Penny Hill, VNGOC. Good morning everyone, I will hand over to colleagues to introduce themselves. We have Deus and Delkushi today, as well as Anya Busha. Unfortunately Annette Verster is unable to join this morning but Anya will answer some of these questions.

Question 1: Can you speak to the current process the WHO is undertaking with the coca leaf, including possible timelines?

Instituto RIA, AC, Mexico (Zara Snapp), in person

This process of review was initiated at the request of a member state under the conventions, requesting that we review the current schedule of the coca leaf under Schedule I. This request came at the end of 2023 through the UNSG and was transmitted to the Director General of WHO. He committed to review the coca leaf within 2 years. The first was to request information that will support the evaluation and decision making, which was made last year, as part of the 47th ECDD, even though the critical review was not scheduled for that session.  Call was made for submission of information and on the 1st day of the ECDD, an open session was held, giving stakeholders a chance to submit oral and written submissions. Most were on the coca leaf. Submissions were accepted until 9th December. We also put out a request for submission of information in terms of experts involved in the evaluation of the information we’re receiving. We have selected experts, bearing in mind conflicts of interest. As part of the 48th ECDD, the agenda for the meeting will come up in May. We will send out a questionnaire to Member States in July. The critical review report, including on the coca leaf, will be published 30 days before the ECDD (20 September), where parties will have an opportunity to look at it and comment on it, including during the public consultation on the 1st day of the ECDD session. The ECDD will then go into a closed session to consider information and elaborate the recommendation. The recommendation will then be transmitted by the Secretary General to the UNSG, who will then transmit it to the CND in December. CND members will vote in March 2026.

Question 2: The WHO, as an agency of the UN, is bound by the core objective of promoting and protecting human rights. Could you explain how human rights, in particular the rights of Indigenous Peoples, will be taken into account during the ECDD’s critical review of the coca leaf?

International Drug Policy Consortium, UK (Marie Nougier), in person

Universal access to health, and the right to health, is supported and promoted by WHO. That’s why we ensure that access and availability to medicines is critical. We also ensure that the public is protected by any harm. The protection of harm is based on a scientific assessment of harms and access to medicines. In the process of the coca leaf review, we know that a number of societies use the coca leaf for traditional purposes. As a result, we have interacted with our traditional medicine unit in WHO to ensure that the expertise in this area is engaged in this evaluation process. We also have a colleague working on human rights at WHO and we had consultations last October on this issue. They were with us at the table to make sure they were fully involved. This is to make sure this issue is considered, but we also want to make sure that people have access to health products and are protected from harm.

Question 3: What are the lessons learned from the previous WHO scientific review of Cannabis could be applied to the ongoing Coca leaf review, to avoid delays in implementation?

European NGO coalition for Just and Effective Drugs policies, Austria (GHEHIOUECHE Farid), in person

Starting with the last bit of delays: for those who were in the session yesterday, I did highlight the challenges of reviewing plant-based products because unlike synthetic chemicals and products that deal with 1 substance you can assess, plant-based products have many. And you must be able to assess the attributes and how they interact with one another. This is why, when the request was received, the Director General notified parties we’d need 2 years to implement the recommendation. The second point is to ensure the process is transparent and independent. That’s why last year, at the reconvened session in December, and now, we’re updating member states on the process and timeline. The criteria we use in the evaluation and in the process are transparent. Lastly, based on the independence of the scientific assessment, we call on anybody with information to submit it.

Question 4: What initiatives and resources does WHO offer to NGOs seeking to implement modern methods of prevention and treatment of drug addiction?

“Youth-Anti-Narcotics” public union (“Gənclərin Anti-Narkomaniya” ictimai birliyi), Azerbaijan (Etibar Mammadov), in person

We mentioned in some side events, we’ve published the guidelines on neurological and substance use disorders, where we have information on psychostimulants, as well as new guidance on digital interventions and recovery management. This points to some of the questions of interest: we are also updating our 2009 guidelines on psychosocially assisted drug use disorders and guidelines on community management of opioid overdoses. We also have assessment tools that go hand in hand with these guides. WHO also has a training academy on substance use disorders in specialised healthcare settings. We also have the SOS initiative on the emergency management of overdoses. CSOs were very much involved in this. The training materials we used in this initiative helped with the success of the initiative.

Question 5: How will community and civil society representatives be involved in the consultations around the WHO guidelines for the treatment of opioid dependence and community management of opioid overdose?

Open Society Foundations, USA (Kiti Kajana Phillips), in person

Going back to the process, CSOs were invited to participate in a formal public consultation in December 2024 to update the guidelines. It was about scoping of the guidelines, identifying research questions, etc. Then, there was an open survey shared for comments, published on the WHO website and disseminated widely, through which we collected feedback to shape the research questions. We then circulated an open call for literature reviews to civil society, academia and others. Then in the guidelines development group, civil society was represented too. The first meeting of the group will take place in November 2025, and consider evidence and make recommendations on the guidelines. After that, a draft document will be circulated for peer review, including to civil society. So watch out for that. The guidelines will be available in 2026 (end of the year).

Question 6: How can the WHO and other UN agencies work together to ensure that member states, in coordination with CSOs, develop and implement national guidelines for community-based naloxone distribution and overdose management in line with the WHO’s 2014 recommendations? Additionally, what mechanisms can be established to track and report on progress, ensuring that all member states prioritize overdose prevention as a public health issue rather than a criminal justice issue?

Youth RISE, Ireland/ Brazil, (Rebeca Marques Rocha), in person

WHO and partner agencies support countries in their own efforts to support strategies to address overdose. Member States themselves declared that overdose responses are a priority in the UNGASS outcome document, which mentions naloxone (only medication mentioned!). It’s good to have continued advocacy and national dialogues and joint work to keep the issue on the agenda. The 2014 guidelines on community management of overdose have been widely shared and implemented, as well as evaluated in the framework of the SOS project I mentioned earlier. The Guidelines the WHO does can be a framework and can be used as guidance in the development of national responses to overdose strategies. WHO also has a Healthy Cities initiative and there are indicators on overdose management. When it comes to work at national level in supporting countries, including CSOs, in developing national guidelines, we are happy to help, although this depends on resources available in our national and regional offices. We also need to highlight that this is a health issue, not a criminal issue. We also have guidelines on alternatives to conviction and punishment. What’s clear from WHO is that drug use disorders are a health issue and the response should be a health and social issue, including for overdose management. Anecdotally, when we did the SOS project, we did a qualitative evaluation with interviews and focus groups and we were told it was helpful to interview first responders, including police and people who use drugs, it reduced stigma and there was a mutual perception that everybody was working together to save lives and support the community.

Question 7: How can WHO’s drug prevention activities be strengthened at the regional level?

Dhaka Ahsania Mission, Bangladesh (Iqbal Masud), in person; Uganda Youth Development Link, Uganda (Rogers Kasirye), in person

I said a few words before on the international standards on drug use prevention. It would be good to update them, and also have implementation toolkits to see how these standards can be updated. In terms of the organisation of WHO, we have the global headquarters, and we have regional offices which play an important role in strengthening health actions, including on prevention. The WHO region in the Eastern Mediterranean has launched as a flagship initiative a programme on substance use. It aims to generate interest and funding to support health actions. All of this continuum of care from prevention to harm reduction, treatment and care in the region has emerged as a priority.

Question 8: We have all witnessed and documented the irreplaceable, lifesaving role of civil society in providing harm reduction services during the COVID-19 crisis—delivering medicine via mobile vans, offering shelter, and providing food for homeless people. In response to humanitarian crises caused by armed conflicts, harm reduction NGOs have become shelters for people who use drugs and their families, ensuring access to comprehensive healthcare. Given this critical contribution, and as WHO coordinates global efforts in pandemic preparedness, how can WHO ensure that governments meaningfully include community-led responses in pandemic preparedness and emergency risk mitigation planning?

Eurasian Harm Reduction Association (EHRA), Lithuana (Ganna Dovbakh), in person

We cannot ensure this, but we can provide technical assistance. One thing I mentioned before in terms of crisis response was shortages in medications such as for OAT. We had a webinar recently inviting CSOs and other stakeholders to provide guidance to address OAT medication shortages. WHO in the framework of the Interagency Standing Platform is co-chairing a group on substance use, under the group on NHPSS. We have developed in collaboration with the co-chairs and CSOs that are part of this group, some training materials on addressing substance use disorders in humanitarian and emergency settings.

Question 9: How does the WHO deal with the issue of ensuring that countries keep balance between harm reduction approaches and prevention instruments, and have effective treatment options available, particularly for vulnerable populations?

Turkish Green Crescent Society (Türkiye Yesilay Cemiyeti), Türkiye, (Sara Evli), in person

 We support countries in their work, we provide technical assistance, facilitate policy dialogues, but cannot tell countries what to do in that sense. In terms of the continuum of different interventions, it’s clear from our publications that it’s not either/or prevention, treatment or harm reduction. What we want is a continuum of care where people in different times and settings access the services that they need. We need harm reduction interventions that are beneficial and protect lives. It’s not an isolated strategy, they all work together. What we are aiming to produce is a technical package that brings everything together and brings the experiences and perspectives together. We also work through an opportunity lens with countries. Some of them are more interested in prevention. But we really promote the continuity of care.

Question 10: In November 2024, the Global State of Harm Reduction, by HRI, reported that 93 countries provide Needle and Syringe Program (NSP) and 94 countries with Opioid Agonist Therapy (OAT) programs. Across low- and middle-income countries, there is an estimated 94% funding gap for harm reduction, with just USD131 million provided by governments and international donors in 2022.

Five months later, that picture is very different, and the sustainability of harm reduction interventions is more uncertain than ever. What actions is WHO taking to mitigate the fallout of the US funding freeze on access to HIV prevention for people who use drugs, in particular OAT and to guarantee access to essential harm reduction services in the long term?

Harm Reduction International, United Kingdom (Marcela Jofre), in person

We are monitoring the capacity of different countries in providing interventions, and we’re asking their capacity to deliver NSPs and others. If you look at the global status report, there is a service capacity index where we report on this aspect as a point of information. On the current crisis, there are organisational-wide strategies to mitigate funding shortages, including programming around harm reduction. The most concrete element we did was a webinar and background document prepared with a lot of support on mitigation measures, focusing on OAT.

Question 11: To what extend is the World Health Organization advocating at the CND on the need to prioritize the prevention of the most prevalent substances in society such as alcohol, tobacco, cannabis or non-medical use of prescription drugs, while addressing the social determinants that are influencing their use?

Association Proyecto Hombre, Spain (Berenice Santamaria), in person

You’ve all been coming to CND for many years and in principle there is a division of work and controlled substances are discussed here but the WHO have a mandate around all psychoactive substances, as well as going further into addictive behaviours. Here we have presented, including now mentioning reports on alcohol service capacity, different prevalence and how alcohol, tobacco, and drug use relate to each other with alcohol being the most widely used substance. Member States have adopted a global alcohol strategy and there is an alcohol action plan available to operationalise it further. There is also a SAFER initiative with 5 “best busy” in relation to alcohol prevention. At the population level interventions are most effective in this area. We also have the tobacco control framework convention and to some extent this was instrumental in the decrease of tobacco use globally. There are teams in the WHO not only working on social determinants of health but also commercial determinants of health and they sharpen our understanding of how the private sector impacts health. Among internationally controlled substances the highest prevalence of use is of cannabis and we are currently updating guidance on health and social effects of nonmedical cannabis use. At the end of the global statute report we are also asking for more advocacy around substance use to keep it on the agenda. Shout out to all of you for the good work you’re doing in this regard.

Question 12: Cannabis regulation models for non-medical adult use are now being implemented on every continent. While the WHO provides high-impact best practice guidance on regulatory policy for alcohol and tobacco, they have yet to provide any to the more than 45 cannabis reform jurisdictions that are home to more than 500 million people. As this reform trend appears set to continue, when might we see some best practice guidance on cannabis regulation from the WHO, so urgently needed at the critical moment in the emergence of a new industry?

Transform, UK (Steve Rolles), in person

We are updating 2016 guidance on health and social effects on non-medical cannabis use which includes evidence from jurisdictions that have changed cannabis laws recently. This will not be normative in nature and will not have recommendations. For full systematic evidence reviews we would need a number of high level systematic reviews in these jurisdictions and we would need significant resources. One thing we found interesting was a 2024 report from the National Academies of Science, Engineering and Medicine in the US which has pointed us to issues of methodological difficulties and heterogeneity of research and policy discussions that have developed. We would also need to think very carefully if we would find sufficient conclusive evidence to make recommendations or if the time is still too early. But in the end it is massively a resource question. What we can learn from other strategies around alcohol and and the “5 best buys” from the SAFER alcohol initiative. This shows us we need to strengthen restrictions on alcohol availability, strengthen drink driving mechanisms, ensure access to screening and treatment interventions, there should be bans and restrictions on alcohol sponsorship, and alcohol prices should be raised through excise and taxation. On cannabis we would need to do an evidence review before making more recommendations.

Adding on access to medicine and health products. We are revising a 2012 document on ensuring balanced access to medicine. During consultation it has been recognized that the initial scope focusing on opioids should be expanded to consider all types of substance being used and explored for medical and scientific purposes. We have been progressing with evidence based guidelines underpinned by a systematic review covering all classes of psychoactive substances including cannabis. This will be launched in May on the sidelines of the World Health Assembly. This will help policymakers ensure balance to ensure cannabis is available where needed while minimizing harm caused by it. This will help shape future work to ensure substances are made available while protecting from harms.

Question 13: What are the strategies being developed by WHO to combat the devastating synthetic drug crisis – the deadly fentanyl overdoses which is witnessing a continuous rise and now spreading to other countries in Europe, in addition to USA?

Karim Khan Afridi Welfare Foundation, Cristina von Sperling Afridi (Pakistan), in person

On the one side we share the concern, we are seeing synthetic drugs emerging in areas previously unseen. General concern is overall lack of service capacity. UNODC estimates only 1 in 11 people has any access to services, we estimate at best 30% of people in need have access to services for drug use disorder treatment. Preparing healthcare systems to offer services in a continuum is the homework we need to do no matter what drugs will emerge. This general guidance is available in documents previously mentioned. In the guidelines we are updating on opioid use disorder treatment and overdose we will say evidence is available and we’ll look at evidence around synthetics and see how we need to change. With other synthetic substances we continued our participation in the #ScaleUp Initiative around more research of responses to stimulant use disorders which we can see in many parts of the world are playing a role in overdoses that we see emerging. There is a lot to be done and that we can do and overall we need to update the health system and responses to drugs overall to be better prepared to deal with synthetic drugs entering the market.

We also convene an expert committee on drug dependence and since 2014, this has been convening on an annual basis to respond to new synthetic drugs on the market. Reviewed on scientific basis on emerging new psychoactive substances of opioid type so they can be scheduled and for health responses. We have been reviewing Nitazene compounds and there will be several this morning that have been reviewed by this committee that will be voted on for control.

Question 14: Given the growing body of international research supporting cannabis as a potential treatment for PTSD in war Veterans—especially considering alarming suicide rates—and for children suffering from severe epilepsy, what concrete steps is the WHO taking to encourage member states to prioritize and fund research on cannabinoid-based therapies?

Veterans Action Council, USA, (Etienne Fontan), in person

This relates to the response earlier on the 2012 update on guidelines on balanced national policies on access to controlled substances which will be updated and reissued in may this year to guide policymakers to ensure substances are available not just as essential medicine but for scientific and research purposes and ensure balance between access and safety. This is not specific to cannabis but more general across controlled substances. 

Question 15: In May, the WHO will release its Traditional Medicine Strategy 2025–2034. To what extent, and how do the different departments working with controlled drugs incorporate the specifics of Traditional and Indigenous medical practices in their work? Please comment on Cannabis as an example of how these specifics are addressed.

Fields of Green for ALL NPC, South Africa (Myrtle Clarke), in person

Our traditional medicine strategy 2025-2034 aims to respect traditional practices by integrating them into medical systems, ensuring research quality and safety. Includes evidence informed decision making, autonomy on health, indigenous peoples right to culture and health, people centered care, integrated services, and health equity. This provides a comprehensive framework but does not specifically mention individual substances but speaks to ensuring quality safety of these products ensures that they are rigorously researched and controlled as needed. They need to establish safety and efficacy standards before being integrated into healthcare services.

Question 16: What would be the procedure to initiate a critical review about a psychoactive substance, requested by a civil society organization

Agora, Mexico (online)

Currently we use a protocol called guidance on review of psychoactive substances, also posted on our website and includes all phases of review in the recommendation process and the ways to initiate a review. Currently there are only predefined mechanisms endorsed through Member States and the WHO Executive Board, and the current processes are limited either to explicit request from CND, formal request from countries or initiation from the Secretariat if information has been brought to their attention. If civil society organisatons have information about a substance we would encourage them to share that directly with the secretariat for review and if information could relate to criteria for the WHO which is in this guidance document online. This can be a way to bring this information to the secretariat for review of a substance.

Question 17: How has the withdrawal of the USA and Argentina affected WHO’s ongoing efforts around drug policy, especially regarding gender sensitive drug policy and support for marginalized communities?

Soroptimist International, United Kingdom/ Austria, (Martina Gredler), in person, YOUTH LEADERSHIP VIEWPOINT INITIATIVE (YLVI), Nigeria, (Lawrence Enaholo), online; Drug Policy Centre in Sweden, Sweden, (Peter Moilanen), in person; Slum Child  Foundation, Kenya (George Ochieng Odalo), in person

For now the mandates are as before and in terms of support for marginalised communities we immediately took action against loss of funding for life saving medicine. For OAT I have mentioned a few times and we have shared guidance and feedback which we have shared with feedback from policymakers, governments, and civil society on how to deal with loss of funding and how to respond to increased overdoses. We are actively fundraising.