INCB meeting with Raymond Yans.
Introduction by Raymond Yans on INCB work. Very proforma.
Michel Perron gave format of the meeting. He will read pre-submitted questions.
Question on prevention.
Yans: Role of INCB is first of all to monitor the implementation of the conventions and in doing so look at all the scope of drug policy. Role is not only law enforcement but to seek for a balanced approach and prevention. Fundamental pillars to balance are exercised by the states. Basically we are monitoring and advising agency and as you know when we consider that there is a breach in respect of the conventions, we have the mandate, to underline the fact that countries are not in line with the conventions any more. National drug policies are not determined by INCB. Governments are fully responsible to make their decisions and establish their own national policies. Taking care of drug users. But always insist when we meet governments that the effectiveness of their prevention programs depends on how balanced their policies are. Can assist with tactical knowledge to monitor and comply with the treaties. NGOs help us understand the best approach that is advisable to various governments in various regions.
There are gaps in evidence based practices around the world. Govt of Kazakstan, ? Span of countries – all have different attitudes. At INCB always we try to have them advance slowly one by one, so they understand, using the examples of other country’s intervention. Using also the relevance of practices adopted by UNODC. In countries almost none are adopted in others, almost all. So you see we have to face all those different situations that we don’t always succeed and we have to appear as independent that does not force a country to adopt cultural a values or policies that are not in line with their national considerations.
Michel Perron: VNGOC.
Question: Harm reduction. Begins with compliment. INCB recent decision on death penalty strongly welcomed. Drug treaties silent on the matter of harm reduction as is international human rights law. Will Board now apply same reasoning beyond death penalty? Considerable human rights jurisprudence that includes harm reduction and right to health.
Yans. As if harm reduction were a human right? What is a human right is the right to adequate health measures. The conventions do not contain or refer to the term harm reduction. Nevertheless, art. 38 of 1961 convention (often forgotten) and 20 of the 1971 convention refer to the need for a state to take measures for the prevention of drug abuse and for the early identification, etc.
Certain respects of the so-called harm reduction are of course useful. But when states as such are not obliged by the conventions to adapt what some of you call harm reduction measures what we should be aware of is basically let be frank, its ideological. HR programs should not be carried out at the expense of to their important activities such as drug abuse prevention activities.
Trend I saw in some EU countries, not in the governments as such but some NGOs which would consider it would be better to do without drug control and just to rely on harm reduction, considering that drugs should be legalized and MS should only take care of HR measures. This is not of course what the conventions require. But to quit the terminology and …let’s see what harm reduction measures, which in my my scientific vocab I would call tertiary prevention measures. Some can be considered as useful treatment measuers in line with the conventions. EG NSP and INCB kept repeating this. IN line with the conventions. Countries deciding to to distribute drugs such as heroin under medical control to users is in line with the conventions as a medical practice.
Yesterday I said that INCB supports work of WHO to make methadone and buprenorphine available to countries that make it available as OST. This is in line with the conventions. But this is not required by the Conventions. Governments do have the freedom to use what they consider appropriate to prevent to develop primary secondary or tertiary prevention measures. And of course it is true when we go to a country that the treatment facilities are not taken into consideration that drug users are put in jail. We remind them of the fact that none of the conventions require a party to convict or punish drug users who commit such offenses. States may choose to deal with abusers through alternative measures, etc… but indeed governments may choose to apply penal sanctions in such cases since drug treaties permit a country to adopt stricter measures than those required by the conventions. We always call on governments to adopt balanced policies and consider users as human beings not outcasts and ensure proportionate response.
HR not and either or… in 2008 VNGOC…manner we have collectively done this is that it is part of the continuum and part of the conventions. Dialog about definitions…greater the clarity that the Board could bring as it relates to International Human Rights Law could be useful. Particularly as we go to 2016 with polarized politically, ideologically, semantically. Ask that you take this on as a topic. MS need this, and NGOs need as they go into governments.
Access to essential medicines. Has been very much discussed today. Eight questions alone.
Question: How does the INCB justify when a country’s proposal under estimate, and drugs clearly insufficient. Some countries indicated they only had 18 codeine, etc. for a population of 1.8 million. How does Board help MS understand supply is woefully inadequate.
Yans. I will explain how the conventions work. There is a mechanism that has been established for INCB for monitoring production, manufacture and consumption of drugs. In a way the conventions have realized that. MS have considered that use of drugs for other reasons, because of their addictive dangers should be limited for medical and scientific use. SO INCB limits use around the world. Based on annual estimate which is done by every MS at the beginning of the year. Those states that produce, export, manufacture also have to file forms to estimate production level of the year. Then, about the use…countries are also free to submit every three months quarterly reports on trade, and then submit national statistics on an annual basis. INCB controls discrepancies between imports and exports. Sometimes we see discrepancies. If a country does not submit an estimate on morphine, for example, the INCB does it automatically, so that the country wouldn’t be prevented during the following year to import morphine. Do it on the basis of calculated daily dose taking into consideration the consumption in the region.
If we consider an estimate is too low, suggest increasing. But in the end, conventions say it is up to the country to decide. Can advise but not decide about the needs of a country. OF course we are not satisfied with this system. Together With WHO we have to better understand national needs. Drafted guidelines for evaluation of needs of national estimates. Have drafted global report on availability of nationally controlled drugs where we give quite a few recommendations. Necessary medical substances under control cited.
VNCGOC. Issue underscored by many. NGO community wants to see more progress on as we move to 2016. How to assist in operationalization, and decrease concern about supply chain issues.
INCB already working with quite a few NGOs in this matter. Those engaged in cancer question. Assisting MS in palliative care knowledge. Invited to world cancer summit in SA last year. Decided to upgrade our work with NGOs involved in this. But concerning every individual MS. We really invite national NGOs to provide NINCB with information as seen by NGOs as seen by them as regards treatment and medical use of controlled substances, so INCB can have more global information than partial one.
Michel P. Good if you could give advice to VNGOC if you can, so we can provide to NGOs.
Another complimentary note on compulsory treatment centers. Kazakstan – Cambodia,. Etc. Concern about compulsory treatment. Clarify INCB position on that please. Read the report. Seen from the Board’s perspective. You have to deal with the world. Deal with different cultural and political uses to cope with treatment. Basically INCB would support all MS states in the way of tackling wdp as long as theya re in the framework of the three conventions. Concerning the related example of Cambodia, which we urged after analyzing the results of the Board’s vision for that country. We urged it to continue developing community based drug treatment programs, instead of compulsory treatment programs. Board noticed there were tow systems. Camps on one side, and the encouragements for the drug user to enter community based. We are aware that the results of CBT are all over the world, whatever the country, better than compulsory treatment.
Kazakhstan another level of evolution. We noticed that for the first time Kazakhstan was considering not putting drug users in jail. That was the rule. They decided to offer as alternative to incarceration. So in that case we encouraged. Maybe ten years from now or five years, if there is an NGO offering community BT, if there were a positive political development on the authority’s level to engage support of NGOs community treatment, that this will be positive for the country, INCB will propose that country engages preferably with community based rather than compulsory treatment. INCB is not in a position to oblige a country to do so when there is no such alternative in a country. That was the case in Cambodia, which is where we insisted.
VNGOC. If INCB could denounce, even if in absence, encourage on a near term basis through work of UNODC and others. Very difficult to get access to governments and create CBT, so INCB should encourage.
Final remarks. Yans. Let me just tell you frankly that when I go on a mission it is really essential for me to have community based meeting with NGOs. Gives us the opportunity to see the real situation, not just statistics. Government gives knowledge of drug control situation in the country, drug use, etc. As a human being to meet with the people who are really interacting with the drug users. So considering this, and I let my staff know this. Board members are not always here in Vienna. Considering interactions with NGOs as an ongoing dialog, not just one day. We are invited to remain in contact with INCB secretariat to provide us with analysis and data of the problems arising in individual countries see from an NGO perspective. It is important for us. Whole drug control world community is aware, work of government is important, but because we are talking about human beings, work of NGOs on prevention, primary, secondary, tertiary is essential. Thank you very much for the work you are doing.