Agenda Item 6: Implementation of the international drug control treaties

a) Challenges and future work of the Commission on Narcotic Drugs and the World Health Organization in the review of substances for possible scheduling recommendations

WHO: Who is responsible for evaluating substances and whether they should be scheduled. They also decided which convention they are scheduled. Evidence is essential to our role. The adverse affects of the substance. Potential for abuse and dependence. The public health data. We have carried out a critical review of a number of NPS. Only a short period of use. There are many NPS, so hard to survey all of them. 11 substances have been reviewed and have been put on the WHO’s surveying list. EMCCDA and member states have been apart of this review process. The mechanism for NPS surveyance has the potential to raise awareness of the public health risks.

UNODC: NPS raise many challenges. These substances are emerging at a very fast pace. There has been a threefold increase in the number of such substances since the Commission first expressed concern about them. NPS pose many risks, especially to young people. We have produced a new overview of trends and challenges of the NPS phenomenon. The report highlights measures such as national legislative responses and international cooperation can address this problem. Some progress has been made, but this must continue. The identification of these substances must be scientific and comprehensive, to help prevent abuse. Very few member states are equipped to achieve this, however. We must effectively communicate the risks of NPS, and reduce supply through the internet. We must prioritise these substances, given their harm, for action. We continue to implement the SMART programme, and report to the WHO as they make scheduling decisions.

China: the growth and spread of NPS has caused great harms. Ketamine is one particular example. We accept that the UN has refused to schedule ketamine. CND in its resolution called on all states to prevent diversion from legitimate sources. China is of the view that there is a need to schedule ketamine for international control. Meanwhile, PCP, which is similar to ketamine, ahs been included in schedule 4 of the 1971 convention. This will ensure medical availability. We concur that the discussion should be postponed until more data is available; following the concerns expressed my member states. We would like to cooperate with MS to expand the data available on ketamine. We would like to call on EECDE to take a comprehensive and balanced look at scheduling.

EU: Narcotic drugs can be essential for the relief of pain. They should be made available for these purposes. Ensuring availability has gained importance in the run-up to UNGASS. Conventions are not intended to hinder access to controlled medicines. NPS are proliferating at a significant rate, posing a challenge to drug policy. We must put the most prevalent and harmful NPS under control.

Thailand: We endorse China’s proposal to control ketamine, under the 1971 drug convention. In reality, Thailand has already put ketamine under domestic control.

Japan: Thank WHO. NPS is an emerging new threat for the international community. We have contributed to the global SMART programme by the UNODC. We would urge this and the early warning advisory to be used by all member states. Japan is seriously concerned by actions by some countries to legalise cannabis, for both medical and non-medical purposes. Medical legalisation must not be a front for legalisation for recreational use.

Nigeria: We thank the WHO for the work of its expert committee. Ketamine use appears to be declining in many countries, and Ketamine has many medical important uses. It is a vital anesthetic in many developing countries. However, we believe that in countries where ketamine abuse is widespread, measures should be taken to control it.

Netherlands, on behalf of the European Union: I have the honor to speak on behalf of the EU and its member states. During war and emergencies, Ketamine is often the only viable anesthetic. It is easy to administer and carries few risks. It does not pose a significant risk to global public health, but we are willing to assist in tackling its recreational use.

Iraq: regarding Item a – the challenges of the intensive discussion we have had over NPS. We are facing a big challenge in NPS. It remains way too vast. I know we receive requests all the time to schedule items, but we cannot schedule them all. Drugs are the primary source of income for terrorist entities to purchase assets. We should also highlight areas under the control of state authorities, including demand reduction.

Canada: In some countries, scheduling at the international level can result in restrictions on essential medicines. We are pleased that the WHO Expert Committee did not recommend the scheduling of ketamine. The scheduling of seven substances will be decided on this week. We praise the SMART programme, and urge member states to participate in it. NPS must be identified and reported.

c) International Narcotics Control Board

Werner Sipp, President of the INCB: I wish to emphasise that the supply of medications containing narcotic drugs for pain relief is still insufficient. The thematic chapters of our annual reports over the last 20 years have addressed topics of particular concern – social cohesion, drugs and corruption and much more. Our annual report was launched on 2nd March. Here are some details of that report. It focuses on the health and welfare of mankind, in line with the three UN drug conventions. The conventions ensure the availability of controlled substances for medical and scientific purposes. Promoting health and welfare requires demand reduction efforts. Social harms of drugs must also be addressed. We reaffirm the principle of proportionality of punishment. Alternatives can be used. Preventing and reducing drug abuse should be accompanied by other efforts – applying scientific knowledge, humane thinking and human rights, proportionality, preventing harm from drug control, reducing the health and social consequences of drug abuse. The conventions do not call for a war on drugs. Some of the militarised policies in some countries, over-incarceration, denial of medical treatment, and inhumane approaches, are not in accordance with the principles of the conventions. We don’t need new approaches to drug policy. We need to simply apply the principles of the existing UN conventions. Reporting is crucial to the functioning of the international drug control conventions. It’s essential to enable the Board to monitor the licit trade in controlled drugs for medical purposes. Many member states fail to submit annual estimates and statistics. We regularly investigate discrepancies in the international trade of psychotropic substances. Inaccurate reporting undermines our analysis of the licit trade. I urge you all to submit full information by the deadline of 13th June each year. We call upon states to ensure their national authorities are sufficiently resourced and trained to meet the requirements of the drug treaties. The Board stands ready to assist. Abuse of prescription medicines containing narcotics continues to be a huge threat to public health. Opioids continue to be overused in some countries, while underused in others. Diversion of precursors has been reduced, and there has been greater cooperation international on this. The Board encourage the PEN Online system for monitoring trade in precursors and identifying suspicious transactions. Member states should also use the PICKS system. NPS remain a significant challenge; early detection and collaborative efforts are key. We need to recognise the importance of sharing real-time information. We have continued our work with Afghanistan, providing support to help improve the drug situation in the country. Despite progress, the situation remains serious. Our work would not be possible without the cooperation of member states, and we count on it continuing.

EU: We support an integrated approach to drugs, in full respect of human rights, as mandated by the UN drug conventions. We welcome the INCB’s call for the abolition of the death penalty for drug offences. Controls can lead to the insufficient availability of opioids for medical purposes. We are concerned about reported negative trends, including the rapid spread of NPS. We must include these substances in prevention programmes. We support the use of a shared evidence base, through the EMCDDA and other regional bodies. We encourage the involvement of civil society, including NGOs, drug users and other affected populations. The EU shares the INCB’s view that strengthening partnerships with the relevant industrial sectors is key to prevent the diversion of precursor chemicals.

Pakistan: We fully endorse China’s suggestion to schedule ketamine and limit its diversion. I urge member states to consider this proposal. Scheduling is not banning – it is simply regulating licit supply.

China: We have taken note of the INCB’s annual report, but express reservations about some parts. The INCB’s role is to monitor; it is not an advisory role – comments on the death penalty therefore go beyond its mandate. Each state has the right to adopt its own drug policies, as are appropriate. The president of the INCB exchanged views on international drug policies, UNGASS, NPS and chemical precursor control. Mr Sipp acknowledged China’s efforts, and we will continue to learn from other countries’ approaches.

Venezuela: We appreciate the role played by the INCB, as the only organisation with the competence to oversee the implementation of the UN drug conventions. We would like to stress our commitment to the three international drug conventions, and wish to ensure you of our ongoing participation in submitting relevant information to you. We endorse the INCB’s 2015 annual report.

Brazil: We remain committed to the three UN drug conventions, and other international agreements on drugs. We have benefited greatly from the materials and resources provided by the INCB. We appreciate the work of the UNODC in strengthening the control mechanisms in Brazil. NPS is a challenging problem. We are committed to finding solutions to this challenge. The side event we hosted yesterday represents part of our response to this problem. We thank Germany and the UK, who have consulted with us on the issue of Sativex. And we thank the INCB for its expertise.

Mexico: Mexico welcomes the 2015 annual report by the INCB. We agree with the call to proceed with a critical assessment of the global drug control system, and to look at how the UN drug treaties have been implemented in practice. The Mexican government has undertaken many efforts to ensure compliance with the treaties. We shall continue to work together with the INCB to help strengthen the drug control system.

Nigeria: We recognise the important role INCB plays in supervising the international drug control treaties. We take note of the INCB’s 2015 report. Progress has been made in the area of drug control and drug treatment. We thank our development partners for their assistance. We continue to work with the UNODC on the fulfilment of its mandate.

US: We reaffirm support for the international drug conventions. The INCB is the guardian of these treaties. The INCB remind us to ensure essential medicines are available and accessible. The goal of our regulations is to regulate appropriate access and ensure scientific and medical uses. We must hone our systems and improve the disparity in access to medicines such as opioid analgesics. The INCB code of conduct provides guidelines for industry, and for governments to engage more with the private sector. The INCB identifies the growing problem of NPS. The CND’s role in responding to this challenge is essential. Closer collaboration between UN agencies involved in drug policy is necessary. The UNODC’s global SMART surveillance list is useful in tracking NPSs. We urge member says to make use of these tools.

d) International cooperation to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes while preventing their diversion

INCB: Indispensable, adequately available, and not unduly restricted. These are the fundamental principles that countries should apply to ensure availability of internally controlled drugs for medical purposes. Has not yet been met in a grave number of countries. Around ¾ of global population does not have access. INCB special report on the matter. Inadequate opioid availability related to AIDS seems to be pronounced in sub-Saharan Africa. Pronounced in low and middle income countries. Availability of psychotropic substances influenced by social and economic factors, including capacity of health care system and medical therapies. Europe and Americas have the highest average consumption. Economic or structural incapacity. Impediments to availability include lack of awareness/training, and fear of addiction. Legislation and regulatory systems, health systems, affordability, training of health care professionals, education and awareness, benchmarks, and improving estimates are all key areas for improvement. Member states need advice, training, and resources to address the problem. Improve cooperation among all stakeholders involved to improve sharing of expertise, resources and technical support.

UNODC: There is a global programme dedicated to the problem of essential medicines. Belgium has lent its support to work in the Democratic Republic of Congo through this programme. We hope to expand our programme to Panama and Antigua by the end of 2016. Many thanks to those partners who have strived for more suitable access to palliative care medicines. This is not an insurmountable problem; INCB has identified the barriers, and we stand ready to help overcome them.

WHO: Improving access to controlled medicines. Lack of access to morphine, and psychotropic substances for epilepsy, pain management, opioid dependence, obstetrics, and surgery. Considered essential medicine. Redoubling of international efforts. Countries with low resources and capacity the most vulnerable. Obligation to prevent misuse and non-medical use, but diversion has received more attention than ensuring adequate availability. Committed public health approach must encompass availability and access to medicines for treatment. Supporting member states efforts towards achieving this objective. As UN specialized agency on health, articulating evidence based policy guidance. As part of standard setting mandate, WHO carries out regular reviews, including for controlled medicines. WHO remains an active advocate of balanced drug policies with access to healthcare at their core. Committed to intensifying our work. With SDGs setting new targets for access to medicines, look forward to enhancing collaborations to protect human health and welfare.

International Association for Hospice an Palliative Care: I thank INCB for the new Supplement, and for the attention at UNODC on this topic. I would also like to recognise the hard work of my colleagues at WHO on improving access to controlled medicines. I also thank the colleagues in member states for the hard work they have done on the section on availability in the Outcome Document, which reflects the intense interest in this topic compared to the one sentence in the 2009 Political Declaration and Plan of Action.

WHO calls many of these controlled medicines essential, meaning they must be available, affordable, and accessible in a public health system, but as we have heard, more than 5.5 billion people live in countries where they are de facto unavailable or unaffordable. This is because there is the huge knowledge gap — at all levels of government, as well as in the healthcare professions, about their rational use, a knowledge gap created by the drug conventions, which contain minute instructions to competent authorities about how to control supply, but not how to ensure provision. Only synergistic multi-stakeholder collaborations convened by WHO, in coordination with INCB UNODC, and civil society, can ensure rational provision throughout the healthcare system.

My organisation, IAHPC, has been modelling the way for these collaborations by holding what we call opioid availability workshops throughout Latin America to help countries provide these essential medicines.

So far we have conducted 13 such workshops, convening prescribers, regulators, patients, and government representatives to identify unduly restrictive legal barriers, and develop practical action plans to eliminate or minimise them. WHO could immediately help to implement these plans by mobilising focal points in each country to provide technical assistance. Of course, WHO must also convene such workshops in other underserved regions such as East Africa, Asia, and the Pacific Rim countries.

Clearly this sort of effort requires sustainable earmarked funding and political will, both of which have been in short supply until now. Until now, this issue of unavailability has been off the radar of member states. Now, as the CNDs draft Outcome Document shows, it is dead center. The Human Rights Council acknowledged the issue of unavailability last year, and countries at this year’s EB meeting highlighted it, urging WHO to situate drug policies on solid public health foundations.

Finally, to close, I urge each and every one of you who make policy in your countries to go on at least one home visit with one of the hospice and palliative care teams in your country, or to tour an outpatient clinic or cancer ward in a public hospital to see for yourselves the difference correct prescription of a controlled essential medicine such as morphine can make in the lives of patients and caregivers. It restores the miracle of rest, dignity and freedom from fear to people who are extremely vulnerable and in extreme, mortal, distress; morphine is cheap to produce, and healthcare providers can learn to prescribe it — even nurses prescribe in Uganda because of astronomical doctor patient ratios in Africa — minimising diversion and abuse.

Viva Rio / YouthRISE: We need youth-oriented drug policies. We have failed to achieve the drug-free world called for in 1998. We therefore need to consider new approaches. Drug prohibition comes from the time when homosexuality was criminalised and abortion was a crime. Modern attitudes to drug use must demonstrate new understandings of people who use drugs. The lack of support and clear information, combined with an attitude focused on criminalisation, undermines human rights. The UNGASS draft outcome has no clear language about the promotion of harm reduction – this must change. Harm reduction is a key tool in protecting health. I’d like to, on behalf of youth, add harm reduction to the UN Convention on the Rights of the Child. Families, individuals, communities are all affected by drugs – plagued by social stigma. Youth who use drugs or are addicted to drugs are worst affected by current drug policies. Young people require access to healthcare and harm reduction. Forced rehabilitation services fuel health problems and distrust in authorities. Youth have been damaged, stigmatised and discriminated against by drug policies around the world. This UNGASS should bring a new step towards a better future for our youth.

Canada: Supports calls for international cooperation to ensure the availability of controlled substances for medical and scientific purposes. We understand it can be challenging to establish systems to ensure availability in rural and remote communities. Targeted and remote strategies. We have issued exceptions under our Controlled Drugs and Substances Act in order to supply narcotics to remote communities. Registered nurses can provide care involving narcotics if needed in these areas. Look forward to continued international cooperation on this issue.

SSDP: Mr Chair, distinguished delegates and dear colleagues, Students for Sensible Drug Policy is a global grassroots NGO working with thousands of youth to acknowledge the many realities of drug use, drug markets, and drug control in our communities. Working with our global youth allies, we have conducted an extensive consultation with thousands of youth from every continent, organized into hundreds of chapters, who have extensive, on-the-ground experience. The paper was also reviewed by our Advisory committee comprised of internationally-recognized experts and senior professionals with years of experience in drug policy, for which we thank them. We believe Punitive drug policies have failed our generation and our society, They are impeding the development of young people and they are impending full enjoyment of basic human rights. Governments typically justify their drug policies by invoking the need to protect young people. but our voice has often been absent from the debate: if policies are being implemented in our name, our voices must be heard. We are here to speak for ourselves and for thousands of youth around the world when we say: …. We want a drug policy that embraces harm reduction, which should be enshrined in the international drug control conventions, as a matter of urgency. We want a drug policy that creates a culture of safety around drug use. We want a drug policy based on evidence, compassion, health, and human rights. In line with these principles, we hereby encourage UN Member States to: 1. Acknowledge and invest in harm reduction services such as drug checking kits, supervised injection facilities, educational material about minimizing risks associated with using drugs, and nightlife harm reduction; strongly encourage states to provide these services and to decriminalize the provision of these life-saving services. 2. Conduct an evaluation of international drug policies with regard to children and young people, seeking compliance with the stipulations of the UN Convention on the Rights of the Child, The World Health Organization, and other United Nations agencies and relevant treaties. 3. Call for evidence-based, age-appropriate education that aims to provide objective information on drug use that prioritizes the reduction of harm rather than relying on fear and intimidation. Young people use drugs, and 50 years of the War on Drugs has done little to change this. We need education that recognized this fact. 4. Call for the decriminalization of drug use and associated penalties for the possession of drugs. This is particularly important for young people, students, homeless youth, and members of marginalized communities who suffer mental stress and long-term consequences from incarceration and whose future employment and educational prospects are often severely affected by criminal records. 5. Allow and invest in research related to medical benefits of psychoactive substances such as cannabis, psilocybin, ayahuasca, ibogaine, and MDMA. Medical and scientific research of these substances has been severely limited due to regulatory and financial obstacles. Here we underscore the need for a drug policy approach which prioritizes medical and scientific research and is grounded in evidence. 6. Further encourage the UN to work to ensure active and meaningful participation of youth and youth-related organizations in the development, implementation and evaluation of drug policies and programs. We welcome the UN’s initiative in appointing an “Affected Populations: Youth” representative as a member of the Civil Society Task Force. However, we are disappointed in the overall lack of opportunities presented for youth to engage in these discussions at the international level. WE believe the following step is crucial to include the youth voice: We invite all member states to include a youth member on any delegation to future sessions, meetings, and events regarding drug policy and request that side events focusing on youth are prioritized. We sincerely hope that the upcoming Special Session is, as expressed by Secretary-General Ban Ki Moon, a forum for “wide-ranging and open debate that considers all options.” It is critical that international bodies and Member States consult and act on the input of youth. While the motto of UNGASS is “A Better Tomorrow for the World’s Youth”, we wish for a drug policy approach which seeks a better tomorrow with the world’s youth. Thank you very much, Mr. Chair.

e) Other matters arising from the international drug control treaties

UNODC: The multilingual dictionaries on drugs and precursors has been updated and released prior to the 59th session. To date, 200 national laboratories have benefitted from the support of the UNODC. Thousands of samples have been sent to labs for analysis around the world, to help with the growing trend of NPS use. UNODC continues to work closely with WHO, INCB, and EMCDDA, using its early warning system to identify the most prevalent and persistent NPS, in response to resolutions 58/9 and 58/11. In this context, we are pleased to inform you that a new commission on NPS will be held in Geneva in 2017.

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