Prevention, testing and treatment services for HIV, viral hepatitis and sexually transmitted infections (STI) have driven unprecedented progress in improving population health over the past two decades, with millions of new HIV infections and AIDS-related deaths averted.

Foreign aid investments in the global HIV response, such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund on AIDS, TB and Malaria, have been pivotal to this success, also contributing significantly to progress towards elimination of hepatitis B and C, and STI control. However, abrupt disruptions to foreign aid and service delivery threaten these gains, putting millions of people at risk – especially people living with HIV and key and vulnerable populations.

Many essential evidence-based prevention interventions, including HIV pre-exposure prophylaxis (PrEP), harm reduction services for people who inject drugs, and community-led programmes have been permanently halted.

Early reports shared with WHO indicate that prevention and treatment services for key populations are those most affected. Reports include the closure of health centres delivering prevention, testing and treatment interventions for key populations previously supported by U.S. funding. These disruptions are resulting in staffing shortages, supply chain interruptions, and increased barriers to access, leaving key populations – including gay men and other men who have sex with men, sex workers, people who inject drugs, people in prisons, and trans and gender diverse individuals – vulnerable to infection and death, as well as increased stigma and discrimination.

 Protecting key populations from abrupt disruptions to essential HIV services

Statement by the International Drug Policy Consortium at the occasion of the 47th WHO Expert Committee on Drug Dependence

Delivered by Marie Nougier, IDPC Head of Research and Communications

Thank you very much for giving me the floor. My name is Marie Nougier and I am here representing the International Drug Policy Consortium – a global network of over 190 NGOs that come together to promote drug policies grounded in social justice and human rights.

I am based in the UK, and my statement relates to the critical review of the coca leaf.

This critical review is coming nearly 75 years after the UN banned the traditional uses of the plant by listing it in Schedule I of the 1961 Single Convention on Narcotic Drugs. This is despite the fact that the coca leaf has been used for millennia by Indigenous Peoples in the Andean-Amazonian region for traditional, religious, ancestral and medicinal purposes.

At the time, the decision to place the plant under strict international control was based on colonial and racist arguments, as is further explained in Bolivia’s dossier annexed to its request for the critical review.

First of all, IDPC calls on the ECDD to correct this historical wrong – and to explicitly distance itself from past racist arguments made by WHO officials themselves regarding the plant.

Secondly, since 1961, a large body of research has shown that the coca leaf does not result in health harms, but may, in fact, have possible benefits, including as a medicine, as a food supplement, and for social, cultural and religious purposes. In addition, the basic premise of the 1961 Single Convention is that plants are only scheduled as a narcotic drug when they are considered to produce harmful effects similar to other scheduled substances. This is certainly not the case for the coca leaf when compared to the effects of cocaine use.

Thirdly, various UN entities have increasingly recognised the need to decolonise drug policy and align the UN drug control regime with human rights – including Indigenous Peoples’ rights. This includes statements from the UN Permanent Forum on Indigenous Issues, the High Commissioner for Human Rights, the UN Special Rapporteur on Indigenous Rights, and resolutions adopted by the UN General Assembly, the Commission on Narcotic Drugs and the Human Rights Council.

As with all UN bodies and entities, the World Health Organization is also bound by the obligation to respect, protect and fulfil human rights – which is one of the overarching pillars of the United Nations. As such, any scheduling decision by the ECDD should also take due account of human rights considerations.

We therefore welcome the decision made by the ECDD to consider the ‘traditional uses’ of the coca leaf, as one of the key topics of the critical review report. We hope that this will ensure that the traditional knowledge and culture of Andean-Amazonian Indigenous Peoples are duly recognised and seriously taken into account as the ECDD conducts its critical review and elaborates its recommendations on the plant.

Linked to this, my last point relates to the need to ensure a transparent and inclusive process that enables the meaningful participation of Indigenous Peoples in the critical review. So far, Indigenous Peoples can only feed into the process by participating in the opening segment of the ECDD session today, and in a year’s time at its 48th session. Considering that the right to cultivate and use the coca leaf constitutes a major part of their ancestral, traditional and religious practices, it would be highly recommended that Indigenous Peoples are consulted at various stages of the review process, including:

In the information collection phase, ensuring that the questionnaire that will be shared with member states next year can also be shared with Indigenous experts

By ensuring that Indigenous Peoples can receive the draft critical review report, and are able to discuss its conclusions at a special meeting of the ECDD

By inviting Indigenous experts to participate in specific segments of the 48th session of the ECDD that relate to the coca leaf, and not just the public hearings.

And finally, by soliciting the advice of other UN entities that work on Indigenous Rights’ issues.

, submitted as a written contribution for this ECDD session, and which further elaborates on the points I have made today.

Thank you very much for your consideration and I wish you a fruitful session.

Indigenous rights, knowledge and expertise should be centred in coca leaf review - IDPC statement to the 47th WHO ECDD

For the provisional agenda of the ECDD, click 

See the following link to find the list of substances, critical and pre review reports, 47th Member State Questionnaire, as well as other documents relevant to the forty-seventh ECDD: 

https://www.who.int/groups/ecdd/forty-seventh-ecdd-documents 

47th meeting of the WHO Expert Committee on Drug Dependence (ECDD)

Nearly 75 years after the United Nations called for the abolition of traditional uses of the coca leaf, the world will have a new opportunity to correct this grave historic error. The World Health Organization (WHO), at Bolivia’s initiative, will conduct a ‘critical review’ of the coca leaf over the next year. Based on its findings, the WHO may recommend changes in coca’s classification under the UN drug control treaties. The WHO recommendations would be submitted for approval by the UN Commission on Narcotic Drugs (CND), with voting likely in 2025.

Changing coca’s status in the drug treaties can vindicate the rights of Indigenous peoples and open legal international markets for natural coca products, fortifying Andean economies while bringing coca’s benefits to increasing numbers of people around the world. The coca review process can also help modernize a drug treaty system still mired in the colonialist biases and racial prejudices from which it arose in the mid-twentieth century. The Washington Office on Latin America (WOLA)and the Transnational Institute (TNI) will be monitoring the coca review process closely and examining key aspects of the debate.

Coca chronicles: Monitoring the UN coca review - Issue #1: Bolivia challenges UN coca leaf ban

 of all drug dependence technical reports and resources was launched today allowing its audience to source information within a single webpage.

WHO’s Expert Committee on Drug Dependence (ECDD)

, is an important resource for health professionals, drug policy experts and policy-makers, as many of the substances reviewed by ECDD have otherwise limited information regarding their public health risk. It represents the only online, freely accessible collection of information and reports on new psychoactive substances and medicines, for medical and scientific use, comprising over 450 substances.

Improving information-sharing with health-care professionals and other experts involved in tackling the world’s drug problems can lead to better awareness on abuse, harms and dependence of psychoactive substances reviewed by ECDD. This can contribute to increased implementation of effective public health responses relating to drugs such as improving detection of substances and clinical treatment of overdose, and other related negative health consequences of drug use. Additionally, this resource is important when sourcing information regarding the therapeutic use of psychoactive drugs.

WHO launches a single-source repository on drug dependence information

In 2022, the World Health Organization (WHO) published the Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. These guidelines outline a public health response to HIV, viral hepatitis and sexually transmitted infections (STIs) for five key populations (men who have sex with men, sex workers, people in prisons and other closed settings, people who inject drugs and trans and gender diverse people). 

In this policy brief, we give an update on those parts of the guidelines which are relevant for people who inject drugs.

In many countries drug use or possession is criminalized, and in almost every country it is considered immoral, and significant stigma and discrimination is experienced by people who use drugs. At the time of writing, there is extremely low coverage of the evidence-based package of needle and syringe programmes (NSPs) and opioid agonist maintenance therapy (OAMT). In 2021, of 105 countries that report injecting drug use, NSPs were available in 94, and OAMT available in 90 countries. There are regional differences, with low availability of both interventions in both Africa and the Middle East. Also, in most countries that provide these services, their coverage is too low to have an impact. 

As a direct result, people who inject drugs are disproportionately affected by HIV and viral hepatitis. The World Drug Report 2022 estimated in 2021 that 11.2 million people injected drugs, 5.5 million of them were living with hepatitis C, 1.4 million were living with HIV and 1.2 million were living with both hepatitis C and HIV. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated in 2021 that people who injected drugs had a 35 times greater risk of acquiring HIV than people who did not inject drugs, and WHO estimates that 23% of new hepatitis C infections globally are attributable to injecting drugs.

For impact on HIV and viral hepatitis, structural barriers for people who inject drugs need to be addressed, including decriminalizing drug use and possession for personal use, ending forced detention in compulsory drug treatment centres, addressing violence, stigma and discrimination and empowering communities of people who use drugs. People who use drugs face additional barriers to accessing health services where cessation of drug use is a condition for eligibility. Women who inject drugs may be more stigmatized than their male counterparts, and many work as sex workers to pay for both their and their partnerʼs drugs. Fear of losing custody of their children may make mothers who inject drugs less likely to access reproductive and other health services. They may experience more police harassment and violence than men who inject drugs. The impact of these barriers on HIV and viral hepatitis acquisition is clear, and for this reason the enabling interventions listed in the table below are considered essential for impact for people who inject drugs.

Recommended package of interventions for HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for people who inject drugs

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.