Agenda Item 8 – WHO advice and scheduling

CND Chair – WHO recommendations on scheduling will be acted upon at CND 2016. At November meeting of 37th expert committee on drug dependence (ECDD) in Geneva, it considered 9 substances including ketamine and cannabis. Draft document E/CN.7/2015/CRP.10 on this has been made available to Board. WHO expert will deliver update to CND.

Dr Gilles Forte, Policy, Access and Use, WHO – role of the ECDD is set out in 1971 and 1972 conventions, including recommending scope of control. ECDD is responsible for considering whether substances should be placed under international control or not. It considers harms to health and therapeutic use of the substance in making its recommendation, which CND will vote upon. So the recommendations currently developed will be subject to a vote at the CND in March 2016. As of today there are about 250 substances, including medicines, that have been put under international control. ECDD will also look at whether the substance is convertible into a substance under control, as required by 1961 convention. In relation to the 1972 convention, ECDD will consider whether the substance will lead to dependence or central nervous system stimulation, and whether there is sufficient evidence that it can lead to abuse under 1971 convention.

Together with UNODC, INCB and EMCDDA, we have done some work to consider substances that are most harmful. We compiled an early warning advisory to pre-select substances for review by the ECDD, with assistance from UNODC. EMCDDA also has an early warning system that as of May 2015 was monitoring 450 substances. ECDD also consider proposals from Member States, and substances under surveillance from previous ECDD meetings. As a result of all these consultations and process, we have developed list of pre-selected 20 substances and compiled data to form recommendations to narrow down the list to 9 substances to be reviewed, and an update given on ketamine and cannabis, by the ECDD, including: MT-45; acetylfentanyl; a-PVP; 4-FA, and; 4,4’-DMAR.

The review process by ECDD includes evidence-based, thorough review of published literature, other data eg. pharmacovigilance, poison centres, questionnaires completed by member states. As a result, recommendations by ECDD for scheduling include: acetyfentanyl in Schedule 1 and 4 of 1971 Convention; MT-45 under Schedule 1; PMMA under Schedule 1 under 1971 convention; a-PVP, 4,4’-DMAR and MXE to be under Schedule 2 of 1971 convention; 4-FA to be under surveillance because not enough evidence for a scheduling decision, and etizolam under critical review.

Update on cannabis, according to CND Resolution 52/5: update on scientific literature was presented and reviewed including the pharmacology, toxicology and claimed therapeutic applications. ECDD requested secretariat to begin collecting data towards a pre-review of cannabis, cannabis resin, extracts and tinctures of cannabis at a future meeting.

Update on ketamine, according to CND Res 58/2 on levels and consequences of abuse and new potential medical applications identified. Levels of ketamine abuse appeared to be declining in many countries world-wide. Potential new therapeutic uses were identified including depression and refractory statues and epilepticus. ECDD unanimously agreed that it found nothing in the updates, nor in what was disclosed during its deliberations, that would lead to recommend a new pre-review or critical review of ketamine with a view to potentially change its standing recommendation of 2014 that ketamine should not be placed under international control. Ketamine has been reviewed in 2006, 2012 and 2014, which all decided ketamine shouldn’t be place under international control. So neither a critical review or pre-review is required.

On options for improved data on NPS, WHO is raising awareness amongst MS on importance of collecting information on harm and prevalence for prioritizing and evaluating NPS (at national and international level).

UK – thank you for keeping WHO informed, in accordance with CND resolution. Regarding NPS and scheduling, what do we do where there is some evidence of harm but not enough to warrant it being put under international control? Ask WHO to work proactively with MS to collect data on substances on list so that they are regularly reviewed and taken off list where appropriate. Please inform CND on provisional timetable of ECDD meetings and which substances are being reviewed to enable MS to be  aware of them beforehand and support ECDD considerations.

China – NPS poses grave threat throughout world. We hope WHO would be more transparent, effective, and responsible in this work. We hope WHO should in more balanced way, relationship with scheduling and availability of substance for medical use. We express regret and disappointment with regard to WHO decision on scheduling ketamine. CND and WHO have been discussing ketamine more than once, and in East Asia, we have seen increasing trend of ketamine abuse which poses real and tangible harm to human health and is a cause of serious crime such as money laundering and murder. Believe there is increasing trend in use and risk of ketamine use is real. We do not deny ketamine has uses in medical purposes, but we can do a good job in following 1971 convention and still retain use for medical purposes. We saw that WHO found that processed red meat can increase harm to human health, I am seriously considering whether I should eat more white meat or become vegetarian. I understand this decision will have impact on meat industry and increase consumption of poultry and fish. But we believe decisions of WHO is responsible and carefully made, but in regard to ketamine we believe WHO needs to be cautious and that CND needs to continue reviewing effects of ketamine.

United States – UNODC Global SMART programme and INCB ION programme should continue to collect information and use it in operational way and share it with WHO. We note that provisional controls can be employed and commend UK on using these controls initially under 1971 convention until WHO could review substances. We encourage MS to consider domestic controls as many other MS have done. Note appreciation for clarifying review process and encourage ECDD to continue along those lines as UK has noted, it is important for MS to receive this information as soon as possible and to weigh in on review of whether substances should be under international controls. As substances are chosen, and there are opportunities to discuss substances further, we welcome being notified, as well as on compilation of ECDD panel. We welcome more interaction and communication with ECDD, further encourage coordination in that regard. Will be useful to look for useful innovation and flexible controls regarding NPS at international and national levels.

Dr Gilles Forte, WHO – it is part of WHO mandate to review dangerous substances as they can endanger large numbers of people, and we take it very seriously. It is true that if we look back at work of previous committees, there were not that many NPS to deal with. But we are trying to improve the way ECDD works, and working together with EMCDDA, INCB and UNODC, so it is a collective responsibility that we have in addressing dangerous substances. I take seriously the concerns noted by US and UK and will make available ahead of time the substances planned to be reviewed. We do brief missions in Vienna and happy to be able to establish this mechanism here thanks to Secretariat. Keen to continue in this direction and engage with you, sharing transparently our methods and taking account of your suggestions to make it work better. It is now mandatory for us to disclose the biography of experts on the panel on our website but if there is anything more we can do, happy to discuss. Data collection is a big challenge ahead of us and happy to work with international agencies on this, but if MS want to share more on this we are happy to work with that. There is need for ECDD to reflect on innovative ways of working and to address large number of substances on list (almost 500), this will be high on our agenda in 2016.

In response to China on ketamine, we do acknowledge the challenges faced by China and other countries in terms of abuse, and making all efforts to engage with MS to collect more data on abuse and dependence potential, side effects and deaths caused by ketamine alone. We cannot say we have striking data to show responsibility of ketamine in terms of creating dependence, serious side effects and deaths to the population. As a public health agency, important that we balance all this and we are trying to do all this in a transparent way and this has been reported by the ECDD. At the moment, the therapeutic value outweighs the dependence risk for morbidity and mortality. We are open to continue to collaborate with China on this. We have been going to Beijing and talking with UNODC on this as well, and hope to develop a closer position on this. There are challenges that can be addressed at national level and we are happy to engage with MS on that.

Debate around the UNGASS roundtables

UNGASS Board Chair – on results of informal consultations, Vice-Chair of UNGASS board Portuguese Ambassador Almeida has been very much leading discussions, I will let him update you.

Portugal – informal consultations on preparations for UNGASS have reached difficult point but a consensus on draft resolution E/CN.7/2015/L.16 ‘Preparations for the special session of the General Assembly on the world drug problem to be held in 2016’ has been reached. Now on screen.

UNGASS Board Chair – as you can see on screen. This resolution is now adopted.

Colombia – this didn’t include everything we wanted, but wish to join consensus

Mexico – We wish to echo the comments of Colombia

CND Chair – Draft decision of reconvened session will be forwarded to ECOSOC. The decision is available here. This now concludes work of the 58th Commission.

 

Adoption of draft resolution  E/CN.7/2015/L.16 – Photo courtesy of UNODC

UNGASS Board Chair – Thank CND Chair Srisamot for high level of professionalism.

CND Chair – Thank everyone for their hard work, and hope this will carry onto negotiations in January. Now we have to elect bureau of 59th CND: a chairperson, 3 vice-chairpersons and a rapporteur. According to rotation system, chairperson has to be elected amongst Eastern European states, who have elected Ambassador of Czech Republic. As there is no objection, please come take your place at the podium.

Czech Republic – Thank you Srisamot for steering us so favourably during the 58th CND. Now have to elect vice-chairpersons, the follow have been nominated according to rotation system: Norway for West Europe, Brazil for LAC, and Nigeria for Africa for the vice-chairpersons, and Korea of East Asia group for the rapporteur. Extended bureau will also be composed.

We will meet again in March for CND and special UNGASS session.