PARADOX OF CONTROL: A STRUCTURAL ANALYSIS OF INTERNATIONAL DRUG CONTROL POLICIES AND THEIR IMPACT ON CLINICAL ACCESS TO TRAMADOL

Abstract

This academic article aims to analyze the structural paradox of international drug control policies and their impact on clinical access to tramadol. The study employs documentary research and legal analysis based on international conventions, domestic laws, reports from international organizations, and relevant academic literature. The findings reveal that although the World Health Organization classifies tramadol as an essential medicine for the treatment of moderate to severe pain, restrictive regulations emphasizing quantitative control and prevention of misuse have significantly limited patient access, particularly in Thailand. Such measures, including dispensing limitations and excessive administrative requirements, have encouraged defensive practices among pharmacists and negatively affected the quality of pharmaceutical care. Furthermore, the study indicates that several countries, including Germany and the United Kingdom, have adopted risk-based regulation combined with real-time digital prescription monitoring systems, enabling a more effective balance between public safety and access to treatment. This article proposes a policy shift from criminalization toward medicalization through the application of smart regulation, professional autonomy, and harm reduction approaches in order to protect the right to access essential medicines while ensuring sustainable public health protection.