VNGOC: Welcome to Jallal Toufiq, the President of the International Narcotics Control Board (INCB), and Mark Colhoun, the INCB Secretary.
International Association for Hospice and Palliative Care (IAHPC): With the USAID program cuts to vital health products, including ARVs in the lowest resource countries, we can expect an escalating pain burden and demand for essential palliative care medicines. How might the INCB address this new crisis, and would you consider interactive roundtables with prescribers and all relevant supply chain actors at Learning Program workshops to solve what is called this ‘wicked problem’?
Jallal Toufiq: Good morning and thank you. I started working a long time ago as an NGO member in the field of AIDS and drugs in Morocco – distributing condoms back in 1987, if you can imagine how difficult that was. We have seen a lot of cuts affecting programmes. The main spirit, the core, of the conventions and treaties is promoting the health and welfare of men and women. Anything that hurts humankind is no good for any UN body, or NGO. The INCB’s role is to make estimates for narcotic drugs to be used in pain management but also for opioid agonist therapy (OAT), mental health and other conditions. We have always noted an immense inequality of access to these internationally controlled substances – even before the cuts, before the crisis which will probably worsen that access. We are keeping an ongoing dialogue with all governments. All of our statements this week are about how to promote the availability of controlled substances, including to manage pain. We conduct meetings with permanent missions. We have meetings with the CND Chair, the UNODC Executive Director, the World Health Organisation (WHO) and all stakeholders. There is injustice worldwide – larger use in some countries and under-use, or no use, in others. This is about human rights. In 2024, INCB signed a Memorandum of Understanding with IAHPC, the sole reason being to promote access to controlled substances. We train national competent authorities worldwide on how to accurately assess their own needs and quantities. Regarding interactive roundtables with prescribers, this is something we could do alongside WHO and the pharmaceutical industry, and find ways to work around the funding cuts and ensure access. I will take this idea to the other INCB members in our May Board session, to discuss the feasibility.
Agora (read by VNGOC in their absence): Are you planning to provide inputs either to the CND or to the World Health Organization about the coca leaf review?
Jallal Toufiq: This has been asked by so many people. We took note of the fact that Bolivia has requested a critical review, which is now on the table of WHO and their Expert Committee on Drug Dependence (ECDD). INCB is an observer for the ECDD, so does not necessarily have a say. But we can advise and participate in meetings and, if the ECDD wants us to give advice, we will. It is a very complex issue, not just about the coca leaf itself but about how we perceive the whole process from the plant to the drug, taking into account controlled aspects of the plant, and listening to what people say about their own use of the coca leaf. I am by nature a listener, so I listen to those voices. Other than that, INCB cannot do much. We promote compliance with the conventions as they are now. How they will be in the future, we cannot predict that. We are eager to see what the WHO and ECDD will tell us once the critical review is done. It is a crucial question for many countries, and I understand that. But we await the critical review. We could talk for hours on this. I have my personal views, but am representing INCB. Let’s wait for the critical review to finish and then we should discuss. This is important to the international community, we cannot turn a blind eye to what some communities have expressed.
Slum Child Foundation: Does INCB intend to resume country visits in the near future and, if not, are there other avenues for NGOs to provide relevant information pertaining countries they work in?
Jallal Toufiq: We are not conducting these country missions due to funds. The core mandate of INCB is to promote and protect the international drug control conventions. We do this through many channels – we meet with permanent representatives and missions [in Vienna]. But the best way is to go on country missions. When we do, we meet with every government agency involved in drug control. But we also meet with civil society and always ask to meet with them. Unfortunately, there is a budget cut which prevents country missions. For how long, no-one knows. We have been frozen on this for the last two years. We have a list of countries that we want to visit but we cannot go there, so we do it in other ways, including here at CND.
Harm Reduction International (Online): In November 2024, the Global State of Harm Reduction report showed that 93 countries provide needle and syringe programmes, and 94 countries provide opioid agonist therapy (OAT) programmes. Across low- and middle-income countries, there is an estimated 94% funding gap for harm reduction, with just USD 131 million provided by governments and international donors in 2022. Five months later, the sustainability of harm reduction interventions is more uncertain than ever. What actions is the INCB taking to mitigate the fallout of reduced access on access to HIV prevention for people who use drugs, and in particular OAT?
Jallal Toufiq: This is a really tough one and thank you for asking. My own programme back home in Morocco has been hit by this same situation. We were almost running out of methadone one month ago, as it is provided via the Global Fund. It was a scary situation but has been resolved through other local channels. There is not much INCB can do in terms of the funding, but we can insist on the crucial importance of making these substances available through every channel that we have – the annual report, our bilateral discussions, consultations, and in every statement we give. We remind countries that, for the sake of ensuring health and welfare, it is important that those compounds are available, accessible and affordable. It was bad before the cuts, and it is worse now. I refer to the very famous article that INCB contributed to with the Lancet Commission, where the map shows many countries in the world where there is a shortage – and not it is even worse. One of the things we can do in our May Board session is look at ways to work with governments to ensure funds are available for those compounds. I am not sure what else we can do, as it is a difficult situation for all of us and there is no magic way to solve the problem. The funds are scarce.
Karim Khan Afridi Welfare Foundation: There is broad scientific evidence and global recognition that prevention strategies play a critical role in addressing drug use, particularly among children and adolescents. At the same time, there is significant advocacy and support for expanding harm reduction programmes. How does the INCB view the balance between investing in prevention efforts aimed at promoting healthy, drug-free lives, and supporting harm reduction measures designed to reduce the risks associated with ongoing drug use?
Jallal Toufiq: The Board has always and consistently promoted balanced access to drug use management – from universal prevention, to indicated treatment, to every alternative and intervention, to reintegration and relapse prevention. The continuum, the spectrum of interventions. You mention children and adolescent prevention. I don’t think we are doing enough. I don’t think there is enough funds allocated. Look at the example of COVID-19, a deadly condition and so is drug use. Look at the amount of money put into prevention for COVID-19: how to wash hands, how to wear masks. Look how much money we put into COVID-19. I don’t think ever in the field of drug use has a similar amount of money has been invested. There are reasons for that, there are reasons why it is not considered a priority – maybe they rather build a treatment centre, a border control facility etc. I think we need to take full responsibility for that. NGOs have to play a role in this. One of the main problems is that the money is in the hands of policy makers, most of the time. The willingness to work is with civil society, and the knowledge is with the academics. And there is no link between the three: civil society is fully aware of the role they need to play in universal prevention, but they don’t necessarily have the knowledge or money. Universal prevention needs to be science based, as you know many measures that are carried out are not based on science. We know what works and what doesn’t work. If you look at the conventions, they are about taking measures to prevent harm, to treat (such as Articles 14, 20 and 38 [of the 1961 Convention]). Do we do it or not? That is a different question. We have focused past reports on prevention and on treatment. That is all we can do. And whenever we are given the opportunity, we promote the use of the [UNODC/WHO] International Standards of Prevention and Treatment.
Turkish Green Crescent Society: Does the INCB have any plan for a monitoring system which addresses the evolution of digital platforms, particularly the dark web’s role in facilitating anonymous transactions and drug trafficking networks, to ensure that international drug control policies remain solid and adaptive?
Jallal Toufiq: I invite you to go to [the INCB exhibition at CND] because I really want you to see how the platforms we have put in place are contributing to what you ask in your question. We have the Global Rapid Interdiction of Dangerous Substances (GRIDS) programme and also its Project ION (International Operations on New Psychoactive Substances) and a global Operational Partnerships to Interdict Opioids’ Illicit Distribution and Sales (OPIOIDS) project which address this issue, with a particular focus on synthetic substances that are under international control. The GRIDS programme developed a technology platform to detect and try to dismantle global trafficking. We also have the Scanning of Novel Opioids on Online Platforms (SNOOP) tool, which focuses mainly on open web transactions to detect suspicious vendors of synthetic drugs that have no legitimate uses. Please do visit the stand that we have, which explains how we work and how we do real-time information sharing. It is a wonderful tool that we have, and I’d be happy to walk there with you and introduce you to the team. It is not about the dark web, but the open web. I think we dismantled something like 60,000 marketplaces on the open web through SNOOP.
European NGO Coalition for Just and Effective Drug Policies (ENCOD), read by Myrtle Clarke: In light of recent legislative developments regarding cannabis regulation in Malta and Germany, ENCOD would like to inquire about the position of INCB on these regulatory frameworks. Specifically, how does the INCB assess these national policies in relation to international drug control treaties and what recommendations does it provide to ensure compliance with international obligations?
Jallal Toufiq: We are seeing a snowball effect with more and more countries taking this direction. The INCB is not responsible for the conventions, the Member States are. The INCB’s role is to monitor and promote compliance with the conventions, but it is not responsible for the design of the conventions themselves. We engage in a dialogue with all the countries that have started to regulate their market for non-medical purposes. And those that have taken other steps to make cannabis more accessible for medical and scientific purposes – which is in line with the conventions. But what is not in line is the legalisation – not because INCB decided so, but because that is what the conventions say. Until member states say otherwise, the conventions restrict the use of cannabis exclusively to medical and scientific purposes. Every country that legalises recreational adult use of cannabis is not in line with the conventions. Those that have decriminalised or depenalised cannabis, that is fine and in line with the conventions, which allow countries not to criminalise the use of cannabis and INCB have been promoting this as it is within a human rights framework. The majority of Member States are still content with the conventions as they are. There are countries that want to promote the legalisation of cannabis for adult, non-medical and non-scientific use, but others are not in favour so it is a problem. Bear in mind that the conventions were designed at the time to acknowledge that this is an international problem and no country can deal with this alone, back in the 1960s. This is a problem for the entire international community, so it is difficult to come up with unilateral initiatives and expect the international community to say ‘yes’. It is complicated, so we published in 2022 a thematic chapter on cannabis. One of the main problems we raised is that in countries, we voice our concerns that it is not in line with the conventions, but we also have to ask ourselves questions: How regulated is that market? What boundaries and controls are in place? What are the effects on the perceptions of the use of cannabis? Studies have shown that the risk perception has reduced. Will that effect prevalences in youth? There is contradictory evidence on that. It does affect adult prevalence in many US states. It depends on the prevention put in place, the marketing restrictions, etc. The other thing we do not master enough is the long-term impact of cannabis on the brain, as we do not have enough long-term studies on that. Some may say that 5, 6 or 7 percent THC is “no big deal”. But we don’t know, we need research. Member States need to take this issue to the ECOSOC if they want to do something about it. I am sure that countries act, health professionals act, in good faith when putting in place laws, policies and regulations. Do they evaluate these enough? Do they put enough money into prevention? Do they invest in impact studies? These are different questions.
Fields of Green for All: In over 700 years of use in South Africa, any long-term effects on the brain would have been picked up. There are also studies that show that prevalence has not increased, such as in Canada. So be wary and look who funded the studies. The harms of prohibition far outweigh the harms of the plant. Any health harms of cannabis do not justify locking me up in a cage as a cannabis user.
Jallal Toufiq: One of the hardest concepts in science is attribution. When you say that we have been using cannabis for centuries, have they been use of young or adolescents?
[Anonymous online interruptions]
Jallal Toufiq: One of the concerns to put on the table is that, when legalising, you facilitate access to cannabis. So put mechanisms in place to know what people are using and how much. I did not say at any moment that cannabis is harming anyone, but if you are allowing people to access that compound you need to make sure, as a public health official, and this applies to any substance in any market, that you master all aspects of the law and regulation.
[Anonymous online interruptions]
I am not saying it is harming, don’t put words in my mouth. Now, the conventions are what they are, and if that is going to change this needs to be taken by Member States to ECOSOC. If one day those conventions change or are modified, then INCB will continue to do their job as requested.
Europe for Action against Drugs (EURAD): There is a push to expand access to cannabis for medical purposes in many countries. Likewise, there is a push to allow the use of psychedelics for medical purposes. What can the INCB do to ensure that the medical use of these substances is evidence-based and in compliance with the drug control conventions?
Jallal Toufiq: To repeat, the INCB mandate is clear – to ensure access for any controlled substances for medical purposes. We want people to have access for medical and scientific purposes, including for clinical trials and research into safety. We want people to have access to those compounds and those medications. I am a psychiatrist, and I deal with PTSD every single day. I would be very happy to have a safe and effective medicine for my patients, whether or not it is a controlled substance. For anxiety disorders too. Everything the INCB does is first focused on this access, it is the first question we ask in any engagement with a country.
Veterans Action Council: What drug policy reforms are needed to ensure that military veterans and sick children throughout the globe have legal and equitable access to controlled substances they medically require – getting away from stigma, bureaucratic barriers or geopolitical restrictions, which INCB has previously called “over-burdensome requirements”?
Jallal Toufiq: As I have said, any person on earth should have access: the children, the elderly, anyone who needs it. This must be our priority. I am a doctor and I see people suffering every single day. Tomorrow, we have a side event on travellers and they suffer so much. They have methadone in one place, then go to another which does not allow it, and they go to jail. Everything that facilitates the access they need is our focus. I am a strong believer in listening to people – not only policy makers, not only health professionals, but people – including those who suffer. We do everything we can to promote access to controlled substances. We sometimes forget that even when available, they can sometimes be too expensive, especially for vulnerable populations.
Instituto RIA (read by IDPC): Are the international drug control conventions still fit for purpose?
Jallal Toufiq: In the 1960s we realised that the drug problem needs international collaboration and we cannot deal with it without certain measures put in place, cross-border etc. So we came up with the conventions and treaties, and ways to operationalise them. Is it still fit for purpose? That is something to ask Member States at the CND. Our role, again, is to monitor compliance with the conventions as they are. If they are amended tomorrow, we will continue to do that job with the amended ones. Until then, they are what they are and I am sorry about that.
[addressing the online participant interrupting]
Sorry if I misunderstood or was misunderstood. The conventions limit access to medical and scientific purposes. But Member States providing any substance should assess and evaluate it.
Myrtle Clarke: I think some of the frustration is because more than 200 NGOs wrote to the INCB asking for more transparency. We have been emailing all year with six recommendations, and asking for a reply which we never received.
Jallal Toufiq: Let me tell you what I did. I took your concerns to the Board members. We answer only to certain bodies at the international level: to UNODC administratively, and to ECOSOC. Because of the confidentiality of the data we handle, Member States rely on our confidentiality. Please come to our session in May to discuss with all 13 members. Keep in mind that this is a very specific, independent body which answers only to ECOSOC and handles tonnes of highly confidential materials coming from countries. The countries trust the way we do things and keep the data confidential. Even the dialogues we have in countries, we keep that between the INCB and the country itself. We answer to those institutions.
Myrtle Clarke: I accept that invitation in May.
VNGOC: Thank you to INCB and those in room and online, and for recognising the importance of these dialogues.
Jallal Toufiq: We will continue to do so, we believe in the importance of civil society, and rely on your work. I know the work of NGOs and know how important civil society is.