What the INCB June alerts tell us on human rights & tramadol

Four new Alerts were published by the INCB this week, dealing with:

• Respect for human rights as an integral part of a balanced approach to addressing the world drug problem
• The risk of long-term use of opioids
• Tramadol, review of the global situation
• Internet-facilitated trade in precursors

We will discuss two of these publication here.

Respect for human rights as an integral part of a balanced approach to addressing the world drug problem

The INCB claims, in this publication, that ‘One of the shared elements to all declarations, action plans and resolutions that underline the principle of a comprehensive, integrated and balanced approach to addressing the world drug problem is the commitment to ensuring compliance with human rights norms’. The Board then goes on to state that in recent years, critics of the drug control regime based their argument on ‘the premise that the drug control conventions stand in contradiction to human rights norms’.

Noting that the term ‘human rights’ must make specific reference to the nine core human rights conventions, the INCB goes on to say that these treaties deploy the same language and rationale as that used in the preamble to the drug control conventions. It therefore sees a convergence, rather than a divergence, between these two regimes.

This text emerges in the wake of Bangladesh’s newly operationalised ‘War on Drugs’, which follows in the footsteps of President Duterte in the Philippines. The INCB acknowledges these approaches and their radical departure from human rights norms; however, it also judges them as in contravention of the international drug control conventions.

‘The INCB reiterates that drug control action must be consistent with international human rights standards and norms’, stresses the Board. It also advises countries that retain the death penalty for drug related offences to consider abolition.

All of these points demonstrate the distance the INCB has travelled in its journey away from a hard line antidrug stance to one in which human rights are embraced. Nonetheless, there remains a certain disingenuousness in its view of the global situation The Single Convention on Narcotic Drugs, 1961 imposes strict measures against the substances used by indigenous peoples. There were and are specific restrictions on these plant-based substances: opium-smoking was to be abolished within 15 years, coca within 25 years and cannabis as soon as possible, but at any rate within 25 years.

The 1988 Convention against Trafficking demands that states criminalise coca for personal consumption (Article 2), while at the same time, states should ‘the measures adopted shall respect fundamental human rights and shall take due account of traditional licit uses, where there is historical evidence of such use’ (1988 Convention, Article 14(2).

By contrast, the Rights of indigenous peoples are well established in international human rights law:

The UN Declaration on the Rights of Indigenous Peoples, 2007; Convention No. 169 of the ILO; Article 27 of the International Covenant on Civil and Political Rights, and Article 15 of the International Covenant on Economic, Social and Cultural Rights.

There is a fundamental clash between these two sets of international legal instruments – and a structural lack of ‘convergence’.

Tramadol, review of the global situation

Tramadol, a synthetic opioid analgesic used in moderate to severe pain, has been the object of considerable international attention from both the drug control agencies and a number of countries. It is not under international control, though various countries have scheduled the substances and made it a prescription-only medicine within their jurisdictions.

The INCB has been the leading UN organ calling for tramadol to be internationally controlled, drawing attention to its use for nonmedical purposes in a number of countries, particularly in North Africa and the Middle East. It is illicit made in South Asia, particularly in India.

However, the drug is often the only appropriate painkiller available in poor, developing nations; in a parallel with ketamine, international controls on tramadol often place obstacles to its accessibility in these states, which can result in patients suffering unnecessary pain and discomfort. International control of this medicine – while in theory it would be legally available for medical purposes under the drug control conventions – would be likely in practice to clash with human rights norms. Specifically, it would diverge from The right to the enjoyment of the highest attainable standard of physical and mental healthas articulated by the 1946 Constitution of the World Health Organization, The 1948 Universal Declaration of Human Rights, the 1966 International Covenant on Economic, Social and Cultural Rights and various subsequent international instruments.

For those who wish to read the other two INCB Alerts published this month, they are here:

• The risk of long-term use of opioids
• Internet-facilitated trade in precursors