﻓﺔ اﻟﺘﻄﺒﻴﻘﺎت اﻟﻤﻼﺋﻤﺔ[ )ص 71(.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 0991، أوﺻﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ‬ ‫ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )4( ﺑﻮﺟﻮب ﻗﻴﺎم اﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ ﺑـ :‬ ‫,‪“...regular review [of legislation], with the aim of permitting importation‬‬ ‫‪manufacture, prescribing, stocking, dispensing and administration of opioids for‬‬ ‫‪medical reasons,...[and] review of the controls governing opioid use, with a view to‬‬ ‫‪simplification, so that drugs are available in the necessary quantities for legitimate‬‬ ‫”...‪...] use‬ﻣﺮاﺟﻌﺔ دورﻳﺔ )ﻟﻠﺘﺸﺮﻳﻊ(، ﺑﻬﺪف اﻟﺴﻤﺎح ﺑﺎﺳﺘﻴﺮاد اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫وﺗﺼﻨﻴﻌﻬﺎ ووﺻﻔﻬﺎ وﺗﺨﺰﻳﻨﻬﺎ وﺻﺮﻓﻬﺎ وإﻋﻄﺎﺋﻬﺎ ﻷﻏﺮاض ﻃﺒﻴﺔ،...)و( ﻣﺮاﺟﻌﺔ اﻟﻀﻮاﺑﻂ اﻟﺘﻲ‬ ‫ﺗﺤﻜﻢ اﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة، وﺗﺒﺴﻴﻄﻬﺎ، ﺑﺤﻴﺚ ﺗﺘﻮاﻓﺮ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺎﻟﻜﻤﻴﺎت اﻟﻼزﻣﺔ‬ ‫ﺪ‬ ‫ﻟﻼﺳﺘﺨﺪام اﻟﻤﺸﺮوع... [ )ص 56-66(.‬ ‫- 11 -‬
‫ﻓﻲ ﻋﺎم 5991، ﻗﺎﻣﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )3( ﺑﺈﺟﺮاء دراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ ﻋﻠﻰ آﺎﻓﺔ‬ ‫اﻟﺤﻜﻮﻣﺎت 8ﻟﺘﺤﺪﻳﺪ ﻣﺎ إذا آﺎﻧﺖ ﻗﺪ اﺳﺘﺠﺎﺑﺖ ﻟﺘﻮﺻﻴﺔ اﻟﻬﻴﺌﺔ اﻟﺼﺎدرة ﻋﺎم 9891 أم ﻻ. وﻗﺪ ﺗﻢ ﺗﺤﻠﻴﻞ‬ ‫اﻻﺳﺘﺠﺎﺑﺎت ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ وﻧﺸﺮهﺎ، آﻤﺎ ﺗﻢ اﻟﺘﻮﺻﻞ إﻟﻰ ﻋﺪد ﻣﻦ اﻟﻨﺘﺎﺋﺞ واﻟﺘﻮﺻﻴﺎت، ﻣﻦ‬ ‫ﺑﻴﻨﻬﺎ:‬ ‫‪“Governments that have not done so should determine whether there are undue‬‬ ‫‪restrictions in national narcotics laws, regulations or administrative policies that‬‬ ‫,‪impede prescribing, dispensing or needed treatment of patients with narcotic drugs‬‬ ‫‪or their availability and distribution for such purposes, and should make the‬‬ ‫”‪] necessary adjustments‬ﻳﻨﺒﻐﻲ ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﻟﻢ ﺗﻘﻢ ﺑﺬﻟﻚ أن ﺗﺤﺪد ﻣﺎ إذا آﺎﻧﺖ ﺗﻔﺮض‬ ‫ﻗﻴﻮ ًا ﻻ ﻣﺒﺮر ﻟﻬﺎ ﻓﻲ اﻟﺴﻴﺎﺳﺎت اﻹدارﻳﺔ أو اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ أو اﻟﻘﻮاﻧﻴﻦ اﻟﻮﻃﻨﻴﺔ اﻟﻤﻌﻨﻴﺔ‬ ‫د‬ ‫ﺑﺎﻟﻤﺨﺪرات واﻟﺘﻲ ﺗﻌﻮق وﺻﻒ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة أو ﺻﺮﻓﻬﺎ أو ﺗﻘﺪﻳﻢ اﻟﻌﻼج اﻟﻼزم ﻟﻠﻤﺮﺿﻰ‬ ‫ﺪ‬ ‫ﺑﺎﺳﺘﺨﺪاﻣﻬﺎ أو ﺗﻮﻓﻴﺮهﺎ أو ﺗﻮزﻳﻌﻬﺎ ﻟﻬﺬﻩ اﻷﻏﺮاض، آﻤﺎ ﻳﻨﺒﻐﻲ ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت إﺟﺮاء اﻟﺘﻌﺪﻳﻼت‬ ‫اﻟﻼزﻣﺔ[ )ص 51(.‬ ‫‪“The Board notes that most governments in the world did not respond to its‬‬ ‫‪questionnaire; thus, the Board did not have sufficient information concerning‬‬ ‫‪approximately one half of the world’s population. Among those governments that‬‬ ‫‪did not respond were most of the developing and least developed countries, as well‬‬ ‫‪as those governments that had frequently failed to submit annual estimates of‬‬ ‫‪narcotic drug requirements as required by the 1961 Convention. The Board is‬‬ ‫-‪cognizant that less developed countries have more difficulty meeting basic health‬‬ ‫‪care needs. Nevertheless, the Board encourages governments of such countries to‬‬ ‫‪make efforts to examine their medical needs for narcotic drugs as well as the‬‬ ‫”‪] impediments to their availability‬ﺗﻼﺣﻆ اﻟﻬﻴﺌﺔ أن أﻏﻠﺐ اﻟﺤﻜﻮﻣﺎت ﻓﻲ أرﺟﺎء اﻟﻌﺎﻟﻢ ﻟﻢ‬ ‫ﺗﺴﺘﺠﺐ ﻟﻼﺳﺘﺒﻴﺎن اﻟﺨﺎص ﺑﻬﺎ؛ وﻣﻦ ﺛﻢ ﻟﻢ ﺗﺘﻮاﻓﺮ ﻟﻠﻬﻴﺌﺔ ﻣﻌﻠﻮﻣﺎت آﺎﻓﻴﺔ ﺣﻮل ﻣﺎ ﻳﻘﺮب ﻣﻦ‬ ‫ﻧﺼﻒ ﺗﻌﺪاد ﺳﻜﺎن اﻟﻌﺎﻟﻢ. وآﺎن ﻣﻦ ﺑﻴﻦ ﺗﻠﻚ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﻟﻢ ﺗﺴﺘﺠﺐ أﻏﻠﺐ اﻟﺪول اﻟﻨﺎﻣﻴﺔ‬ ‫واﻷﻗﻞ ﺗﻘﺪ ًﺎ، ﻓﻀﻼ ﻋﻦ ﺗﻠﻚ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﺗﺨﻠﻔﺖ ﻣﺮا ًا ﻋﻦ ﺗﻘﺪﻳﻢ ﺗﻘﺪﻳﺮاﺗﻬﺎ اﻟﺴﻨﻮﻳﺔ‬ ‫ر‬ ‫ً‬ ‫ﻣ‬ ‫ﻟﻤﺘﻄﻠﺒﺎت اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﺣﺴﺒﻤﺎ ﺗﻘﺘﻀﻲ ذﻟﻚ اﺗﻔﺎﻗﻴﺔ 1691. وﺗﺪرك اﻟﻬﻴﺌﺔ أن اﻟﺪول اﻷﻗﻞ‬ ‫ﺪ‬ ‫ﺗﻘﺪ ًﺎ ﺗﻮاﺟﻪ ﺻﻌﻮﺑﺎت أآﺒﺮ ﻓﻲ اﻟﻮﻓﺎء ﺑﺎﺣﺘﻴﺎﺟﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻷﺳﺎﺳﻴﺔ. وﻣﻊ ذﻟﻚ ﻓﺈﻧﻬﺎ‬ ‫ﻣ‬ ‫ﺗﺸ ﱢﻊ ﺣﻜﻮﻣﺎت هﺬﻩ اﻟﺪول ﻋﻠﻰ ﺑﺬل اﻟﺠﻬﻮد ﻟﻔﺤﺺ اﺣﺘﻴﺎﺟﺎﺗﻬﺎ اﻟﻄﺒﻴﺔ ﻣﻦ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺠ‬ ‫ﻓﻀﻼ ﻋﻦ اﻟﻌﻘﺒﺎت اﻟﺘﻲ ﺗﻌﺘﺮض ﺗﻮﻓﻴﺮهﺎ[ )ص 41(.‬ ‫ً‬ ‫‪“The Board concludes that the recommendations contained in its 1989 special report‬‬ ‫‪are far from being implemented and that, while there have been efforts by some‬‬ ‫‪governments to ensure the availability of narcotic drugs for medical and scientific‬‬ ‫”‪] purposes, it appears that many others have yet to focus on that obligation‬ﺗﺴﺘﺨﻠﺺ‬ ‫اﻟﻬﻴﺌﺔ أن اﻟﺘﻮﺻﻴﺎت اﻟﻮاردة ﻓﻲ ﺗﻘﺮﻳﺮهﺎ اﻟﺨﺎص ﻟﻌﺎم 9891 هﻲ أﺑﻌﺪ ﻣﺎ ﺗﻜﻮن ﻋﻦ اﻟﺘﻄﺒﻴﻖ‬ ‫اﻟﻔﻌﻠﻲ وأﻧﻪ ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺑﺬل اﻟﺠﻬﻮد ﻣﻦ ﺑﻌﺾ اﻟﺤﻜﻮﻣﺎت ﻟﻀﻤﺎن ﺗﻮﻓﻴﺮ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ، ﻳﺘﻀﺢ أن اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻷﺧﺮى ﻣﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻴﻬﺎ اﻟﺘﺮآﻴﺰ‬ ‫ﻋﻠﻰ ذﻟﻚ اﻻﻟﺘﺰام[ )ص 41(.‬ ‫8اﺳﺘﺠﺎﺑﺖ 56 ﺣﻜﻮﻣﺔ ﻓﻲ وﻗﺖ إﻋﺪاد ﺗﻘﺮﻳﺮ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻟﻌﺎم 5991، واﻟﺬي ﺗﻢ ﻧﺸﺮﻩ ﻓﻲ ﻋﺎم 6991. وﻣﻨﺬ ذﻟﻚ‬ ‫اﻟﺤﻴﻦ، اﺳﺘﺠﺎﺑﺖ 75 دوﻟﺔ أﺧﺮى. وﻳﺸﻴﺮ ﺗﺤﻠﻴﻞ اﻟـ 221 دراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ ﺟﻤﻴﻌﻬﺎ إﻟﻰ أن اﻟﻤﺸﻜﻼت اﻟﺘﻲ ﺗﻮاﺟﻪ ﺗﻮﻓﻴﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ‬ ‫اﻟﻤﺨ ﱢرة آﺎﻧﺖ أآﺜﺮ ﺣﺪة ﻣﻤﺎ آﺎن ﻣﺘﺼﻮ ًا ﺣﺴﺐ اﻻﺳﺘﺠﺎﺑﺔ اﻟﻤﺒﺪﺋﻴﺔ )وﻗﺪ ﺗﻢ اﻟﻨﺸﺮ ﻓﻲ اﻟﺘﻘﺮﻳﺮ اﻟﺴﻨﻮي ﻟﻠﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ر‬ ‫ﺪ‬ ‫ﻟﻌﺎم 9991(.‬ ‫- 21 -‬
Achieving Balance Opioids Ar
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Achieving Balance Opioids Ar

  • 1. ‫4.0002/‪WHO/EDM/QSM‬‬ ‫اﻟﺘﻮزﻳﻊ: ﻋﺎم‬ ‫‪WORLD HEALTH ORGANIZATION‬‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة وذات اﻟﺘﺄﺛﻴﺮ اﻟﻨﻔﺴﻲ‬ ‫ﺪ‬ ‫ﺗﺤﻘﻴﻖ اﻟﺘﻮازن‬ ‫ﻓﻲ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫ﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤ ﱢﺪرة‬ ‫ﺨ‬ ‫ﻣﺒﺎدئ ﺗﻮﺟﻴﻬﻴﺔ ﻟﻠﺘﻘﻴﻴﻢ‬ ‫‪WORLD HEALTH ORGANIZATION‬‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬
  • 2.
  • 3. ‫ﺣﻘﻮق اﻟﻨﺸﺮ © 0002 ﻣﺤﻔﻮﻇﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫ﻟﻴﺴﺖ هﺬﻩ اﻟﻮﺛﻴﻘﺔ إﺻﺪا ًا رﺳﻤ ًﺎ ﻣﻦ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ‬ ‫ﻴ‬ ‫ر‬ Ce document n'est pas une publication officielle ‫(، وآﺎﻓﺔ اﻟﺤﻘﻮق ﻣﺤﻔﻮﻇﺔ ﻟﻠﻤﻨﻈﻤﺔ. وﻣﻊ‬WHO) ‫اﻟﻌﺎﻟﻤﻴﺔ‬ de l'Organisation mondiale de la Santé (OMS) et tous les droits y afférents sont réservés par ‫ذﻟﻚ، ﻳﺠﻮز أن ﺗﺘﻢ ﻣﺮاﺟﻌﺔ اﻟﻮﺛﻴﻘﺔ أو اﻻﻗﺘﺒﺎس ﻣﻨﻬﺎ أو‬ l'Organisation. S'il peut être commenté, resumé ‫إﻋﺎدة إﻧﺘﺎﺟﻬﺎ أو ﺗﺮﺟﻤﺘﻬﺎ، ﺟﺰﺋ ًﺎ أو آﻠ ًﺎ، دون ﻗﻴﺪ، وﻟﻜﻦ ﻻ‬ ‫ﻴ‬ ‫ﻴ‬ ou cité sans aucune restriction, il ne saurait ‫ﻳﺠﻮز أن ﻳﺘﻢ ذﻟﻚ ﺑﻬﺪف اﻟﺒﻴﻊ أو اﻻﺳﺘﺨﺪام ﻷﻏﺮاض‬ cependant être reproduit ni traduit, partiellement .‫ﺗﺠﺎرﻳﺔ‬ ou en totalité, pour la vente ou à des fins commerciales. ‫اﻵراء اﻟﻮاردة ﻓﻲ اﻟﻮﺛﺎﺋﻖ ﻣﻦ ﻗﺒﻞ اﻟﻜﺘﺎب اﻟﻤﺬآﻮرة‬ Les opinions exprimées dans les documents par .‫أﺳﻤﺎؤهﻢ ﺗﻘﻊ ﻣﺴﺌﻮﻟﻴﺘﻬﺎ ﻋﻠﻰ هﺆﻻء اﻟﻜﺘﺎب وﺣﺪهﻢ‬ des auteurs cités nommément n'engagent que lesdits auteurs, ‫ﺟﺪول اﻟﻤﺤﺘﻮﻳﺎت‬
  • 4. ‫اﻟﺼﻔﺤﺔ‬ ‫اﻟﻤﻠﺨﺺ اﻟﺘﻨﻔﻴﺬي ..............................................................................................................1‬ ‫اﻟﻐﺮض واﻟﺠﻤﻬﻮر.....................................................................................2‬ ‫اﻟﻘﺴﻢ 1‬ ‫ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ..............................................................................3‬ ‫اﻟﻘﺴﻢ 2‬ ‫اﻟﺤﺎﺟﺔ اﻟﻄﺒﻴﺔ إﻟﻰ ﺗﻨﺎول اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ......................................................4‬ ‫اﻟﻘﺴﻢ 3‬ ‫اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ......................................................5‬ ‫ﺪ‬ ‫اﻟﻘﺴﻢ 4‬ ‫ﻋﻮاﺋﻖ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪ ﱢة ..............................................................7‬ ‫ر‬ ‫اﻟﻘﺴﻢ 5‬ ‫اﻟﻀﺮورة اﻟﺤﺘﻤﻴﺔ ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ......................................01‬ ‫اﻟﻘﺴﻢ 6‬ ‫أﺳﻠﻮب إﻋﺪاد اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ .....................................................................31‬ ‫اﻟﻘﺴﻢ 7‬ ‫اﺳﺘﺨﺪام اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ...........................................................................41‬ ‫اﻟﻘﺴﻢ 8‬ ‫اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ .....................................................................................51‬ ‫اﻟﻘﺴﻢ 9‬ ‫ﻗﺎﺋﻤﺔ ﺗﺪﻗﻴﻖ اﻟﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ..............................................................................13‬ ‫اﻟﻘﺴﻢ 01‬ ‫ﺷﻜﺮ وﺗﻘﺪﻳﺮ ....................................................................................................................43‬ ‫اﻟﻤﺮاﺟﻊ .........................................................................................................................53‬ ‫اﺳﺘﺨﺪام اﻟﻤﺼﻄﻠﺤﺎت ﻓﻲ هﺬا اﻹﺻﺪار ...........................................................83‬ ‫اﻟﻤﻠﺤﻖ 1‬ ‫ﻣﻌﻠﻮﻣﺎت اﻟﻄﻠﺐ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺼﺎدر اﻟﺮﺋﻴﺴﻴﺔ ....................................................04‬ ‫اﻟﻤﻠﺤﻖ 2‬ ‫ﻣﻠﺨﺺ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ............................................................................34‬ ‫اﻟﻤﻠﺤﻖ 3‬ ‫اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة اﻟﺮﺋﻴﺴﻴﺔ .....................................................44‬ ‫ﺪ‬ ‫اﻟﻤﻠﺤﻖ 4‬ ‫‪ii‬‬
  • 5. iii
  • 6. ‫اﻟﻤﻠﺨﺺ اﻟﺘﻨﻔﻴﺬي‬ ‫ﻗﺮرت ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ )‪ (WHO‬أن اﻟﺘﻌﺎﻣﻞ ﻏﻴﺮ اﻟﻤﻼﺋﻢ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ ﻣﺮض اﻟﺴﺮﻃﺎن‬ ‫ﻳﻌﺪ ﺑﻤﺜﺎﺑﺔ ﻣﺸﻜﻠﺔ ﺻﺤﻴﺔ ﻋﺎﻣﺔ ﻋﻠﻰ ﺟﺎﻧﺐ آﺒﻴﺮ ﻣﻦ اﻟﺨﻄﻮرة ﻓﻲ اﻟﻌﺎﻟﻢ. ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ، هﻨﺎك 01‬ ‫ﻣﻼﻳﻴﻦ ﺣﺎﻟﺔ ﺟﺪﻳﺪة ﻟﻺﺻﺎﺑﺔ ﺑﻤﺮض اﻟﺴﺮﻃﺎن و6 ﻣﻼﻳﻴﻦ ﺣﺎﻟﺔ وﻓﺎة ﺳﻨﻮ ًﺎ ﻳﺘﺴﺒﺐ ﻓﻴﻬﺎ هﺬا اﻟﻤﺮض ﻏﻴﺮ‬ ‫ﻳ‬ ‫اﻟﻤﻌﺪي )1(. وﺳﻮف ﻳﺘﻀﺎﻋﻒ اﻟﻌﺐء اﻟﻌﺎﻟﻤﻲ اﻟﻤﺘﺮﺗﺐ ﻋﻠﻰ اﻟﺴﺮﻃﺎن، ﺑﻌﺪ اﺛﻨﻲ ﻋﺸﺮ ﻋﺎ ًﺎ ﻣﻦ اﻵن.‬ ‫ﻣ‬ ‫ﺳﻴﺘﺰاﻳﺪ ﻣﻌﺪل اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﺮﻃﺎن ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ أآﺜﺮ ﻣﻨﻪ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ، واﻟﺘﻲ ﺗﺸﻬﺪ ﻣﻌﺪﻻ أﻋﻠﻰ‬ ‫ً‬ ‫ﻟﻺﺻﺎﺑﺔ ﻋﻦ اﻟﻤﻮﺟﻮد ﺑﺎﻟﺪول اﻟﻨﺎﻣﻴﺔ ﻓﻲ اﻟﻮﻗﺖ اﻟﺤﺎﻟﻲ، ﻣﻤﺎ ﻳﻌﻜﺲ إﺳﺘﺮاﺗﻴﺠﻴﺎت أﻓﻀﻞ ﻟﻠﻮﻗﺎﻳﺔ ﻓﻲ اﻟﻌﺎﻟﻢ‬ ‫اﻟﻤﺘﻘﺪم. وﻟﻘﺪ ﻗ ﱠر ﺑﺮﻧﺎﻣﺞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﻤﻌﻨﻲ ﺑﺎﻟﺴﻴﻄﺮة ﻋﻠﻰ ﻣﺮض اﻟﺴﺮﻃﺎن أﻧﻪ ﺑﺤﻠﻮل ﻋﺎم‬ ‫ﺪ‬ ‫0202 ﺳﻮف ﻳﺤﺪث ﻧﺤﻮ 07% ﻣﻦ ﺣﺎﻻت اﻹﺻﺎﺑﺔ اﻟﺴﻨﻮﻳﺔ ﺑﺎﻟﺴﺮﻃﺎن واﻟﺘﻲ ﺗﺼﻞ إﻟﻰ ﻋﺸﺮﻳﻦ ﻣﻠﻴﻮن‬ ‫ﺣﺎﻟﺔ ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ )1(، واﻟﺘﻲ ﻳﺘﻢ ﺗﺸﺨﻴﺺ اﻟﻤﺮض ﻓﻴﻬﺎ ﻟﺪى ﻣﻌﻈﻢ اﻟﻤﺮﺿﻰ ﺑﻌﺪ وﺻﻮل اﻟﻤﺮض‬ ‫إﻟﻰ ﻣﺮاﺣﻞ ﻣﺘﺄﺧﺮة. وﻳﺘﻔﺸﻰ اﻷﻟﻢ ﻓﻲ ﺣﺎﻟﺔ اﻹﺻﺎﺑﺔ ﺑﻤﺮض اﻟﺴﺮﻃﺎن، وإن آﺎن ذﻟﻚ ﻳﺤﺪث ﻓﻲ اﻟﻤﺮاﺣﻞ‬ ‫اﻷﺧﻴﺮة ﻣﻦ اﻟﻤﺮض ﻋﻠﻰ وﺟﻪ اﻟﺨﺼﻮص، ﻋﻨﺪ دﻧﻮ اﻟﻤﻮت.‬ ‫وﻣﻦ اﻟﻤﺆﺳﻒ أن اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻻ ﺗﺘﻢ ﻣﻌﺎﻟﺠﺘﻪ ﺑﺸﻜﻞ ﻣﺘﻜﺮر، وﻋﻨﺪﻣﺎ ﺗﺘﻢ ﻣﻌﺎﻟﺠﺘﻪ ﻏﺎﻟ ًﺎ ﻣﺎ‬ ‫ﺒ‬ ‫ﻳﻜﻮن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻏﻴﺮ آﺎف. وﻣﻊ ذﻟﻚ ﻓﻘﺪ أوﺿﺤﺖ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ أن أﻏﻠﺐ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ‬ ‫ٍ‬ ‫اﻟﺴﺮﻃﺎن، إن ﻟﻢ ﻳﻜﻦ آﻠﻪ، ﻳﺘﻌﺬر ﺗﺨﻔﻴﻔﻪ ﻓﻲ ﺣﺎﻟﺔ ﺗﻄﺒﻴﻖ اﻟﻌﻼﺟﺎت واﻟﻤﻌﻠﻮﻣﺎت اﻟﻄﺒﻴﺔ اﻟﺤﺎﻟﻴﺔ. ﺛﻤﺔ هﻮة‬ ‫ﻋﻼﺟﻴﺔ: وهﻲ ﺗﺘﻤﺜﻞ ﻓﻲ اﻟﻔﺎرق ﺑﻴﻦ ﻣﺎ ﻳﻤﻜﻦ ﻓﻌﻠﻪ وﻣﺎ ﻳﺘﻢ ﻓﻌﻠﻪ إزاء اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻳﻤﻜﻦ‬ ‫ﺗﻀﻴﻴﻖ اﻟﻬﻮة اﻟﻌﻼﺟﻴﺔ ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﻘﻴﻒ وﺗﺪرﻳﺐ اﻟﻌﺎﻣﻠﻴﻦ ﻓﻲ ﻣﺠﺎل اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ وإﺗﺎﺣﺔ اﻟﻤﺰﻳﺪ‬ ‫ﻣﻦ ﺧﺪﻣﺎت ﺗﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻌﻼج ﺑﺘﻘﺪﻳﻢ اﻟﻤﺴﻜﻨﺎت. وﻣﻊ ذﻟﻚ، ﻓﻘﺪ ﺗﻢ ﺗﺤﺪﻳﺪ ﻗﺪر آﺒﻴﺮ ﻣﻦ اﻟﻬﻮة اﻟﻌﻼﺟﻴﺔ،‬ ‫وﺑﺨﺎﺻﺔ ﻓﻲ اﻟﺪول اﻟﻨﺎﻣﻴﺔ، ﻋﻠﻰ أﻧﻬﺎ ﺗﺘﻤﺜﻞ ﻓﻲ اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻷدوﻳﺔ ﺗﺨﻔﻴﻒ اﻷﻟﻢ، وﻋﻠﻰ اﻷﺧﺺ‬ ‫اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ.‬ ‫وﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ وﺟﻮد اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻼﺟﺎت اﻟﺪواﺋﻴﺔ وﻏﻴﺮ اﻟﺪواﺋﻴﺔ، ﻓﺈن اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ﻣﻦ ﻗﺒﻴﻞ‬ ‫اﻟﻜﻮداﻳﻴﻦ واﻟﻤﻮرﻓﻴﻦ ﺗﻌﺪ ﺿﺮورﻳﺔ ﺣﺘ ًﺎ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻋﻨﺪﻣﺎ ﻳﻜﻮن اﻷﻟﻢ‬ ‫ﻤ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻣﺘﻮﺳ ًﺎ أو ﺣﺎ ًا، ﻻ ﻳﻜﻮن ﺑﺪﻳﻼ ﻻﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ‬ ‫ﺪ‬ ‫ً‬ ‫د‬ ‫ﻄ‬ ‫اﻟﻌﻼﺟﻴﺔ ﻟﻠﻤﻮرﻓﻴﻦ. وﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )‪ ،1(INCB‬ﺑﻮﺻﻔﻬﺎ‬ ‫اﻟﺠﻬﺔ اﻟﺪوﻟﻴﺔ اﻟﺘﻲ ُﻌﻨﻰ، ﻣﻦ ﺑﻴﻦ أﺷﻴﺎء أﺧﺮى، ﺑﻤﺮاﻗﺒﺔ اﻟﺘﻮﻓﺮ اﻟﻌﺎﻟﻤﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة، ﺗﺸ ﱢد ﻋﻠﻰ‬ ‫ﺪ‬ ‫ﺪ‬ ‫ﺗ‬ ‫ﺿﺮورة إﺗﺎﺣﺔ هﺬﻩ اﻟﻌﻘﺎﻗﻴﺮ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ.‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻣﺼﻨﻔﺔ آﻌﻘﺎﻗﻴﺮ ﻣﺨ ﱢرة ﻧﻈ ًا ﻻﺣﺘﻤﺎﻟﻴﺔ إﺳﺎءة اﺳﺘﺨﺪاﻣﻬﺎ. وآﻨﺘﻴﺠﺔ ﻟﺬﻟﻚ، ﻳﺘﻢ‬ ‫ﺮ‬ ‫ﺪ‬ ‫ﺪ‬ ‫ﺗﻨﻈﻴﻢ ﺗﻌﺎﻃﻲ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺗﺒ ًﺎ ﻟﻠﻤﻌﺎهﺪات اﻟﺪوﻟﻴﺔ واﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻤﺮاﻗﺒﺔ‬ ‫ﻌ‬ ‫ﺪ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ. أﻓﺎدت آﻞ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ‬ ‫ﺑﺄن اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻴﺴﺖ ﻣﺘﻮﻓﺮة ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ ﺑﺸﻜﻞ آﺎف. وﻳﺮﺟﻊ ذﻟﻚ إﻟﻰ ﻋﺪد ﻣﻦ‬ ‫ٍ‬ ‫ﺪ‬ ‫اﻷﺳﺒﺎب، ﻣﻦ ﺑﻴﻨﻬﺎ اﻷوﻟﻮﻳﺔ اﻟﻤﻨﺨﻔﻀﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﻓﻲ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ، واﻟﻤﺨﺎوف اﻟﻤﺒﺎﻟﻎ‬ ‫ﻓﻴﻬﺎ ﺑﺸﻜﻞ آﺒﻴﺮ إزاء اﻹدﻣﺎن، واﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﺘﺴﻢ ﺑﺎﻟﺘﻘﻴﻴﺪ اﻟﻤﻔﺮط، وآﺬا‬ ‫اﻟﻤﺸﻜﻼت اﻟﺨﺎﺻﺔ ﺑﺎﻟﺤﺼﻮل ﻋﻠﻰ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة وﺗﺼﻨﻴﻌﻬﺎ وﺗﻮزﻳﻌﻬﺎ.‬ ‫ﺪ‬ ‫ﻓﻲ ﺑﻌﺾ اﻟﺪول، ﻗﺎﻣﺖ اﻟﺤﻜﻮﻣﺎت وأﺧﺼﺎﺋﻴﻮ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﺑﺎﻟﻌﻤﻞ ﻣ ًﺎ ﻟﺘﺤﺴﻴﻦ ﻃﺮﻳﻘﺔ اﻟﺘﻌﺎﻣﻞ ﻣﻊ‬ ‫ﻌ‬ ‫اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت، وﻗﺪ ﺑﺪأت ﺑﻌﺾ اﻟﺪول ﻓﻲ ﺗﺤﺪﻳﺪ وﺗﺼﺤﻴﺢ اﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ ﺗﻔﺮط ﻓﻲ ﺗﻘﻴﻴﺪ اﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻟﻠﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ. أﻣﺎ ﺑﺎﻗﻲ اﻟﺪول ﻓﻤﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻴﻬﺎ‬ ‫ﻣﻌﺎﻟﺠﺔ هﺬﻩ اﻷﻣﻮر. وﻳﻤﻜﻦ ﻟﻠﺤﻜﻮﻣﺎت اﺳﺘﺨﺪام هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﺘﺤﺪﻳﺪ ﻣﺎ إذا آﺎﻧﺖ اﻟﺴﻴﺎﺳﺎت‬ ‫اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻗﺪ وﺿﻌﺖ اﻹﻃﺎر اﻟﻘﺎﻧﻮﻧﻲ واﻹداري، اﻟﺬي ﻳﻀﻤﻦ اﻟﺘﻮﻓﺮ اﻟﻄﺒﻲ ﻟﻠﻤﺴﻜﻨﺎت‬ ‫اﻷﻓﻴﻮﻧﻴﺔ، ﻃﺒ ًﺎ ﻟﻼﺗﻔﺎﻗﻴﺎت اﻟﺪوﻟﻴﺔ واﻟﺘﻮﺻﻴﺎت اﻟﻤﻘﺪﻣﺔ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ‬ ‫ﻘ‬ ‫اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ.‬ ‫1ﺗﻌﺪ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﺟﻬﺔ ﻣﺴﺘﻘﻠﺔ ﻣﺴﺘﻨﺪة إﻟﻰ اﺗﻔﺎﻗﻴﺔ ُﻌﻨﻰ ﺑﻤﺮاﻗﺒﺔ ﺗﻨﻔﻴﺬ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات‬ ‫ﺗ‬ ‫ﻟﺴﻨﺔ 1691، واﻻﺗﻔﺎﻗﻴﺎت ذات اﻟﺼﻠﺔ اﻷﺧﺮى. ﻟﻠﺤﺼﻮل ﻋﻠﻰ وﺻﻒ ﻟﻠﻬﻴﺌﺔ وأﻧﺸﻄﺘﻬﺎ، راﺟﻊ: ‪.(2) 1999 ،INCB‬‬ ‫-1-‬
  • 7. ‫ذآﺮ ﺗﻘﺮﻳﺮ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻟﻌﺎم 5991 )3( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“...an efficient national drug control regime must involve not only a programme to‬‬ ‫‪prevent illicit trafficking and diversion, but also a programme to ensure the adequate‬‬ ‫”‪...] ."availability of narcotic drugs for medical and scientific purposes‬ﻳﺠﺐ أﻻ‬ ‫ﻳﻨﻄﻮي اﻟﻨﻈﺎم اﻟﻮﻃﻨﻲ اﻟﻔﻌﺎل ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻋﻠﻰ ﺑﺮﻧﺎﻣﺞ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ ﻓﻲ ﻏﻴﺮ‬ ‫اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ واﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع ﻓﻴﻬﺎ وﺣﺴﺐ، وإﻧﻤﺎ أﻳ ًﺎ ﻋﻠﻰ ﺑﺮﻧﺎﻣﺞ‬ ‫ﻀ‬ ‫ﻟﻀﻤﺎن اﻟﺘﻮﻓﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ[. )ﺻﻔﺤﺔ 41(.‬ ‫ﺪ‬ ‫اﻟﻘﺴﻢ 1 – اﻟﻐﺮض واﻟﺠﻤﻬﻮر‬ ‫ﻳﺘﻤﺜﻞ اﻟﻐﺮض ﻣﻦ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﻠﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ ﻓﻲ ﺗﺸﺠﻴﻊ اﻟﺤﻜﻮﻣﺎت ﻋﻠﻰ ﺗﺤﻘﻴﻖ ﺗﻌﺎﻣﻞ أﻓﻀﻞ‬ ‫2‬ ‫ﻣﻊ اﻷﻟﻢ وذﻟﻚ ﻋﻦ ﻃﺮﻳﻖ اﻟﺘﻌﺮف واﻟﺘﻐﻠﺐ ﻋﻠﻰ اﻟﻌﻘﺒﺎت اﻟﺘﻨﻈﻴﻤﻴﺔ أﻣﺎم ﺗﻮﻓﻴﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة.‬ ‫ﺪ‬ ‫وﻳﻤﻜﻦ اﺳﺘﺨﺪام هﺬﻩ اﻹرﺷﺎدات أﻳ ًﺎ ﻟﻮﺿﻊ ﺳﻴﺎﺳﺎت وﻃﻨﻴﺔ ﻣﺘﻮازﻧﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ )ﺑﻤﺎ ﻓﻲ ذﻟﻚ‬ ‫ﻀ‬ ‫ﺳﻠﻄﺎت اﻟﻮﻻﻳﺔ أو اﻟﻤﻘﺎﻃﻌﺔ أو اﻟﻤﻨﻄﻘﺔ آﻠﻤﺎ أﻣﻜﻦ( ﻓﻲ ﺣﺎﻟﺔ ﻋﺪم وﺟﻮدهﺎ ﺑﺎﻟﻔﻌﻞ. )اﻧﻈﺮ اﻟﻤﻠﺤﻖ 1‬ ‫ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟـ "اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ"(. ﻳﺸﻴﺮ "اﻟﺘﻮازن" إﻟﻰ اﻟﻐﺮض اﻟﻤﺰدوج ﻟﻤﻨﻊ اﺳﺘﻐﻼل‬ ‫اﻟﻌﻘﺎﻗﻴﺮ ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ واﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع، ﻣﻊ ﺿﻤﺎن ﺗﻮﻓﺮهﺎ ﻟﻸﻏﺮاض‬ ‫اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ، وﺧﺼﻮ ًﺎ ﻟﻌﻼج اﻷﻟﻢ واﻟﻤﻌﺎﻧﺎة )اﻧﻈﺮ اﻟﻘﺴﻢ 7 ﻟﻼﻃﻼع ﻋﻠﻰ ﻣﺰﻳﺪ ﻣﻦ اﻟﻨﻘﺎش(.‬ ‫ﺻ‬ ‫هﺬﻩ اﻟﻮﺛﻴﻘﺔ ﻣﺨﺼﺼﺔ ﻟﻸﻓﺮاد اﻟﺬﻳﻦ ﻳﻘﻮﻣﻮن ﺑﻮﺿﻊ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ، ﻓﻀﻼ ﻋﻦ اﻷﻓﺮاد‬ ‫ً‬ ‫اﻟﺬﻳﻦ ﻳﻘﻮﻣﻮن ﺑﺘﻨﻔﻴﺬهﺎ. وﻳﺠﻮز ﻷﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ واﻟﻤﺆﺳﺴﺎت اﻟﺨﺎﺻﺔ ﺑﻬﻢ اﺳﺘﺨﺪام اﻟﻮﺛﻴﻘﺔ‬ ‫أﻳ ًﺎ وذﻟﻚ ﻟﺘﺸﺠﻴﻊ اﻟﺘﻌﺎون ﻣﻊ اﻟﺤﻜﻮﻣﺎت وﻟﺘﻮﻓﻴﺮ ﻗﺪر أآﺒﺮ ﻣﻦ اﻟﺘﺜﻘﻴﻒ.‬ ‫ﻀ‬ ‫ﺗﺤ ﱢﻖ هﺬﻩ اﻟﻮﺛﻴﻘﺔ ﻏﺮﺿﻬﺎ ﺑﻌﺪة ﻃﺮق:‬ ‫ﻘ‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ ﻣﻌﻠﻮﻣﺎت ﻣﺮﺟﻌﻴﺔ ﺣﻮل اﻟﻤﺸﻜﻠﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺗﺞ ﻋﻦ ﻣﺮض‬ ‫1.‬ ‫اﻟﺴﺮﻃﺎن ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف )اﻟﻘﺴﻢ 2(؛‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت ﺣﻮل ﺳﺒﺐ اﻻﺣﺘﻴﺎج إﻟﻰ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة )أي اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺪ‬ ‫2.‬ ‫3‬ ‫واﻷﻓﻴﻮن( ﺑﻐﺮض اﻟﺘﻌﺎﻣﻞ اﻟﻄﺒﻲ ﻣﻊ اﻷﻟﻢ )اﻟﻘﺴﻢ 3(.‬ ‫ﻳﺘﻢ إﻋﻄﺎء ﻣﻌﻠﻮﻣﺎت ﺣﻮل اﻟﺘﻮﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ ﻓﻲ ﻣﻌﻈﻢ اﻟﺪول‬ ‫3.‬ ‫)اﻟﻘﺴﻢ 4(.‬ ‫2ﺗﻮﺟﺪ ﺛﻼﺛﺔ ﻣﺴﺘﻮﻳﺎت ﻟﻠﻌﻘﺒﺎت اﻟﺘﻲ ﺗﺤﻮل دون اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﺑﺸﻜﻞ آﺎف: ﻣﺴﺘﻮى اﻗﺘﺼﺎدي، وﺁﺧﺮ ﻃﺒﻲ، وﺛﺎﻟﺚ‬ ‫ﺗﻨﻈﻴﻤﻲ. وﺑﻴﻨﻤﺎ ﺗﺮآﺰ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻋﻠﻰ اﻟﻤﺸﻜﻼت اﻟﺘﻨﻈﻴﻤﻴﺔ وﺣﺪهﺎ، إﻻ أﻧﻪ ﻣﻦ اﻟﻤﻔﻬﻮم ﺟﻴ ًا أن اﻟﻌﻘﺒﺎت‬ ‫ﺪ‬ ‫اﻻﻗﺘﺼﺎدﻳﺔ واﻟﻄﺒﻴﺔ ﺗﻠﻌﺐ أدوا ًا رﺋﻴﺴﻴﺔ ﻓﻲ ﻣﻌﺎﻟﺠﺔ اﻷﻟﻢ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف. ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل، ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﺳﺒﺎب‬ ‫ر‬ ‫اﻻﻗﺘﺼﺎدﻳﺔ، ﻳﺘﻢ ﺗﺸﺠﻴﻊ أﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻠﻰ اﺳﺘﺨﺪام ﻣﻨﺘﺠﺎت دواﺋﻴﺔ أﻋﻠﻰ آﻠﻔﺔ وأﻗﻞ ﻓﻌﺎﻟﻴﺔ. وﻗﺪ ﻳﺘﺴﺒﺐ هﺬا‬ ‫ﻓﻲ ﺗﻔﺎﻗﻢ ﺣﺎﻟﺔ ﺗﻮاﻓﺮ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف، ﺑﺎﻟﻨﺴﺒﺔ ﻟﻨﻈﺎم اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻤﻮ ًﺎ وﻟﻠﻤﺮﻳﺾ اﻟﻔﺮد ﻋﻠﻰ ﺣﺪ ﺳﻮاء.‬ ‫ﻣ‬ ‫وﻓﻲ ﺑﻌﺾ اﻟﺪول، ﻳﺘﻢ إﻧﻔﺎق اﻟﻤﻮارد اﻟﻄﺒﻴﺔ اﻟﻨﺎدرة ﻋﻠﻰ اﻟﻌﻼﺟﺎت اﻟﻤﻜﻠﻔﺔ اﻟﺘﻲ ﺗﻜﻮن ﻋﺪﻳﻤﺔ اﻟﺠﺪوى ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ‬ ‫اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ ﻣﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ ﻣﺮض اﻟﺴﺮﻃﺎن )4(. ﺗﺤﻮل هﺬﻩ اﻟﺴﻴﺎﺳﺎت دون ﺗﻮﻓﻴﺮ اﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت.‬ ‫وأﺧﻴ ًا، ﻓﺈن اﻟﺘﺜﻘﻴﻒ اﻟﻄﺒﻲ اﻟﺬي ﻻ ﻳﻌﺎﻟﺞ اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ ﻳﺴﻬﻢ ﻓﻲ اﻟﺘﻌﺎﻣﻞ ﻏﻴﺮ اﻟﻤﻼﺋﻢ ﻣﻊ اﻷﻟﻢ.‬ ‫ﺮ‬ ‫3راﺟﻊ اﻟﻤﻠﺤﻖ 3 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺷﺮح ﻟـ "اﻷﻓﻴﻮن" و"اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة" وﻟﻠﻤﺼﻄﻠﺤﺎت اﻟﺮﺋﻴﺴﻴﺔ اﻷﺧﺮى‬ ‫ﺪ‬ ‫اﻟﻮارد ذآﺮهﺎ ﻓﻲ هﺬا اﻹﺻﺪار.‬ ‫-2-‬
  • 8. ‫ﻳﺘﻢ إﺑﺪاء اﻷﺳﺒﺎب اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺘﻮﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ، ﻣﻊ إﺷﺎرة ﺧﺎﺻﺔ إﻟﻰ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ‬ ‫4.‬ ‫ﺗﺘﺴﻢ ﺑﺎﻟﺘﻘﻴﻴﺪ اﻟﻤﻔﺮط إزاء أدوﻳﺔ ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﻤﻮﺟﺐ ﺑﻌﺾ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫)اﻟﻘﺴﻢ 5(.‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ أﺳﺎس ﻣﻨﻄﻘﻲ ﻟﻠﺤﻜﻮﻣﺎت ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﺑﻬﺪف ﺗﺤﻘﻴﻖ اﻟﺘﻮازن )اﻟﻘﺴﻢ 6(.‬ ‫5.‬ ‫ﻳﺘﻢ وﺻﻒ اﻟﻄﺮﻳﻘﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ وﺿﻊ ﻣﺒﺎدئ ﺗﻮﺟﻴﻬﻴﺔ ﻹﺟﺮاء ﺗﻘﻴﻴﻢ ذاﺗﻲ )اﻟﻘﺴﻢ 7(.‬ ‫6.‬ ‫ﻳﺘﻢ ﺗﻘﺪﻳﻢ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﺤﺚ اﻟﺮأي اﻟﺠﻤﺎﻋﻲ ﻋﻠﻰ اﺗﺨﺎذ ﺳﻴﺎﺳﺔ وﻃﻨﻴﺔ ﻣﺘﻮازﻧﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ.‬ ‫7.‬ ‫وﺗﺴﺘﻨﺪ هﺬﻩ اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ إﻟﻰ اﻟﺮأي اﻟﺠﻤﺎﻋﻲ اﻟﻄﺒﻲ واﻟﺘﻨﻈﻴﻤﻲ اﻟﺪوﻟﻲ واﻟﺬي ﻳﻔﻴﺪ ﺏﻮﺟﻮب إﺡﺪاث ﺗﻮازن‬ ‫ﻟﺴﻴﺎﺳﺔ ﻣﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ )اﻟﻘﺴﻢ 9(.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻗﺎﺋﻤﺔ ﺗﺪﻗﻴﻖ ﻟﻸﺳﺌﻠﺔ وذﻟﻚ ﻟﺘﻮﺟﻴﻪ اﻟﺘﻘﻴﻴﻢ اﻟﺬاﺗﻲ )اﻟﻘﺴﻢ 01(.‬ ‫8.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت ﻟﻠﻤﺮاﺟﻊ ﻓﻲ اﻟﺼﻔﺤﺘﻴﻦ 43-53.‬ ‫9.‬ ‫ﻳﺘﻢ ﺗﻮﻓﻴﺮ ﻣﻌﻠﻮﻣﺎت اﻟﻄﻠﺐ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺼﺎدر اﻟﺮﺋﻴﺴﻴﺔ ﻓﻲ اﻟﻤﻠﺤﻖ 2.‬ ‫01.‬ ‫ﻳﺘﻮﻓﺮ دﻟﻴﻞ ﺑﺎﻟﻤﻜﺎﺗﺐ اﻟﺤﻜﻮﻣﻴﺔ اﻟﻤﻌﻨﻴﺔ ﺑﺘﻨﻈﻴﻢ اﻟﻤﺨﺪرات )اﻟﺴﻠﻄﺎت اﻟﻮﻃﻨﻴﺔ‬ ‫11.‬ ‫اﻟﻤﺨﺘﺼﺔ( ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻋﺒﺮ اﻟﻮﺳﺎﺋﻞ اﻟﺘﺎﻟﻴﺔ:‬ ‫ﻣﻮﻗﻊ اﻟﻮﻳﺐ: ‪،http://www.incb.org‬‬ ‫أو اﻟﻬﺎﺗﻒ: 7724-06062-1-34+، أو اﻟﻔﺎآﺲ: 8685/7685-06062-1-34+‬ ‫اﻟﻘﺴﻢ 2 - ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﺸﻜﻞ ﻏﻴﺮ آﺎف‬ ‫ﻳﻌﺎﻧﻲ آﺎﻓﺔ اﻟﻤﺼﺎﺑﻴﻦ ﺑﺎﻟﺴﺮﻃﺎن ﻣﻦ اﻷﻟﻢ. وﻗﺪ ﻳﺤﺘﺎج ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن إﻟﻰ ﺗﺨﻔﻴﻒ ﻟﻸﻟﻢ ﻓﻲ آﻞ ﻣﺮﺣﻠﺔ‬ ‫ﻣﻦ اﻟﻤﺮض. واﻟﺠﺪﻳﺮ ﺑﺎﻟﺬآﺮ أن ﺛﻠﺜﻲ ﻋﺪد اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ وﺻﻠﻮا ﻟﻤﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ اﻟﺴﺮﻃﺎن ﻳﻌﺎﻧﻮن‬ ‫ﻣﻦ أﻟﻢ ﺣﺎد )5(. ﺑﺎﻟﻨﺴﺒﺔ ﻟﻬﺆﻻء اﻟﻤﺮﺿﻰ، ﻳﻨﺒﻐﻲ أن ﻳﻜﻮن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺟﺰ ًا ﻣﻦ اﻟﻌﻼج اﻹﺟﻤﺎﻟﻲ اﻟﺬي‬ ‫ء‬ ‫ﻳﺨﻀﻌﻮن ﻟﻪ. أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ اﻟﺬﻳﻦ وﺻﻠﻮا ﻟﻤﺮﺣﻠﺔ ﻣﺘﺄﺧﺮة ﻣﻦ اﻟﺴﺮﻃﺎن، ﻓﺈن اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ‬ ‫واﻷﻋﺮاض اﻟﻤﺮﺿﻴﺔ اﻷﺧﺮى ﻳﻨﺒﻐﻲ أن ﻳﻤﺜﻞ اﻟﻬﺪف اﻟﺮﺋﻴﺴﻲ ﻟﻠﺒﺮاﻣﺞ اﻟﻮﻃﻨﻴﺔ ﻟﻠﺴﻴﻄﺮة ﻋﻠﻰ ﻣﺮض‬ ‫اﻟﺴﺮﻃﺎن.‬ ‫ﻓﻲ ﻋﺎم 6991، ذآﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ‬ ‫ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )5(:‬ ‫‪“In most parts of the world, the majority of cancer patients present with advanced‬‬ ‫‪disease. For them, the only realistic treatment option is pain relief and palliative‬‬ ‫”‪].care‬ﻓﻲ ﻣﻌﻈﻢ أﻧﺤﺎء اﻟﻌﺎﻟﻢ، ﻳﺘﺴﻢ أﻏﻠﺐ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﺑﻤﺮﺣﻠﺔ ﻣﺘﻘﺪﻣﺔ ﻣﻦ اﻟﻤﺮض.‬ ‫وﺑﺎﻟﻨﺴﺒﺔ ﻟﻬﻢ، ﻳﺘﻤﺜﻞ ﺧﻴﺎر اﻟﻌﻼج اﻟﻮاﻗﻌﻲ اﻟﻮﺣﻴﺪ ﻓﻲ ﺗﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻌﻼج ﺑﺎﻟﻤﺴﻜﻨﺎت[‬ ‫)ص ‪.(v‬‬ ‫ﺗﻘﺘﺮح اﻟﺪراﺳﺎت اﻻﺳﺘﻘﺼﺎﺋﻴﺔ أن أآﺜﺮ ﻣﻦ 05% ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن ﻳﻌﺎﻧﻮن ﻣﻦ أﻟﻢ ﻣﺘﻮاﺻﻞ )6(.‬ ‫ﻳﻤﻜﻦ ﻟﻸﻟﻢ اﻟﻤﺘﻮاﺻﻞ أن ﻳﺆﺛﺮ ﺑﺎﻟﺴﻠﺐ ﻋﻠﻰ آﺎﻓﺔ ﺟﻮاﻧﺐ ﺣﻴﺎة اﻹﻧﺴﺎن، ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺸﻬﻴﺔ واﻟﺤﺎﻟﺔ‬ ‫اﻟﻤﺰاﺟﻴﺔ واﻻﻋﺘﺪاد ﺑﺎﻟﻨﻔﺲ واﻟﻌﻼﻗﺎت ﻣﻊ اﻵﺧﺮﻳﻦ ﺑﻞ وﺣﺘﻰ اﻟﻘﺪرة ﻋﻠﻰ اﻟﺤﺮآﺔ. ﻓﻲ ﺑﻌﺾ اﻟﺪول، ﺗﺒﻴﻦ‬ ‫أن اﻷﻟﻢ اﻟﻤﺘﻮاﺻﻞ ﻳﻤﻜﻦ أن ﻳﺆدي إﻟﻰ اﻟﺮﻏﺒﺔ ﻓﻲ اﻟﻤﻮت ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ وﺟﻮد ﺟﺪل ﺣﻮل اﻟﻘﺘﻞ اﻟﺮﺣﻴﻢ‬ ‫واﻻﻧﺘﺤﺎر ﺑﻤﺴﺎﻋﺪة اﻟﻐﻴﺮ. آﻤﺎ ﺛﺒﺖ أن ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﻳﺆدي إﻟﻰ ﺗﺤﺴﻴﻦ ﻃﺒﻴﻌﺔ اﻟﺤﻴﺎة.‬ ‫-3-‬
  • 9. ‫اﻟﻘﺴﻢ 3 -‬ ‫اﻟﺤﺎﺟﺔ اﻟﻄﺒﻴﺔ إﻟﻰ ﺗﻨﺎول اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻦ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺬي ﺗﻨﺎول آﻴﻔﻴﺔ اﻟﺘﻌﺎﻣﻞ‬ ‫اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“In patients with severe pain, morphine -- a strong opioid -- is the drug of‬‬ ‫”‪].choice‬ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﻜﺎﺑﺪون أﻟ ًﺎ ﻣﺒﺮ ًﺎ، ﻳﻌﺪ اﻟﻤﻮرﻓﻴﻦ – وهﻮ ﻣﺎدة‬ ‫ﺣ‬ ‫ﻤ‬ ‫أﻓﻴﻮﻧﻴﺔ ﻣﺨ ﱢرة – ﺑﻤﺜﺎﺑﺔ اﻟﻌﻘﺎر اﻷﻣﺜﻞ[ )ص 81(.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻨﺖ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻠﻌﺎﻟﻢ أن أﻏﻠﺐ، إن ﻟﻢ ﻳﻜﻦ آﻞ، اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫ﻳﻤﻜﻦ ﺗﺨﻔﻴﻔﻪ ﻓﻲ ﺣﺎﻟﺔ ﺗﻄﺒﻴﻖ اﻟﻤﻌﺮﻓﺔ اﻟﻄﺒﻴﺔ اﻟﻤﺘﻮﻓﺮة ﺣﺎﻟ ًﺎ )6(. ﻳﻤﻜﻦ ﺗﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫ﻴ‬ ‫ﺑﺎﺳﺘﺨﺪام ﻣﺠﻤﻮﻋﺔ ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﺘﺪاﺑﻴﺮ اﻟﺪواﺋﻴﺔ وﻏﻴﺮ اﻟﺪواﺋﻴﺔ، ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ. وﻣﻊ ذﻟﻚ‬ ‫ﻓﺈن اﻟﻤﻮرﻓﻴﻦ واﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ اﻟﻌﻼﺟﻴﺔ ﻟﻠﻤﻮرﻓﻴﻦ ﺗﻌﺪ أﻣ ًا ﺿﺮور ًﺎ‬ ‫ﻳ‬ ‫ﺮ‬ ‫ﺪ‬ ‫ﻋﻨﺪﻣﺎ ﻳﻜﻮن اﻷﻟﻢ ﻣﺘﻮﺳ َﺎ أو ﺣﺎ ًا )4، 5، 6(. ﺗﻢ ﺗﺸﺠﻴﻊ أﺧﺼﺎﺋﻴﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ ﻋﻠﻰ اﺳﺘﺨﺪام‬ ‫د‬ ‫ﻄ‬ ‫ً‬ ‫اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﻤﺆآﺪة اﻟﻤﻜﻮﻧﺔ ﻣﻦ ﺛﻼث ﺧﻄﻮات )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( واﻟﺘﻲ ﺗﻢ‬ ‫ﺗﻄﻮﻳﺮهﺎ ﻣﻦ ﻗﺒﻞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ آﻄﺮﻳﻘﺔ ﻓﻌﺎﻟﺔ ﻟﻌﻼج اﻷﻟﻢ.‬ ‫ذآﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )4( ﻓﻲ ﻋﺎم 0991 أن:‬ ‫‪“Freedom from pain should be seen as a right of every cancer patient and access to‬‬ ‫”‪] pain therapy as a measure of respect for this right‬ﻳﻨﺒﻐﻲ اﻋﺘﺒﺎر اﻟﺘﺨﻠﺺ ﻣﻦ اﻷﻟﻢ‬ ‫ﺑﻤﺜﺎﺑﺔ ﺣﻖ ﻟﻜﻞ ﻣﺼﺎب ﺑﺎﻟﺴﺮﻃﺎن آﻤﺎ ﻳﻨﺒﻐﻲ اﻋﺘﺒﺎر اﻟﺤﺼﻮل ﻋﻠﻰ ﻋﻼج اﻷﻟﻢ ﻳﻌﺪ ﻣﻘﻴﺎ ًﺎ ﻟﻤﺪى‬ ‫ﺳ‬ ‫اﺣﺘﺮام هﺬا اﻟﺤﻖ [ )ص 01(.‬ ‫ﻳﻌﺘﻤﺪ ﺗﺨﻔﻴﻒ اﻷﻟﻢ اﻟﺤﺎد اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن ﻋﻠﻰ ﺗﻮﻓﺮ واﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ‬ ‫ﺪ‬ ‫اﻟﻌﻼﺟﻴﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﻤﻮرﻓﻴﻦ. ﻟﻴﺲ ﻟﺪى هﺬﻩ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة أي "ﺳﻘﻒ ﺗﺴﻜﻴﻨﻲ" )أي ﺳﻤﺔ‬ ‫ﺪ‬ ‫دواﺋﻴﺔ ﻟﻌﻘﺎر ﻋﻨﺪﻣﺎ ﻻ ﺗﻮﻓﺮ ﺟﺮﻋﺔ ﻣﺘﺰاﻳﺪة ﻣﻨﻪ ﻗﺪ ًا إﺿﺎﻓ ًﺎ ﻣﻦ اﻟﺘﺴﻜﻴﻦ(. وﻳﻤﻜﻦ إﻋﻄﺎؤهﺎ ﺑﺄﻣﺎن ﻓﻲ‬ ‫ﻴ‬ ‫ر‬ ‫ﺷﻜﻞ ﺟﺮﻋﺎت ﻣﺘﺰاﻳﺪة إﻟﻰ أن ﻳﺘﻢ ﺗﺨﻔﻴﻒ اﻷﻟﻢ، ﻃﺎﻟﻤﺎ ﻳﻤﻜﻦ ﺗﺤﻤﻞ اﻷﻋﺮاض اﻟﺠﺎﻧﺒﻴﺔ )5(. وﻻ ﺗﻮﺟﺪ‬ ‫ﺟﺮﻋﺔ ﻋﻼﺟﻴﺔ ﻗﻴﺎﺳﻴﺔ ﻣﻦ هﺬﻩ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة. وﻳﻨﺒﻐﻲ ﺗﺤﺪﻳﺪ اﻟﺠﺮﻋﺔ اﻟﻤﻨﺎﺳﺒﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ ﻋﻦ‬ ‫ﺪ‬ ‫4‬ ‫ﻃﺮﻳﻖ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻔﺮدﻳﺔ ﻟﻠﻤﺮﻳﺾ.‬ ‫ﻳﺠﺐ ﺗﻮﻓﻴﺮ ﻣﻘﺎدﻳﺮ آﺎﻓﻴﺔ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ ودواء واﺣﺪ أو أآﺜﺮ ﻣﻦ اﻷدوﻳﺔ اﻷﻓﻴﻮﻧﻴﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ، ﻓﻀﻼ ﻋﻦ‬ ‫ً‬ ‫اﻷدوﻳﺔ اﻷﺧﺮى اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ واﻷﻋﺮاض اﻟﻤﺮﺿﻴﺔ، ﻋﻨﺪﻣﺎ ﻳﺤﺘﺎج اﻟﻤﺮﺿﻰ إﻟﻴﻬﺎ وﻓﻲ‬ ‫اﻷﻣﺎآﻦ اﻟﺘﻲ ﻳﻌﻴﺸﻮن ﻓﻴﻬﺎ )4(.‬ ‫ﻓﻲ ﻋﺎم 6891، أﻋﻠﻦ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل آﻴﻔﻴﺔ اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﻣﺎ ﻳﻠﻲ:‬ ‫1691 ‪“Of 22 drugs commonly used for cancer pain relief, eight are covered by the‬‬ ‫‪Single Convention on Narcotic Drugs and one by the 1971 Convention on‬‬ ‫”...‪] Psychotropic Substances‬ﻣﻦ ﺑﻴﻦ اﻟـ 22 دواء ﻣﺴﺘﺨﺪ ًﺎ ﺑﺸﻜﻞ ﺷﺎﺋﻊ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ‬ ‫ﻣ‬ ‫اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن، ﺗﻐﻄﻲ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691 ﺛﻤﺎﻧﻴﺔ أدوﻳﺔ ﻣﻨﻬﺎ، آﻤﺎ‬ ‫ﺗﻐﻄﻲ إﺣﺪاهﺎ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻤﺆﺛﺮات اﻟﻌﻘﻠﻴﺔ ﻟﺴﻨﺔ 1791... [)ص 72(.‬ ‫آﺎﻧﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ اﻷﺳﺎﺳﻴﺔ )7( ﻗﺪ ﺻﻨﻔﺖ ﻷﻋﻮام‬ ‫4ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻣﻌﻠﻮﻣﺎت إآﻠﻴﻨﻴﻜﻴﺔ ﺣﻮل آﻴﻔﻴﺔ اﺧﺘﻴﺎر اﻟﻤﺴﻜﻨﺎت واﺳﺘﺨﺪاﻣﻬﺎ، راﺟﻊ: ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، 6991 )5(.‬ ‫-4-‬
  • 10. ‫ﻋﺪﻳﺪة اﻟﻤﻮرﻓﻴﻦ واﻟﻜﻮداﻳﻴﻦ وﻏﻴﺮهﺎ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة آـ "ﻋﻘﺎﻗﻴﺮ أﺳﺎﺳﻴﺔ" وﻋﺮﻓﺘﻬﺎ ﻋﻠﻰ‬ ‫ﺪ‬ ‫اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫‪“those that satisfy the health care needs of the majority of the population; they‬‬ ‫‪should therefore be available at all times in adequate amounts and in the‬‬ ‫”...‪] appropriate dosage forms‬هﻲ ﺗﻠﻚ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﻠﺒﻲ اﺣﺘﻴﺎﺟﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫ﻷﻏﻠﺐ اﻟﺴﻜﺎن؛ وﻳﻨﺒﻐﻲ إﺗﺎﺣﺘﻬﺎ داﺋ ًﺎ ﺑﺎﻟﻤﻘﺎدﻳﺮ اﻟﻜﺎﻓﻴﺔ وﺑﺄﺷﻜﺎل اﻟﺠﺮﻋﺎت اﻟﻤﻼﺋﻤﺔ... [‬ ‫ﻤ‬ ‫)ص 2(.‬ ‫ﺗﺰاﻳﺪ اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻤﻮرﻓﻴﻦ ﺑﺼﻮرة آﺒﻴﺮة ﺣﻴﺚ ﺗﺒﻨﺖ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت وأﺧﺼﺎﺋﻴﻮ اﻟﺼﺤﺔ‬ ‫اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻣﻊ ذﻟﻚ‬ ‫ﻓﺈن ﻣﻌﻈﻢ اﻻﺳﺘﻬﻼك اﻟﻤﺘﺰاﻳﺪ ﻟﻠﻤﻮرﻓﻴﻦ ﻗﺪ ﺣﺪث ﻓﻲ ﻋﺪد ﻗﻠﻴﻞ ﻣﻦ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ اﻟﺘﻲ ﺗﻤﺜﻞ ﺟﺰ ًا‬ ‫ء‬ ‫ﺿﺌﻴﻼ ﻣﻦ ﺗﻌﺪاد ﺳﻜﺎن اﻟﻌﺎﻟﻢ )3(. وﻓﻲ اﻵوﻧﺔ اﻷﺧﻴﺮة، ﺑﺪأ اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ ﻓﻲ اﻟﺘﺰاﻳﺪ ﻓﻲ دول‬ ‫ً‬ ‫أﺧﺮى، وﻣﻦ ﺑﻴﻨﻬﺎ ﻋﺪد ﻣﻦ اﻟﺪول اﻟﻨﺎﻣﻴﺔ. وﺗﻮﺿﺢ اﻟﺒﻴﺎﻧﺎت اﻹﺣﺼﺎﺋﻴﺔ ﻟﻠﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻋﻦ اﻟﻔﺘﺮة ﻣﻦ 0991 إﻟﻰ 8991 ﺣﺪوث ﺗﺰاﻳﺪات آﺒﻴﺮة ﻓﻲ آﻞ ﻣﻦ اﻟﺪول اﻟﻤﺘﻘﺪﻣﺔ واﻟﻨﺎﻣﻴﺔ ﻋﻠﻰ ﺣﺪ‬ ‫ﺳﻮاء، ﺑﻴﻨﻤﺎ ﺑﻘﻰ ﻣﻌﺪل اﻻﺳﺘﻬﻼك ﺛﺎﺑ ًﺎ أو ﺣﺘﻰ ﺗﻨﺎﻗﺺ ﻓﻲ دول أﺧﺮى. وﺗﺴﺘﺨﺪم أﻏﻠﺐ اﻟﺪول ﻗﺪ ًا‬ ‫ر‬ ‫ﺘ‬ ‫ﺿﺌﻴﻼ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ.‬ ‫ً‬ ‫ﻳﻘﺪم اﻟﻤﻠﺤﻖ 4 ﺑﻴﺎﻧﺎت ﺣﻮل اﺳﺘﻬﻼك ﻧﻄﺎق واﺳﻊ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻤﺤﺪدة ﻓﻲ ﺷﻜﻞ ﺟﺮﻋﺔ‬ ‫ﺪ‬ ‫ﻳﻮﻣﻴﺔ ﻣﻘﺮرة )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻟﻜﻞ ﻣﻠﻴﻮن ﻧﺴﻤﺔ، وﻳﻤﺜﻞ اﻟﻤﺘﻮﺳﻂ ﻓﻲ ﺧﻤﺴﺔ‬ ‫أﻋﻮام. وﻳﺘﻴﺢ اﻟﻤﻠﺤﻖ 4 إﻣﻜﺎﻧﻴﺔ اﻟﻤﻘﺎرﻧﺔ ﺑﻴﻦ اﺳﺘﻬﻼك ﻋﺪد ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة داﺧﻞ اﻟﺪول‬ ‫ﺪ‬ ‫وﻓﻴﻤﺎ ﺑﻴﻨﻬﺎ. وﻓﻲ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺪول، ﻳﻈﻞ ﻣﻌﺪل اﻻﺳﺘﻬﻼك ﻣﻨﺨﻔ ًﺎ ﻟﻠﻐﺎﻳﺔ ﻣﻘﺎرﻧﺔ ﺑﺎﻻﺣﺘﻴﺎج اﻟﻄﺒﻲ،‬ ‫ﻀ‬ ‫وﻣﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻰ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ ﺳﺪ هﺬا اﻟﻨﻘﺺ اﻟﺒﺎﻟﻎ )3(.‬ ‫اﻟﻘﺴﻢ 4‬ ‫اﻟﺘﻮاﻓﺮ ﻏﻴﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻓﻲ أﻏﻠﺐ اﻟﺪول، ﻻ ﻳﺘﻮﻓﺮ اﻟﻤﻮرﻓﻴﻦ واﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻷﺧﺮى اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﻤﺠﻤﻮﻋﺔ اﻟﻌﻼﺟﻴﺔ‬ ‫ﺪ‬ ‫اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻠﻤﻮرﻓﻴﻦ، أو ﺗﻜﻮن ﻣﺘﻮﻓﺮة ﺑﻜﻤﻴﺎت ﻣﺤﺪودة أو ﻓﻲ أﻣﺎآﻦ ﻣﺤﺪودة، أو ﺗﻜﻮن ﻣﺘﻮﻓﺮة ﻣﻊ‬ ‫اﺳﺘﺨﺪاﻣﻬﺎ ﺑﺸﻜﻞ ﻧﺎﻗﺺ )4( .وﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن ﻣﻨﺸﻮر اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﻤﻜﻮﻧﺔ ﻣﻦ ﺛﻼث‬ ‫ﺧﻄﻮات واﻟﺨﺎﺻﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺬي ﻧﺸﺮﺗﻪ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻓﻲ ﻋﺎم‬ ‫6891 ﻗﺪ ﺳﺎهﻢ ﻓﻲ ﺗﺰاﻳﺪ ﻣﻌﺪل اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ. وﻗﺒﻞ ﻣﻄﻠﻊ اﻟﺜﻤﺎﻧﻴﻨﻴﺎت ﻣﻦ‬ ‫اﻟﻘﺮن اﻟﻌﺸﺮﻳﻦ، آﺎن ﻣﻌﺪل اﺳﺘﻬﻼك اﻟﻤﻮرﻓﻴﻦ )راﺟﻊ اﻟﻤﺮاﻓﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻣﻨﺨﻔ ًﺎ وﺛﺎﺑ ًﺎ‬ ‫ﺘ‬ ‫ﻀ‬ ‫)راﺟﻊ اﻟﺸﻜﻞ اﻟﺘﻮﺿﻴﺤﻲ اﻟﺘﺎﻟﻲ(.‬ ‫-5-‬
  • 11. ‫اﻻﺳﺘﻬﻼك اﻟﻌﺎﻟﻤﻲ ﻟﻠﻤﻮرﻓﻴﻦ‬ ‫8991-2791‬ ‫آﻴﻠﻮﺟﺮام‬ ‫8991 7991 6991 5991 4991 3991 2991 1991 0991 9891 8891 7891 6891 5891 4891 3891 2891 1891 0891 9791 8791 7791 6791 5791 4791 3791 2791‬ ‫اﻟﻤﺼﺪر: اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻓﻲ ﻋﺎم 3991، أﻗﺮت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ )8(:‬ ‫‪“...that there was a great need to ensure, in seeking to reduce the non-medical use‬‬ ‫‪of therapeutic psychoactive drugs, that patients with legitimate medical needs are‬‬ ‫‪not prevented from being treated with adequate amounts of appropriate‬‬ ‫‪medications. Evidence suggests that medical needs for opioids are not being fully‬‬ ‫‪satisfied, particularly among patients with cancer, who may require large doses of‬‬ ‫”‪...] opioids to obtain optimal pain relief‬آﺎﻧﺖ هﻨﺎك ﺣﺎﺟﺔ ﻣﺎﺳﺔ ﻟﻀﻤﺎن أﻧﻪ ﻻ ﻳﺘﻢ ﻣﻨﻊ‬ ‫اﻟﻤﺮﺿﻰ ذوي اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ اﻟﻤﺸﺮوﻋﺔ ﻣﻦ ﺗﻠﻘﻲ اﻟﻌﻼج ﺑﻤﻘﺎدﻳﺮ آﺎﻓﻴﺔ ﻣﻦ اﻷدوﻳﺔ‬ ‫اﻟﻤﻼﺋﻤﺔ، وذﻟﻚ ﻓﻲ إﻃﺎر اﻟﺴﻌﻲ إﻟﻰ ﺧﻔﺾ اﻻﺳﺘﺨﺪام ﻏﻴﺮ اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﻌﻼﺟﻴﺔ اﻟﻨﻔﺴﻴﺔ.‬ ‫وﺗﺸﻴﺮ اﻷدﻟﺔ إﻟﻰ ﻋﺪم ﺗﻠﺒﻴﺔ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ ﻣﻦ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺑﺸﻜﻞ آﺎﻣﻞ،‬ ‫ﺪ‬ ‫ﺧﺎﺻﺔ ﺑﻴﻦ اﻟﻤﺮﺿﻰ اﻟﻤﺼﺎﺑﻴﻦ ﺑﺎﻟﺴﺮﻃﺎن، واﻟﺬﻳﻦ ﻗﺪ ﻳﺘﻄﻠﺒﻮن ﺟﺮﻋﺎت آﺒﻴﺮة ﻣﻦ اﻟﻤﻮاد‬ ‫اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﺤﺪ اﻷﻗﺼﻰ ﻣﻦ ﺗﺨﻔﻴﻒ اﻷﻟﻢ[ )ص 02(.‬ ‫ﺪ‬ ‫ﻃﺒ ًﺎ ﻟﺪراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ أﺟﺮﻳﺖ ﻋﺎم 5991 ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت ﻣﻦ ﻗﺒﻞ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ﻘ‬ ‫)3(، ﻻ ﺗﺰال اﻷﺷﻜﺎل اﻟﻘﺎﺑﻠﺔ ﻟﻠﺤﻘﻦ ﻣﻦ اﻟﻤﻮرﻓﻴﻦ أآﺜﺮ ﺗﻮﻓ ًا ﻣﻦ اﻟﺸﻜﻞ اﻟﺬي ﻳﺘﻢ ﺗﻌﺎﻃﻴﻪ ﻋﻦ ﻃﺮﻳﻖ اﻟﻔﻢ‬ ‫ﺮ‬ ‫واﻟﺬي ﺗﻮﺻﻲ ﺑﻪ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ. وﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن 06% ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﺧﻀﻌﺖ‬ ‫ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ ﻗﺪ أﻗﺮت اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، ﻓﺈن ﻧﺤﻮ ﻧﺼﻒ‬ ‫اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ اﺳﺘﺠﺎﺑﺖ ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ أﺑﻠﻐﺖ ﻋﻦ ﻋﺪم ﺗﻮاﻓﺮ اﻟﻤﻮرﻓﻴﻦ ﻓﻲ آﺎﻓﺔ اﻟﻤﺴﺘﺸﻔﻴﺎت اﻟﺘﻲ‬ ‫ﺗﺤﺘﻮي ﻋﻠﻰ ﺑﺮاﻣﺞ ﻟﻌﻼج اﻟﺴﺮﻃﺎن. وﻟﻘﺪ أﺻﺒﺢ اﻟﻨﺠﺎح اﻟﻤﺤﺮز ﻓﻲ ﺗﻄﺒﻴﻖ اﻟﻄﺮﻳﻘﺔ اﻟﺘﺴﻜﻴﻨﻴﺔ اﻟﺘﺎﺑﻌﺔ‬ ‫ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻣﺤﺪو ًا ﻣﻦ ﺟﺮاء ﻧﻘﺺ اﻟﻤﺴﻜﻨﺎت اﻷﻓﻴﻮﻧﻴﺔ؛ وﺳﻮف ﻳﻌﺘﻤﺪ اﻟﻨﺠﺎح ﻓﻲ اﻟﻤﺴﺘﻘﺒﻞ‬ ‫د‬ ‫ﻋﻠﻰ ﺟﻬﻮد اﻟﺤﻜﻮﻣﺎت ﻧﺤﻮ ﺗﺤﺪﻳﺪ وﻣﺠﺎﺑﻬﺔ اﻟﻌﻘﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ ﻧﻈﻢ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ واﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫اﻟﺨﺎﺻﺔ ﺑﻬﻢ.‬ ‫-6-‬
  • 12. ‫اﻟﻘﺴﻢ 5‬ ‫ﻋﻮاﺋﻖ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻟﻤﺨﺪ ﱢة‬ ‫ر‬ ‫دﻋﺖ آﻞ ﻣﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ إﻟﻰ اﻻهﺘﻤﺎم ﺑﺎﻟﻌﻼج ﻏﻴﺮ اﻟﻜﺎﻓﻲ‬ ‫ﻟﻸﻟﻢ، وﻗﺪ ﺗﻮﺻﻠﺘﺎ إﻟﻰ أن هﺬا اﻷﻣﺮ ﻳﺮﺟﻊ ﺟﺰﺋ ًﺎ إﻟﻰ اﻟﻘﻮاﻧﻴﻦ واﻟﺘﺸﺮﻳﻌﺎت اﻟﻤﻘ ﱢﺪة ﻋﻠﻰ ﻧﺤﻮ ﻣﺒﺎﻟﻎ ﻓﻴﻪ‬ ‫ﻴ‬ ‫ﻴ‬ ‫واﻟﺘﻲ ﺗﻌﻮق اﻟﺘﻮاﻓﺮ اﻟﻜﺎﻓﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة واﺳﺘﺨﺪاﻣﻬﺎ اﻟﻄﺒﻲ )3، 4، 5، 9،‬ ‫ﺪ‬ ‫5‬ ‫01، 11(.‬ ‫ﻓﻲ وﻗﺖ ﻣﺒﻜﺮ وﺗﺤﺪﻳ ًا ﻓﻲ ﻋﺎم 6891، اﻋﺘﺮف اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل‬ ‫ﺪ‬ ‫اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن )6( ﺑﺎﻟﺤﺎﺟﺔ إﻟﻰ ﺗﺤﺪﻳﺚ ﻧﻈﻢ اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ وذﻟﻚ ﻟﺘﻠﺒﻴﺔ اﻻﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ اﻟﻤﺘﻐﻴﺮة: :‬ ‫‪“Systems regulating the distribution and prescription of opioid drugs were designed‬‬ ‫‪before the value of the oral use of opioid drugs for cancer pain management was‬‬ ‫‪recognized. These systems were developed to prevent the social misuse of strong‬‬ ‫”‪opioids; there was no intention to prevent the use of opioids for pain relief in cancer‬‬ ‫]ﺗﻢ ﺗﺼﻤﻴﻢ اﻟﻨﻈﻢ اﻟﺘﻲ ﺗﻨﻈﻢ ﺗﻮزﻳﻊ ووﺻﻒ اﻟﻌﻘﺎﻗﻴﺮ اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻗﺒﻞ اﻟﺘﻌﺮف ﻋﻠﻰ ﻗﻴﻤﺔ‬ ‫ﺪ‬ ‫اﻟﺘﻌﺎﻃﻲ ﺑﺎﻟﻔﻢ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. وﻗﺪ ﺗﻢ وﺿﻊ هﺬﻩ‬ ‫ﺪ‬ ‫اﻟﻨﻈﻢ ﻟﻠﺤﻴﻠﻮﻟﺔ دون ﺳﻮء اﻻﺳﺘﺨﺪام اﻻﺟﺘﻤﺎﻋﻲ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة اﻟﻘﻮﻳﺔ؛ وﻟﻢ ﻳﻜﻦ هﻨﺎك‬ ‫ﺪ‬ ‫ﻋﺰم ﻟﻤﻨﻊ اﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن[‬ ‫ﺪ‬ ‫)ص 72(.‬ ‫آﻤﺎ أوﺿﺢ اﻟﻤﺸﺎرآﻮن ﻓﻲ اﺟﺘﻤﺎع ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺣﻮل اﻟﺘﻌﺎﻣﻞ اﻟﺸﺎﻣﻞ ﻣﻊ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ‬ ‫اﻟﺴﺮﻃﺎن ﻋﺎم 6891 )6( أهﺪاف اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691، واﻟﻤﻌﺪﻟﺔ ﺑﺒﺮوﺗﻮآﻮل‬ ‫2791 اﻟﻤﻌﺪل ﻟﻼﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ 1691 )واﻟﻤﺸﺎر إﻟﻴﻬﺎ ﻓﻴﻤﺎ ﻳﻠﻲ ﺑﺎﺳﻢ‬ ‫” اﺗﻔﺎﻗﻴﺔ 1691“، راﺟﻊ اﻟﻤﻠﺤﻖ 1(، واﺗﻔﺎﻗﻴﺔ اﻟﻤﺆﺛﺮات اﻟﻌﻘﻠﻴﺔ ﻟﺴﻨﺔ 1791:‬ ‫,‪“...The principal object of these two conventions is to stop trade in, and use of‬‬ ‫‪controlled drugs, except for medical and scientific purposes. The conventions are‬‬ ‫‪not intended to be an impediment to the use of necessary drugs for the relief of‬‬ ‫,‪cancer pain. It is therefore important that, by complying with the conventions‬‬ ‫‪national laws should not, at the same time, impede the use of these drugs in cancer‬‬ ‫‪patients. Some countries have gone beyond the minimal control measures laid down‬‬ ‫‪in the conventions. Some have established stringent controls, especially in relation to‬‬ ‫”‪...] drug prescription and distribution‬ﻳﺘﻤﺜﻞ اﻟﻐﺮض اﻟﺮﺋﻴﺴﻲ ﻣﻦ هﺎﺗﻴﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ ﻓﻲ ﻣﻨﻊ‬ ‫اﻻﺗﺠﺎر ﻓﻲ اﻟﻌﻘﺎﻗﻴﺮ اﻟ ُﺮا َﺒﺔ، إﻻ ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ. وﻻ ﻳﻘﺼﺪ ﻣﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ أن‬ ‫ﻤ ﻗ‬ ‫ﺗﺸﻜﻼ ﻋﺎﺋ ًﺎ أﻣﺎم اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ اﻟﻀﺮورﻳﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن. ﻟﺬا ﻣﻦ‬ ‫ﻘ‬ ‫اﻷهﻤﻴﺔ ﺑﻤﻜﺎن أن ﺗﻠﺘﺰم اﻟﻘﻮاﻧﻴﻦ اﻟﻮﻃﻨﻴﺔ ﺑﺎﻻﺗﻔﺎﻗﻴﺘﻴﻦ وﻳﻨﺒﻐﻲ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ أﻻ ﺗﻌﻮق اﺳﺘﺨﺪام‬ ‫هﺬﻩ اﻟﻌﻘﺎﻗﻴﺮ ﻟﻤﺮﺿﻰ اﻟﺴﺮﻃﺎن. وﻟﻘﺪ ﺗﺠﺎوزت ﺑﻌﺾ اﻟﺪول اﻟﺤﺪ اﻷدﻧﻰ ﻣﻦ ﺗﺪاﺑﻴﺮ اﻟﻤﺮاﻗﺒﺔ‬ ‫اﻟﻮاردة ﻓﻲ هﺎﺗﻴﻦ اﻻﺗﻔﺎﻗﻴﺘﻴﻦ. إذ أﻗﺮت ﺑﻌﺾ اﻟﺪول ﺿﻮاﺑﻂ ﺻﺎرﻣﺔ، وﻋﻠﻰ اﻷﺧﺺ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ‬ ‫ﺑﺎﻟﻮﺻﻒ اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ وﺗﻮزﻳﻌﻬﺎ )ﺗﻤﺖ إﺿﺎﻓﺔ ﺗﺸﺪﻳﺪ([ )ص 72(.‬ ‫ﻓﻲ ﻋﺎم 9891، ﺟﺬﺑﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( اﻻﻧﺘﺒﺎﻩ إﻟﻰ رد اﻟﻔﻌﻞ اﻟﻤﻔﺮط ﻟﺒﻌﺾ‬ ‫اﻟﺤﻜﻮﻣﺎت إزاء ﻣﺸﻜﻠﺔ إﺳﺎءة اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ ﻋﻨﺪﻣﺎ:‬ ‫‪“...the reaction of some legislators and administrators to the fear of drug‬‬ ‫5ﻟﻤﺰﻳﺪ ﻣﻦ اﻟﻨﻘﺎش ﺣﻮل آﺎﻓﺔ اﻟﻌﻘﺒﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﻌﻼج اﻟﺘﺴﻜﻴﻨﻲ وﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪرة،‬ ‫ﱢ‬ ‫راﺟﻊ: ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، 0991 )4(؛ 6991 )5(.‬ ‫-7-‬
  • 13. ‫‪abuse developing or spreading has led to the enactment of laws and‬‬ ‫‪regulations that may, in some cases, unduly impede the availability of‬‬ ‫‪opiates. The problem may also arise as a result of the manner in which‬‬ ‫”‪drug control laws and regulations are interpreted or implemented‬‬ ‫]...أﻓﻀﻰ رد ﻓﻌﻞ ﺑﻌﺾ اﻟﻤﺴﺌﻮﻟﻴﻦ واﻟﻤﺸﺮﻋﻴﻦ إزاء اﻟﺨﻮف ﻣﻦ ﺗﻄﻮر أو اﻧﺘﺸﺎر‬ ‫إﺳﺎءة اﺳﺘﺨﺪام اﻟﻌﻘﺎﻗﻴﺮ إﻟﻰ ﺳﻦ اﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺘﻲ ﻗﺪ ﺗﻌﻮق ﺑﺸﻜﻞ‬ ‫ﻣﻔﺮط ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﺗﻮاﻓﺮ اﻷﻓﻴﻮن. وﻗﺪ ﺗﻨﺸﺄ اﻟﻤﺸﻜﻠﺔ أﻳ ًﺎ آﻨﺘﻴﺠﺔ ﻟﻠﻄﺮﻳﻘﺔ‬ ‫ﻀ‬ ‫اﻟﺘﻲ ﻳﺘﻢ ﺑﻬﺎ ﺗﻔﺴﻴﺮ أو ﺗﻄﺒﻴﻖ اﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﻤﺘﻌﻠﻘﺔ ﺑﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ[‬ ‫)ص 1(.‬ ‫,‪“...legislators sometimes enact laws which not only deal with the illicit traffic itself‬‬ ‫‪but also impinge on some aspects of licit trade and use, without first having‬‬ ‫‪adequately assessed the impact of the new laws on such licit activity. Heightened‬‬ ‫‪concern with the possibility of abuse may also lead to the adoption of overly‬‬ ‫‪restrictive regulations which have the practical effect of reducing availability‬‬ ‫”‪...] for licit purposes‬أﺣﻴﺎ ًﺎ ﻣﺎ ﻳﻘﻮم اﻟﻤﺸ ﱢﻋﻮن ﺑﺴﻦ اﻟﻘﻮاﻧﻴﻦ اﻟﺘﻲ ﻻ ﺗﺘﻨﺎول ﻓﻘﻂ‬ ‫ﺮ‬ ‫ﻧ‬ ‫اﻻﺗﺠﺎر ﻏﻴﺮ اﻟﻤﺸﺮوع ﻓﻲ ﺣﺪ ذاﺗﻪ، وإﻧﻤﺎ ﺗﺼﻄﺪم أﻳ ًﺎ ﺑﺒﻌﺾ ﻧﻮاﺣﻲ اﻟﺘﺠﺎرة‬ ‫ﻀ‬ ‫واﻻﺳﺘﺨﺪام اﻟﻤﺸﺮوﻋﻴﻦ، دون إﺟﺮاء ﺗﻘﻴﻴﻢ آﺎف أوﻻ ﻟﺘﺄﺛﻴﺮ اﻟﻘﻮاﻧﻴﻦ اﻟﺠﺪﻳﺪة ﻋﻠﻰ هﺬا‬ ‫ٍ ً‬ ‫اﻟﻨﺸﺎط ﻏﻴﺮ اﻟﻤﺸﺮوع. وﻗﺪ ﻳﺆدي أﻳ ًﺎ اﻟﻘﻠﻖ اﻟﻤﻀﺎﻋﻒ إزاء اﺣﺘﻤﺎﻟﻴﺔ إﺳﺎءة اﻻﺳﺘﺨﺪام‬ ‫ﻀ‬ ‫إﻟﻰ اﺗﺨﺎذ ﻟﻮاﺋﺢ ﺗﻨﻈﻴﻤﻴﺔ ﻣﻘﻴﺪة ﺑﺸﻜﻞ ﻣﻔﺮط ﺗﻨﻄﻮي ﻋﻠﻰ ﺗﺄﺛﻴﺮ ﺧﻔﺾ ﻣﻌﺪﻻت اﻟﺘﻮاﻓﺮ‬ ‫ﻟﻸﻏﺮاض اﻟﻤﺸﺮوﻋﺔ[ )ص 51(.‬ ‫ﻓﻲ واﻗﻊ اﻷﻣﺮ، ﻟﻢ ﻳﺤﻆ اﻻﺳﺘﺨﺪام ﻃﻮﻳﻞ اﻟﻤﺪى ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﺑﻐﺮض ﺗﺨﻔﻴﻒ اﻷﻟﻢ ﺑﺎﻟﺘﺸﺠﻴﻊ،‬ ‫ﺪ‬ ‫وذﻟﻚ ﻟﻮﺟﻮد ﺧﻄﺮ ﻧﺎﺟﻢ ﻋﻦ "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ". اﻻﺳﺘﺨﺪام اﻟﺪﻗﻴﻖ ﻟﻠﻤﺼﻄﻠﺤﺎت هﻮ ﻣﺎ ﻳﻔﺼﻞ‬ ‫اﻟﺘﺼﻮرات واﻟﺨﺮاﻓﺎت ﻋﻦ اﻟﻮاﻗﻊ.‬ ‫ﻳﻤﻜﻦ أن ﻳﺤﻮل اﻻﻟﺘﺒﺎس ﻓﻲ اﻟﻤﺼﻄﻠﺤﺎت دون اﺳﺘﺨﺪام آﻞ ﻣﻦ اﻷﻃﺒﺎء واﻟﻤﺮﺿﻰ ﻟﻠﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ‬ ‫اﻟﻤﺨ ﱢرة ﻋﻨﺪ ﺗﻮاﻓﺮ ﻣﺒﺮر ﻃﺒﻲ ﻗﻮي ﻻﺳﺘﺨﺪاﻣﻬﺎ. وﻗﺪ ﻳﺤﺪث ﻧﻮﻋﺎن ﻣﺮﺗﺒﻄﺎن ﻣﻦ اﻻﻟﺘﺒﺎس: )1( اﻟﺘﺨﺒﻂ‬ ‫ﺪ‬ ‫ﺑﻴﻦ "اﻟﺘﻌﺎﻃﻲ" )أو "إﺳﺎءة اﻻﺳﺘﺨﺪام"( واﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻃﻮﻳﻞ اﻟﻤﺪى، و)2( اﻟﺘﺨﺒﻂ ﺑﻴﻦ "اﻹدﻣﺎن"‬ ‫و"اﻻﺗﻜﺎل".‬ ‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻨﻮع اﻷول ﻣﻦ اﻻﻟﺘﺒﺎس، ﻳﺘﻤﺜﻞ اﻟﻬﺪف اﻟﺮﺋﻴﺴﻲ ﻻﺗﻔﺎﻗﻴﺔ 1691 ﻓﻲ ﻣﻨﻊ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻣﻊ ﺿﻤﺎن ﺗﻮاﻓﺮهﺎ ﻟﻼﺳﺘﺨﺪام اﻟﻄﺒﻲ. ﻟﺬا ﻓﻤﻦ اﻷهﻤﻴﺔ ﺑﻤﻜﺎن إﺟﺮاء ﺗﻤﻴﻴﺰ واﺿﺢ ﺑﻴﻦ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫اﻟﻤﺨ ﱢرة واﺳﺘﺨﺪاﻣﻬﺎ ﻃﺒ ًﺎ.‬ ‫ﻴ‬ ‫ﺪ‬ ‫ﻻ ﺗﻘﻮم اﺗﻔﺎﻗﻴﺔ 1691 ﺑﺘﻌﺮﻳﻒ ﻣﺼﻄﻠﺤﻲ "إﺳﺎءة اﻻﺳﺘﺨﺪام" أو "اﻟﺘﻌﺎﻃﻲ". وﻣﻊ ذﻟﻚ ﻓﺈن‬ ‫ﻣﺼﻄﻠﺢ "اﻟﺘﻌﺎﻃﻲ" ﻣﻌﺮف ﻣﻦ ﻗﺒﻞ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ‬ ‫ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ )91( ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫‪“persistent or sporadic excessive drug use inconsistent with or unrelated to‬‬ ‫”‪] acceptable medical practice‬اﻻﺳﺘﺨﺪام اﻟﺰاﺋﺪ ﻋﻦ اﻟﺤﺪ ﻟﻠﻌﻘﺎﻗﻴﺮ ﺑﺸﻜﻞ ﻣﻨﺘﻈﻢ أو‬ ‫ﻏﻴﺮ ﻣﻨﺘﻈﻢ ﺑﻤﺎ ﻻ ﻳﺘﻔﻖ أو ﻳﺘﺼﻞ ﺑﺎﻟﻤﻤﺎرﺳﺔ اﻟﻄﺒﻴﺔ اﻟﻤﻘﺒﻮﻟﺔ[ )ص 6(.‬ ‫اﻧﻄﻼ ًﺎ ﻣﻦ هﺬا اﻟﺘﻌﺮﻳﻒ، ﻳﺘﻀﺢ أن اﻻﺳﺘﺨﺪام اﻟﻄﺒﻲ ﻟﻠﻌﻘﺎﻗﻴﺮ، ﺳﻮاء ﻋﻠﻰ اﻟﻤﺪى اﻟﻄﻮﻳﻞ أم ﻻ،‬‫ﻗ‬ ‫وﺳﻮاء ﺣﺪﺛﺖ ردود ﻓﻌﻞ ﺳﻴﺌﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ )ﺑﻤﺎ ﻓﻲ ذﻟﻚ "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ"( أم ﻻ، ﻓﻼ ﻳﻤﺜﻞ "إﺳﺎءة‬ ‫اﺳﺘﺨﺪام ﻟﻠﻌﻘﺎﻗﻴﺮ".‬ ‫أﻣﺎ اﻟﻨﻮع اﻵﺧﺮ ﻣﻦ اﻻﻟﺘﺒﺎس ﺑﻴﻦ "اﻹدﻣﺎن" و"اﻻﺗﻜﺎل" ﻓﻴﺼﻌﺐ ﺗﻮﺿﻴﺤﻪ ﺑﺼﻮرة أآﺒﺮ ﻧﻈ ًا ﻷن‬ ‫ﺮ‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻢ ﺗﻌﺪ ﺗﺴﺘﺨﺪم ﻣﺼﻄﻠﺢ "اﻹدﻣﺎن". وﺑﻨﺎء ﻋﻠﻴﻪ، ﻻ ﻳﻮﺟﺪ ﺗﻌﺮﻳﻒ رﺳﻤﻲ ﻣﻦ‬ ‫ً‬ ‫-8-‬
  • 14. ‫6‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻤﺼﻄﻠﺢ "اﻹدﻣﺎن" ﺑﺤﻴﺚ ﻳﻤﻜﻦ ﻣﻘﺎرﻧﺘﻪ ﻣﻊ ﺗﻌﺮﻳﻒ ﻣﺼﻄﻠﺢ "اﻻﺗﻜﺎل".‬ ‫اﻟﺘﻌﺮﻳﻒ اﻟﺤﺎﻟﻲ ﻟﻤﺼﻄﻠﺢ "اﻻﺗﻜﺎل" 7 ﺣﺴﺐ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫واﻟﻤﻌﻨﻴﺔ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ )8( هﻮ:‬ ‫‪“A cluster of physiological, behavioural and cognitive phenomena of variable‬‬ ‫‪intensity, in which the use of a psychoactive drug (or drugs) takes on a high‬‬ ‫‪priority. The necessary descriptive characteristics are preoccupation with a‬‬ ‫.‪desire to obtain and take the drug and persistent drug-seeking behaviour‬‬ ‫‪Determinants and problematic consequences of drug dependence may be‬‬ ‫”‪] biological, psychological or social, and usually interact‬ﻣﺠﻤﻮﻋﺔ ﻇﻮاهﺮ‬ ‫ﻓﺴﻴﻮﻟﻮﺟﻴﺔ وﺳﻠﻮآﻴﺔ وﻣﻌﺮﻓﻴﺔ ذات ﺷﺪة ﻣﺘﻔﺎوﺗﺔ، ﻳﻜﻮن ﻓﻴﻬﺎ اﺳﺘﺨﺪام ﻋﻘﺎر )أو ﻋﻘﺎﻗﻴﺮ(‬ ‫ﻧﻔﺴﻴﺔ ذا أوﻟﻮﻳﺔ ﻋﺎﻟﻴﺔ. ﺗﺘﻤﺜﻞ اﻟﺴﻤﺎت اﻟﻮﺻﻔﻴﺔ اﻟﻼزﻣﺔ ﻓﻲ وﺟﻮد رﻏﺒﺔ ﻋﺎرﻣﺔ ﻓﻲ‬ ‫اﻟﺤﺼﻮل ﻋﻠﻰ اﻟﻌﻘﺎر وﺗﻌﺎﻃﻴﻪ وآﺬا ﺳﻠﻮك ﻣﻨﺘﻈﻢ ﻟﻄﻠﺐ اﻟﻌﻘﺎر. وﻗﺪ ﺗﻜﻮن اﻟﻤﺤﺪدات‬ ‫واﻟﻌﻮاﻗﺐ اﻹﺷﻜﺎﻟﻴﺔ ﻟﻼﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎر ﺑﻴﻮﻟﻮﺟﻴﺔ أو ﻧﻔﺴﻴﺔ أو اﺟﺘﻤﺎﻋﻴﺔ وﻋﺎدة ﻣﺎ ﺗﺘﺪاﺧﻞ‬ ‫ﺑﻌﻀﻬﺎ ﻣﻊ اﻟﺒﻌﺾ[ )ص 5(.‬ ‫ﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﻓﺈن اﻟﻤﻔﻬﻮم اﻷﺳﺎﺳﻲ ﻟﺘﻌﺮﻳﻒ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺨﺎص ﺑﻤﺼﻄﻠﺢ "اﻻﺗﻜﺎل ﻋﻠﻰ‬ ‫اﻟﻌﻘﺎﻗﻴﺮ" ﻳﺘﻄﻠﺐ ﺗﻮاﻓﺮ رﻏﺒﺔ ﻗﻮﻳﺔ أو إﺣﺴﺎس ﺑﺎﻹﻟﺰام ﻟﺘﻌﺎﻃﻲ اﻟﻌﻘﺎر.‬ ‫آﻤﺎ أن اﻟﻤﺒﺎدئ اﻟﺘﻮﺟﻴﻬﻴﺔ اﻹآﻠﻴﻨﻴﻜﻴﺔ )01-‪ (ICD‬اﻟﺨﺎﺻﺔ ﺑﺘﺸﺨﻴﺺ ﻣﺤﺪد ﻟـ "اﻻﺗﻜﺎل" واﻟﺘﻲ وﺿﻌﺘﻬﺎ‬ ‫ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﺗﺘﻄﻠﺐ ﻇﻬﻮر ﺛﻼث أو أآﺜﺮ ﻣﻦ اﻟﺴﻤﺎت اﻟﻤﻤﻴﺰة اﻟﺴﺖ اﻟﺘﺎﻟﻴﺔ أو اﻟﺘﻌﺮض ﻟﻬﺎ‬ ‫)12(:‬ ‫)أ( رﻏﺒﺔ ﻗﻮﻳﺔ أو إﺣﺴﺎس ﺑﺎﻻﺿﻄﺮار ﻟﺘﻌﺎﻃﻲ اﻟﻌﻘﺎر؛‬ ‫)ب( ﺻﻌﻮﺑﺎت ﻓﻲ اﻟﺘﺤﻜﻢ ﻓﻲ ﺳﻠﻮك ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎﻗﻴﺮ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺒﺪﺋﻪ أو إﻧﻬﺎﺋﻪ أو ﻣﺴﺘﻮﻳﺎت‬ ‫اﺳﺘﺨﺪاﻣﻪ؛‬ ‫)ج( ﺣﺎﻟﺔ ﺳﺤﺐ ﺑﻴﻮﻟﻮﺟﻴﺔ ﻋﻨﺪ اﻟﺘﻮﻗﻒ ﻋﻦ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر أو ﺧﻔﺾ ﻣﻌﺪﻟﻪ، ﺣﺴﺒﻤﺎ ﻳﺘﻀﺢ ﻣﻦ‬ ‫ﺧﻼل: أﻋﺮاض اﻟﺴﺤﺐ اﻟﻤﻤﻴﺰة ﻟﻠﻌﻘﺎر؛ أو اﺳﺘﺨﺪام ﻧﻔﺲ اﻟﻌﻘﺎر )أو ﻋﻘﺎر ﻣﺮﺗﺒﻂ ﺑﺸﺪة(‬ ‫ﺑﻘﺼﺪ ﺗﺨﻔﻴﻒ أﻋﺮاض اﻟﺴﺤﺐ أو ﺗﺠﻨﺒﻬﺎ؛‬ ‫)د( دﻟﻴﻞ اﻟﺘﺤﻤﻞ، ﺣﻴﺚ إن اﻟﺠﺮﻋﺎت اﻟﻤﺘﺰاﻳﺪة ﻟﻠﻌﻘﺎر اﻟﻨﻔﺴﻲ ﺗﻜﻮن ﺿﺮورﻳﺔ ﻟﺘﺤﻘﻴﻖ‬ ‫اﻟﺘﺄﺛﻴﺮات اﻟﺘﻲ ﺗُﺤﺪﺛﻬﺎ اﻟﺠﺮﻋﺎت اﻷﻗﻞ؛‬ ‫)هـ( إهﻤﺎل ﻣﺘﺰاﻳﺪ ﺑﺎﻟﻤﺘﻊ أو اﻻهﺘﻤﺎﻣﺎت اﻟﺒﺪﻳﻠﺔ ﻣﻦ ﺟﺮاء ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر اﻟﻨﻔﺴﻲ، وﻗﺪر ﻣﺘﺰاﻳﺪ‬ ‫ﻣﻦ اﻟﻮﻗﺖ اﻟﻼزم ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﻌﻘﺎر أو ﺗﻌﺎﻃﻴﻪ أو ﻟﻠﺘﻌﺎﻓﻲ ﻣﻦ ﺁﺛﺎرﻩ؛‬ ‫6ﻟﻔﻬﻢ اﻟﻔﺎرق ﺑﻴﻦ "اﻟﺘﻌﺎﻃﻲ" و"اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ"، ﻣﻦ اﻟﻀﺮوري ﻣﺮاﺟﻌﺔ ﺗﺎرﻳﺦ ﺗﻄﻮر ﻣﻔﻬﻮم "اﻻﻋﺘﻤﺎد ﻋﻠﻰ اﻟﻤﺨﺪرات"‬ ‫ﺑﺈﻳﺠﺎز. إﺑﺎن اﻟﺴﺘﻴﻨﻴﺎت ﻣﻦ اﻟﻘﺮن اﻟﻌﺸﺮﻳﻦ، ﻗﺎﻣﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺎﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﻮﻟﺪة ﻟﻺدﻣﺎن )02(‬ ‫ﺑﻤﺤﺎوﻻت ﺟﺎدة ﻟﺒﻴﺎن اﻟﻔﺎرق ﺑﻴﻦ "اﻹدﻣﺎن" و"اﻟﺘﻌﻮد"، وﻗﺪ ﺗﻮﻗﻔﺖ ﻋﻦ هﺬا اﻟﺠﻬﺪ واﻗﺘﺮﺣﺖ ﻋﻮ ًﺎ ﻋﻨﻪ اﺳﺘﺨﺪام ﻣﺼﻄﻠﺢ "اﻻﻋﺘﻤﺎد‬ ‫ﺿ‬ ‫ﻋﻠﻰ اﻟﻤﺨﺪرات". وﻓﻲ ﻋﻘﻮل ﺑﻌﺾ اﻟﺨﺒﺮاء، أدى هﺬا إﻟﻰ ﺣﺪوث ﺳﻮء ﻓﻬﻢ ﻣﻔﺎدﻩ أن ﻣﻌﻨﻰ اﻟﻤﺼﻄﻠﺢ اﻟﺠﺪﻳﺪ ﺁﻧﺬاك "اﻻﻋﺘﻤﺎد" ﻳﻤﺎﺛﻞ‬ ‫"اﻹدﻣﺎن" أو "اﻟﺘﻌﻮد" أو آﻠﻴﻬﻤﺎ ﻣ ًﺎ. ﻏﻴﺮ أن هﺬا ﻟﻢ ﻳﻜﻦ ﺻﺤﻴ ًﺎ. وﺣﺴﺒﻤﺎ ﺷﺪدت ﻟﺠﻨﺔ اﻟﺨﺒﺮاء ﺳﺎﻟﻔﺔ اﻟﺬآﺮ، ﻻ ﻳﻨﻄﻮي ﻣﺼﻄﻠﺢ‬ ‫ﺤ‬ ‫ﻌ‬ ‫"اﻻﻋﺘﻤﺎد" ﻋﻠﻰ أﻳﺔ دﻻﻟﺔ ﻟﺪرﺟﺔ اﻟﺨﻄﻮرة ﻋﻠﻰ اﻟﺼﺤﺔ اﻟﻌﺎﻣﺔ. وﻗﺪ آﺎن هﺬا ﺑﻤﺜﺎﺑﺔ ﻓﺎرق آﺒﻴﺮ ﻋﻦ ﻣﺼﻄﻠﺢ "اﻹدﻣﺎن"‬ ‫واﻟﺬي آﺎن ﻳﻨﻄﻮي ﻋﻠﻰ هﺬﻩ اﻟﺪﻻﻟﺔ.‬ ‫7ﻗﺪﻣﺖ ﻧﻔﺲ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء )8( أﻳ ًﺎ ﺗﻮﺻﻴﺎت ﻓﻲ ﻣﻘﺎﺑﻞ اﻟﺠﻬﻮد اﻟﻤﺒﺬوﻟﺔ ﻟﻠﺘﻤﻴﻴﺰ ﺑﻴﻦ "اﻻﺗﻜﺎل اﻟﻌﻀﻮي" و"اﻻﺗﻜﺎل اﻟﻨﻔﺴﻲ"، ﻧﻈ ًا‬ ‫ﺮ‬ ‫ﻀ‬ ‫ﻷﻧﻬﺎ رأت أﻧﻪ ﻣﻦ اﻟﻤﻤﻜﻦ ﻓﻬﻢ ﺗﺄﺛﻴﺮات اﻟﻌﻘﺎﻗﻴﺮ ﻋﻠﻰ اﻷﻓﺮاد ﺑﺎﺳﺘﺨﺪام ﻣﺼﻄﻠﺤﺎت ﺑﻴﻮﻟﻮﺟﻴﺔ. وﻓﻀﻼ ﻋﻦ ذﻟﻚ، ﻻﺣﻈﺖ اﻟﻠﺠﻨﺔ أن‬ ‫ً‬ ‫"اﻻﺗﻜﺎل اﻟﻌﻀﻮي" آﺎن ﻣﺮﺑ ًﺎ ﻟﺒﻌﺾ اﻷﻃﺒﺎء اﻹآﻠﻴﻨﻴﻜﻴﻴﻦ ﻧﻈ ًا ﻷﻧﻪ ﻗﺪ ﺗﻢ ﺗﻔﺴﻴﺮ ﻇﻬﻮر أﻋﺮاض اﻟﺴﺤﺐ )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل‬ ‫ﺮ‬ ‫ﻜ‬ ‫ﻋﻠﻰ ﺗﻌﺮﻳﻒ( ﻋﻠﻰ أﻧﻪ دﻟﻴﻞ ﻋﻠﻰ "اﻻﺗﻜﺎل اﻟﻌﻀﻮي" و"اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ" ﻓﻲ ﺁن واﺣﺪ.‬ ‫-9-‬
  • 15. ‫)و( اﻹﺻﺮار ﻋﻠﻰ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر ﺑﺮﻏﻢ اﻟﺪﻟﻴﻞ اﻟﻮاﺿﺢ ﻋﻠﻰ ﻋﻮاﻗﺒﻪ اﻟﻀﺎرة ﺑﺸﻜﻞ ﻣﻔﺮط، ﻣﺜﻞ‬ ‫اﻟﻀﺮر اﻟﺬي ﻳﻠﺤﻖ ﺑﺎﻟﻜﺒﺪ ﻋﻦ ﻃﺮﻳﻖ اﺣﺘﺴﺎء اﻟﻜﺤﻮﻟﻴﺎت ﺑﺸﻜﻞ ﻣﻔﺮط، واﻟﺤﺎﻻت اﻟﻤﺰاﺟﻴﺔ‬ ‫اﻟﻤُﻜﺘﺌﺒﺔ اﻟﺘﻲ ﺗﻌﻘﺐ ﻓﺘﺮات اﻟﺘﻌﺎﻃﻲ اﻟﻜﺜﻴﻒ ﻟﻠﻌﻘﺎر، أو ﻗﺼﻮر اﻟﻮﻇﺎﺋﻒ اﻹدراآﻴﺔ ﺑﺴﺒﺐ‬ ‫اﻟﻌﻘﺎر؛ ﻳﺠﺐ ﺑﺬل اﻟﺠﻬﻮد ﻟﺘﺤﺪﻳﺪ أن اﻟﻤﺘﻌﺎﻃﻲ آﺎن ﺑﺎﻟﻔﻌﻞ أو ﻳﻤﻜﻦ ﺗﻮﻗﻊ آﻮﻧﻪ ﻋﻠﻰ دراﻳﺔ‬ ‫ﺑﻄﺒﻴﻌﺔ اﻟﻀﺮر وﻣﺪاﻩ )ص 57 - 67(.‬ ‫ﻣﻦ اﻟﻮاﺿﺢ أن اﻟﻤﺼﺎب ﺑﻤﺮض اﻟﺴﺮﻃﺎن اﻟﺬي ﻳﺘﻄﻠﺐ ﺟﺮﻋﺎت ﻣﺘﺰاﻳﺪة ﻣﻦ ﻣﺎدة أﻓﻴﻮﻧﻴﺔ ﻣﺨ ﱢرة ﻟﺘﺨﻔﻴﻒ‬ ‫ﺪ‬ ‫اﻷﻟﻢ )راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟﻤﺼﻄﻠﺢ "اﻟﺘﺤﻤﻞ"( واﻟﺬي ﻳﻌﺎﻧﻲ أﻳ ًﺎ ﻣﻦ أﻋﺮاض ﺳﺤﺐ‬ ‫ﻀ‬ ‫)راﺟﻊ اﻟﻤﻠﺤﻖ 1 ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﺗﻌﺮﻳﻒ ﻟﻤﺼﻄﻠﺢ "أﻋﺮاض اﻟﺴﺤﺐ"( ﻋﻨﺪ وﻗﻒ ﺗﻌﺎﻃﻲ اﻟﻌﻘﺎر، ﻳﻄﺎﺑﻖ‬ ‫ﺷﺮﻃﻴﻦ ﻓﻘﻂ ﻣﻦ اﻟﺸﺮوط اﻟﻤﻄﻠﻮﺑﺔ ﻟﻠﺘﺸﺨﻴﺺ اﻹﻳﺠﺎﺑﻲ ﻷﻋﺮاض اﻻﺗﻜﺎل. وﻣﻦ ﺛﻢ ﻻ ﻳﻜﻮن اﻟﻤﺮﻳﺾ‬ ‫ﻣﺼﺎ ًﺎ ﺑﺎﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻤﺎدة اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة، إﻻ إذا ﻃﺎﺑﻖ ﺷﺮ ًﺎ واﺣ ًا ﻋﻠﻰ اﻷﻗﻞ ﻣﻦ اﻟﺸﺮوط اﻷرﺑﻌﺔ‬ ‫ﺪ‬ ‫ﻃ‬ ‫ﺪ‬ ‫ﺑ‬ ‫اﻟﻤﺘﺒﻘﻴﺔ اﻟﻮاردة أﻋﻼﻩ )أ أو ب أو هـ أو و(.‬ ‫ﺗﺸﻴﺮ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺴﺮﻃﺎن‬ ‫واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )5( إﻟﻰ أن "اﻻﺗﻜﺎل" ﻳﺤﺪث ﺑﺸﻜﻞ ﻧﺎدر ﻟﺪى ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن:‬ ‫‪“Studies have shown that, while withdrawal syndrome and tolerance do occur in‬‬ ‫.‪patients who take opioids over a long period, [drug] dependence is extremely rare‬‬ ‫‪Consequently, the risk of [drug] dependence should not be a factor in deciding‬‬ ‫”‪] whether to use opioids to treat the cancer patient with pain‬أوﺿﺤﺖ اﻟﺪراﺳﺎت أﻧﻪ‬ ‫ﺑﺮﻏﻢ ﺣﺪوث أﻋﺮاض اﻟﺴﺤﺐ واﻟﺘﺤﻤﻞ ﻟﺪى اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ ﻳﺘﻌﺎﻃﻮن اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨﺪرة‬ ‫ﻋﻠﻰ ﻣﺪار ﻓﺘﺮة زﻣﻨﻴﺔ ﻃﻮﻳﻠﺔ، ﻳﻜﻮن اﻻﺗﻜﺎل )ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ( ﻧﺎدر اﻟﺤﺪوث إﻟﻰ ﺣﺪ آﺒﻴﺮ. وﺑﺎﻟﺘﺎﻟﻲ‬ ‫ﻳﻨﺒﻐﻲ أﻻ ﻳﻜﻮن ﺧﻄﺮ اﻻﺗﻜﺎل )ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ( ﺑﻤﺜﺎﺑﺔ ﻋﺎﻣﻞ ﻓﻲ ﺗﺤﺪﻳﺪ ﻣﺎ إذا آﺎن ﻳﻨﺒﻐﻲ اﺳﺘﺨﺪم‬ ‫اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ ﻋﻼج ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن اﻟﺬﻳﻦ ﻳﻌﺎﻧﻮن ﻣﻦ اﻷﻟﻢ أم ﻻ[ )ص 85(.‬ ‫ﺪ‬ ‫ﺗﺪﻋﻢ هﺬﻩ اﻟﻤﻼﺣﻈﺔ ﺗﻘﺎرﻳﺮ ردود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ اﻟﺼﺎدرة ﻋﻦ اﻟﻤﺮآﺰ اﻟﻤﺘﻌﺎون ﻣﻊ ﻣﻨﻈﻤﺔ‬ ‫اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ ﻟﻠﻤﺮاﻗﺒﺔ اﻟﺪوﻟﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ ﻓﻲ أﺑﺴﺎﻻ ﺑﺎﻟﺴﻮﻳﺪ. ﻓﻲ إﻃﺎر ﺑﺮﻧﺎﻣﺞ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ‬ ‫ﻟﻠﻤﺮاﻗﺒﺔ اﻟﺪوﻟﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ، ُﻌ ّف "اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ" ﻋﻠﻰ أﻧﻪ أﺣﺪ ردود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ واﻟﺘﻲ‬ ‫ﻳﺮ‬ ‫ﺗﺘﻢ ﻣﺮاﻗﺒﺘﻬﺎ واﻹﺑﻼغ ﻋﻨﻬﺎ إﻟﻰ اﻟﻤﺮآﺰ اﻟﻤﺘﻌﺎون وذﻟﻚ ﻋﻦ ﻃﺮﻳﻖ ﻣﺮاآﺰ اﻟﻤﺮاﻗﺒﺔ اﻟﻮﻃﻨﻴﺔ. واﻋﺘﺒﺎ ًا ﻣﻦ‬ ‫ر‬ ‫ﻋﺎم 9991، ﺗﺸﺎرك 65 دوﻟﺔ ﻓﻲ هﺬا اﻟﺒﺮﻧﺎﻣﺞ اﻟﺪوﻟﻲ، وﺗﺤﺘﻮي ﻗﺎﻋﺪة اﻟﺒﻴﺎﻧﺎت ﻋﻠﻰ أآﺜﺮ ﻣﻦ ﻣﻠﻴﻮﻧﻲ‬ ‫ﺗﻘﺮﻳﺮ ﺣﺎﻟﺔ ﻟﺮدود اﻟﻔﻌﻞ اﻟﻌﻜﺴﻴﺔ ﻟﻠﻌﻘﺎﻗﻴﺮ. ﺗﺸﻴﺮ ﻗﺎﺋﻤﺔ اﻟﻌﻘﺎﻗﻴﺮ اﻟﺘﻲ ﺗﻢ إﺑﻼغ هﺬا اﻟﻨﻈﺎم ﺑﻮﻗﻮع ﺣﺎﻻت‬ ‫"اﺗﻜﺎل ﻋﻠﻴﻬﺎ" ﻋﻠﻰ اﻗﺘﺮان أﻋﺪاد ﻣﺘﻮاﺿﻌﺔ ﻓﻘﻂ ﻣﻦ ﺣﺎﻻت اﻻﺗﻜﺎل ﻋﻠﻰ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺎﺳﺘﺨﺪام اﻟﻤﺴﻜﻨﺎت‬ ‫اﻷﻓﻴﻮﻧﻴﺔ وأﻧﻪ ﻗﺪ ﺗﻢ اﻹﺑﻼغ ﻋﻦ ﺣﺎﻻت "اﺗﻜﺎل" ﻋﻠﻰ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻘﺎﻗﻴﺮ اﻷﺧﺮى، ﺳﻮاء آﺎﻧﺖ ﻋﻘﺎﻗﻴﺮ‬ ‫ﺗﺨﻀﻊ ﻟﻠﻤﺮاﻗﺒﺔ أم ﻻ )22(.‬ ‫اﻟﻘﺴﻢ 6‬ ‫اﻟﻀﺮورة اﻟﺤﺘﻤﻴﺔ ﻟﺘﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ‬ ‫ﻃﺎﻟﺒﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات وﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ اﻟﺤﻜﻮﻣﺎت ﺑﺘﻘﻴﻴﻢ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬ ‫واﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﺸﺮﻳﻌﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻬﺎ، وﺗﺤﺪﻳﺪ وإزاﻟﺔ اﻟﻌﻘﺒﺎت أﻣﺎم ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻟﻼﺣﺘﻴﺎﺟﺎت اﻟﻄﺒﻴﺔ )3، 4، 5، 9، 01، 11(. وإذ ﻳﺘﻤﺘﻊ ﺑﻨﻔﺲ اﻟﻘﺪر ﻣﻦ اﻷهﻤﻴﺔ ﺗﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ ﻋﻦ ﻗﺪرﺗﻬﺎ اﻟﻤﺤﺘﻤﻠﺔ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟ ُﺮاﻗﺒﺔ ﻓﻲ أﻏﺮاض ﻏﻴﺮ ﻣﺨﺼﺼﺔ ﻟﻬﺎ‬ ‫ﻤ‬ ‫واﻻﺗﺠﺎر ﻓﻴﻬﺎ وﺗﻌﺎﻃﻴﻬﺎ، ﺗﺘﻮاﻓﺮ ﻣﻌﻠﻮﻣﺎت وإرﺷﺎدات ﻟﻬﺬا اﻟﺘﻘﻴﻴﻢ )21(.‬ ‫وﻗﺪ ﻋﻠﻖ ﺗﻘﺮﻳﺮ ﺻﺎدر ﻋﺎم 5991 ﻋﻦ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )3( ﻋﻠﻰ ﻣﺪى اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ‬ ‫اﻟﻤﺨﺪرة ﻓﻲ أﻏﺮاض ﻏﻴﺮ ﻣﺨﺼﺼﺔ ﻟﻬﺎ ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ:‬ ‫- 01 -‬
  • 16. ‫.‪“The international system to prevent diversion of narcotic drugs is working well‬‬ ‫‪The number of incidents involving diversion of narcotic drugs is small considering‬‬ ‫”‪] the large number of transactions at the international and national level‬ﻳﺆدي‬ ‫اﻟﻨﻈﺎم اﻟﺪوﻟﻲ ﻟﻤﻨﻊ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ ﻟﻬﺎ دورﻩ ﺟﻴ ًا.‬ ‫ﺪ‬ ‫ﺪ‬ ‫آﻤﺎ أن ﻋﺪد اﻟﺤﻮادث اﻟﺘﻲ ﺗﺘﻀﻤﻦ اﺳﺘﻐﻼل اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﻓﻲ ﻏﻴﺮ اﻷﻏﺮاض اﻟﻤﺨﺼﺼﺔ‬ ‫ﺪ‬ ‫ﻟﻬﺎ ﻳﻌﺪ ﻋﺪ ًا ﻗﻠﻴﻼ ﻣﻊ اﻟﻮﺿﻊ ﻓﻲ اﻻﻋﺘﺒﺎر اﻟﻌﺪد اﻟﻜﺒﻴﺮ ﻟﻠﺼﻔﻘﺎت اﻟﺘﻲ ﺗﺘﻢ ﻋﻠﻰ اﻟﻤﺴﺘﻮﻳﻴﻦ‬ ‫ً‬ ‫د‬ ‫اﻟﺪوﻟﻲ واﻟﻤﺤﻠﻲ[ )ص 1(.‬ ‫وﺑﺎﻟﺘﺎﻟﻲ ﻳﺮآﺰ هﺬا اﻟﻤﺒﺪأ اﻟﺘﻮﺟﻴﻬﻲ ﺑﺸﻜﻞ ﺧﺎص ﻋﻠﻰ ﺗﻘﻴﻴﻢ اﻟﺴﻴﺎﺳﺎت اﻟﻮﻃﻨﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻌﻘﺎﻗﻴﺮ واﻟﺘﻲ ﺗﺆﺛﺮ‬ ‫ﻋﻠﻰ ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 9891، أوردت اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( ﻣﺎ ﻳﻠﻲ:‬ ‫‪“One of the objectives of the Single Convention on Narcotic Drugs, 1961, and of that‬‬ ‫‪Convention as amended by the 1972 Protocol amending the Single Convention on‬‬ ‫‪Narcotic Drugs, 1961, is to ensure the availability of opiates, such as codeine and‬‬ ‫‪morphine, that are indispensable for the relief of pain and suffering, while minimizing‬‬ ‫”‪] the possibility of their abuse or diversion‬أﺣﺪ أهﺪاف اﻻﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ‬ ‫1691 وﺗﻠﻚ اﻻﺗﻔﺎﻗﻴﺔ اﻟﻤﻌﺪﻟﺔ ﺑﺒﺮوﺗﻮآﻮل 2791 اﻟﻤﻌﺪل ﻟﻼﺗﻔﺎﻗﻴﺔ اﻟﻮﺣﻴﺪة ﻟﻠﻤﺨﺪرات ﻟﺴﻨﺔ‬ ‫1691 هﻮ ﺿﻤﺎن ﺗﻮاﻓﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻣﻦ ﻗﺒﻴﻞ اﻟﻜﻮداﻳﻴﻦ واﻟﻤﻮرﻓﻴﻦ واﻟﺘﻲ ﺗﻌﺪ‬ ‫ﺪ‬ ‫ﺿﺮورﻳﺔ ﻟﺘﺨﻔﻴﻒ اﻷﻟﻢ واﻟﻤﻌﺎﻧﺎة، ﻣﻊ ﺗﻘﻠﻴﻞ إﻣﻜﺎﻧﻴﺔ ﺗﻌﺎﻃﻴﻬﺎ أو ﺗﺤﻮﻳﻠﻬﺎ إﻟﻰ اﻟﺤﺪ اﻷدﻧﻰ[‬ ‫)ص 3(.‬ ‫ﻓﻲ 9891، راﺟﻌﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )9( أﺳﺒﺎب ﻋﺪم آﻔﺎﻳﺔ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺑﺎﻟﺘﻌﺎون ﻣﻊ ﻣﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ، وﻃﺎﻟﺒﺖ اﻟﺤﻜﻮﻣﺎت ﻓﻲ آﺎﻓﺔ أرﺟﺎء اﻟﻌﺎﻟﻢ ﺑـ :‬ ‫‪“...examine the extent to which their health-care systems and laws and regulations‬‬ ‫‪permit the use of opiates for medical purposes, identify possible impediments to‬‬ ‫‪such use and develop plans of action to facilitate the supply and availability of‬‬ ‫”‪...] opiates for all appropriate indications‬ﻓﺤﺺ اﻟﻤﺪى اﻟﺬي ﺗﺴﻤﺢ ﺑﻪ ﻧﻈﻢ اﻟﺮﻋﺎﻳﺔ‬ ‫اﻟﺼﺤﻴﺔ واﻟﻘﻮاﻧﻴﻦ واﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ اﻟﺨﺎﺻﺔ ﺑﻬﺎ ﻻﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة ﻓﻲ‬ ‫ﺪ‬ ‫اﻷﻏﺮاض اﻟﻄﺒﻴﺔ، واﻟﺘﻌﺮف ﻋﻠﻰ اﻟﻌﻘﺒﺎت اﻟﻤﺤﺘﻤﻠﺔ ﻻﺳﺘﺨﺪاﻣﻬﺎ ووﺿﻊ ﺧﻄﻂ ﻋﻤﻞ ﻟﺘﻴﺴﻴﺮ‬ ‫إﻣﺪاد اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة وﺗﻮﻓﻴﺮهﺎ ﻟﻜﺎﻓﺔ اﻟﺘﻄﺒﻴﻘﺎت اﻟﻤﻼﺋﻤﺔ[ )ص 71(.‬ ‫ﺪ‬ ‫ﻓﻲ ﻋﺎم 0991، أوﺻﺖ ﻟﺠﻨﺔ اﻟﺨﺒﺮاء اﻟﺘﺎﺑﻌﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﻴﺔ واﻟﻤﻌﻨﻴﺔ ﺑﺘﺨﻔﻴﻒ اﻷﻟﻢ اﻟﻨﺎﺟﻢ‬ ‫ﻋﻦ اﻟﺴﺮﻃﺎن واﻟﺮﻋﺎﻳﺔ اﻟﺪاﻋﻤﺔ اﻟﻨﺸﻄﺔ )4( ﺑﻮﺟﻮب ﻗﻴﺎم اﻟﺤﻜﻮﻣﺎت اﻟﻮﻃﻨﻴﺔ ﺑـ :‬ ‫,‪“...regular review [of legislation], with the aim of permitting importation‬‬ ‫‪manufacture, prescribing, stocking, dispensing and administration of opioids for‬‬ ‫‪medical reasons,...[and] review of the controls governing opioid use, with a view to‬‬ ‫‪simplification, so that drugs are available in the necessary quantities for legitimate‬‬ ‫”...‪...] use‬ﻣﺮاﺟﻌﺔ دورﻳﺔ )ﻟﻠﺘﺸﺮﻳﻊ(، ﺑﻬﺪف اﻟﺴﻤﺎح ﺑﺎﺳﺘﻴﺮاد اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫وﺗﺼﻨﻴﻌﻬﺎ ووﺻﻔﻬﺎ وﺗﺨﺰﻳﻨﻬﺎ وﺻﺮﻓﻬﺎ وإﻋﻄﺎﺋﻬﺎ ﻷﻏﺮاض ﻃﺒﻴﺔ،...)و( ﻣﺮاﺟﻌﺔ اﻟﻀﻮاﺑﻂ اﻟﺘﻲ‬ ‫ﺗﺤﻜﻢ اﺳﺘﺨﺪام اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ اﻟﻤﺨ ﱢرة، وﺗﺒﺴﻴﻄﻬﺎ، ﺑﺤﻴﺚ ﺗﺘﻮاﻓﺮ اﻟﻌﻘﺎﻗﻴﺮ ﺑﺎﻟﻜﻤﻴﺎت اﻟﻼزﻣﺔ‬ ‫ﺪ‬ ‫ﻟﻼﺳﺘﺨﺪام اﻟﻤﺸﺮوع... [ )ص 56-66(.‬ ‫- 11 -‬
  • 17. ‫ﻓﻲ ﻋﺎم 5991، ﻗﺎﻣﺖ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات )3( ﺑﺈﺟﺮاء دراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ ﻋﻠﻰ آﺎﻓﺔ‬ ‫اﻟﺤﻜﻮﻣﺎت 8ﻟﺘﺤﺪﻳﺪ ﻣﺎ إذا آﺎﻧﺖ ﻗﺪ اﺳﺘﺠﺎﺑﺖ ﻟﺘﻮﺻﻴﺔ اﻟﻬﻴﺌﺔ اﻟﺼﺎدرة ﻋﺎم 9891 أم ﻻ. وﻗﺪ ﺗﻢ ﺗﺤﻠﻴﻞ‬ ‫اﻻﺳﺘﺠﺎﺑﺎت ﻟﻠﺪراﺳﺔ اﻻﺳﺘﻘﺼﺎﺋﻴﺔ وﻧﺸﺮهﺎ، آﻤﺎ ﺗﻢ اﻟﺘﻮﺻﻞ إﻟﻰ ﻋﺪد ﻣﻦ اﻟﻨﺘﺎﺋﺞ واﻟﺘﻮﺻﻴﺎت، ﻣﻦ‬ ‫ﺑﻴﻨﻬﺎ:‬ ‫‪“Governments that have not done so should determine whether there are undue‬‬ ‫‪restrictions in national narcotics laws, regulations or administrative policies that‬‬ ‫,‪impede prescribing, dispensing or needed treatment of patients with narcotic drugs‬‬ ‫‪or their availability and distribution for such purposes, and should make the‬‬ ‫”‪] necessary adjustments‬ﻳﻨﺒﻐﻲ ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﻟﻢ ﺗﻘﻢ ﺑﺬﻟﻚ أن ﺗﺤﺪد ﻣﺎ إذا آﺎﻧﺖ ﺗﻔﺮض‬ ‫ﻗﻴﻮ ًا ﻻ ﻣﺒﺮر ﻟﻬﺎ ﻓﻲ اﻟﺴﻴﺎﺳﺎت اﻹدارﻳﺔ أو اﻟﻠﻮاﺋﺢ اﻟﺘﻨﻈﻴﻤﻴﺔ أو اﻟﻘﻮاﻧﻴﻦ اﻟﻮﻃﻨﻴﺔ اﻟﻤﻌﻨﻴﺔ‬ ‫د‬ ‫ﺑﺎﻟﻤﺨﺪرات واﻟﺘﻲ ﺗﻌﻮق وﺻﻒ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة أو ﺻﺮﻓﻬﺎ أو ﺗﻘﺪﻳﻢ اﻟﻌﻼج اﻟﻼزم ﻟﻠﻤﺮﺿﻰ‬ ‫ﺪ‬ ‫ﺑﺎﺳﺘﺨﺪاﻣﻬﺎ أو ﺗﻮﻓﻴﺮهﺎ أو ﺗﻮزﻳﻌﻬﺎ ﻟﻬﺬﻩ اﻷﻏﺮاض، آﻤﺎ ﻳﻨﺒﻐﻲ ﻋﻠﻰ اﻟﺤﻜﻮﻣﺎت إﺟﺮاء اﻟﺘﻌﺪﻳﻼت‬ ‫اﻟﻼزﻣﺔ[ )ص 51(.‬ ‫‪“The Board notes that most governments in the world did not respond to its‬‬ ‫‪questionnaire; thus, the Board did not have sufficient information concerning‬‬ ‫‪approximately one half of the world’s population. Among those governments that‬‬ ‫‪did not respond were most of the developing and least developed countries, as well‬‬ ‫‪as those governments that had frequently failed to submit annual estimates of‬‬ ‫‪narcotic drug requirements as required by the 1961 Convention. The Board is‬‬ ‫-‪cognizant that less developed countries have more difficulty meeting basic health‬‬ ‫‪care needs. Nevertheless, the Board encourages governments of such countries to‬‬ ‫‪make efforts to examine their medical needs for narcotic drugs as well as the‬‬ ‫”‪] impediments to their availability‬ﺗﻼﺣﻆ اﻟﻬﻴﺌﺔ أن أﻏﻠﺐ اﻟﺤﻜﻮﻣﺎت ﻓﻲ أرﺟﺎء اﻟﻌﺎﻟﻢ ﻟﻢ‬ ‫ﺗﺴﺘﺠﺐ ﻟﻼﺳﺘﺒﻴﺎن اﻟﺨﺎص ﺑﻬﺎ؛ وﻣﻦ ﺛﻢ ﻟﻢ ﺗﺘﻮاﻓﺮ ﻟﻠﻬﻴﺌﺔ ﻣﻌﻠﻮﻣﺎت آﺎﻓﻴﺔ ﺣﻮل ﻣﺎ ﻳﻘﺮب ﻣﻦ‬ ‫ﻧﺼﻒ ﺗﻌﺪاد ﺳﻜﺎن اﻟﻌﺎﻟﻢ. وآﺎن ﻣﻦ ﺑﻴﻦ ﺗﻠﻚ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﻟﻢ ﺗﺴﺘﺠﺐ أﻏﻠﺐ اﻟﺪول اﻟﻨﺎﻣﻴﺔ‬ ‫واﻷﻗﻞ ﺗﻘﺪ ًﺎ، ﻓﻀﻼ ﻋﻦ ﺗﻠﻚ اﻟﺤﻜﻮﻣﺎت اﻟﺘﻲ ﺗﺨﻠﻔﺖ ﻣﺮا ًا ﻋﻦ ﺗﻘﺪﻳﻢ ﺗﻘﺪﻳﺮاﺗﻬﺎ اﻟﺴﻨﻮﻳﺔ‬ ‫ر‬ ‫ً‬ ‫ﻣ‬ ‫ﻟﻤﺘﻄﻠﺒﺎت اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة ﺣﺴﺒﻤﺎ ﺗﻘﺘﻀﻲ ذﻟﻚ اﺗﻔﺎﻗﻴﺔ 1691. وﺗﺪرك اﻟﻬﻴﺌﺔ أن اﻟﺪول اﻷﻗﻞ‬ ‫ﺪ‬ ‫ﺗﻘﺪ ًﺎ ﺗﻮاﺟﻪ ﺻﻌﻮﺑﺎت أآﺒﺮ ﻓﻲ اﻟﻮﻓﺎء ﺑﺎﺣﺘﻴﺎﺟﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻷﺳﺎﺳﻴﺔ. وﻣﻊ ذﻟﻚ ﻓﺈﻧﻬﺎ‬ ‫ﻣ‬ ‫ﺗﺸ ﱢﻊ ﺣﻜﻮﻣﺎت هﺬﻩ اﻟﺪول ﻋﻠﻰ ﺑﺬل اﻟﺠﻬﻮد ﻟﻔﺤﺺ اﺣﺘﻴﺎﺟﺎﺗﻬﺎ اﻟﻄﺒﻴﺔ ﻣﻦ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﺠ‬ ‫ﻓﻀﻼ ﻋﻦ اﻟﻌﻘﺒﺎت اﻟﺘﻲ ﺗﻌﺘﺮض ﺗﻮﻓﻴﺮهﺎ[ )ص 41(.‬ ‫ً‬ ‫‪“The Board concludes that the recommendations contained in its 1989 special report‬‬ ‫‪are far from being implemented and that, while there have been efforts by some‬‬ ‫‪governments to ensure the availability of narcotic drugs for medical and scientific‬‬ ‫”‪] purposes, it appears that many others have yet to focus on that obligation‬ﺗﺴﺘﺨﻠﺺ‬ ‫اﻟﻬﻴﺌﺔ أن اﻟﺘﻮﺻﻴﺎت اﻟﻮاردة ﻓﻲ ﺗﻘﺮﻳﺮهﺎ اﻟﺨﺎص ﻟﻌﺎم 9891 هﻲ أﺑﻌﺪ ﻣﺎ ﺗﻜﻮن ﻋﻦ اﻟﺘﻄﺒﻴﻖ‬ ‫اﻟﻔﻌﻠﻲ وأﻧﻪ ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺑﺬل اﻟﺠﻬﻮد ﻣﻦ ﺑﻌﺾ اﻟﺤﻜﻮﻣﺎت ﻟﻀﻤﺎن ﺗﻮﻓﻴﺮ اﻟﻌﻘﺎﻗﻴﺮ اﻟﻤﺨ ﱢرة‬ ‫ﺪ‬ ‫ﻟﻸﻏﺮاض اﻟﻄﺒﻴﺔ واﻟﻌﻠﻤﻴﺔ، ﻳﺘﻀﺢ أن اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺤﻜﻮﻣﺎت اﻷﺧﺮى ﻣﺎزال ﻳﺘﻌﻴﻦ ﻋﻠﻴﻬﺎ اﻟﺘﺮآﻴﺰ‬ ‫ﻋﻠﻰ ذﻟﻚ اﻻﻟﺘﺰام[ )ص 41(.‬ ‫8اﺳﺘﺠﺎﺑﺖ 56 ﺣﻜﻮﻣﺔ ﻓﻲ وﻗﺖ إﻋﺪاد ﺗﻘﺮﻳﺮ اﻟﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات ﻟﻌﺎم 5991، واﻟﺬي ﺗﻢ ﻧﺸﺮﻩ ﻓﻲ ﻋﺎم 6991. وﻣﻨﺬ ذﻟﻚ‬ ‫اﻟﺤﻴﻦ، اﺳﺘﺠﺎﺑﺖ 75 دوﻟﺔ أﺧﺮى. وﻳﺸﻴﺮ ﺗﺤﻠﻴﻞ اﻟـ 221 دراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ ﺟﻤﻴﻌﻬﺎ إﻟﻰ أن اﻟﻤﺸﻜﻼت اﻟﺘﻲ ﺗﻮاﺟﻪ ﺗﻮﻓﻴﺮ اﻟﻤﻮاد اﻷﻓﻴﻮﻧﻴﺔ‬ ‫اﻟﻤﺨ ﱢرة آﺎﻧﺖ أآﺜﺮ ﺣﺪة ﻣﻤﺎ آﺎن ﻣﺘﺼﻮ ًا ﺣﺴﺐ اﻻﺳﺘﺠﺎﺑﺔ اﻟﻤﺒﺪﺋﻴﺔ )وﻗﺪ ﺗﻢ اﻟﻨﺸﺮ ﻓﻲ اﻟﺘﻘﺮﻳﺮ اﻟﺴﻨﻮي ﻟﻠﻬﻴﺌﺔ اﻟﺪوﻟﻴﺔ ﻟﻤﺮاﻗﺒﺔ اﻟﻤﺨﺪرات‬ ‫ر‬ ‫ﺪ‬ ‫ﻟﻌﺎم 9991(.‬ ‫- 21 -‬