In a decision that shocked some observers, key advisers to the US Food and Drug Administration (FDA) voted that the effectiveness of 

Members of an independent scientific advisory committee voted 9 to 2 that human trials of MDMA did not prove its efficacy. They also voted 10 to 1 that the risks of MDMA, also known as ecstasy, outweigh its benefits. The FDA does not have to follow its advisory committee’s recommendations when deciding whether to approve a drug, but often does.

the difficulty of assessing psychedelic drugs

 and the FDA’s limited ability to evaluate psychiatric treatments. “It felt strange to vote no,” says committee member Satish Iyengar, a statistician at the University of Pittsburgh in Pennsylvania, given that 

. “There were just too many problems with it.”

The vote took place at a meeting on 4 June in Silver Spring, Maryland.

US: MDMA therapy for PTSD rejected by FDA panel

The U.S. Drug Enforcement Agency announced in late April 2024 that it plans to ease federal restrictions on cannabis, reclassifying it from a Schedule I drug to the less restricted Schedule III, which includes drugs such as Tylenol with codeine, testosterone and other anabolic steroids. This historic shift signals an acknowledgment of the promising medicinal value of cannabis.

The move comes in tandem with growing interest in the use of psilocybin, the active component in magic mushrooms, for treatment of depression, chronic pain and other conditions. In 2018 and 2019, the U.S. Food and Drug Administration granted a breakthrough therapy designation to psilocybin, meant to expedite drug development given that preliminary studies suggest it may have substantial therapeutic value over currently available therapies for treatment-resistant depression and major depressive disorder.

Both of these developments represent a dramatic change from long-standing federal policy around these substances that has historically criminalized their use and blocked or delayed research efforts into their therapeutic potential.

How cannabis and psilocybin might help some of the 50 million Americans who are experiencing chronic pain

KARACHI -- Pakistan is establishing a legal framework for cannabis trade after the government approved the herb for industrial uses nearly four years ago, hoping to capitalize on the booming market to increase its foreign exchange reserves.

A presidential order passed in February delineated rules for the formation of Pakistan's first Cannabis Control and Regulatory Authority. The government approved cannabis for industrial use in September 2020 but had not established a regulatory framework due to internal conflict.

"We are very serious about this initiative, and things are moving at a very fast pace," a senior official of the Special Investment Facilitation Council, which is spearheading government efforts to draw investments and overhaul the economy, told Nikkei Asia.

The new coalition government -- formed of the Pakistan Muslim League-Nawaz (PMLN) and Pakistan Peoples Party (PPP) -- is setting up the regulatory body to formulate policies, such as issuing licenses to growers and sellers, and earmarking regions for cultivation, the official added.

Pakistan hopes to take advantage of its conducive growing conditions to enter the global cannabis market, that according to Indian research company MarketsandMarkets, will grow to $82.3 billion by 2027 from $27.2 billion in 2022. The country is seeking ways to increase exports and raise taxes to break its dependency on foreign loans and bailouts from the International Monetary Fund.

Pakistan sets cannabis rules, eyes sales to help balance books

Ukrainian President Volodymyr Zelenskiy signed into law a bill legalising the medical use of cannabis, a parliamentary database showed on Thursday.More than 6 million people, including cancer patients, civilians with post-traumatic stress disorder, and wounded soldiers need medicine containing cannabis, according to a lawmaker.The bill signed by Zelenskiy on Tuesday would only come into force six months after it is officially published, and the ban on selling or supplying cannabis for recreational use would remain in effect.

Ukraine legalises cannabis for medical use

The Government of Saint Lucia, through the Ministry of Commerce, Manufacturing, Business Development, Cooperatives and Consumer Affairs, has been engaged in the revision and development of policy, legislation and a regulatory framework for cannabis in Saint Lucia.

In keeping with these advancements, the Government of Saint Lucia will be hosting a two-day Cannabis Symposium from March 19 – March 20, 2024 as an open-ended regional policy discussion on matters relating to cannabis.

This symposium will afford relevant stakeholders and Cannabis Authorities within the region an opportunity to hold candid discussions on some of the issues and challenges experienced throughout the region.

Subsequently, a Memorandum of Understanding (MOU) will be signed by the aforementioned parties, guided by a common interest to establish and maintain robust, inclusive and safe regimes surrounding cannabis cultivation, manufacturing, sale and use in the individual states of the region.

This MOU will, in effect, establish the Caribbean Cannabis Forum—a mechanism to encourage and host joint discussions on national, regional or international cannabis matters of relevance to the Caribbean region.

Saint Lucia to host Caribbean Cannabis Symposium

OAT reduces many of the harms associated with opioid dependence in the context of criminalisation. Improving OAT coverage globally will significantly affect morbidity and mortality outcomes for people who use drugs. Although there is a gradual increase in harm reduction intervention coverage globally, coverage and scale of interventions, such as OAT, is limited.

The meeting provided a forum for discussing increasing country-level and individual OAT access. By discussing delivery models, treatment modalities, developments in OAT options, and the necessary frameworks for structuring OAT implementation and scale-up, the meeting aimed to:

Promote introduction of OAT in countries yet to provide

Promote scale up of OAT in countries not reaching targets for level of provision

Promote tailored OAT delivery models that are locally relevant and responsive to clients’ needs

Increasing opioid agonist treatment (OAT) coverage globally

Japan has passed a bill to legalize cannabis-based medicines in a landmark revision of its stringent drug laws, while toughening its ban on recreational use of marijuana. This is a win for patient groups that have campaigned for access to these medicines.

However the changes amount to a tightening of Japan's already tough cannabis policy. Marijuana consumption was criminalized, closing a loophole that officials partly blame for a recent rise in cannabis-related arrests. Prior to the revisions, inhaling marijuana had been technically legal, as opposed to a jail term of up to five years for possession. Under the revised laws, those caught using or possessing marijuana can face a prison sentence of up to seven years.

Still, decades of a strident government crusade against illegal drugs, synonymous with the mantra of "dame zettai" (absolutely not), have led to marijuana being heavily stigmatized in Japan. Just 1.4 percent of people in Japan say they have tried marijuana, compared to more than 40 percent in France and around half in the United States, data compiled by the health ministry show.

Japan's tough anti-cannabis laws have ensnared international stars including Beatle Paul McCartney, who spent nine days in detention in 1980 after the drug was found in his baggage.

Japan to legalize cannabis-based medicines

There has been a growing concern about the misuse of pharmaceutical opioids in Africa, with some commentators describing it as part of a “global opioid crisis” (e.g. Kurth et al., 2018), ignoring the socio-historical peculiarities and contextually distinct materializations of these public health crises. Scholars have challenged this broad-brush approach through critical commentaries and original research (Klein et al., 2020; Klantschnig and Dele-Adedeji, 2021). Others have argued that conflating these distinct crises “blocks the path to rational regulatory reforms and public health strategies that could constructively address each crisis on its own terms” (Pettus and Radbruch, 2023, p. 2). A notable outcome of the global crisis narrative, according to Klantschnig and Dele-Adedeji (2021), and crucially for the purpose of this Special Issue, is the increased focus on the tramadol economy in Africa. The narrative has stirred political interests and enforcement-based responses across the continent and among international drug control agencies, who view the crisis as a “drugs” problem that should be addressed with law enforcement and bureaucratic controls (Klein et al., 2020). However, the wider social and structural drivers of opioids consumption on the continent are neglected, and the potential impacts of restrictive controls on health care remain poorly understood. This Special Issue aims to fill these knowledge gaps.

Tinasti and Outleb analyse opioid regulation in Morocco, showing how recent restrictive regulations are influenced by international frameworks and how they affect access to opioid analgesics for pain management and palliative care, as well as opioid agonist therapy. Ane-Loglo examines tramadol regulation in Ghana and six other African countries, showing how they impact the medical use of tramadol. Although tramadol is essential for managing pain in these countries, existing regulatory frameworks hinder access to these medicines. Onyima documents how street-involved young men in a south-eastern Nigerian city obtain opioids from street drug dealers and pharmacies and consume them by sniffing, popping and mixing tramadol with other drugs. These practices emerged in response to the threat of formal control. Nwafor and colleagues show how manual labourers in two south-eastern Nigerian cities consume tramadol to improve energy for work, pain relief and sexual performance. These consumption practices are contextualized by difficult working conditions and low access to pain management. Nelson and colleagues show how strict measures imposed by the Nigerian state on opioid supply due to public concerns about non-medical use among youth did not mitigate this practice. Instead, it constrains access to opioids for medical purposes and fuel police corruption. Dele-Adedeji and colleagues show how social relationships facilitate the illegal tramadol market in Nigeria, enabling market actors to resolve frictions between illegality and the social acceptability of tramadol. Last, but not the least, Otu and colleagues describe how domestic and international politics shape opioid control in Nigeria, reproducing punitive approaches that hinder access to opioids for medical purposes.

An overview of legal and policy barriers to opioid analgesics access and opioid agonist therapy in Morocco

Tramadol control measures and supply for health-care services: findings from Ghana and other West African countries

Prescription opioids, consumption cultures and “informal governing images” among “young street guys” in Nigeria

“It worked for my friend”: non-medical use of tramadol among manual labourers in Anambra state, Nigeria


Chidozie Edwin Nwafor, Chukwuemeka Felix A. Okoye, Nelson I. Nwankwo, Paschal Chukwuma Ugwu

Tramadol regulation, illegal markets and consumption practices: exploring frictions of drug control in Nigeria


Ediomo-Ubong Nelson, Ogochukwu Winifred Odeigah, Emeka W. Dumbili

Resolving friction in the tramadol economy in Nigeria


Ini Dele-Adedeji, Lala Ireland, Gernot Klantschnig

Beyond evidence and reality: the politics, political economy and fallout of hawkish regulatory policy on prescription drugs in Nigeria


Smart E. Otu, Macpherson Uchenna Nnam, Mary Juachi Eteng, Ijeoma Mercy Amugo, Babatunde Michel Idowu

Drinking to cope and college grade point average


Morgan A. Douglass, Madison L. Colley, Alexander J. Tyskiewicz, Mark A. Prince

Ayahuasca ceremonies: set and setting features across Italy and Colombia


Federica Ambrosini, Laura Pariset, Roberta Biolcati

Family ties: examining family functioning and alcohol use among American Indian youth


Morgan A. Douglass, Meghan A. Crabtree, Linda R. Stanley, Randall C. Swaim, Mark A. Prince

Frictions in drug control: prescription opioids, prohibition and consumption cultures in Africa

 Thursday, 30 November 2023 / 15:00 - 16:30 (GMT - London)

This recording is available in English and 

Global Coalition to Address Synthetic Drugs Threats

 with the objective of mobilising the international community to “come together to collectively combat this shared challenge”. By October 2023, some 120 governments had signed up to be part of the Coalition.

In parallel, the USA will table a resolution at the 78th Session of the UN General Assembly that calls on UN Member States to prioritise global action to address the public health and security challenges posed by synthetic drugs.

Nonetheless, the question remains as to whether the Global Coalition will seek to promote innovative approaches to synthetic drugs, that are grounded in health and human rights, or whether it will be yet another vehicle to continue promoting interdiction and eradication.

This online event aims to inform and feed into this discussion, with inputs from health and human rights experts. Speakers will discuss a breadth of issues which include:

How prohibition itself has fuelled the increase in the diversity and use of synthetic substances (the so-called balloon effect) and the flaws this exposes in international drug control.

The medical significance of synthetic drugs like tramadol and ketamine in many parts of the world and how international scheduling would drastically reduce their availability.

The importance of harm reduction as the foremost pillar in the response to all drug use, including synthetic drugs, especially as it relates to preventing and responding to overdoses - as well as measures aimed at ending sanctions and reducing stigma against people who use drugs.

A discussion of the potential offered by the Global Coalition and its resolution to directly and progressively address these issues.

Keynote: Professor Adeeba Kamarulzaman, Global Commission on Drug Policy

Daan van der Gouwe, Drug Markets Researcher, Trimbos Instituut, Netherlands

Theshia Naidoo, Managing Director of U.S. Foreign Policy, Drug Policy Alliance, USA

Andrzej Celinski, Contract Manager & Executive Administrator, Canadian Association of People who Use Drugs

Lisa Sánchez, Executive Director, Mexico Unido Contra la Delincuencia

Smriti Rana, Head of Strategic Programs and Partnerships, Pallium India 

Moderated by Ann Fordham, International Drug Policy Consortium.

Synthetic realities: Global drug policies beyond the 'new threat' narrative

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.

Access to controlled medicines