International Drug Policy Consortium Statement - Pre-review of Kratom, mitragynine and 7-hydroxymitragynine at the 44th WHO Expert Committee on Drug Dependence, 11 – 15 October 2021

This written submission is by the International Drug Policy Consortium (IDPC): a global network of more than 190 NGOs that promotes drug policies grounded in the principles of health, human rights, development, and civil society engagement. As the ECDD is planning to conduct pre-reviews on Kratom and its active ingredients mitragynine and 7-hydroxymitragynine, we offer some insights and recommendations on the impacts of criminalisation that have resulted from national policies.

Despite the UNODC categorising kratom as a new psychoactive substance (NPS), it has been used for centuries as a traditional medicine in Southeast Asia, particularly amongst rural communities in Thailand, Malaysia and Myanmar. Kratom is often consumed by chewing the fresh leaves and boiling fresh or dried leaves to drink as a decoction or herbal tea. Consumption of kratom is culturally accepted in ways similar to drinking coffee and tea. It is commonly consumed amongst agricultural workers to relieve the physical pains of hard labour.

In Thailand, the kratom plant was classified as illegal in 1943. However, it was not until 2004 that the laws became widely enforced in practice, due partly to the practice of mixing kratom with beverages containing caffeine and codeine-based medications that emerged in 2003 but also to the war on drugs launched by then-Prime Minister Thaksin. By 2019, the government reported that kratom cases constituted one sixth (47,809 of 304,784) of all drug-related court cases during the January to October 2019 period.

In August 2021, after almost two decades of advocacy for ending the criminalisation of kratom to allow its use for medical, research, personal and traditional purposes, legal reforms in Thailand to decriminalise the use and cultivation of the kratom plant came into effect. Over 12,000 people convicted for kratom-related offences were granted an amnesty. Elsewhere in Asia, including in Malaysia, Myanmar and Singapore, the use, possession and supply of kratom remains punishable; the UNODC reported in 2011 that 14,556 people (accounting for 8% of all drug-related arrests) were arrested for kratom in the region in 2010.

It is crucial to acknowledge that there are harms and benefits associated with drug policy. How a substance or plant is scheduled can have profound outcomes for consumers. A punitive legal framework that criminalises kratom use has caused enormous harm. We call on the ECDD to consider the profound impacts of legal and policy choices that may be triggered by international scheduling and to take the lessons from past national controls duly into account before taking any further steps towards bringing kratom under international control.

IDPC statement at the occasion of the 44th meeting of the WHO Expert Committee on Drug Dependence

Access to controlled medicines in humanitarian emergencies remains constrained

Recognizing World Humanitarian Day 2021, the International Narcotics Control Board (INCB), the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) once again call on governments to facilitate access to medicines containing controlled substances in emergency settings, including during pandemics and the increasing number of climate-related disasters.

The theme of World Humanitarian Day 2021 acknowledged the impact of climate-related emergencies. Over 7,348 disasters have been reporting in the last two decades of which 40% are now estimated to be climate-related according to United Nations reports. The impact of their increasing number combined with the persistent COVID-19 pandemic creates a complex landscape for ensuring access to controlled medicines in emergencies.

A year after an earlier joint statement, unprecedented trade restrictions, shortages of medicines, surges in infections, and new variants of SARS-CoV-2 compound the problems related to maintaining a supply of controlled medicines, according to WHO and the World Trade Organization.

The problem of access to controlled medicines in emergencies

There is an increase in demand for controlled medicines in emergency responses. Since the beginning of the COVID-19 pandemic, WHO has identified over 20 medicines with global-level shortages, including four that contain controlled substances that are used in intensive care units for the treatment of severe cases of COVID-19. Internationally controlled medicines such as morphine, diazepam, and midazolam listed as WHO essential medicines, are vital for the management of pain, palliative care, surgical care and anesthesia, and treatment of drug-use disorders, mental health, and neurological conditions.

Shortages impact countries of all income levels. Low- and middle-income countries (LMIC) are often disproportionately impacted by shortages--partly related to their relative purchasing power in international medicines markets and partly because specialized systems to manage controlled medicines do not always accommodate sufficient exceptions for emergencies.

Urgent action is needed to ensure that national systems improve access to controlled medicines for people affected by emergencies, including pandemics, and climate-related disasters.

INCB, UNODC and WHO joint statement on access to controlled medicines in emergencies

The Expert Committee on Drug Dependence (ECDD) of the World Health Organization (WHO) will hold its 41st Meeting in Geneva on 12th to 16th November 2018. The ECDD is the body mandated by the Single Convention on Narcotic Drugs of 1961 and the UN Convention on Psychotropic Drugs of 1971 to conduct scientific reviews of substances with a view to understanding their public health risks and therapeutic uses, and to recommend their assignment to the appropriate schedule within the international drug control conventions.

In the context of the proliferation of new psychoactive substances, the principle of scientific review is of special significance. Many governments are presently subject to anxieties that can drive the process of scheduling – not on an evidential basis, but a political and ideological one. This gives an added importance to the Expert Committee, that of ensuring its recommendations are made on the basis of scientific evidence, as per its mandate and despite political pressures.

The significance of this role is underscored by the UNGASS Outcome Document of 2016, which devotes an entire chapter to the issue of access to controlled medicines. Among a broad collection of substances subject to critical review at the 41st ECDD meeting, an especially important medicine is included: tramadol, which is currently not under international control.5 Certain countries have called for tramadol to be placed under international control, in particular, Egypt, which submitted a conference room paper on the issue to the 60th Session of the Commission on Narcotic Drugs.

In the meantime, discussions around the scheduling of cannabis at national and global levels have accelerated over the past few years, while more and more countries are adopting medicinal cannabis schemes. For the first time in the history of the current international drug control regime, a critical review of cannabis and its derivatives is also planned for the 41st ECDD meeting.

This IDPC advocacy note will provide recommendations on both tramadol and cannabis, with the hope that it will inform the discussions of the Expert Committee for its meeting in November.

Contribution to the 41st WHO Expert Committee on Drug Dependence: IDPC recommendations on cannabis and tramadol

The Expert Committee on Drug Dependence (ECDD) of the World Health Organization (WHO) will hold its 39th meeting from 6th to 10th November 2017 in Geneva. The ECDD is mandated by the 1961 and 1971 UN drug conventions with the task of undertaking scientific reviews of substances and recommending their appropriate scheduling to the Commission on Narcotic Drugs (CND), taking into account both risks related to non-medical use and therapeutic usefulness.

In the context of the proliferation of new psychoactive substances, the principle of scientific review is of greater importance than ever. In this regard, scheduling plays a key role in both restricting non-medical use of controlled substances and ensuring access to controlled medicines. The UNGASS Outcome Document gives due prominence to ensuring access to controlled medicines with an entire chapter dedicated to the issue, thereby raising the profile of the ECDD, which work in maintaining the principle of scientific review is critical and fully supported by IDPC.

At its 39th session, the ECDD will review a number of psychoactive substances and make recommendations to the UN Secretary General on whether and how these substances should be internationally controlled. Sixteen substances will be under review at the upcoming meeting, including cannabidiol (CBD) and tramadol. In this advocacy note, IDPC offers some analysis and key recommendations on these two substances to inform the ECDD’s meeting.

IDPC statement at the occasion of the 44th meeting of the WHO Expert Committee on Drug Dependence

INCB, UNODC and WHO joint statement on access to controlled medicines in emergencies

Contribution to the 41st WHO Expert Committee on Drug Dependence: IDPC recommendations on cannabis and tramadol

IDPC contribution for the pre-review of CBD and Tramadol at the 39th WHO Expert Committee on Drug Dependence