Scientific distinctions between coca and cocaine support policy reform

The coca bush, a sacred South American crop plant, is classified alongside cocaine and heroin as a Schedule I controlled substance under international law. This scheduling, and the myriad effects of prohibition, have fostered a general perception that coca and its purified alkaloid cocaine are one and the same. Yet this conflation obscures a striking contrast: Whereas cocaine’s 165-year history is marked by health risks and social disruption, the use of coca leaf has played a positive role in Andean and Amazonian societies for thousands of years. Studies across the biological and social sciences corroborate coca leaf as a benign, nonaddictive stimulant and a culturally vital plant, profoundly different from its purified derivative. The World Health Organization (WHO)’s Expert Committee on Drug Dependence (ECDD) is now reviewing the health effects of coca, offering a rare opportunity to correct this misclassification and align international drug policy with scientific evidence and social reality.

Under the 1961 United Nations (UN) Single Convention on Narcotic Drugs, coca crops and their wild relatives are legally treated as Schedule I narcotics and prohibited from use and cultivation. The convention defines “coca” as all members of the genus Erythroxylum, a group of around 285 plant species closely related to red mangroves that grow in tropical forests across the globe. This sweeping legal framework criminalizes more than 11 million primarily Indigenous and mixed-Indigenous (mestizo) South American peoples whose lifeways are intertwined with traditional coca farming and use while also restricting scientific research on one of the world’s most culturally important and pharmacologically intriguing plant groups. Coca policy has targeted specific peoples and cultural practices, a distinction that enables the engagement of international frameworks such as the UN Declaration on the Rights of Indigenous Peoples (UNDRIP), the International Labour Organization’s Indigenous and Tribal Peoples Convention, 1989 (ILO Convention 169), and the Nagoya Protocol to the Convention on Biological Diversity, which affirm Indigenous rights to territory, traditional knowledge, and biocultural heritage.

The ECDD’s forthcoming recommendation to the UN Commission on Narcotic Drugs considers five established criteria: chemistry, pharmacology, toxicology, therapeutic and/or traditional use, and epidemiology. Among these, the criterion of traditional use offers a particularly appropriate and underutilized lens for evaluating coca on its own scientific and cultural terms. We offer a synthesis of scientific evidence and practical considerations to support the descheduling of coca leaf and the implementation of more informed and equitable policy.