Side event – The drug control conventions: a multi-faceted framework for the promotion of the health and welfare of humankind

 

INCB President Werner Sipp (Chair): opens side event

 

Bernard Leroy – INCB Board member: Drug conventions requires states to legislate in various fields, on institutional infrastructure for domestic and international drug issues, international justice sector cooperation, among others. When we read the documents that relate to drug control objectives, one of main areas is on drug-related criminality, including prevention of drug crime. During negotiation process, states reiterated that while resources have been poured into investigation and prosecution of drug-related crime, the same cannot be said of prevention. States have affirmed shared commitment to sharing best practice approaches to drug-related criminality. When individuals are affected by drug abuse, the outcome document recalls conventions that call for alternatives to conviction and punishment, including measures to foster rehabilitation and reintegration. The Board has emphasized need for proportionality and human rights in application of criminal justice responses.

At this UNGASS, states again acknowledge complex nature of drug problem requiring international cooperation, including at regional level, and intelligence sharing, border control strategies and provision of technical assistance, particularly for transit states. The outcome document highlights what the Board has repeatedly said on responding to money laundering. The outcome document also draws attention to need for responses to micro-trafficking and new psychoactive substances. These responses do not need to involve punishment or rooted in the criminal justice system. Some involved in drug-related crime do so for economic reasons and should be offered assistance such as in establishing alternative livelihoods.

The outcome document shows that the three conventions continue to provide a framework for effective responses to drug-related criminality. The Board reiterates its readiness to assist member states.

 

Jagjit Pavadia – INCB Board member: The conventions when implemented appropriately provide an effective response, including to ensure adequate supply of medicines while preventing diversion. The system for preventing diversion provided for in the treaties must also ensure adequate provision of medicines. The Board has made available tools, mainly guide in estimating requirements, reflected in 2(e) of the draft outcome document. The outcome document also emphasizes need for exchange of information, which is important because of the use of the internet in drug supply and proliferation of NPS. Precursor control is a form of prevention in supply reduction because aim to deprive organized crime from obtaining chemicals for drug manufacture. Articles in 1988 convention are crucial for preventing diversion of precursors. The PEN online system, Project Prism, and cooperation with industry are a few of the mechanisms that are involved in implementation of balanced strategy.

 

Richard Mattick – INCB Board member : my specialization is on the health and welfare aspect of the treaties, which are not well recognized. The ultimate goal of conventions is on individual and public health, mentioned in all the treaties. Conventions require governments to take all practical measures for prevention of drug abuse, early identification, education, aftercare and social reintegration.

In recent years, new challenges appeared with NPS and with injecting drug use, the need to introduce programmes to reduce injection of drugs including sharing of needles and prevention of overdose deaths. The conventions clearly indicate there should be provision of human measures including medically based treatment, eg. OST and NSP. Harsh treatment programmes including use of physical punishment are not only inhumane, they are not evidence-based and do not solve the problems of drug dependence. It is essential that treatment services are targeted to groups such as women. Treatment services should not be provided in isolation but as part of continuum of care including prevention, aftercare and reintegration. Board encourages member states to implement a balanced approach.

Many countries have accumulated experience and this should be shared, and is most needed. The Special Session is an opportunity to affirm drug policies and practices, while recognizing there are limitation to current approaches. There should be reinforcement of what works and changing what doesn’t work.

 

Sri Suryawati – INCB Board member: States should ensure adequate availability of medicines. Although there has been improvement, there is still significant imbalance in availability of narcotics and psychotropic substances in different parts of the world. Around 3 quarters of the world do not have adequate access. Less than 17% of the world have adequate access to pain relief medication. Inadequate or no access to controlled drugs remain a problem.

The recent 2015 survey of INCB reveal that major impediments identified by member states to narcotic and psychotropic substances include lack of awareness by medical professionals, fear of addiction, sourcing and onerous regulation. More member states highlight problem of financial resources, problems in sourcing and high costs of medicines. INCB recommends member states and stakeholders work together to ensure strengthening health infrastructure, ensuring opioid analgesics are affordable and medicines covered by health insurance schemes and affordance, ensuring healthcare professional are capable of issuing medicines in rational manner, reduce resistance to prescribing opioid analgesics and other medicines, report to INCB, etc.

In 2016, there is no good reason why people around the world should go without medicines they need. INCB will continue to ensure states have adequate availability and rational practices in prescribing them.

 

Questions from Canadian SSDP: the existing paradigm of drugs being inherently abusive – will this ever change?

Reply – INCB President: the conventions say that use has to be limited to medical and scientific purposes. The question of whether other uses should be allowed could be discussed by member states, but for the INCB the wording of the convention is binding for us.

Reply – Bernard Leroy: The interpretation of ‘medical’ use is up to the states. I think there is room for flexibility on ‘medical purpose’. Conventions say that states have obligation to adopt as a criminal offence in domestic law, the possession for personal consumption, purchase or cultivation of narcotic drugs. There is some flexibility. Penal offences, criminal offences, doesn’t mean imprisonment, it could be a fine. We have no problem with states using administrative sanctions. On the point of the criminal offences, it is up to the states. It is not the role of INCB to make a decision on this point.

Reply – Richard Mattick: I’m not sure your question was answered. The conventions are written by the countries not the Board. Whether they are likely to change, I think that change will be somewhat limited, unless governments are able to accept uses of drugs other than for medical and scientific purposes.

 

Comment from Esbjorn: welcome your statement this morning on the mandate of INCB. From civil society, some say they would like to see opening of conventions, others say there are sufficient flexibilities in the conventions. We welcome your ongoing input on this.

 

Question from French-speaker, exchange with INCB President – summary by President of the exchange: the lady said even use of cannabis for medical purpose is dangerous and shouldn’t be allowed. The President said its use for medical purposes is accepted.

 

Question from Katherine Pettus, IAHPC: The President’s statement this morning was excellent. In the outcome document, there are 6 paragraphs on ensuring access to essential medicines compared with almost nothing before. There is far more global attention to this now, and I call for redoubling of efforts, to collaborate more extensively with WHO, ILO and other involved agencies to solve this problem. If we really are to solve this problem we need all agencies involved. You are doing a great job, but there is more to be done.  I know there is sovereignty issue, and I am a theorist, but you can talk to policymakers for example. We need more to be done, and I think you can do it.

 

Werner Sipp: In this year’s report, we have a better analysis on what is happening and we have better recommendations. We need to have analysis on why the situation is what it is, and the reasons are very different in each country. It might be the regulatory system for example, or a lack of training, the cost and many other reasons. The combination of reasons can be different in each country. All we can ask of governments is that they check on what can be improved. We know that the governments most affected by disparity, many are not able to follow these recommendations. That’s why we call on the international community to offer assistance. Countries need help to improve legal situation, to reduce regulatory barriers. This is a task for international community, and this is one of the key recommendations in this year’s report.

Richard Mattick: I think the members of the Board agree with you. There has been a change and attention is coming around on whether we intervene politely or collaborating more, not only with international agencies but also with palliative care groups. The Board is also pursuing change in a number of countries to assist particular regions who need help and we are keen to continue that work. That does require funds but the Board is motivated to continue it.

Katherine Pettus: do you mean clinical training?

Werner Sipp: No we mean for the competent authorities, because many are not able to assess need. If they gave us figures of estimates on consumption, we can know if they are not realistic. We try to train the personnel in competent authorities to allow them to assess better the realistic need in their country.

 

Question from student studying impacts of drug policy in Africa: what language in the outcome document does the Board consider limiting in its own aims? How does the Board hope for countries to implement evidence-based treatment?

Richard Mattick: in INCB reports, there are commentaries on some regions failing to implement evidence-based treatment. They are not happy with that. Evidence-based treatment is not just OST but also humane treatment options for example.

Werner Sipp: As Richard said, we collaborate closely with countries. Our possibilities are limited, we cannot force countries to do anything. We can urge them, and we do that very often. The outcome document is a governmental instrument. Our communications with the government is a bilateral one. All of the crucial questions under discussion are being tackled in the annual reports, eg. proportionate sentencing.

Sri Suryawati: On issue of improving access to essential medicines, it is very complicated. First of all we start with stigma. It is responsibility of the state to make it available, as it is a human right. Then the estimated requirement by member states may not be accurate, and if they had previously submitted low estimates, they have to mobilise many stakeholders to produce new estimate. What we need to do is focus on countries with very low level of availability and make a re-calculation, and we make a lot of efforts to work towards this.

 

Question – journalist in Washingto DC: with 24 states legalizing marijuana, is it the position of INCB to consult with DEA about rescheduling it or provide them information to make a decision or is it closed doors?

Werner Sipp: this is a concern we have for several years, and this is a subject we discuss with DEA. First of all, where cannabis is for medical use, it is permissible under the conventions. Second, to regulate provision of it the convention sets out some requirements, eg. set up cannabis regulation agency, and this is not implemented in the 24 US states that allow medical cannabis. We have devoted one chapter in a previous annual report on this topic and we reiterated to the US Government to implement these pre-requisites.

Follow up question: Do you think it should be re-scheduled or de-scheduled?

Werner Sipp: Scheduling is not out job, it is for governments and the WHO to decide on what should be scheduled. We do not encourage or recommend scheduling in one or the other sense. We are not able to anyway. This is the role of the WHO Expert Committee on which schedule should be put in which schedule. If it is considered as a substance that can be used for a medical purpose, we say yes you can but you must follow the rules.

Richard Mattick: are you talking about the scheduling in the US? [Yes] I don’t think this will make much difference.

Jagjit: the conventions have very strict rules on opium licensing and regulation, and there are rules that apply to cannabis as well. These rules are not being followed.

Werner: Need to clarify that the US states have different regimes on regulating cannabis.

 

Esbjorn: Many of our members are in the Global South. We now have information beforehand about the countries that the INCB will visit, so that we can advise on the NGO groups that the INCB should meet with.

 

Werner: Thank you, the role of civil society has become more important for INCB missions. We are very happy to have this. We want to know and learn when we go into a country what is really happening. We understand that governments are likely to show us the splendid things in their country so we welcome more objective sources.

 

Comment from US government: participation of civil society to INCB but also to CND. Those who look at outcome document and see information about availability of essential medicines, this was brought to our attention because of CSOs. It is critical that CSOs bring us this information so that member states can then also call on the INCB to help. Thank you and appreciate your work, particularly on NPS.

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