, the International Narcotics Control Board (INCB) once again draws attention to a longstanding failure of the UN drug control regime: the persistent lack of, and stark disparities in access to affordable morphine. In doing so, the Report underscores the importance of opioids for severe pain management in palliative care and harm reduction, and of psychotropics to treat mental health conditions, including in situations of conflict.

According to the INCB, opioid consumption remains higher in Western and Central Europe, North America and Oceania – while consumption continues to be inadequate in East and South-East Asia, Central America and the Caribbean, South Asia and Africa. North America continues to have the highest per capita consumption of opioids (United States 27,709 S-DDDpmpd) and Africa has the lowest (Namibia, 92 S-DDDpmpd).

The largest producers of the world’s morphine include France, Iran, India, Norway, the UK, Japan, and Australia. Most of the morphine manufactured in the world is utilised to produce codeine (211,202 kg) and other substances. As a result, only 33,547 kg are used directly for palliative care, mostly in high-income countries, with only a fraction (4,750 kg) being consumed for that purpose in low- and middle-income countries. This falls drastically short of the INCB’s estimate that at least 43,000 kg of morphine would be needed annually to reach minimally adequate consumption levels in all regions. This is the amount required to raise the availability to 200 S-DDDpmpd in all regions with low consumption

The INCB Report urges opioid-producing countries to increase the manufacture of morphine preparations for pain management and palliative care, and to make morphine more broadly available and more affordable, in particular in low- and medium-income countries.

The Report also highlights the chronic under-provision of opioid agonist therapy (OAT) for people dependent on opioids – pointing out that only 10% of people in need have access to OAT with methadone and buprenorphine, mostly in the Americas and Europe. The largest consumer country (24,6 tons) remains the United States, accounting for half of the global consumption. In a notable shift from previous years, 

the Board’s Report for 2024 explicitly encourages countries to develop and expand services, including the use of controlled medicines such as methadone and buprenorphine for OAT – a reflection of the INCB’s evolving stance on harm reduction.

Various psychotropic substances controlled under the 1971 Convention – such as alprazolam (the most consumed psychotropic in the world), diazepam, lorazepam, midazolam and phenobarbital, which are all included on the WHO Model List of Essential Medicines – are used for the treatment of ADHD, anxiety, narcolepsy, epilepsy and sleeping disorders. 

It is estimated by WHO that 301 million people were suffering from anxiety globally in 2019, a number that has increased by 25% since the pandemic. And yet, once again, access is highly unequal.

 In 2023, the consumption of alprazolam in the United States stood at 9.89 S-DDDpmpd, while it didn’t exceed 1 S-DDDpmpd in Africa and East and South-East Asia. In this context, 

the Board recommends better training of healthcare providers to ensure more rational prescribing, particularly in low- and middle-income countries.

With the increased instability and exacerbation of conflicts in various parts of the world over the past few years, it is unsurprising that the Board devotes a special section of its Annual Report to humanitarian emergencies caused by armed conflict. In doing so, the Board reaffirms that the safe passage of medical supplies is a critical aspect of the Geneva Conventions, and that the international drug control conventions allow for the expedited movement of controlled medicines during emergencies, even in the absence of import authorisations or estimates.

This Report reflects a notable shift by the INCB over the past decade towards a recognition of the importance of ensuring better access to controlled medicines for palliative care, pain relief and harm reduction.

 These changes have been gradually made thanks to the evolving composition of the Board and increased engagement with civil society, which have encouraged more progressive views about the complexity of the drug situation. Nonetheless, the recent US funding cuts on foreign aid and health cooperation are now adding an extra challenge for low- and middle-income countries to implement the INCB’s recommendations.

The persistent challenge in ensuring access to controlled medicines for an overwhelming majority of the world’s population also raises serious concerns over the ability of the current UN drug control regime to fulfil its core mandate

 – the protection of the ‘health and welfare of humankind’. As the UN system is undergoing a severe financial and liquidity crisis and the Secretary-General is embarking on an overall reform of the UN, the global drug control regime is also facing criticism. In March, a 

 tabled by Colombia and supported by a cross-regional coalition of Member States was adopted at CND to create a panel of 19 independent experts appointed by the CND, the UN Secretary-General, the INCB and the WHO, to rethink the implementation of the drug control conventions. 

The panel is an opportunity to propose concrete changes prioritising health and human rights and thus close the gap in access to and availability of controlled medicines for palliative care and harm reduction.

¹ The INCB considers consumption under 200 S-DDDpmpd to be inadequate. S-DDDpmpd: defined daily doses for statistical purposes per million inhabitants per day.

INCB recommends increased morphine production for palliative care

Last week, Ghada Waly, the Executive Director of the United Nations Office on Drugs and Crime (UNODC), resigned from her position 

. Her announcement came in a Friday afternoon email to all staff, and comes at a critical juncture both in terms of drug policy reform as well as geopolitics.

This is an opportunity for the UN Secretary-General to appoint a strong and courageous leader with a genuine commitment to transforming UNODC into a champion of the health- and human-rights based approach to drug policy 

enshrined in the UN System Common Position on drugs

— including through support for harm reduction and the decriminalisation of people who use drugs.

During Ms. Waly’s five-year tenure, she is credited with focusing on efforts to improve gender parity and geographical representation within the UNODC, and 

 increasing the global presence and budget of the agency. However, 

her leadership and visibility on drug policy was sparse. 

UNODC’s corporate strategy for the 2021 to 2025 period, developed under her leadership without any engagement with civil society and affected communities, 

 to align with the strategic priorities laid down in the UN System Common Position on Drugs. This further entrenched UNODC’s disconnect with other agencies, like the Office of the High Commissioner for Human Rights, UNAIDS, and the World Health Organisation.

She also failed to explicitly endorse harm reduction or decriminalisation, and 

 the wide-ranging egregious human rights abuses committed in the name of drug control

 (despite the repeated calls from civil society for her to do so) — such as the state-sanctioned execution of hundreds of people for drug offences, in violation of international standards.

In fact, at the time of her appointment, several voices raised concerns about Ms Waly’s role as Egypt’s Minister for Social Solidarity under President Al Sisi’s regime, as

 she was in charge of overseeing the third sector at a time of 

Her time in office also saw a shift in UNODC’s priorities, leaning heavily on the crime and corruption dimension of the agency’s mandate, at the expense of their drug-related work. In fact, UNODC’s drug-related portfolio is entirely dominated by supply reduction, drug law enforcement, border control and container interdiction. In spite of 

 to fundraise for a revived global prevention programme, the reality is that UNODC’s health and development-oriented drugs projects have become negligible.

The need for a transformative leader at UNODC has never been more urgent.

 Against the backdrop of an ever diversifying and growing drug market and 

the abject failure of prohibitionist policies to achieve any of their stated aims

, the winds of change have been blowing at the Commission on Narcotic Drugs (CND). In 2024, the 

 was adopted that explicitly mentioned ‘harm reduction’, while in 2025, the CND passed a resolution that 

mandates an independent panel of experts to undertake a review

 of the UN drug policy ‘machinery’. In April, two UN member states that have been particularly vocal at the CND in favour of repressive responses, Russia and Iran, 

 for the coming four years, and will therefore not be able to vote on resolutions in the next four CND sessions.

UNODC’s leadership transition also now coincides with the UN Secretary-General’s 

, which aims to reinvigorate and streamline the whole UN system and improve coherence across its work on peace, development and human rights.

 A bold new UNODC Executive Director would play a pivotal role in aligning drug policy with these reform goals—moving away from punitive approaches and toward policies rooted in dignity, equity and human rights.

In parallel, the international landscape is fraught with uncertainty. The volatility of the U.S. administration—a key player and funder of global drug control efforts—adds further urgency for strong, principled leadership at UNODC. 

The agency, like the rest of the UN family, is facing severe funding challenges as multiple donors delay or withdraw their support, and it will take a tenacious and brave leader to weather these storms as well as work towards greater coherence with the core UN values.

This is a moment of rare opportunity as UNODC will also be providing the administrative secretariat for the ‘multidisciplinary 

panel of independent experts’ to review UN drug control

Together with 183 civil society organisations, we have urged the UN Secretary-General to 

ensure that this review process is transformative and impactful

, to bring ‘long-overdue alignment of global drug policy with the UN pillars of peace and security, human rights, and development.’

 Getting the right person at the helm of UNODC will help to ensure the review is not a wasted opportunity. 

We therefore urge the UN Secretary-General to appoint a leader who will help to usher in a more just and effective global drug policy future.

'When the going gets tough’: Leadership change at UNODC amidst global turmoil, UN reforms and drug policy opportunities 

UN Committee on the Rights of Persons with Disabilities Releases Landmark Observations Urging Canada to Embrace Safe Supply and End Coercive Drug Treatment

This past April, the United Nations Committee on the Rights of Persons with Disabilities (Committee) called on Canada to support safe supply programs

explicitly called on a State Party to do so.

 of the Committee, shared on April 15, 2025, address Canada’s implementation of the 

Convention on the Rights of Persons with Disabilities

 (Convention) and highlight a range of concerns with Canada’s current drug laws and policies, particularly those which impact the liberty and security of persons with disabilities.

explicit endorsement of harm reduction and safe supply programs which respond to the intersecting identities of people who use drugs

 comes at a moment when key harm reduction programs, including supervised consumption services, needle and syringe programs, and safe supply programs in Canada are under attack from all levels of government. This recommendation by a UN human rights body — which explicitly situates harm reduction and safe supply programs within a broader 

continuum of voluntary, rights-based care

The report also expressed concern with calls for involuntary detention and treatment in Canada, and identified specific practices such as the continued use of drug treatment courts and the rise in involuntary hospitalization. These concerns were also raised by the HIV Legal Network in a 

 to the Committee, pointing to troubling developments in the provinces of British Columbia, Alberta, Nova Scotia, and New Brunswick that further authorize involuntary care and detention of people who use drugs.

The Committee noted that Canada’s legal and policy frameworks allowing for involuntary detention and treatment of people who use drugs raise serious concerns under 

 that protects the right to liberty and security of the person. As such, 

the Committee unequivocally called for the repeal of all such federal, provincial, and territorial mental health and substance-use treatment laws and policies

 — confirming again that such approaches are clear violations of international human rights law, as the 

The Committee further expressed concern about over-policing and its adverse impacts on Indigenous, Black, and racialized people, persons with disabilities in situations of homelessness, and persons with psychosocial disabilities. This has led to their frequent contact with the criminal legal system, incarceration, and the overrepresentation of persons with disabilities in prisons, which lack culturally appropriate, gender-sensitive health services, including mental health and drug treatment options.

To rectify rights violations, the Committee recommended 

 in rights-based, culturally appropriate, voluntary community-based mental health and substance-use supports and treatment options that include peer-led options, as well as the implementation of laws and policies enabling access among prisoners with disabilities to culturally appropriate and gender-sensitive mental health and drug treatment options. Crucially, the Committee stressed the need for 

 to ensure that these supports genuinely uphold the autonomy of the diverse peoples accessing them.

At the same time, the Committee called on Canada to take all measures to address the overrepresentation of persons with disabilities in the criminal legal system and prisons, including by addressing the social determinants of incarceration, such as poverty, ableism, racial injustice and gender inequality. Throughout the Observations, the Committee was clear that all proposed recommendations must be developed and implemented 

rejection of forced treatment approaches, calls for

investments in voluntary, rights-based alternatives, and

 programs underscore the urgent need for Canada to realign its drug policies with its obligations under the Convention. Grounded in the principles of 

active participation of persons with disabilities, the Committee

 has provided a vital roadmap for Canada to preserve and scale up essential components of a rights-respecting approach that 

 to the diverse identities of people who use drugs.

By centering their voices, Canada can do better and uphold the human rights of all.

Sandra Ka Hon Chu, Bhargavi Munshi, and Anne-Rachelle Boulanger

UN Committee on the Rights of Persons with Disabilities releases landmark observations urging Canada to embrace safe supply and end coercive drug treatment

Today, the UNODC released its flagship publication - the 

. Despite the agency’s best efforts to convey progress, the report is an indictment of the global drug control regime. Data point after data point reveal a systemic failure to contain drug markets and protect the health of people who use drugs.

In a welcome move, the thematic Booklets in this year’s publication explicitly acknowledge the harmful consequences of punitive policies, and their inability to disrupt drug markets and organised crime. However, this recognition is still limited by the UNODC's self-imposed commitment to preserve the current drug control regime, rather than to openly acknowledge the failure so starkly evidenced in its own report.

The divergence between the UNODC's political messaging and technical reporting is problematic, but not new. As the international community embarks on an independent 

 of the global drug control machinery, the UNODC must provide Member States with an unbiased presentation and narrative around the evidence. UN entities should be honest brokers of information, not spin doctors. Now that Ghada Waly has 

, the future Executive Director must have the courage to engage honestly with Member States on the failings of the current system.

The World Drug Report always opens with a preface by the Executive Director of UNODC. With Ghada Waly having announced her 

 a few weeks ago, the lack of excitement is palpable in this year’s text, which mainly lists the growing challenges in illegal drug market

Only one paragraph proposes solutions, and these are but UNODC's traditional priorities: 'Investing in the prevention of drug use at an early age', criminal justice responses that 'focus on disrupting the illegal market', and – more positively – treatment and services that are tailored and responsive to people's needs. Notably absent are harm reduction, human rights, or any reference to the new 

There is a real disconnect between the policy prescriptions contained in this paragraph and the contents of this year’s World Drug Report, which question the effectiveness of law enforcement, emphasise the evidence for harm reduction, and highlight the consequences of punitive policies. But let’s start with the basic facts.

Drug use is growing, as are drug-related harms.

The 2025 World Drug Report's main headline is that drug use continues to hit record highs. The UNODC estimates that 316 million people (6% of those aged 15-65) used drugs in 2023, up from 243 million in 2013. Growth is concentrated in cannabis and cocaine use. 14 million people injected drugs in 2023, and half of them are living with hepatitis C.

Drug-related deaths increased from over 350,000 in 2011 to over 450,000 in 2021 - unfortunately we lack updated data for later than 2021. An estimated 64 million people experience drug-related problems, a 13% increase over 10 years. Only 1 in 7 men and 1 in 18 women have access to drug treatment. Only 26 of 110 reporting countries provide access to naloxone, and 76 of 133 offer some coverage of opioid agonist treatment.

Law enforcement does not disrupt drug markets, but it can make them deadlier

A thematic Booklet in this year's World Drug Report examines the links between drug trafficking and organised crime. While the topic would appear politically convenient to UNODC - making the case for more investment in law enforcement and drug control - the Booklet contains an illuminating section that assesses  the effectiveness of drug responses.

In a nutshell, the Booklet finds that 'drug markets, as a whole, are highgly resilient to law enforcement intervention'. Indiscriminate actions against trafficking, which are 'a common type of drug law enforcement response', leave 'drug trafficking groups largely unaffected'. Additionally, 'drug seizures and arrests can change the market equilibrium, sometimes reducing purities and increasing prices, but never eliminating the market as a whole'.

In fact, the Booklet acknowledges that crackdowns can drive insecurity, as ‘ violence increases only when those at the very top are removed, suggesting that inner-and inter-group conflict emerges from power vacuums’. Additional research suggests that major drug seizures — especially involving synthetic opioids — have been 

associated with increased overdose deaths

These conclusions are backed by the data provided elsewhere in the Word Drug Report. For instance, seizures of stimulants such as MDMA have more than doubled in 7 years, from under 300 ton equivalents to over 600. Methamphetamine seizures have also doubled from under 200 ton equivalents in 2017 to over 400 in 2023. But the size of both drug markets has continued to grow, which shows that increasing seizures result mostly from the expansion of production. A message that Member States will need to hear loud and clear during the upcoming review of the global drug control regime.

A technical endorsement of harm reduction – with no political backing

A second thematic Booklet concerns the ‘Impact of drug use’ on people who use drugs, families, and communities. The Booklet may be seen as a reaction to the 

 on ‘Drug use and the right to health’, as some Member States felt that it was necessary to switch the focus from the right to health of people who use drugs, to the harmful consequences of drug use.

The Booklet opens with the recognition that ‘most of the harms caused by drug use, the impact of drug use and drug use disorders are preventable or can be mitigated by acting on different modifiers’. Thus, the focus of the chapter shifts from preventing drug use in itself, to preventing its harms. In fact, a significant part of the Booklet is dedicated to explaining that drug use does not automatically result in harms, but that those are mediated and shaped by social and political determinants, including class, race, and gender.

The booklet also contains a summary of the very well-established evidence on the effectiveness of traditional harm reduction interventions for drug use. Newer approaches such as drug consumption rooms and sites, drug checking services, and heroin-assisted treatment are also mentioned. In general, the chapter is a complex and nuanced document that reacts positively to many of the 

 raised by IDPC with regards to last year’s chapter on the ‘Drug Use and the right to health’.

Whilst this is very welcome, the failure once again to explicitly acknowledge ‘harm reduction’ as a holistic, lifesaving approach - rather than a set of technical interventions in response to injecting drug use - continues to hamper the Report and, by extension UNODC itself. It  also puts it  at odds with the rest of the 

, which wholeheartedly endorses harm reduction, and with the entities and experts that have recognised the harms of drug policies themselves (see, for example, the 

 by the UN Special Rapporteur on the right to health).

In a critical development, the Booklet on 'impacts of drug use' recognises that punitive laws and practices exacerbate the harms of drug use. Particularly notable is a direct critique of criminalisation - a very welcome improvement compared to last year’s reports.

Thus, the Booklet notes that 'the criminalization of drug use and resulting incarceration of people who use drugs or have drug use disorders have high costs, both direct and indirect, for individuals, their families and the community.' Additionally, 'Policies that target people in relation to their drug use add to the stigma and discrimination against such people and can also exacerbate the negative impact of drug use on health.' Let us hope that the next UNODC Executive Director to take this recognition from the depths of the report and finally joins other UN entities in calling for the decriminalisation of people who use drugs.

This recognition is important because the punitive thrust of the drug control regime continues unabated. According to new data provided by this year’s World Drug Report, in 2023 6.1 million people were in contact with the criminal legal system for drug-related activities - 4 million for mere possession for personal use. Up to 1.6 million were prosecuted and 850,000 convicted solely for drug possession or use offenses. There can be no doubt that people who use drugs continue to be the main target of the drug control machinery.

Political narratives still permeate the report.

Despite these welcome developments, serious concerns remain regarding the Booklet on 'impacts of drug use'. The chapter's opening framing positions 'drug use' as a driver of societal harms, potentially pitting people who use drugs against their families and communities. While the report acknowledges that social and political determinants mediate harms, this recognition is not consistently applied. For example, at one point the Booklet bizarrely includes the millions spent on criminal justice responses amongst the ‘costs of substance use disorders’.


We are also concerned by claims that 'the children of parents who use drugs or suffer from drug use disorders are also more likely to lack a safe nurturing environment’. Whilst parental drug use may have in some cases impact on the welfare of children, such a generic statement can be deeply stigmatising and harmful in a policy context where many parents - particularly mothers - fear being deprived of parental rights because of mere drug use. It would have been helpful to add a note explaining that, according to existing 

, the sole act of using drugs is not harmful to children and should entail no limitation on rights.

Political bias appears elsewhere in the report. For instance, UNODC fails to acknowledge the possibility that the actual aim of legal regulation may be to curb the power of organised crime - as UN High Commissioner for Human Rights Volker Turk 

. This leaves Member States without evidence on a policy option that could bring success where law enforcement has resoundingly failed.

Human rights are completely absent from the World Drug Report, despite the catastrophic human costs of drug policy, 

 by the UN’s own human rights system. Notably, the 2024 World Drug Report had proposed a framework on the right to health and drug use. Whilst that analysis was 

, it was the first time that the UNODC’s flagship publication touched explicitly on human rights and we hoped it would be continued. It is disappointing to see almost no reference to the right to health in this year’s entire report.

This points to the well documented lack of willingness of UNODC to engage with human rights, which is highlighted in the 

 released today by 70 civil society organisations calling for UNODC and CND to explicitly and unequivocally condemn the use of the death penalty for drug-related offences.

At a time of global rethinking, we need an honest and unbiased UNODC

In sum, the World Drug Report 2025 provides a good example of UNODC’s contorted position. On the one hand, much of the report details the obvious failings of the global drug control regime, as well as the harms it continues to exacerbate. On the other hand, at a political level the UNODC remains committed to defend the 

In March 2025, the CND decided to initiate a historical exercise to rethink the global drug control machinery. This process requires accurate, unbiased information. The Colombian delegation noted as much during the debates, 

We don’t want politically correct reports but accurate ones, that tackle developments and problems that we face, so states know then what to do’

Blog

INCB recommends increased morphine production for palliative care

'When the going gets tough’: Leadership change at UNODC amidst global turmoil, UN reforms and drug policy opportunities

UN Committee on the Rights of Persons with Disabilities releases landmark observations urging Canada to embrace safe supply and end coercive drug treatment

Evidence that cannot be contained: The World Drug Report 2025 reveals the ongoing failure of the drug control regime