WHO Brussels: (Video link presentation) The 36th Expert Committee took place in June. At the moment 36 substances are to be reviewed, 23 psychotropic substances and 3 therapeutic. UK asks mephredone to be scheduled 2 under the 1971 convention. China critical review of ketamine although WHO didn’t recommend any scheduling for ketamine.
Director General of WHO- 1ST DEC. deliberations: There are ongoing discussions of Ketamine. To add to expert committee, has already look at the case of ketamine 3 times. It is an important medical use, low and middle-income countries need and situations of crisis. Ketamine is a veterinary medicine and has anaesthetic purposes. The WHO Expert Committee looking at evidence, has come to conclusion of not recommending scheduling.
Committee recognises abuse of substance countries should take measures at national level.
Last executive board meeting at WHO, GENEVA. Resolution adopted WHO May, Ketamine is essential for surgery and primary care level. Within that resolution stressed importance of anaesthesia at primary care level and low and middle-income countries. We call for member states for these drugs to be available.
Concern of committee, placing ketamine under international scheduling would create barriers to its access which is not in the interest of patients and public health.
Chair: what is the criteria the WHO used?
WHO Brussels: Similarity between GBL and GHB. Because GHB has been scheduled and similar drug. Dependence potential, considered to be substantial. GBL has no major recognised therapeutic…
1,4 Butanediol has an effect on central nervous system. This has created serious concerns from the committee. Therapeutic usefulness almost none, propose placement under the schedule.
Chair: I open the floor any questions to countries or colleagues.
China: Regarding the ECDD report and ketamine , we have are concerns over dangerous properties, dependence potential, negative effect on central nervous system and another criteria, potential for abuse. Why is ketamine not recommended for control when PCP, which has similar chemical properties, has been in Schedule 1 for years?
Dependency in humans of ketamine are rare and in many developed countries it is mainly used for animals. In developed countries not used on humans even though it has high medical value. Likely hood of abuse, maintaining status quo.
The sentence ‘’Ketamine does not appear to pose risk’’ might be a view from status quo perspective. As members of CND, judging from continued efforts and the resolution from last year, we need to look at potential and further exploiting of Ketamine.
It is arguably that ketamine is not being abused on global scale- contradictions because there are public health concerns in regions.
WHO Brussels: Ketamine was critically reviewed based on data and facts. Dependency numbers are rare and are based on evidence by experts. Abuse of the drug has been assessed by The ECDD, although it has been low, abuse has been acknowledged. However, this is a localised threat, not a global threat.
Therapeutic use of Ketamine- has demonstrated therapeutic advantages. Maybe in developed countries there is not medicine of choice but in low and middle income countries it is. In crisis situations Ketamine is very useful. Ketamine is easy to use in a difficult context.
US: We have a procedural question- Regarding 26 substances, 13 were sent/chosen to be reviewed. How did the ECDD send 13 recommendations from the 26 considered by the committee ? How were they categorised and assessed?
WHO Brussels: For the first time ECDD involved in new psychoactive substances review made on basis of info. Shared by UNODC by EMCDDA as well as info. From National Authorities. Shared and exchange of info. Substances emerged. And also looked at availability of data. We tried to prioritise those with greatest potential risk to health, but also mitigated by availability of medicine. Reports on the remaining ones will be submitted in due course.
Switzerland: EMCDD report. Ketamine in included in the WHO list of essential medicines. Could you elaborate on what that means? What is the criteria for a medicine to be included in this list?
UK: At the 36th meeting, main recommendations were not revealed until very late in the year. We need time to look things over, before CND. Does the Committee have any plans in making reports available some time in advance?
Russia: 57th CND- We need to ensure availability for medical and scientific purposes but also need to prevent abuse. GHB- some doctors praise and some say it has negative effects but it does have therapeutic purposes. Concerning the ketamine, In Russia there are used only for veterinary purposes, not for anaesthetic purposes. If it is such a good medicine, why in so many countries is it not used as medicine of choice on humans? UNODC and INCB reports describe diversion, are WHO not concerned about this? Is it not possible to find a safer replacement anaesthetic for use in poorer countries? Ketamine is recommended to have national restrictions. Sometimes produced illicitly, request to comment on that. What are the prospects for introducing another medicine instead of ketamine? (Alternative to Ketamine)
WHO Brussels: Referring to Switzerland question: Essential medicines are put on the list because they are effective and safe. Ketamine itself has few risks in medical and low income settings (it has a therapeutic added value, safety profile, efficacious and safe). In high income settings, anaesthetic and painkilling options include opiate based gases that need equipment and close observation. 26 substances reviewed this year (highest ever) including 23 new psychoactive substances.
Referring to Russia Question: In high income countries there are other medicines which are used, like gases but you need sophisticated equipment, skilled workers, etc. which are not available in crisis situations and low income countries.
Netherlands: China and Russia, contested medical and scientific analysis. When it comes to medical and scientific issues for decision making, the views of WHO are determinative. If we don’t like the WHO being determinative, then we should amend section 2(5) of the 1971 Convention. Returned to conventions issue of ‘determinative’. Discussing WHO position is fine, but CND should not base decisions on anything else than their scientific advice. Russia and China welcome to discuss their advice.
France: We need the WHO. GBL AND 1.4 Butanediol….Does WHO have any figures on abuse of substance and can they share this with us? And regarding ketamine, could WHO clarify which countries/regions still use ketamine in medical procedures?
India: We understand that ketamine has medical uses, and also potential for misuse. Therefore, can see why not schedule 1, but why not schedule 3. Similarly, Mephedrone has no medical uses, so why not suggested as schedule 1, not schedule 2?
WHO: On Mephedrone, the recommendation was for schedule 2 because of a lower level assessment of harm or dependence potential.
Norway: We have been informed by Norwegian doctors that Ketamine is of great importance for them to do their work. Especially in rural places in Africa. So we are really confident in the ECDD recommendations. What How can ketamine be used in hospitals where there is no electricity, no gas machines or the doctor doesn’t have a big team?
Russian Federation: We Rely on the CND authority. We are mixing concepts, provision of measures which would end up with no more control. We are not here to propel a (regulation) agenda. Contesting the WHO is good for well informed decision.
China: Netherlands comments. UK intervention contesting WHO- as said by colleague of Russia these are legitimate questions. Ketamine has only 3 pages of information althought there have been many years of problems for some countries, so questioning WHO is legitimate. The ECDD is not answering questions substantially enough. In particular the India’s question about why scheduling under schedule 3 not recommended. We emphazise PCP is already being scheduled, and it is similar to ketamine.
Japan: Mephedrone recommended as schedule 2, but abuse potential may be underestimated on
NPS because of lack of data and experience. We are also reluctant around the recommendations on GBL.
WHO Brussels: Responding the France and Norway Ketamine Question, we have to say that Ketamine is on the national EM list of over 100 countries. Used primarily in Africa, Middle East and Asia, and in emergency/crisis situations. Can be injected, easily transported/stored. Repeated reason why ephedrine proposed for schedule 2. Concerning the Indian question on industrial chemicals. Conventions look at abuse and dependency even if it has no medical use. WHO committee is foreseeing conventions-discussion of risks and benefits. Accessible while preventing the abuse. Matter of seeking balance. Look at website for additional material- on different questions.
Chair : Thanks WHO for their presence and briefing. We will consult with secretariat for future video conference in order to answer questions. May be possible to do another one next month (looking round the room, this seems unlikely). Reiterated that these scheduling discussions will be restarted at the 6th March intersessional. Informals to be held tomorrow morning to discuss the UNGASS modalities, chaired by Portugal and Colombia ambassadors. Mentioned the meetings with Global Commission and SG of OAS – welcomed the contribution of these events to the debate.
Esbjorn then informed the room about the plans for CSTF, including the need for an interactive CS hearing before the UNGASS , and another one in the UNGASS agenda. He called for funding, and announced the list of names on the task force.
Agenda Item 2: UNGASS Preparations
Khaled Shamaa: (Chair, UNGASS Board): 57/2 preparations of UNGASS 2016 Draft resolution by Chair- procedural 69/200 the assembly decided CND- drug related matters. The advice was sought. 57/2 negotiations and adoption of this resolution. Last 29th jan 2015 we made progress further elaborating preparations. We will hold 5 interactive discussions at the 58th session of the CND.
Panellists from regional groups decided by today. The following panellists are considered: Michael Botecili, Paul Griffiths, Ruth Greifuss, Pier Venizzo (France), Daniel Rumburgha (Germany)
Concerning the Civil society task force. We will be Chairing by interactive discussions by members of the board. The presentations will be 7mins long, and those of the speakers from the floor 3mins.
Not to be subject to negotiations.
Khaled Shamaa Chair: The Ambassador of Portugal and Colombia tomorrow at 10am. On 12th Feb- former president of Portugal- 2nd event 19th Jan- Ambassador of Guatemala amongst others also met.
NGO: Civil society task force was finalised in Nov 2014. It serves to liaise between civil society and member states, and provides a comprehensive structure and participation of civil society. It has 27 members- two per region, two of them of affected populations. It will prepare UNODC civil society teams, lead regional consultations, and interactive civil society hearings. Funding is crucial.
Switzerland: How many meeting entitlements? Indications from Mr. Chair- how you plan to assign topics? It is very important to the intersessional work between March 2015 and March 2016 – how many intersessionals are planned for this period?
Chairman : The secretariat will produce a proposed timetable at the CND for the work to be done ahead UNGASS.
Norway: Practical interventions, not ready made national statements. These roundtables will be a mixture of civil society, member states, other UN organisations…will there be the normal CND plenary rules/procedures?
Chair: It is more of a forum format. Intro. Up to the chair of each session, to ensure that it is a free flowing discussion. Ask each one of you speakers, representatives, panellists need to be in an interactive mood. These participations will be concise points but not statements. (seemed to confirm that ‘interactive discussions’ means a free flowing discussion with all able to equally participate, with the Chairpersons empowered to invite any participant to speak in the interests of open debate.)
India – Is May 7th event intended to mirror the agenda of the UNGASS or something else?
Khalid Chair: It is important that the event gets on with substantive debate.
Italy : Clarification of time for panel speakers in round tables – 7 minutes in total. Health section will need to cover both topics in that 7 minutes.
Spain: Panels are useful but have been bitter sweet experiences in the past. There are positives and negatives to these debate formats, speaking time is allocated but people never stick to it and not all participants take part. We need to know exactly what topics, we need to avoid duplication of topics within a panel, and panellists need true interactive debate.
Panama: 5 regional groups, plus UN agency, plus CS rep – all have 7 minutes. Total of 50 minutes before open to floor. Also, very difficult to get all regional points into 7 minutes. Will NGOs be in these interactive debates, and if so, what role?
Khaled Shamaa Chair: We need to focus in saying what we want to say in 7 mins.
Nicaragua: Time is money. Flow of information and time management. Our currency is time so to speak is information, therefore we cannot be left penniless so it were, one particular comment we want clarified. The resolution that was discussed that will be submitted to UNGASS, addresses corporation, CND as policy making body. Are are getting involved in the CND as the preparatory body of the UNGASS- the support and assistance we can get in terms of receiving info, through you and the secretariat because we haven’t received much.
Chair : Coming back to CS question from Panama. There will be a CS panellist in each round table. Also, many CS will be present in each panel as observers, and will therefore have the right to ask to speak.
Arab States: We need clarification on one point. Will it involve mainly member states? Or also international and regional organisations?
Chair – As with previous response, all attendees can contribute on an equal basis, including regional groupings.
Agenda item 3: 26th Feb comments to be sent to secretariat. Shamaa passed back to Thai Chairman.
Proposal by WHO- consult with member countries whether written or video answers by WHO delegation.