For the first time since its conception, this year the World Drug Report consists of two products, a web-based element and a set of booklets. The latest global, regional and subregional estimates of and trends in drug demand and supply are presented in a user-friendly, interactive 

 include key takeaways and policy implications, 

 takes the form of an executive summary based on analysis of the key findings of the online segment and the thematic

 and the conclusions that can be drawn from them. In addition to providing an in-depth analysis of key developments and emerging trends in selected drug markets, including in countries currently experiencing conflict, booklet 2 focuses on a number of other contemporary issues related to drugs.

World Drug Report 2023

Mexico’s president has been the first North American leader 

 the outright ban of the medical use of fentanyl, as relationships between his country and its northern neighbour sour through the handling of the overdose crisis.

The traffic of fentanyl from Mexico across to the US has strained relationships between both countries: Mexican President Andrés Manuel López Obrador has 

 in the past that his government is doing more to control the drug than their northern neighbours, and that the American overdose crisis is more related to the decay of family and moral values than about the drugs.

Fentanyl in North America is the iron law of prohibition in action

While concerns with drug deaths involving fentanyl are important to highlight, banning their use from medical contexts will do nothing to stem deaths. This is primarily because fentanyl is 

 the heroin (and increasingly other substances’) supply. As a 

, small quantities of it can be mixed into -or entirely replace – many drugs to potentiate their effects. However, this can have deadly effects as consumers are not aware that this is going on unless they 

. Since its introduction into the North American heroin and benzodiazepine drug supply (which happened as early as

, fentanyl has come to dominate drug markets.

Fentanyl’s infiltration of the North American market is an example of the iron law of prohibition 

 of opioid medication like OxyContin to North American patients, as well as lax regulation on prescribing, created a massive demand for this class of drugs. After the American Centre for Disease Control and Prevention 

 of opioids in 2016, cracking down on pill mills and excessive prescribing, the disappearance of a safe supply of this drug alongside massive demand created the perfect conditions for a potent, easily imported and manufactured substitute to appear.

Mexico's threat to ban medical fentanyl is painfully misguided

The Seventy-sixth World Health Assembly is being held in Geneva, Switzerland, on 21–30 May 2023.

. Simultaneous interpretation is available in Arabic, Chinese, English, French, Russian and Spanish.

Inter-ministerial dialogue: 'Essential medicines under international control: ensuring equitable and affordable access to and safe use for all'

Tuesday, 23 May | 13:00 - 14:00 | Hotel President Wilson, 47 Quai Wilson, Geneva 

To join in person or online, please RSVP 

by 22 May to Tamara Garcia (tamara.garcia[@]globalcommissionondrugs.org) specifying whether you will be attending in-person or online.

Co-organised by the Global Commission on Drug Policy (GCDP) and the World Health Organization (WHO)

The goal of this Ministerial Dialogue is to provide a space where member States (in this case, Ministries of Health) can present and discuss progress and shortfalls in their national policies, while providing examples and noting promising practices in the field of access to and safe use of essential medicines under international control. The dialogue will also provide a means to check in on global progress and problems, while at the same time aiming to identify and discuss concrete collaborative solutions.

Responding to the global crisis of overdose

Friday, 26 May | 11:00 - 13:00 (CEST) | Hybrid event | UNAIDS Secretariat 20, Avenue Appia CH-1211 Geneva 27 Switzerland in the Kofi Annan Room

Responding to the Global Crisis of Overdose

 Please RSVP to giavana.margo[@]opensocietyfoundations.org to receive a Zoom link

Co-organised by the Open Society Foundations and UNAIDS

Opioid overdose, already a major cause of mortality in many countries, is increasing alarmingly across the world. A key factor in death rates everywhere is the presence of fentanyl and other strong synthetic opioids in the illicit drug supply, coupled with increasing availability and decreasing costs for all drugs. Globally, overdose mortality data is often incomplete and does not tell the whole story. However, many signs suggest this crisis will expand across the world in the coming years.

Overdose mortality has long term global, economic, social, cultural, and political implications – like AIDS – and similar global health leadership is needed in framing the response. Most opiate overdose deaths are easily avoidable with the right intervention, and there much evidence to support known interventions. We need the political will to bring these solutions to scale.

This event brings together an expert panel to review global trends on overdose and to discuss what progress has been made in the past decade on overdose intervention and response. It will provide a forum to discuss progress and challenges within national policies, while learning from innovative interventions from multiple countries.

76th World Health Assembly

Accra, Ghana, was recently host to a visionary conference on the future of cannabis in the country. The event, organised by 

the International Drug Policy Consortium,

, brought together over 50 participants from the drug policy reform and economic justice sectors, policymakers and cannabis farmers across Ghana.

The two-day conference on 25 - 26 April titled “

An Equitable Roadmap for the Legal Regulation of Cannabis in Ghana that Protects Livelihoods and Supports Sustainable Development

” sought to explore drug policy reform beyond the Narcotics Act 1019 (2020) and look towards establishing a shared, equitable vision for the legal regulation of medical and adult-use cannabis.

Three key areas were addressed: the historical and current harms caused by prohibition; the significant risks of international corporate capture of future legal trade; and, the opportunities of legal regulation to prioritise social and economic justice and achieve a sustainable transition for those working in the trade.

Through participatory and cross-sector workshops, participants were invited to envision models of legal regulation for industrial hemp, medical and adult-use cannabis using 

Health Poverty Action’s Social Justice Lens

. The models of regulation developed sought to address the harms of prohibition and strengthen a wide range of social justice areas, such as governance, public health, environmental protection and human rights.

The models of regulation developed sought to address the harms of prohibition and strengthen a wide range of social justice areas, such as governance, public health, environmental protection and human rights.

This process culminated in a draft vision presented to policymakers on day two. The vision highlighted some clear shared goals, notably in relation to gender equality, avoiding corporate capture and progressive taxation. Participants strongly highlighted the gender dimension, with farmers proposing that the market regulations adopt a gender-sensitive approach to address the issues of disproportionate harm and exclusion experienced by women under prohibition, as well as the lack of comprehensive childcare for agricultural workers. Many suggested that the revenues raised from taxes from the new cannabis market should support the provision of childcare, removing barriers in women's access to stable livelihoods in farming.

They also called for the legal market to be equitably taxed, and for measures to be implemented to impede the diversion of fiscal revenue into tax havens. In the same vein, participants called for the reinvestment of taxation into serving national and community needs, particularly public health and harm reduction programmes.

Participants learnt about a range of legal regulatory models being used around the world, all with particular priorities and unique results. Dasheeda Dawson

Founding Director of Cannabis NYC, delivered a special report on day two, inspiring stakeholders with the community-led campaign for social and restorative justice at the heart of New York's cannabis reforms.

The meeting was the first of its kind in West Africa to bring together the expertise and knowledge of Ghanaian trade unionists and economic justice experts with the drug policy community. Participants learnt about other trades in Ghana, such as cashew, biofuel and cocoa, that have all been captured by oppressive and harmful tactics of exploitation from international foreign corporations. A key question voiced loud and clear was whether Ghana would continue its colonial mandate and legacy of producing raw materials for the metropole or could cannabis rewrite the textbook?

A key question voiced loud and clear was whether Ghana would continue its colonial mandate and legacy of producing raw materials for the metropole or could cannabis rewrite the textbook?

To ensure that economic justice is at the heart of any new legal framework for cannabis, measures must be put in place to prevent commercialisation and corporate monopolisation. Our economic justice colleagues urged farmers and civil society to organise themselves into associations and trade unions. Whether these unions should be specific to cannabis or join existing agricultural unions was a critical question to be given further attention. There was strong support for stakeholders to be better equipped with knowledge on how corporations behave and a commitment to continue working on a shared vision of future markets through more intersectoral meetings. After a comprehensive presentation on 

 from Steve Rolles, Senior Policy Analyst from 

 participants explored what cannabis corporation ‘takeovers’ might look like and what to anticipate and avoid.

Working on a shared vision helped farmers and civil society to identify risks that regulation might bring about. These were mainly the possibility of new markets facilitating land grabbing and eroding food security for the poorest communities. With an incoming climate crisis farmers agreed that Ghana must not find itself in a situation of planting more cannabis than food, and that sustainable farming methods and environmental safeguards must be prioritised in regulation.

Farmers felt that to ensure local farmers' participation, there is a need for transparency and accountability from the start by considering the inclusion of local content and standardisation in the certification process as it develops, not after. Most farmers believed it is critical to prevent the emergence of foreign or domestic corporate monopolies and use licensing to ensure the market prioritises small and medium-sized businesses.

Feedback from policymakers indicated that the workshop was timely and valuable, Many noted it was a relief to discuss the impacts of cannabis regulation from so many viewpoints and intersections in a non-judgemental space. This allowed everyone to approach the subject through common sense and logical perspective rather than from their specific area of expertise.

Almost all participants concluded that drug policy reform in Ghana must be addressed through multi-sector meetings like these, which allow for a diverse conversation. There was a strong consensus that prohibition was harming communities and an emphasis on seeking ways to avoid repeating the mistakes of other trades that have prioritised big business over people.

There was a strong consensus that prohibition was harming communities and an emphasis on seeking ways to avoid repeating the mistakes of other trades that have prioritised big business over people.

 in Ghana and paved the way for a multi-stakeholder journey towards legal regulation that protects livelihoods and supports sustainable development.

The meeting was made possible with financial support from Health Poverty Action.

Envisioning equitable cannabis reform in Ghana 

Cannabis has a long history of medical use that spans back thousands of years. The first recorded medical use for the plant dates back to 2737 BC, in the world’s oldest pharmacopeia where cannabis was indicated for over a hundred ailments including gout and malaria.

Across time and space, various cultures, including the local one, have grown the plant and utilized it spiritually, culturally, industrially as well as medicinally. Scholars have studied and recorded its medical properties and benefits through the ages until the 20th century when the international drug control regime strictly restricted its use, scheduling it under both Schedule I of the 1961 and 1971 conventions and Schedule IV of the 1961 convention. Schedule IV of the 1961 Convention contains “the most dangerous substances which are particularly harmful and of extremely limited medical or therapeutic value”. Schedule I of the 1971 convention contains, for its part, the substances “presenting a high risk of abuse, posing a particularly, serious threat to public health which are of very little or no therapeutic value.”

As such, the drug conventions effectively halted any research into cannabis, until a recently renewed interest emerged worldwide with a number of research institutions focusing on the properties of the plant, and experimenting with different legal frameworks for the control, regulation or legalization of controlled substances. 

In 2018, the World Health organization’s Expert Committee on Drug Dependence (ECDD) recommended rescheduling cannabis to recognize its medicinal properties and medical uses, allowing for a more flexible approach towards the use and research of cannabis. In December 2020, the Committee on Narcotic Drugs (CND) partially took into consideration the ECDD’s recommendation and removed cannabis from Schedule IV of the 1961 Convention while keeping THC under Schedule I of the 1961 Convention.

In the meantime, after years of regional instability and faced with the growing threat of economic and financial collapse, Lebanon was looking at avenues for possible economic growth and financial gains. Enter the 2018 Mc Kinsey report, proposing around 150 economic options for Lebanon’s economy, including the export of cannabis which promised returns of $1 Billion. 

In April 2020, the Lebanese parliament passed a law legalizing “the Cultivation of Cannabis for medicinal and industrial purposes.” Law 178/2021 establishes two bodies in charge of granting licenses to persons or entities for the cultivation of cannabis and defines the requirements to apply for a permit, cultivate cannabis and sell it or manufacture products from the plant. 

In the section detailing the rationale for the law, Lebanese legislators highlight the “scientific findings and the many studies pertaining to the medicinal benefits of cannabis”, all the while denying the rights of local population and residents to access medicinal cannabis. 

Since the days of the French mandate in Lebanon, the state has adopted a repressive approach to drugs and has considered cannabis an illicit substance despite the long history of cultivation of the plant in the country. In 1998, Lebanon passed law 673/1998 which criminalizes the use of illicit drugs and schedules cannabis as a “very dangerous substance with no medical use3”. 

Despite legalizing the cultivation of cannabis for medical purposes and recognizing the plant’s medicinal properties, the 2020 law fails to expressly provide the right to consume medicinal cannabis, fails in amending the Lebanese Law on Drugs which criminalizes substance use and personal possession, and fails to reschedule cannabis as a substance with medicinal properties. 

By failing to consider avenues through which the local population could benefit from the scientific and medical advances linked to cannabis, it emerges that the Lebanese legislator has solely focused on the economic prospects all the while avoiding reconsidering its drug policies. It has done so, as evidenced by the raison d’etre of the law, to “protect public health” and shield it from the “health risks linked to the use of cannabis.” Whereas the medical use of other substances that are considered “dangerous and harmful” is still allowed under certain conditions.

Should the state focus only on the legality of a substance, upholding its moralistic view of cannabis while disregarding the medical evidence that would benefit the individual’s health?

In light of these contradictions, Skoun interviewed health care professionals in Lebanon as well as patients and academics to establish the need to amend drug laws in Lebanon in order to ensure access to medicinal cannabis to people residing in Lebanon. 

This policy paper will look at the history of cannabis in Lebanon and the attempts to control its cultivation, the specificities of Lebanese cannabis, the right to access medicinal cannabis through the right to health lens, the right to access medicinal cannabis in light of the SDGs, and finally explore legal avenues to ensure access to medical cannabis. 

Before tackling access to medical cannabis, this paper will briefly go over the law regulating cultivation of medicinal cannabis and some of its most prominent failures that go beyond the absence of recognition of the right of people to access medical cannabis for medical purposes.

The legalization of the cultivation of cannabis in Lebanon - Moralistic views vs the right to health

The sale of nitrous oxide, or laughing gas, to the public will be banned and the police will be given enhanced drug-testing powers as part of Rishi Sunak’s attempt to crack down on antisocial behaviour “with urgency”.

The levelling up secretary, Michael Gove, 

 the proposals would stop parks being turned into drug-taking arenas, and would help ministers stamp out antisocial behaviour.

The ban comes a month after the independent Advisory Council on the Misuse of Drugs (ACMD) 

 and said it would be disproportionate with the level of harm associated with nitrous oxide. It said such control could create “significant burdens” for legitimate uses of the substance.

Experts have criticised the “same old tired drug policy” from the Conservatives, insisting the ban will not stop young people from using it.

Rishi Sunak to ignore independent advice and ban laughing gas in UK

The INCB Annual Report, prepared in accordance with the three international drug control treaties, examines the global drug control situation and makes recommendations to Governments and regional and international organizations.

The thematic chapter of the INCB Annual Report for 2022 is on the trend to legalize the non-medical use of cannabis. 

INCB highlights that this contravenes the drug control conventions, which limit drug use to medical and scientific purposes. The Report reviews the functioning of the international drug control system, and notes, inter alia, the Board's concern about the surge in illicit cocaine production and trafficking.

The report is accompanied by a special supplement on the availability of internationally controlled medicines, as well as the 2022 precursors report.

INCB Annual Report 2022

90% of the morphine for pain relief is consumed by 10% of the world’s richest countries. Asia’s morphine per capita consumption is 36 times less than the global average. The roots of the 

 can be historically traced through the commodification of substances that were traditionally used as medicine.

Current policies – largely determined and imposed by the Global North, and influenced by the US narrative – are centred around licencing, prescription and control, disproportionately impacting the very countries that grow and manufacture the raw material. Western corporate capture continues to dictate and shape access, manifested in essential medicines lists and reimbursable insurance packages. 

The UN Drug Conventions place on all member states the dual obligation of two core imperatives – to prevent the non-medical use of controlled substances, and equally, to ensure adequate availability of controlled substances for medical and scientific purposes. Historical misalignment between these two core imperatives has produced two opioid crises – one of access and “the global pandemic of untreated pain,” and the other a more regionally defined epidemic of opioid use disorder and fatal overdose.

Excessive prescription opioids in some countries shouldn’t blind policy makers to the pain crisis in other countries. The singular focus on inappropriate use is not adequately evened out by the available evidence of successful achievement of balance, which should be models.

Let us focus on not only improved access, but 

 access to opioids. On well-calibrated, compassionate and 

 regulatory systems, and fit-for-purpose supply chains for controlled medicines, while simultaneously providing the guardrails of training and evidence-based information about the safe use of opioids for pain relief.

Bringing severe pain to an end

The Japanese government is set to allow the medical use of cannabis to treat patients with incurable conditions, while cracking down on recreational consumers.

The Japanese government plans to submit several bills, including one which would see the revision of the Cannabis Control Act, during the current session of the Diet, Japan’s national legislature, according to 

Possession, sale and cultivation of cannabis for recreational and medical purposes is currently 

, along with the manufacturing of medicines derived from the plant. The proposed revision would enable patients with conditions such as refractory epilepsy to use drugs made from cannabis plants.

The first moves towards legalising medical cannabis in Japan have only concerned the authorisation of 

 a pharmaceutical CBD oil prescribed for certain types of rare refractory epilepsy, which has been approved for use by the US FDA and European health authorities.

However, the proposed revision would further criminalise recreational cannabis consumers.

Japan to legalise medical cannabis

Australia has become the first country to recognise psychedelics as medicines, after the Therapeutic Goods Administration took researchers by surprise and approved the psychedelic substances in magic mushrooms and MDMA for use by people with certain mental health conditions.

MDMA and psilocybin, the active ingredient in magic mushrooms, will be considered schedule 8 drugs - meaning they’re approved for controlled use when prescribed by a psychiatrist - from July this year after the TGA acknowledged there were few other options for patients with specific treatment-resistant mental illnesses.

The changes will allow MDMA to be used to treat post-traumatic stress disorder, and psilocybin for treatment-resistant depression. They will still be considered prohibited substances - or schedule 9 drugs - for all other usages.

Australia becomes first country to recognise psychedelics as medicines

VIENTIANE, Jan 31 (Loatian Times): The Ministry of Health has issued an agreement stating their approval to produce and distribute hemp or cannabis sativa L and the restrictions businesses must follow for medical purposes in Laos.

The agreement states that the seeds produced from cannabis sativa L must be registered, authorize their sources of origin, and control amount of tetrahydrocannabinol (THC) of 1% per weight, under the approval from the ministry.

The ministry permits certified businesses to use cannabidiol (CBD) for main medical purposes, while tetrahydrocannabinol (THC) must not exceed 1 percent by weight, or 0.2 percent for both raw and processed products.

Laos approves regulated production of cannabis for medical use

If you have been following TalkingDrugs’ cover of Brazilian drug policy in these last twenty-four months, you must be well acquainted with the current government’s efforts to 

 reform and, more specifically, with its disinformation 

. From publishing primers that claim medical cannabis does not exist, to blocking the medical cannabis bill from following to the senate for final approval, the soon-to-be former president Jair Bolsonaro, his cabinet ministers and allies have not spared any efforts to complicate access to this life-restoring medicine as much as possible.

The latest attempt has been led by the Federal Council of Medicine, 

which is ideologically aligned with the current government

. Last October, the council banned physicians from prescribing CBD to adult patients, and restricted prescription to children and adolescents 

 before backfiring by generating a lot of public criticism. Physicians who prescribe CBD 

 that they would keep on prescribing the medicine despite the Federal Council’s authoritarian attempts to restrict it. In challenging the resolution, these physicians would act in civil disobedience but, nonetheless, would still be abiding by the Hippocratic Oath. Last year, Dr Carolina Nocetti, a physician who pioneered cannabis therapy in Brazil, told TalkingDrugs that it is within every physician's professional and ethical duty to relieve patients’ suffering; declining to prescribe cannabis for those who stand to benefit from the medicine goes against the profession’s ethical code. 

Access to controlled medicines