Informal NGO Dialogue with the INCB President Dr. Viroj Sumyai

Lucia Goberna, Vice Chair of VNGOC. I apologise that the VNGOC Chair is not here with you today. I am happy for the INCB Director and Secretary as other INCB colleagues are here with us today. For us, it is helpful to meet in this NGO dialogue. Thank you for taking the time to be with us in this busy week. Thank you to the civil society team for making this possible. I want to inform you about the new VNGOC Board which was elected yesterday. We are here to represent all VNGOC members.

Dr. Viroj Sumyai. I congratulate you for your election yesterday, it is a good opportunity to discuss with you today for our cooperation in the future and how we can share experiences and how to improve the drug control situation. NGOs have been instrumental in addressing gaps in raising awareness in the area of prevention, treatment and rehabilitation. We appreciate the opportunity to meet with you and hope our cooperation will continue to flourish and we look forward to meet you during our country missions. Then, we sometimes consult with NGOs to explore the possibility to dialogue with civil society and have a dialogue. We released our 2017 annual report, with a thematic chapter on treatment and social reintegration. We advocate for access to treatment and attention to often neglected groups. We are interested in partnering with NGOs to increase access to treatment. This is important because drug use is stigmatised worldwide, which is a major barrier to access to treatment. As we commemorate the 70th anniversary of the Universal Declaration of Human Rights, we want to make a greater link to human rights and drug policy. We call on governments to recognise drug dependence treatment as a key component to the right to health. We also call for proportionality of sentencing and the abolition of the death penalty. We reiterate that extrajudicial killings are unacceptable under the international drug control framework. We also underscore the importance of availability of substances for medical and scientific purposes. We also highlight the opioid crisis in North America. We call for actions in line with the international drug control treaties to prevent diversion to the illicit market, and access to treatment. We emphasise that any measure allowing the use of cannabis for non-medical purposes are contrary to the UN drug conventions. We should not be condoning abuse and trafficking. We need prevention, treatment and social reintegration services. We also reported on the drug situation in Afghanistan. We called on the international community to provide support to the country. This is just a snapshot of issues addressed in our annual report. I encourage you to read it, it is available in the 6 official UN languages. I look forward to hearing from you.

ICEERS. The 2016 annual report discussed cannabis social clubs and announced it would engage in dialogue with the central government. How do you address the tensions between the central government and the autonomous communities, and engage in a dialogue with the latter to ensure pathways for allowing this practice?

Dr. Sumyai, INCB. Spain is the party to the conventions, so it is not possible for the INCB to engage in a dialogue with provinces. We engage solely with the national government because it is the rule.

ICEERS. How come the conventions continue to be based on the dangerousness of the substances when this is not based on scientific evidence but on bias?

Dr. Sumyai, INCB. This is a very interesting question. I attended the meetings in Geneva because the WHO has a role in assessing this and giving suggestions to the CND. For example, fentanyl analogues are very potent and we are working on that. There is a committee within the WHO, which is the Expert Committee on Drug Dependence, whose members come from different institutions and they don’t represent their nationality. They are independent experts. They support the knowledge and research. In the meeting of the ECDD, there is a step to consider bringing the substance into the scheduling system. State authorities have also to respond to the questionnaire sent by the UN system governing body with regard to the substance and member states can report back on any incidents related to the substance in their own country. The first step is then a pre-review, with research in scientific journals and literature. If there is enough research, there will be a document and recommendations, then there will be a critical review which is the second step. This is presented to WHO with suggestions on how to control the substance. This depends on the nature of the chemical or substance. Every expert has to present impartial findings. Everybody has to express their opinion. Member states can send a request to ECOSOC in NY if there is a substance that is particularly problematic. When ECOSOC see the conflicts, there may be a process or inquiry to sort the tensions. There can be different opinions. WHO can ask about the issue again. We need to think quickly and diligently to cope with the new challenges in the illicit drug market, such as NPS. We try to cope with these substances and recommend to schedule substances in the 1961 and 1971 conventions. We look at the harmful effect but also the benefits of the drugs. The objective of the UN drug control conventions is to provide access to these medications for patients in need. If there is no benefit, we will go on to schedule the substance in Schedule I. If there is a medical value, we will put the substance in Schedule IV so that people who need the substance can access it. The FDA and public health ministries then have to control these substances at national level.

ICEERS. The Committee on Economic, Social and Cultural Rights has set that the rights of indigenous people should be protected. How do the UN drug control conventions address these conflicts with regards to the right for indigenous people to use substances controlled in the UN drug control conventions?

Dr. Sumyai, INCB. States have a legal obligation to exclusively allow access to substances for medical and scientific purposes. This is the key requirement of the UN drug conventions. The 1961 convention did provide a transition for states becoming parties to the convention, allowing temporary traditional use of opium, coca and cannabis. But these provisions are transitional and have not been in effect for decades. It is up to states parties to arrange the system in their country. This is the case in my country. Before, there was a opium smoking tradition in Bangkok. The government ratified the 1961 convention and there was a transition period of 25 years for people who smoked opium, and the government set up a treatment system for them. After 25 years, this should be abolished, with a plan of how to deal with people who smoke opium or chew coca. The conventions do not provide any exceptions for traditional and religious use. So I have to apologise for this interpretation. Nobody was concerned with religious or traditional use at the time of the signature of the 1961 convention. Governments have to try to bring people who use drugs into normal lives.

Association Proyecto Hombre. We observe that the countries continue to implement policies of different degrees to deal with the drug problems, from highly criminalising legislation to new regulations such as the legal sale of cannabis. Our concern is to what extent member states are adopting demand reduction policies based on evidence and are establishing measurement systems that can demonstrate their effectiveness?

Dr. Sumyai, INCB. It is up to states to set up their own framework to deal with this issue and the best thing from my experience is that treatment is the best for reducing demand for drugs. Prevention is the first step. but for people who fall victims of drugs, treatment is the best. This is our demand reduction strategy.

IDPC. What actions are the INCB taking to stop the killings and murders that are committed in the course of drug law enforcement operations?

Dr. Sumyai, INCB. We have made a number of public statements in this regard, in our annual report and at the CND and ECOSOC. We have also done press releases calling on an end to the extrajudicial response. We have also concerns about experiences in South East Asia although I will not name any country. I have tried for about eight months to dialogue with the government and with the permanent mission here in Vienna. Luckily, at the CND session, we can reach out to the governments attending CND. We are concerned with the situation and would like to carry out a country mission there. Please bring this information back to your capital, we are very concerned. I used to live in that country for one year for training. This is also very strict and there is an extrajudicial response to any crime. When the church extended their focus to this problem, it is a reason to be concerned. During that time, every evening every church would ring the bell and people in the community would gather and discuss the issue. This is a serious problem now. We want to d a country mission and have a high level dialogue in this country. We hope this situation will be resolved soon. Sometimes, these issues affect elections. I can understand his state of mind, he has to keep his promises and he is at the highest position. He cannot sleep well at night. He must be using some psychotropic substances to get to sleep!

IDPC. We have appreciated the number of alerts released by the INCB over the past few months. Could you consider drafting alerts on two critical issues: one to clarify medically assisted treatment, the other on ensuring access to naloxone to prevent overdose deaths?

Dr. Sumyai, INCB. On these alerts, I am pleased they are welcome, and I will take note of your request and keep them in mind as we define new areas of focus. Medical Assisted Treatment is something I have been working on in the past 20 years. Treatment of people who are addicted to drugs are able to use medication to alleviate symptoms of withdrawal as the person quits the drug: for example for heroin addition you could have vomiting. We will draft this in our annual report soon. The issue of naloxone to prevent overdose deaths is also important. Naloxone is an antidote of opiate overdoses. The first sign is respiratory depression. If the health centre does not have naloxone, we cannot relieve the symptoms of respiratory depression. Naloxone injection into the system will enable the person to recover from respiratory depression and will be resuscitated. This is the benefit of naloxone, but it is lacking in many areas of the worlds and it is an expensive drug. I did a country mission in one country in South East Asia, which is not concerned with naloxone, it is concerned with opiate medication. I dialogued with the health ministry and the chief doctors and scientists came to our discussion. They told me that there is morphine injection on all shelves but nobody wants to use it so it is set to expire. I asked them why they didn’t use it for cancer patients. They responded that it was because there was no naloxone in their country. And so there may be risks of overdose and death. So we encourage access to naloxone to prevent overdoses.

FAAAT think & do tank. The hierarchy of norms clearly places human rights obligations over and above certain drug control conventions. How is the INCB dealing with these issues in particular around the death penalty for drug offences?

Dr. Sumyai, INCB. Thank you, this is an interesting question. As I said in my foreword of the 2017 annual report, without consideration of human rights, there are devastating consequences. We are celebrating the universal declaration of human rights anniversary. We want to take this as an opportunity to reinstate human rights in drug policy. Drug control should be consistent with international human rights. We emphasise the need to respect the rights of drug users including in criminal justice processes. The UN drug control treaties are required to be proportional as a response to drug offences. The INCB continues to encourage states that retain the death penalty to commute death sentences that have been handed down and to consider the abolition of the death penalty for drug offences. I have also responded on extrajudicial responses to drug offences, these are contrary to drug control. We are engaged in dialogue with states. The drug conventions cannot be applied in a vacuum which ignores other international law, particularly those related to human rights. In my previous life, before I joined the INCB, I worked in Thailand. I served in the Ministry of Public Health, and I also worked in an NGO to raise awareness about HIV in Bangkok. Because during that time there was no awareness on this issue. I worked with NGOs from many countries. I understand the focus of NGOs, we want to improve lives for everybody. I walked in every corner of the district of Bangkok to raise awareness of the issue. I respect my profession, but you have to protect yourself. We initiated a project on condom distribution. With this project, we evaluated after one year to see progress made among sex workers. Every entertainment complex agreed with the idea. We could reduce HIV infections from 80% to 0% with our ‘100% condoms’. We have to praise NGOs for initiating this programme. So please feel free to contact me and ask my email address through Lucia and contact me at any time. I am 100% with you. When I started working at the UN, I had to interpret international law. When I worked as an NGO I worked a different way. So please contact me.

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