The INCB Annual Report, prepared in accordance with the 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 2024 focuses on the scenarios and possible responses to the rapid expansion of synthetic drug manufacture, marketing and consumption. The Report reviews the functioning of the international drug control system and analyses the global availability of narcotic drugs and psychotropic substances for medical and scientific purposes.

The Report is accompanied by the 2024 INCB Precursors Report.

INCB Annual Report 2024

This blog post was originally published by the EAPC blog and is available here.

Screams of pain punctuate households worldwide, but disproportionately more so in low and middle income countries.

Our home witnessed this for two years as my adoptive mother was ravaged by cancer. She was finally administered pentazocine two days before she died. It barely made a dent on the pain emanating from a backbone broken by cancer. As she took her last breath, we exhaled in guilty, tearful relief.

Twenty three years later, my biological mother lay dying of interstitial lung disease and needed oral morphine to ease her breathlessness. Despite working for a WHO Collaborating Centre for Training and Policy on Access to Pain Relief, getting access to these pills in the most populated state in India was a nightmare. Ironically, the same state where the only government-run opium and alkaloids factory is located. A local doctor reluctantly prescribed oral morphine, which was then sent from Kerala – an approximate distance of 1952 kms.

Read more from Smriti Rana’s powerful piece for the EAPC (European Association for Palliative Care) Blog 

The influence of colonialism on the pain relief access abyss

During the 141st session of the International Narcotics Control Board (INCB), the Board held consultations with Member States on the human rights dimensions of drug control.

Opening the consultation, Prof. Jallal Toufiq, INCB President, emphasized that respect for human rights and implementation of the drug control conventions are mutually reinforcing, and reiterated INCB’s calls for human rights to be respected in the development and implementation of drug control policy. He went on to say: “Measures adopted with the purported aim of furthering drug control which are inconsistent with universally recognized human rights norms are a violation of the international drug control conventions.” Members of the Board spoke in depth about obligations stemming from human rights instruments, including the right to health, promotion of equality and non-discrimination towards people who use drugs, prohibition of arbitrary arrest and detention, the right to a fair trial for drug-related crimes, and protection against all forms of cruel and inhuman punishment. These statements are available on the INCB website. Representatives of 51 Permanent Missions to the United Nations in Vienna and one Permanent Observer attended the consultation and had the opportunity to share their perspectives.

During the session, the Board also held consultations with the Chair of the Commission on Narcotic Drugs, Philbert Abaka Johnson, the Executive Director of the United Nations Office on Drugs and Crime, Ms. Ghada Waly, the World Health Organization and the Office of the High Commissioner for Human Rights.

On the margins of the session, the Board concluded a memorandum of understanding with the International Association of Hospice and Palliative Care (IAHPC). Signed by the INCB President and Katherine Pettus, Senior Advocacy and Partnerships Director of the International Association of Hospice and Palliative Care (@IAHPC), the cooperation agreement provides for exchange of research, data and analysis on the issue of availability and the dissemination of information to the international community. Speaking after the signing of the agreement, Prof. Toufiq noted: “INCB and IAHPC share common objectives with regard to the provision of guidance and support to governments and the international community on issues related to the availability of controlled substances for medical and scientific purposes. The Board is committed to ongoing cooperation with governments, international and regional organizations and civil society to further the health and welfare objectives of the drug control conventions, including to promote availability of internationally controlled medicines. This also extends to humanitarian emergencies, whether they be caused by natural disasters or armed conflict, where patient access to controlled medicines must be ensured”.

INCB holds consultation on the human rights dimensions of the international drug control treaties

VIENNA, 10 December 2024 - On the occasion of Human Rights Day 2024, the International Narcotics Control Board emphasizes that respect for human rights is a prerequisite for the implementation of the international drug control conventions. INCB reiterates its call for human rights to be respected in the development and implementation of drug policy. Measures adopted with the purported aim of furthering drug policy that are inconsistent with universally recognized human rights norms are a violation of the international drug control conventions.

Ensuring availability of internationally controlled substances for medical purposes and access to evidence-based treatment, rehabilitation, recovery and social reintegration services for people with drug use disorders are important elements of the right to health.

Internationally controlled narcotic drugs and psychotropic substances are used for anaesthesia, pain management, treatment of neurological and mental health conditions and for opioid agonist therapy. Although the global supply of opiate raw materials exceeds the requirements reported by Governments to INCB, the estimated requirements submitted by some countries may not reflect actual medical needs, and there are persistent global disparities in the availability of internationally controlled medicines. The Board is committed to working with Member States to improve the implementation of the drug control treaties with a view to improving availability of controlled substances for medical, scientific and industrial purposes as well as access to evidence-based and stigma-free services for prevention, treatment, rehabilitation, recovery and social reintegration. This also extends to humanitarian emergencies - whether they result from natural disasters, armed conflict or other anthropogenic causes - where patient access to essential controlled medicines and treatment services must be ensured. Affected States and exporting countries are reminded about the possibility of applying simplified control measures during emergency situations as foreseen in the drug control conventions.

Other human rights obligations related to drug policy include the promotion of equality and non-discrimination towards people who use drugs, prohibition of arbitrary arrest and detention, the right to a fair trial for drug-related crimes, the principle of proportionality, and protection against all forms of cruel and inhuman punishment. INCB continues to remind Governments that the drug control conventions provide States with the possibility of applying alternative measures to conviction, punishment and incarceration, including education, rehabilitation or social reintegration. This extends to the need to ensure that the rights of vulnerable population groups are protected against exploitation by drug traffickers and that appropriate safeguards exist in criminal justice systems.

Human Rights Day is a timely reminder of the need to better safeguard human rights protections and place people at the heart of drug policies. In carrying out its treaty-based mandate, INCB is committed to ongoing cooperation with Member States to improve the implementation of the drug control conventions and their human rights dimensions, with the ultimate aim of safeguarding health and welfare, the overarching concern of the three conventions.

INCB President statement for Human Rights Day 2024

Join us for the Geneva Course on Drug Policy, Health, and Diplomacy from January 27-30, 2025! Co-organized by the Institute of Global Health, University of Geneva, the Global Health Center of the Geneva Graduate Institute, and the Global Commission on Drug Policy.

Participate in person in Geneva or online. Scholarships available!

Drug control, public health, harm reduction, and human rights

Current issues with cannabis, the opioid epidemic, and access to controlled medicines

Perspectives on drug policy reform in today's global diplomatic context

Join us and be part of the discussion! For more info and to apply, contact Kamila Guseinova at kamila.guseinova[@]unige.ch

Don’t miss this opportunity to engage with critical global drug policy issues!

Geneva course on drug policy, public health, and diplomacy

Thailand will regulate cannabis for medicinal use instead of re-listing the plant as a narcotic, the deputy prime minister said on Tuesday, in the government's U-turn on its previous policy.

Prime minister Srettha Thavisin had vowed to make cannabis illegal by the end of 2024, just two years after Thailand became one of the first countries in Asia to decriminalise marijuana.

Thailand decides not to re-criminalise cannabis as it eyes $1bn medicinal industry

There has been a growing willingness among federal policymakers to adapt legal frameworks, using existing flexibilities, to reduce barriers to health and harm reduction services for people who use drugs, prompted by the ongoing drug poisoning crisis and more recently the COVID-19 pandemic.

The experience of recent years has demonstrated that evidence-based, human rights–based analyses, combined with community capacity-building, mobilization, and knowledge translation engaging program and policy decision-makers can lead to important legal/policy shifts — 

creating a more enabling environment to protect the health of people who use drugs.

Safe supply is increasingly considered to be a key harm reduction intervention, including proposals to look beyond strictly medicalized models. In the context of an unprecedented drug poisoning crisis, it is imperative that novel and innovative approaches are explored to address the scalability of safe supply, as a matter of life and death. To meet the diverse needs of people who use drugs, it is also pragmatic and ethically imperative that innovative approaches are adopted to scale up access to safe supply beyond the existing medical model, including within SCS. Although safe supply at SCS is not without its limitations, including with respect to the absence of SCS in many communities and the lack of 24/7 access where they do exist, they are one viable option among the range of services that are desperately needed.

As described above, courts in Canada have repeatedly affirmed the right of people who use drugs to access harm reduction and other health services, and governments have a legal and ethical obligation to ensure access to safe supply and to SCS as a necessary component of the rights to life and to health, among other human rights. While policy and legislative reform requires time, all levels of government also have broad emergency powers allowing them to act swiftly — and to compel other entities to take action. As this report confirms, a diversity of tools is available for law and policy makers to eliminate barriers to safe supply at SCS and begin to fully realize a continuum of options that are accessible and honour the autonomy and human rights of people who use drugs. What we need now is political will.

How to innovate in an emergency: legal and policy measures to scale up safe supply at supervised consumption services

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

Permission for the use of the two Category 5 drugs was announced in a directive of the ministry that was published in the Royal Gazette on Tuesday.

The directive, which was signed by Public Health Minister Cholnan Srikaew, took effect on Wednesday.

The directive referred to opium and psilocybin mushrooms, better known as magic mushrooms for their hallucinogenic effects when eaten, as narcotics on the Category 5 list, which are not extracts of marijuana and hemp.

Thailand allows use of opium, magic mushrooms for medical purposes, research

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.

Access to controlled medicines