‘Harm reduction’ takes centre stage as UN drug policy breaks free from the shackles of consensus

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‘Harm reduction’ takes centre stage as UN drug policy breaks free from the shackles of consensus

25 March 2024

The 67th session of the Commission on Narcotic Drugs (CND) culminated in a historical day of high drama in Vienna on Friday, 22nd March, as member states resorted to voting on resolutions for the first time in modern history, and finally included the words “harm reduction”. Previously, the CND’s dedication to the so-called “Vienna spirit” (whereby all resolutions and policy documents are agreed by consensus) had allowed certain member states to block progressive language or anything that they did not like.

With the high-level midterm review over, the regular CND session took place from 18th to 22nd March 2024. The Deputy Prime Ministers, Secretaries of State and other high profile guests had left the building, leaving the remaining government officials to a week of fraught negotiations and debates. There were just four resolutions on the table, yet progress was slow. Text that had been agreed last year, and even text agreed just weeks prior, was being challenged and changed, and the “Vienna spirit” was clearly diluted by the challenges facing multilateralism right now. It took until Thursday for two of the four resolutions to reach consensus - the Belgian submission on access to pain medicines, including for children, and the Chilean document on rehabilitation and recovery.

And so the final day, Friday, began with all eyes on the remaining two. Thailand, Peru and Germany’s submission on alternative development - the latest in a series of annual resolutions which largely repeat wording - was being held up by Iran’s attempts to include language on to reject unilateral sanctions and/or support technology transfer (a debate bubbling up across the UN with respect to how intellectual property hinders the right to development and undermines access to medicines). The USA’s timely submission on overdose prevention was even further behind - with Russia and China continuing to block any reference to “harm reduction” as they have done for years. In the past, the resolution authors would simply concede, remove contentious words or paragraphs, or even withdraw their entire proposals if consensus was not achieved. But, this year, several factors pushed the negotiations towards a vote. Firstly, the USA still holds huge sway in UN spaces. Secondly, many countries that support harm reduction were strongly motivated to work together and reject the inevitable attempts from others to weaken the text. Thirdly, Colombia (buoyed after successfully coordinating the strong statement of 62 countries they led for the high-level segment) threatened to call a vote if the resolution was sent to the plenary without a single reference to harm reduction.

IDPC’s Executive Director, Ann Fordham, had captured the mood a few days earlier in her Plenary statement:

“The CND must work to overcome senseless taboos that hinder urgently needed interventions, such as the long-running controversy with the words ‘harm reduction’... The outdated Vienna spirit is now undermining progress. Most UN forums do vote on resolutions when needed. Consensus-based decision making is holding back Vienna’s ability to address today’s serious drug policy challenges”.

At nearly 5pm, the Plenary session was resumed by the Ghanaian Chair with countless questions floating around the room: how would voting work? who would have to call the vote? would the resolutions be agreed? what would the reactions and implications be?

The alternative development resolution came first. Thailand asked if it could be adopted by consensus, Iran was the one who took the floor to formally call a vote and break the long-held consensus. Of the 53 countries that are members of the CND, 45 voted in favour, none against, three abstained, and five did not vote. The CND had passed a resolution by vote for the first time in more than half a century.

All eyes then turned to the overdose prevention resolution from the USA – signalling their 180-degree transformation on harm reduction at the UN, driven by the appalling human toll of a domestic overdose epidemic (quite a shift given that, for decades, the USA have been the most vociferous barrier to this term being accepted in Vienna). The USA opened by asking if the CND could adopt the text by consensus: after many hours of negotiations, nine references to harm reduction had been reduced to one, references to drug checking had been sacrificed, and several caveats and disclaimers had been inserted. In the end, however, it was Russia who was still unhappy, and called for the vote. The result was one of overwhelming support for the resolution:

  • In favour - 38 countries: Argentina, Australia, Austria, Belgium, Bolivia, Brazil, Canada, Chile, Colombia, France, Finland, Ghana, Guatemala, Hungary, India, Indonesia, Italy, Japan, Lithuania, Malta, Mexico, Morocco, Netherland, Peru, Poland, Portugal, Republic of Korea, Saudi Arabia, Singapore, Slovenia, South Africa, Spain, Switzerland, Thailand, Trinidad and Tobago, UK, USA, Uruguay
  • Against - 2 countries: China and Russia
  • Abstained - 6 countries: Algeria, Armenia, Bangladesh, Dominican Republic, Iran, Zimbabwe

Applause and cheers followed as the resolution was adopted, and the sponsoring delegations hugged and cheered along with the civil society colleagues at the back of the room. Harm reduction is now ‘agreed language’ at the CND, as it has been for years at the UN General Assembly (2001) and the Human Rights Council (2023). The USA spoke to thank other countries for their support and for acknowledging the importance of preventing overdose and saving lives, noting that “We regret that this minority of states has pushed the spirit of Vienna to the brink, but we believe the vote count for this measure demonstrates that a small number of states are utilising our consensus based decision-making process to hold the CND hostage, putting their domestic interests above the collective goals of this Commission”.

As if to prove this point, the Russian Ambassador then took the floor for a quite remarkable 10 minute rant in which he condemned the vote’s outcome as “unacceptable” - a “dire situation which can hardly be a cause of applause” - while explaining how Russia is a “responsible country” committed to the Vienna spirit and “a society free of drugs”, and how they were “compelled” to call for the vote this time around due to the “knowingly contentious language”. Clearly wounded, they accused the US of “lowering the bar” and “raising the white flag in the war on drugs”, and declared that they regarded the resolution as “null and void”.

So, after decades of relying on consensus at the expense of progress, the Commission finally broke free in 2024 – agreeing on the words “harm reduction” for the first time to finally align with other parts of the UN system by acknowledging this evidence-based, life-saving approach. Closing the session, the Ghanaian Ambassador told the room “You have made history… [but] not a history that I’m proud of” and called for “deep reflection on this matter by all of us”. Indeed, exactly what this all means for the future of international drug policy, and of the Commission itself, remains to be seen. Several countries expressed their willingness to maintain the ‘Vienna spirit’ and try to repair the broken consensus. However, the taboo of voting is over, opening the door for member states to vote again at moments of impasse in the future. In that sense, the 67th session was certainly a pivotal moment and a step in the right direction after so many years of stagnation.

On 8th April, IDPC will host a public event to debrief and unpack the highlights, headlines and implications of this milestone CND – click here for more information. The CND Blog provides a searchable record of statements and interventions, while a more detailed CND Proceedings Report will follow in the summer.

Read: UNAIDS welcomes the adoption of a crucial resolution recognizing harm reduction measures at the UN Commission on Narcotic Drugs