Organised by delegates from WHO, OHCHR, UNAIDS and UNDP.

Speakers:

Jason White – Chair of the WHO Expert Committee on Drug Dependence

Vladimir Poznyak – Coordinator of the WHO Management of Substance Abuse unit

Annette Verster – WHO Technical Officer on HIV, drug use and most at risk populations

Zaved Mahmood – OHCHR Human Rights Officer

Boyan Konstantinov – Policy Specialist, HIV & Health group of UNDP

Christine Stegling – Deputy Executive Director of UNAIDS

 

1.     Mathare Community Anti-Drugs Coalition (Kenya), Joseph Arthur, IFSW (Austria), Silvia Franke  

For WHO: How are you addressing the global problem of mental health and ways in which you are pushing governments, the private sector and multinationals to set aside mental health funding, as well as clear guidelines you are putting in place to reduce the cost of treatment and for wider treatment with controlled substance such as ketamine?

Vladimir Poznyak, WHO: The pandemic attracted a lot of attention to mental health needs and services. Improving not only coverage and quality of treatment but also improving wellbeing overall. Particularly for emergencies like the pandemic. Who in collaboration with member states, academia & civil society – lots of high level events that invest in mental health issues. Last year the WHO released the world mental health report subtitled transforming mental health for all. This is the report we share for everybody as it covers many issues. It shows how little money is spent on mental health in countries. On average less than 2% of overall health budgets are spent on mental health. This is not at all equivalent to the overall mental health suffering and conditions of populations. That was one of the key messages in the report to allocate more funds and resources to mental health in the health budgets of countries. When it comes to medicines, WHO has always been very attentive to mental health conditions and special activities and programmes have been allocated to ensure access to medicines. We are constantly updating our guidelines on pharmacological treatment. When it comes to ketamine in the context of mental health treatment, ketamine is very important for anaesthesia and many other things. It is interesting in regard to mental health, we are monitoring studies which are promising. But at the same time, ketamine cannot be easily administered in primary health care where you can increase effectively the coverage and quality of treatment. That is why ketamine for treatment of mental health is not in the focus of our activities. We frequently have requests about ketamine in WHO portfolio for treatment of mental health but for now we still need to accumulate sufficient evidence about the populations that will benefit most from ketamine in mental health.

2.     International Drug Policy Consortium, Marie Nougier  

For ALL: In 2019, the UN Task Team responsible for the implementation of the UN System Common Position on drugs contributed to the Ministerial Segment by producing a landmark report reviewing evidence over the past 10 years of drug policy. As preparations are being made for the mid-term review of the Ministerial Declaration in 2024, how is the UN Task Team planning to contribute to this important process?

Boyan Konstantinov, UNDP: It’s an interesting question, it would be good for UNODC colleagues to be in the room so maybe there is a special meeting for them it would be good to ask the same question as they are the chair of the task team. What we are doing as UNDP as member of task team is to insist that the task team reconvenes and evaluates the work of implementing the UN system common position on drugs which was rolled out 2 years ago. This has to happen soon and I think UNODC colleagues are working on this. So far what we see is that implementation is not sufficient and it has to happen more and it has to happen faster. But then again we don’t have all the pieces of the puzzle. We need to gather the information and the second thing is to find avenues to engage with regional country leadership and the UN teams through the resident coordinators and in UNDP case, resident representatives in 170 countries around the world to ensure that where appropriate, the UN common position is being implemented. And of course all the supporting materials that the task team share including the human rights policy guidelines are used to facilitate this implementation.

Zaved Mahmood, OHCHR: I would like to add a few points particularly with regard to UN task team and how we can contribute to 2024. The high commissioner made a video statement message at the CND opening. He clearly mentioned that there is a need to engage with civil society in the process. He would like to see that active involvement of the UN entities in the process. We do believe that task team has a role to play but what role, we need to discuss in the un task team. If you have any proposal, please put forward to us how we can play a good role in the process. If you have any specific proposal, I would like to pass the ball to suggest to us. I would like to mention one thing, just last week and this week, the human rights council members are negotiating new resolution on drug policy and human rights. There is one specific operative paragraph that will request the high commissioner to produce a report on human rights and drug policy ahead of the 2024 review. At 2016 UNGASS meeting we produced a report of human rights and drug policy. Again in 2018 we did another report ahead of ministerial meeting in 2019. All reports were produced to contribute to the debate and discussion during these review processes. We hope that this will also contribute. From office perspective we are looking forward to that resolution and to implement that operative paragraph. If you have proposal, please put forward to us. We will take it forward to the UN task team.

Vladimir Poznyak, WHO: There is very little to add, there is a clear task for the task force but it is not yet defined. It is still in the process of deliberations.

3.     Recovering Nepal, Bishnu Fueal Sharma, Middle East and North Africa Network of People who Use Drugs, Zeeshan Ayyaz   

For WHO: How does WHO work to ensure quality assurance in national OST programmes, and to ensure its roll out in setting such as Pakistan?

Vladimir Poznyak, WHO: There are many activities that WHO are doing. All 3 levels of the organisation also in collaboration with other UN entities and this includes policy dialogue and research as well. Several documents were recently released, some of them directly related to treatment programs. Together with UNODC, the international standards. There is a special activities on quality assurance for treatment programs for drug use disorders which are also relevant for quality of programs of OST. When it comes to Pakistan there are several high level missions to Pakistan where the issues of provision there was a very complex process back and forth in the national limitation starting from studying some years ago then pilot project. Now I think my colleague will add, so it is definitely high on the agenda but again the government decide how to make it happen.

Annette Verster, WHO: We work closely with our regional and country office in Pakistan. Focus has ben on registration of the appropriate medication. It was difficult to take the appropriate dose as you had to take 10 tablets so at that level we are very much engaged. We are looking to hire a consultant at the country office together with UNODC to guide the implementation. Finally we are also reviewing the global fund grant proposals that countries are putting in and we make sure that harm reduction and OST are included where there is relevance which is most countries. We also just reviewed the Pakistan grant proposal.

4.     International Center for Ethnobotanical Education, Research and Service (ICEERS), Maja Kohek  

For WHO: Current drug policy decisions are generally based on pharmacological and toxicological evidence and focused exclusively on the problematic uses of scheduled substances, or their therapeutic potential. Is the WHO considering non-biomedical evidence such as anthropological and epidemiological research and studies on non-problematic drug use (including adult recreational use) as equally important in its recommendations and decisions?

Jason White, WHO: The point you make is very important. If you look at the conventions they require WHO to evaluate social problems associated with the use and if there is medical use, to weight the problems against that medical use. So you will find that when there are reports about drugs they do focus to some extent on problems as that is what is required in the conventions. But that doesn’t preclude WHO from looking at the full extent of use, and that includes the type you described. Its often buried somewhat that information, but I would like to reassure you that is considered. We always look at evidence and that is necessary because we are balancing out info about problematic drug use with use. We need to know about potentially non-problematic use of these substances. That info is certainly considered. That is not to say we couldn’t do a better job of that. We could always try and improve. I’ll give you an example of kratom that was recently reviewed. We certainly looked at traditional use of kratom, we also had information about use by people in various countries who were using it for their own therapeutic purposes. We are very much aware of that kind of use. That is an example where we certainly have looked at use in general. Some of the NPS are examples where we do look at users websites and their information about the use of the drug. There are certainly some attempts to access the type of information that you describe and we take that into account in our decision making but its certainly something we could improve on.

5.    Virginians Against Drug Violence (USA), Michael Krawitz     

For OHCHR: It has been stated by member states during CND meetings that the death penalty for drug use, possession or distribution conflicts with the Universal Declaration on Human Rights, the UN Charter and the spirit of the drug control conventions. How can these principles be better applied and adopted in CND for drug control?

Zaved Mahmood, OHCHR: Thank you very much. First of all I would like to reaffirm the commissioner statement yesterday. He called for the abolition of the death penalty for drug offences. the state has obligation to stop the use of death penalty as it doesn’t reach the threshold as intention to kill. With regard to here about what could be done, I would like to refer to the INCB. Last few years since 2012, they issued a note verbal to all member states to call upon them to stop it. Since then we have seen systematically INCB in their report addressing this issue. That needs to continue. I think INCB engagement is good and we welcome that. I would like to reaffirm UNODC executive director has addressed this issue and called on member states to abolish the death penalty. Obviously we would like to see more engagement and the main decision making body to actively address this issue. High commissioner are regularly addressing this issue. We are happy to see many members also calling for abolition of this penalty and we want the CND this time to see more. What we can do more needs to be discussed but our position is very clear.

6.     Students for Sensible Drug Policy, Iulia Cristiana Vatau, Youth RISE, Ruby Lawlor

For WHO: Stigma and discrimination are factors which deeply affect the lives of key populations, especially young people, and can be a significant barrier for access to healthcare. How is the WHO planning to engage with the reduction of stigma revolving around substance use and the needs of young people, including young sex workers who use drugs, particularly in environments where drug use is addressed as a criminal matter rather than a health issue?

Annette Verster, WHO: You may be aware that in 2014, WHO issued guidelines on key populations where stigma, discrimination and decriminalisation recommendations were made. we issued the update to these guidelines last year and published them in 2022. We have these important recommendations that besides talking about health interventions, its critical to discuss the structural barriers first. Stigma and discrimination are absolutely critical. We have a recommendation that countries should work towards decriminalisation of behaviours such as drug use and possession. That’s been out there since 2014. Of course these guidelines need to be disseminated and of course we do, we use these kinds of occasions to advocate for this. Tomorrow we have a WHO side event where we will address this is in more detail. We met with youth RISE during the development of these recommendations. It was a subgroup of the working group of key populations. We were able to review the guidance before it came out. Unfortunately of course, we can only look at the evidence, make recommendations and advocate for them. At the end of the day, its up to countries what they do. As life goes. I want to add we recently started a new project on stigma and discrimination and its not just about HIV, its about stigma in the health sector particularly and we hope to come out with a training that will be accredited and hopefully part of the WHO academy. We look forward to your engagement and involvement in further work.

Vladimir Poznyak, WHO: Stigma is one of the key barriers to effective care. Attention should be given to addressing stigma in the context of health professionals and service providers. People with lived experience was shown to be one of the most effective strategies based on the literature. We are consistently trying to do that.

Boyan Konstantinov, UNDP: It is about key populations and a bit disconnected from this question but I was very impressed with WHO for the inclusion of youth voices. I’m going to share information about a UNDP joint program toolkit at various side events. Feel free to reach out to UNDP when it comes to opportunities for partnership or specific challenges in relation to legal and structural barriers. I’m also going to share a report for submission around these issues as well as community engagement. Right now there is an opportunity to submit your concerns and good practices about what is done and it will be reviewed in the process of this partnership which focuses on the 10/10/10 indicators.

Zaved Mahmood, OHCHR: from the human rights perspective, stigma and discrimination are one of the key causes of criminalisation e.g. sex work, LGBT community, drug use. We need to address the criminalisation issue. In this regard myself and the high commissioner would like to refer most recently 8 march principles of criminal law and human rights with support of UNAIDS, UNDP etc. in these 8 march principles juries have identified various categories of acts that should not be criminalised including drug possession, sex work, same-sex conduct, reproductive rights related issues. I would like to request SSDP and also Youth RISE to look at that 8 March principle. If you google it immediately it will come up.

7.     CADCA (USA), Sue Thau, Movendi International, Esbjörn Hörnberg

For WHO: Substance use prevention is a sound investment, with every dollar invested having the potential to result in savings of between $2 and $20. However, it has been underutilized and under-resourced. How will WHO work together with UNODC and other agencies to strengthen the prevention work and make it a higher priority?

Vladimir Poznyak, WHO: Indeed prior substance use prevention is the best and most cost effective approach when it comes to health consequences of substance use. But we need to have the right balance between different prevention approaches e.g. primary, secondary. Particularly important for us is elimination of any marketing or advertising to young people regarding all substances e.g. alcohol, nicotine, drugs. To remove any indication that can increase attractiveness. Second point I would like to make is the commercial influences. We know commercial influences tobacco, on alcohol. Recently we have new developments that make new activities changing particularly in marketing. Finally digital and social influences and their role in the communication which is targeting underage people, which is critically important for protecting their health. Indeed prevention is not very well addressed in activities in the UN system. For this reason along with UNODC we created the inter-agency technical working group on prevention and treatment of drug use disorders and we are trying to address it in collaboration with other UN entities. We have international standards on prevention. There are several other standards; prevention of substance use cannot be considered in isolation. It is linked to mental health, overall health and there are lots of activities that target all of these factors in children and adolescence.

8. Eurasian Harm Reduction Association (EHRA), Ganna Dovbakh

For ALL: Globally and regionally, what can be done to ensure access to AIDS, TB and other healthcare services for the imprisoned Ukrainian population in the territories occupied by Russia, and for those inmates who were deported to different Russian prisons from Ukraine?

Zaved Mahmood, OHCHR: with regard to Ukraine situation, the Crimean population occupied by Russia and their access to AIDS, TB and other healthcare services. We have colleagues that are in better position to answer but from human rights perspective, we have established special bodies to deal with this issue in Ukraine. I would recommend to you and colleagues to present evidence and bring that to their attention.

Christine Stegling, UNAIDS: it’s a complex situation as we all know. From our perspective the country office is really engaged and trying the best it can to work with partners on the ground. What we have seen in the last 12-13 months, creating access and ensuring access to services, working with civil society – that has happened. I was previously involved in that before I became part of UNAIDS. We need to be really creative – one of the substantial partners is to work in collaboration with civil society who have been able to work in creative ways to explain the way of saying that. But I think there is a lot more to be done and the situation is changing. Its becoming a much more long term situation now and our response will have to change as well. I don’t have all the answers but we are in contact with out Ukraine office every day.

Annette Verster, WHO: very similar to Christine (UNAIDS) – we work with our country and regional office. This is very important especially around people in the occupied territory. We focus on short term continuation of OAT, but more needs to be done there.

9.     Veterans Action Council, United States, Etienne Fontan      

For WHO: How has the discovery of the Endogenous Cannabinoid System in the late 1990’s affected your work, given that it serves a critical modulating function in all mammals?

Jason White, WHO: There has certainly been a lot of research over the last 20-30 years into this, and it has had a couple of different influences. One is we better understand the different functions that the cannabinoid system can have on the brain and effects of immune function. That gives a better understanding of cannabinoids including therapeutic actions, but also the potential adverse effects as well. This research has led to a better understanding of cannabis, particularly THC compared to a lot of synthetic cannabinoids. In terms of the endo-cannabinoid system, THC is a relatively weak compound that doesn’t produce the effects that you see in a lot of cannabinoids. The difference in pharmacology of THC compared to synthetic compounds has also been down to better understanding of the cannabinoid system.

10.     Peace and Hope for Youth Development (PHY), Augustine Nyakatoma, Slum Child Foundation (Kenya), George Ochieng  

For WHO: A lot of young people have been affected by drug abuse, how are you collaborating with CSOs at the grassroots level to assist young people, including to clear the air about the cannabis vote that took place here in Vienna and what it really means?

Jason White, WHO: Unfortunately there has been a lot of misunderstandings about the changes that occurred as a result the vote on cannabis. The only change is that cannabis has been removed from schedule 4. Schedule 4 means that countries are encouraged to have relatively strict regulations, stricter than they would normally have than in schedule 1. In terms of international controls, there is no challenge that has occurred as a result of the CND vote. But the change has also been to indicate that cannabis is not a dangerous substance so that it can never be used in medical practice, which is part of the guidelines discussed in the convention originally. We are aware that there are some different understandings of what has occurred but certainly WHO has made every effort to try and clarify exactly what occurred and what the implications of that are.

Vladimir Poznyak, WHO: In collaboration with civil society and young people we have a youth forum now for mental health which we see of critical importance to involve young people including with lived experience.

11.     Skoun (Lebanon), Tatyana Sleiman        

For UNAIDS: We would like clarify reports on the closure of the UNAIDS Middle East and North Africa Office, the reasons behind that decision (if accurate), and the implications on programming and funding for the HIV response in the region?

Christine Stegling, UNAIDS: Yes indeed this is correct. UNAIDS decided earlier in the year to close their regional office in Egypt. We still have and will maintain and possibly strengthen our presence in 5 countries in the region e.g. Tunisia, Morocco, Egypt and Sudan. We have arranged for the Francophonie countries to be working with the regional office in Dakar and the other countries to work with our regional office in Johannesburg. I want to emphasise that this is not an easy to decision to make – it is a cost saving decision and we are really committed, I have had lots of conversations to explain that really behind this there is nothing that says we are not committed to the region. I have also challenged civil society to show UNAIDS what they will lose and what creative solutions there are to fill what ever we cannot do in the same way without a regional office. UNAIDS is a joint program of 11 UN agencies and what we really need to tap into is how we can make use of that joint program. Financial constraints have meant that we have to close the regional office. We are open to discussions please speak to us. We are winding down the office by June this year. One last thing to say is that I did have a separate civil society meeting yesterday and its not that I didn’t want to talk to civil society. UNAIDS is really committed to this work and that is why I am at CND. For us, prevention in particular and harm reduction is a big part of prevention is a big priority for us so yeah, I could say more but please be reassured that not only is this a big issue for us, but working in collaboration with civil society is and always will be a big part of what UNAIDS does.

12.     Turkish Green Crescent Society, Ergin Beceren

For OHCHR:  In some parts of America and Europe continents, the legalization and decriminalization trends in cannabis policies have initiated a phase of the liberalization of other psychoactive drugs in the levels of personal use and possession. As OHCHR, do you think these kinds of limited freedoms should be analysed in the concept of public health of the communities or individual freedom only?

Zaved Mahmood, OHCHR: First I would like to highlight that what is our office position. This morning I was in one event organised by civil society in Norway and we were discussing decriminalisation. Our office position on personal use and possession is about ALL types of drugs. We are not making the distinction between cannabis and not cannabis. However we do realise that countries have different priorities and want to move gradually. But from human rights perspective we are very clear that we call for decriminalisation. The right to health perspective put forward that argument of the decriminalisation of all drugs. That is our office position and I would like to give the floor to WHO for public health perspective on what the discourse should be.

Vladimir Poznyak, WHO: What we do is promote public health approach to drug issues, to drug use, and to drug use disorders and consider them as a health conditions. That has always been the position of WHO.

[Time limit was reached. The following questions were unanswered]

13.     Instituto RIA (Mexico), Zara Snapp   

For WHO: Building on the recent critical review of cannabis, does the Expert Committee on Drug Dependence foresee critical reviews of other substances that could have an impact on current scheduling – particularly based on the ongoing studies regarding the benefits of psychedelic-assisted therapies and mental health?

14.     Fields of Green for ALL (South Africa), Myrtle Clarke, FAAAT (France), Farid Ghehioueche

For WHO: We recognise the WHO’s leadership in collaborating and amplifying patients’ voices and expertise. Every year, WHO presents scheduling recommendations to the CND – so would the WHO be inclined to consider giving a few minutes of its Plenary statement time to patient voices?

15.     Association Proyecto Hombre (Spain), Oriol Esculies    

For UNDP (and others): The UN’s International Guidelines on Human Rights and Drug Policy state that children have the right to be heard in all matters concerning them, and their best interests shall be a primary consideration in drug laws, policies and practices. To what extent do current and planned drug policies adhere to the rights and needs of children and youth, particularly those groups in vulnerable situations such as ethnic minorities or those living with HIV?

16.     Transform Drug Policy Foundation (UK), Steve Rolles   

For WHO: Almost half a billion people are now living in jurisdictions where cannabis is legally available for non-medical purposes. When will the relevant UN agencies be able to support member states with normative guidance on best practices, to avoid the mistakes made with other under regulated legal drug industries like alcohol and tobacco, and to optimise policy development in favour of health, rights and the Sustainable Development Goals?

17.     Open Society Foundations, Sarah Evans

For WHO: WHO has historically chosen not to issue recommendations on safe drug consumption sites. Given that Fentanyl and other strong synthetic opiates are driving historic overdose death rates in some countries, and this is likely to become a global phenomenon, is WHO prepared to issue a recommendation on safe drug consumption sites as an effective and life-preserving overdose death prevention intervention? And if so, how?

18.     Amnesty International, Daniel Joloy   

For OHCHR: Given that UNODC has failed to regularly report on the human rights impact of punitive drug policies, including in their yearly World Drug Report, how can OHCHR and other UN agencies fill this gap to ensure the incorporation of this information into UNODC’s work as a way to provide credible and evidence-based information to policy makers in Vienna?

19.     Helsinki Foundation for Human Rights (Poland), Magdalena Dąbkowska

For WHO: Research shows that the criminalisation of drug possession fuels stigma and discrimination, and can lead to numerous human rights violations. Recognizing WHO’s attention to discrimination in healthcare settings and the achievement of the SDG on health and well-being, how can WHO build on its recommendations for decriminalization of drug use and possession and support member states’ progress into that direction – possibly through the release of new Guidelines?

20.     RIOD, Gisela Hansen  

For UNDP: In October 2022, the Committee on Economic, Social and Cultural Rights agreed to work towards the adoption of a new ‘General Comment’ on the impact of drug policies on economic, social and cultural rights. How will UNDP engage with this initiative, and how can we establish cooperation mechanisms with UNDP?