VNGOC: Good morning, and welcome to the informal dialogue with the WHO. First of all, I’d like to thank you on behalf of the Vienna NGO Committee and to thank the representatives of the World Health Organization for being here today to answer all the questions from civil society. Also, I’d like to say thank you very much to the WHO for maintaining this tradition of giving space to civil society to ask their questions. We have around 19 questions, so we will start immediately.

Nakuru Drop-In Center (Kenya): Thank you for this opportunity. In the face of persistently high global rates of lapse, relapse, and preventable deaths – outcomes directly linked to rigid, inpatient-dominated and one-size-fits-all substance use disorder programmes, particularly in under-resourced settings – why has the international community not yet declared and operationalized substance use disorders as a global public health emergency, and when will the WHO mandate the rapid scale-up of evidence-based, client-centered, holistic outpatient care with peer-therapeutic models as an essential, infinite and coordinated mitigation, comparable to global pandemic medical responses? Thank you.

WHO: Thank you so much, and as we are speaking for the first time, we are all very happy to be here. Coming to your question, which is of course a very interesting and thought-provoking one, the issue that you are raising is obviously very real and an area of high concern for the WHO Secretariat in our work in addressing public health responses to drug use and associated health and social harms. WHO estimates that there are around 600,000 drug attributable deaths on an annual basis, and we’re currently updating those data, so we will see how the new estimates look like. And we also need to not forget obviously the number associated with other psychoactive substances such as, for example, 2.6 million additional deaths attributable to alcohol use. And WHO therefore, and same as you, remains highly concerned about the prevailing and apparently increasing gap when it comes to access to health and social services, treatment services and service capacity at the country level, which we are monitoring in the WHO global report on alcohol and health, the last version was published in 2024.

We [the Secretariat] are working across three departments and with country and regional offices providing technical guidance on effective responses to substance use, including prevention, treatment, harm reduction and access to medicines from normative guidelines, technical and policy briefs, and the support to our countries and global and regional initiatives, often with other UN agencies, with a view to addressing the global funding cuts for public health, treatment and harm reduction services around the world. WHO issued an implementation guidance on mitigating disruption of services for treatment of opioid dependence, highlighting again opioid agonist maintenance treatment as an essential health service.

It may also be of relevance to you that every two years, and also this year, the Director General of WHO reports on the public health dimension of the world drug problem to the World Health Assembly, our own governing body, and this will happen in May in Geneva. This is really an important opportunity for member states and civil society organizations registered to the World Health Assembly to express concerns and request WHO Secretariat to elevate the importance of public health responses to substance use even further.

That being said, the declaration of a public health emergency of international concern follows a very structured process that starts by notification of an outbreak that poses a global health risk, followed by convening an emergency committee of independent experts assessing the severity of the event and so on, before the Director General can declare such a public health emergency. And so far, according to my and my colleagues’ knowledge, a public health emergency has never been declared for a noncommunicable disease. Nevertheless, the international community are gathering here at CND, and at the World Health Assembly, to coordinate their efforts to reduce the burden associated with non-medical substance use and to support affected populations through international collaboration and local action. I hope this clarifies a bit: we share the concern, but the bar to raise it to a global public health emergency is pretty high and has never been used in this area.

(Read on behalf of Slum Child Foundation): How is WHO supporting people-centered, youth-led drug prevention as a public health priority in marginalized informal settlements, where substance use is increasing, access to healthcare is limited, and families face a growing burden of care and are there ways we can work together to address this at the community level

WHO: The World Health Organization has developed international standards on preventing drug use and on the treatment of drug use disorders, together with our colleagues at UNODC. So those provide, in this case especially the prevention standards, a good overview of recommendations available from WHO and our partners in these areas. Technical recommendations referred to in the standards of course need to be updated regularly and we have already had initial discussions with UNODC to do this but it’s also a funding issue. We do need to start an update of the prevention standards soon, but all of this is as always depending on extra-budgetary resources. I also would like to highlight additional tools on screening and brief interventions like the WHO ASSIST, which also can be seen as a prevention strategy especially for health care settings. And then especially also maybe for the second part of the question, we have for non-specialized settings the WHO Mental Health Gap Action Programme (mhGAP) recommendations and intervention guide which bring together mental health guidance and substance use guidance. Many of those tools are by now also available on the WHO Academy free and for self-learning and guided learning available there. With a view to this young population, also to say that WHO and UNICEF have a joint program on mental health and psychosocial well-being and development of children and adolescents, and WHO has developed a Helping Adolescents Thrive initiative, again together with UNICEF. That aims to strengthen policies and programmes for mental health of adolescents. But these are also intended to help prevent self-harm and other risk behaviors such as harmful use of alcohol and drugs that can have negative impact on the mental health and physical health of young people, and vice versa of course. In terms of really reaching and helping local communities, I think we will hear later a good example of a flagship initiative in our Eastern Mediterranean region because of course a lot of the local support is really provided by our country offices and guided by our regional offices. Thank you.

Open Society Institute: Given the UN80 reform proposal to sunset UNAIDS by the end of 2026, how does WHO intend to ensure that the legacy of harm reduction is protected going forwards? Specifically, how does WHO intend to safeguard the continuity of leadership, data systems, community engagement, and accountability mechanisms that UNAIDS currently provides, especially in light of projected increases in AIDS related mortality and the crucial role UNAIDS plays in supporting countries facing funding withdrawals.

WHO: Thank you very much for this important question. And I think first of all, we have to say that there has not been a final decision to close UNAIDS, especially by 2026. So, what has been agreed so far is a process to consider options for the future arrangement of the Joint UN Programme with member states discussing those through the PCB [UNAIDS Programme Coordinating Board] process during this year. As for WHO, we recognize the concerns by partners and by civil society of what this discussion could mean for the HIV response. Our position is clear that the changes in the UN system must protect and strengthen the progress toward ending AIDS as a public health threat by 2030, as we have all agreed. As one of the co-sponsors of UNAIDS, WHO will continue to play a key role in areas where we have a clear mandate and a comparative advantage. That includes providing normative guidance and technical leadership on the HIV response, but also related areas of viral hepatitis and harm reduction and strengthening strategic information to support member states to be able to monitor the HIV response and so they can use data to close the gaps and support the integration of HIV services within broader health – without losing the focus on low-threshold and community-based and community-led services. So we will continue to work closely with communities and civil society to ensure that the HIV response remains people-centred and accountable, and to support countries facing funding pressure to prioritise effective and evidence-based interventions, Finally, on the countries facing funding withdrawals that we have seen last year, we continue to support governments to prioritise the most cost-effective interventions and also to integrate HIV and harm reduction within stronger health systems, as I said already without losing focus on low-threshold community delivery models, and to sustain access to essential medicines and services. Thank you.

Veterans Action Council [question merged with ones from Oesterreichischer Verein der Drogen Fachleute & Fundación Latinoamérica Reforma]: In light of emerging clinical and real-world evidence supporting psychedelic-assisted therapies (for example psylocibin and ketamine) for PTSD, chronic pain, depression and other psychological disorders, how is WHO accelerating guidance to avoid policy lag that leaves patients without access to evidence-based care and has the possibility of updating the information regarding the therapeutic uses of psilocybin been discussed with the CND in the ECDD [the WHO Expert Committee on Drug Dependence]?

WHO: In 2025, WHO published its guideline on balanced national controlled medicines policies to ensure medical access and safety. This is a guideline that addresses how to improve national policies, balanced national policies, and improve access to all types of controlled medicines, including not just those that are essential, also those that are in the kind of research pipeline. So, this extends to psychedelic therapies. The guidance was just published in August of last year, and is available now in all six official UN languages. We’ll be working in the coming months on the implementation and the roll-out of the recommendations that were made to ensure both access and safe use of all types of controlled medicines.

With regards to the ECDD’s work on psilocybin, it’s currently under schedule one of the 1971 Convention as a substance with limited recognized therapeutic use. It has never been reviewed by the ECDD and so we’re continuing to monitor the situation. The current practice is that the ECDD reviews substances that are not under international control currently. But as I said, we’re currently monitoring the situation and following the guideline that we just published last year.

WHO: I just wanted to add also from the team on alcohol, drugs and addictive behaviours that we’re of course acknowledging and welcoming intensified research in the area of substance use disorder treatment. But at this moment we are not aware of a sufficient level of high quality and independent research on psychedelic assisted therapies for substance use related health outcomes to inform further WHO guidance, but we will obviously continue to monitor the situation and the evidence emerging. Thank you so much.

WHO: We have a few copies of the guidance in all the six languages of the UN, so please pick a copy. Hopefully we can also work with you to make sure that these guidelines are implemented at the country level so that we ensure the balanced access that we have talked about. Thank you.

Pakistan Youth Organization: WHO has a clear mandate to address substance use, mental health and other health related issues globally. However, in South Asia, service delivery projects in these areas remain limited compared to the growing need. Could you please share WHO’s plans and strategic priorities to strengthen substance use prevention, treatment services, and mental health support in the region?

WHO: Similar to what we responded in the previous question, action at regional and country level is really very much driven also by prioritization of needs from WHO member states and regional committees. At the global level, the WHO member states have agreed, for example, on the Global Mental Health Action Plan etc. But then we have programme vehicles such as a WHO Special Initiative on Mental Health and the WHO SAFER Initiative, which is on reducing, for example, a drug-related and alcohol-related harm. Those help to put global commitments into national level action and then to also address specifically the health impact of drug use. We’re working closely here with the colleagues at UNODC, for example in the framework of the UNODC-WHO programme on drug dependence treatment of care. In the region that you are asking from, there is a good example of a country support programme in Afghanistan which is both on mental health and substance use and supported by WHO and other UN agencies. Then, at the technical level, I think we spoke already about numerous technical guidelines that are developed by WHO and partners. I hope here we will have a chance to hear especially about the WHO EMRO regions’ flagship initiative on substance use, which is helping further to support member states and what they have prioritized. I think in terms of what’s happening in Pakistan, there is the regional mental health framework, which is basically to operationalize the Global Mental Health Action Plan and it is supported by the recently adopted Mental Health and Psychosocial Support Action Plan. Pakistan is a member of that and there is the process of developing specifically the mental health and substance use strategies ongoing in Pakistan. It would be a good idea to work together on that, to make sure that it sort of reflects all the voices in the country as well as what are the best practices in the region. As mentioned, there are three flagship initiatives going on which are interlinked: one on developing a resilient health workforce; one is on access to essential medicines and technologies; and the third one is on substance use. All three have been developed and approved by member states based on the priorities identified by the countries, which includes Pakistan. And a bit later probably I’ll be talking more about the mental health test and the substance use flagship work because there we have very clearly identified what are the priority actions which can be undertaken by different stakeholders from the public sector, from civil society, from academia, and it is categorized according to the country’s level of resources and capacity.

World Federation Against Drugs: Given the evidence from WHO data showing a continued closing of the gender gap in substance use, how does WHO intend to support Member States with gender-sensitive prevention and awareness strategies? Are current resource constraints affecting the Organisation’s ability to expand work in this area?

WHO: Let me respond to the second part of the question first, which is something that would be good to address and explain at some point. Yes, current resource constraints are affecting the work that we are doing and also the possibilities to do new work and strengthen certain areas. When it comes to gender sensitive prevention strategies, I think I said already before a little bit. On one side there are the international standards for prevention of drug use developed by WHO and UNODC and those report gender specific outcomes of prevention strategies when that evidence is known or available. But also, as mentioned before, I think we it would be timely and desirable to embark on an update of the prevention standards, including a more in-depth review of effective strategies for sub-populations such as women and girls. But this is all depending on extra-budgetary resources and unfortunately at the moment it is very difficult. We have just done evidence reviews for an update of our guidelines on treatment of opioid use disorders and overdose management. We realised also there that in the evidence and in the research, there are still prevailing limitations in evidence on health outcomes available on populations with special clinical needs. It is in the evidence and in the guidance, but something that definitely could be strengthened and it would be again nice to update guidelines on identification and management of substance use and substance use disorders during pregnancy, which we are currently translating into Spanish to make them more available. I think it’s an important issue and we would be happy to work more on it, but there are the real-life limitations that you mentioned already also in your question.

WHO: Thank you, and good morning to all. I think that this is important: yes, there are serious limitations. I am now leading a department that before was three departments, others are the same. So that is where we are right now in WHO. The technical programmes had to reduce our capacity by 40 percent. It is a miracle that the three teams represented on this panel have been preserved. That means that the priorities have been maintained, because we did have to deprioritise a lot of areas. But the capacity to get to countries to implement all of these guidelines and the work that we have is reduced. So, we need more of your contribution and your advocacy to make sure that member states are engaged in these areas, that they request our support, and that resources are made available not necessarily for us all involved in the area.

Transform [question merged with one from Drug Free America]: There are now over 500 million people living in jurisdiction that have or are implementing some form of legally regulated adult access to cannabis for non-medical use. At this critical moment, given the growing challenges of over-commercialization and corporate capture in emerging markets, could the WHO produce best practice guidance in cannabis regulation to help protect public health – and I’m specifically thinking of the type of guidance we have for alcohol and tobacco, which is so useful. Thank you, we could do with your help.

WHO: Thank you so much for the question and the continued interest. The update of the WHO 2016 guidance on health and social effects of non-medical cannabis use is coming – it is currently going through final editing and should be available this year (I have already seen the cover of it, so that’s definitely coming!). Nevertheless, this upcoming update will not be normative in nature. It will provide an evidence update of what has happened since 2016 in terms of mental and physical health outcomes. But a full systematic evidence review – which would be required to produce public health guidance on non-medical cannabis use in different jurisdictions, including jurisdictions with regulated markets – would require a range of additional evidence reviews and work from us, including substantial resources. I think we pointed to that already last year that we unfortunately do not have the resources available at the moment. This document [the guidance update] is not going to answer all of your related questions, but while you know there have been other reviews like the National Academy of Science in the USA. We mentioned last year that have been looking into the consequences of changes in the cannabis landscape, but we don’t have guidance – we have not done this work yet for cannabis. For alcohol guidance, there are five high impact strategies that have been identified to reduce alcohol related harm and that are being supported, for example, through the SAFER initiative that I mentioned. And those include: strengths and restrictions on alcohol availability; advancing and enforcing drink driving countermeasures; facilitating access to screening, brief interventions and treatment; forcing bans or comprehensive restrictions on alcohol, advertising, sponsorship and promotion; and raising prices on alcohol through excise taxes or pricing policies. In general also what we learned from alcohol is that less is better. In summary, we will come out with updated guidance, but unfortunately we just don’t have the resources to go with normative guidance [on cannabis] or deeper technical guidance in these type of recommendations

Transform: What if we can get you the resources?

WHO: Yes, that would be interesting. Let’s talk about it. Thank you.

Harm Reduction International [merged with another question from Ágora]: As harm reduction interventions are increasingly framed as part of broader health systems, how will WHO ensure that this integration strengthens, rather than dilutes, the quality, accessibility, and community-led nature of harm reduction services, particularly in overburdened health systems? And in the context of integration, what guidance is WHO providing to Member States to ensure sustainable financing for the full package of harm reduction services? Thank you.

WHO: Thank you. First of all, WHO fully recognises that harm reduction has been built and advanced through the leadership of communities and civil society, and also that these services are increasingly being integrated or pushed into the broader health and primary care systems. I think it’s very essential to ensure that this process strengthens rather than dilutes the core principles of harm reduction. As for WHO guidance, I think we can repeat that we emphasise that harm reduction services must remain low threshold, voluntary, evidence-based and community centred. Community-led and peer-based organizations are best placed to reach people who use drugs, particularly in the settings with criminalization and stigma which create barriers to accessing traditional health services. Integration therefore does not mean replacing community services with facility-based services. Rather it means strengthening the linkages between community-led harm reduction programmes and health systems including HIV, hepatitis, and primary care services, while ensuring that community organisations remain central partners in service delivery.

We recently published updated implementation guidance on harm reduction and needle and syringe programmes which emphasises even more the role of low-threshold and community-based services. WHO also continues to highlight that the full package of harm reduction interventions – including needle and syringe programmes, overdose management through naloxone provision, and HIV and hepatitis services – should be considered essential components of national health responses, including in times of crisis. We also last year published guidance for member states to prioritise essential services, and harm reduction is specifically mentioned as a priority service that needs to be maintained in times of crisis, whether it be conflicts or funding cuts.

We also engage actively with the Global Fund to make sure that this guidance makes into their information note so that countries follow this guidance when they apply for funding grants from the Global Fund. We try to support member states in integrating those services within the universal health coverage framework, while also emphasizing the importance of sustainable and dedicated financing, including for community-led programmes. This year, there will also be a report by WHO and UNAIDS about different models of sustainable services for key populations, including people who inject drugs, where some examples from around the world are shown including different models of funding by governments or other models. This should be published in a couple of months I hope

Association Proyecto Hombre [merged with questions from Kathak Academy and ARTM]: Given the 28% global increase in drug use over the past decade, how does WHO plan to scale up its role in supporting Member States to adopt health-centred, community-based approaches to prevention and treatment?

WHO: I want to remind again what my colleague commented on how difficult the overall situation was when it comes to global health and prevention and treatment of substance use within global health. For WHO, with all the best of intentions, I think it needs to go both ways: we need to be mandated and get requests from member states that are supported by financial resources in order to support member states, and to implement what they are requesting from WHO. It would help tremendously to also see more action of member states, including at the World Health Assembly which is our governing body. Nevertheless, here at CND, we’re seeing a resolution [from Finland and Norway] which shows there is interest from member states in public health approaches and strengthening of national health authorities in responses to drug policy and drug use. Let’s see where the resolution ends – the wording I think is important for us. Despite all these challenges, which are very real in the last year, we have been able to work thanks to the teams that are very resilient. We have advanced, for example, the update of the guidelines on psychosocially assisted pharmacological treatment of opioid use disorders and community management of opioid overdose, which will be merged into a new guideline that we are working on right now, and which will come out in the next year. And the other really positive example is from the WHO EMRO region and the development of a flagship initiative of substance use, which I think was the first time that the WHO regional office has put substance use so high on the political agenda. In that sense, it’s really a give and take. It’s not only us putting out technical guidance, but we need to work with the member states, and you all here play a very important role through the in-reach to your own governments and as non-state actors in relation to WHO to put the topic higher on the agenda. And I think from that everything else will follow, but we also have to recognise that there are a lot of competing health priorities of course in this world. So I think, the one thing I wanted to mention is to invite you to our own site event today at 16:30 here at CND where I will speak more also about this initiative, which is specifically on stimulant dependence. Thank you.

Transnational Institute: The WHO critical review did not find evidence of meaningful public health harms of coca leaf. Still, the WHO recommends that coca leaf be retained in Schedule I because it is ‘convertible’ to cocaine. This is the first time that raw plant material would be scheduled as a ‘convertible substance’, which until now has only be used to schedule precursor chemicals. The WHO Guidance document (the ‘blue book’) also refers to the 1961 ‘convertibility principle’ as the ‘control of precursors’. Conflating the terms conversion, transformation, extraction and manufacture, the ECDD concludes that simply because cocaine ‘is made’ from coca leaf, it meets the Convention’s criterion for convertibility. Thus far, no legal justification has been given to substantiate this unprecedented and controversial treaty interpretation. Is the WHO willing to explain in writing the legal basis for its treaty interpretation; the advice the ECDD received from the WHO legal department, UNODC and the INCB; and how it compares with previous WHO scheduling recommendations regarding the control of plant materials, extracted alkaloids, convertible substances and precursors? Thank you.

WHO: Thank you for the question. In response, WHO fulfils its treaty mandate following the protocols which are outlined in the guidance on the WHO review of psychoactive substances for international control. This document was published by WHO in 2010 after being endorsed by the WHO Executive Board. And that is the document that we follow, drafted in line with the conventions themselves, as well as the commentaries to the 1961 and 1971 conventions. Paragraph 49 of the guidance document describes WHO’s interpretation of ‘convertibility’ in the context of fulfilling its mandate. The definition of ‘convertibility’, according to this WHO guidance document, is that a substance is ‘convertible’ if it is of such a kind as to make, first, by the ease of process. So, there’s an element of ease of process by the yield and by the practicality of the process and the profitability for a clandestine manufacturer to transform the substance in question into controlled drugs.

So, the evidence on those criteria – ease of process, yield, practicability and profitability – are weighed against the criteria and are not limited to a substance’s chemical properties. For example, practicability and profitability may be determined through epidemiological data rather than through chemical data. So, all the information on the chemistry demonstrates how easily a substance could be used to create another substance already in Schedule I of Schedule II. The epidemiological data can demonstrate whether that practice is actually occurring to show that the criteria are being met. We consult with WHO’s legal department as part of the ECDD review process. The legal department is part of the WHO Secretariat, and ensures that the WHO is following its established process.

Seizures, which again as I mentioned, are outlined in the so-called Blue Book which was drafted in line with the conventions as well as the commentaries with regards to other scheduling recommendations. Again, as I mentioned, this Blue Book was published in 2010. The existing protocols which were established to standardize the working methods of the ECDD applied to all of the substances that have been reviewed by ECDD from 2010 onwards – we would follow that that guidance document.

The vast majority of plant materials that have been considered, either informally or formally, by the ECDD have fallen within the remit of the 1971 Convention. Precursor substances, which according to the document are precursors of psychotropic substances and chemicals in the illicit production of controlled substances, fall within the INCB’s mandate – so those are within the purview of the 1988 Convention. The 1961 Convention specifically mandates to WHO to compare a substance under review to those that are currently under Schedule I or Schedule II, to determine whether they’re similar and/or ‘convertible’ using that definition that I mentioned. We can provide a further clarification. Thank you very much.

International Drug Policy Consortium: The WHO’s ECDD plays a critical role in international scheduling decisions. And yet, the critical reviews of substances like cannabis and the coca leaf have shown that the human rights implications of scheduling are not given due consideration. How can the ECDD ensure that potential human rights implications are systematically considered in its scheduling decisions? Could the ECDD, for instance, request inputs from external human rights experts, including from Office of the United Nations High Commissioner for Human Rights? Thank you.

WHO: The ECDD operates under a technical mandate established to fulfil WHO’s mandate to advise the CND on the international control that should be applied to psychoactive substances based on pre-determined criteria. So, although its work is grounded in the assessment of substances and harms to health, similarity and or convertibility to other controlled substances, therapeutic usefulness and public health risks and benefits, the recommendations are intended to promote the realization of the right to health and equitable access to psychoactive substances with medical and scientific use in line with the mandate of WHO. WHO’s technical lead on human rights advises the ECDD Secretariat on matters that relate to health and human rights. External human rights experts, for example from OHCHR, are also consulted as part of the ECDD Secretariat’s public consultation. And we also receive written materials from external human rights observers. Evidence or testimony that relates to directly to the ECDD’s technical mandate would be considered in the ECDD’s decision making process – evidence that would map on to the criteria that the committee are considering. Relevant submissions are reviewed alongside the scientific evidence base, reflected as appropriate in the critical review reports that are published online, and are also taken into account in the formulation of the recommendations.

Jordan Anti-Drugs Society: How is WHO supporting member states, particularly in the Middle East, in integrating evidence-based drug use prevention and treatment services into primary health care systems, with a focus on youth and families and in partnership with community-based organizations?

WHO: As I mentioned earlier on, in 2024 the regional committee endorsed the flagship initiative on substance use along with two others. So based on that particular mandate, we have been working on integrating mental health as well as substance use and neurological conditions into community based and general healthcare systems including primary health care. That is what my colleague was referring to earlier. The implementation of mental health gap guidelines is something which is ongoing and almost all the countries at this point are implementing given the situation in the region following protracted emergencies in most of the countries. There is a fairly high uptake of initiative. Secondly, there is a regional diploma for family physicians. So, the move is from having general practitioners manning the primary care system towards family physicians manning the system and able to facilitate the transition. There is a regional diploma in place and for the first time a substance use component has been integrated into that and has been enhanced over the last year or so. Similarly, we are in the process of developing curricula for addiction medicine specialists as well as training for nurses because that’s again a fairly obvious shortage which is there. In addition to that, we have established a regional coalition of civil society organizations, which are often led by people with lived experience or their family members, as well as the youth and the Regional Youth Council. So, I would suggest and I would also request people to feel free to join. It is available on our website: the links are there, all the details are available, and you can actually see the details of the mandate, what are the activities being undertaken through that coalition, as well as individual profiles of the organisations. At this point have close to 100 organisations which are part of the regional coalition and the more there are, the stronger the advocacy would be and stronger the ability to provide services which are accessible to the people.

VNGOC: I’m really happy to say that VNGOC also joined your regional coalition, so we are part of the process. Thank you very much for giving the opportunity also to civil society to be part of this processes.

Youth RISE: Nightlife settings are significant contexts of drug use among young people, yet they remain absent from the WHO harm reduction guidelines. Given the proliferation of new psychoactive substances and adulterants in unregulated drug markets, will WHO develop specific technical guidance on nightlife interventions, specifically including standardized protocols for drug checking services as an important health intervention? Thank you.

WHO: First of all, WHO recognises that nightlife and recreational settings can be important contexts for substance use, particularly among young people, and these environments present specific public health risks, including exposure to new psychoactive substances and adulterants in unregulated markets. And so, at present, our harm reduction guidance focuses primarily on interventions with a strong evidence base for preventing the most severe outcomes associated with drug use, including HIV, viral hepatitis infections and overdose. In the recent scoping work conducted as a part of the update of WHO guidelines on treatment of opioid use disorder and community management of opioid overdose, WHO didn’t identify sufficient evidence to commission a full systematic review on drug checking services in the context of opioid overdose management. At the same time, we recognize that drug checking services may have potential public health benefits beyond opioid overdose prevention – for example, by providing information on drug market composition, enabling early warning systems and creating opportunities to engage people who use drugs with health and harm reduction services. We continue to monitor emerging evidence and experience from countries implementing such interventions. We also discuss with the European Drug Agency about their work in this area. As with all WHO normative work and the development of any new guidance, it depends on the availability of sufficient evidence and resources to conduct the necessary systematic reviews and processes. It is on our ‘to do list’, but it will take some time maybe.

Helsinki Foundation for Human Rights: Around the world, there are countries and regions that face challenges arising from situations such as armed conflict, humanitarian crises, poverty and the issue that brings us here, the war on drugs. While these circumstances have a profound impact on entire societies, people who use drugs often find themselves in an even worse situation. Among many actions that can be taken to support communities, accessible take-home naloxone is a simple measure that could improve the situation for at least some of them. How does WHO see its role in promoting wider access to this medication?

WHO: Thank you very much for the question. As you likely know, naloxone is on the WHO List of Essential Medicines and is not internationally controlled. So, we agree that it should be widely available? In 2014, WHO already issued guidelines on community management of opioid overdose, including a recommendation that people likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose. Following the issuance of the guideline, a feasibility study on opioid overdose prevention in low- and middle-income countries in line with the guideline recommendations was conducted just before the pandemic. That was a project of the Stop Overdose Safely (SOS) Initiative, and it demonstrated systematically – I think for the first time – that the feasibility of take-home naloxone programmes also works fine in low- and middle-income countries. We have now completed an updated evidence review and are planning to release an update of these 2014 guidelines, as I mentioned, together with the update of the guidelines on treatment of opioid dependence around the time of the World Health Assembly next year. While I cannot talk about the details of the updated guideline development process, I think we can assure you that we continue to promote and monitor access to effective medicines for treatment of substance use disorders and for emergency management of opioid overdose as part of our work.

Just so you know, maybe to highlight from last year, in the light of the sudden funding cuts occurring and service interruptions in many places around the world, we published the implementation guidance on opioid agonist treatment as an essential health service, but also with mitigation strategies for service disruptions. While this highlighted OAT [opioid agonist treatment] as an essential health service, at the same time it also highlighted again the role of naloxone in times of including unplanned service interruptions to mitigate risks and obviously prevent.

Drug Policy Centre Sweden: I understand that WHO along with other UN agencies is facing budget cuts. Will these budget cuts impact the long-awaited update on 2016 report on the harms of cannabis? How will WHO continue to ensure that up-to-date research on cannabis and cannabis related harms is reflected in a systematic way?

WHO: I don’t think I had this question on my list, but I think it’s similar in reality to what we have presented already. We are doing the update of the guidance on the health and social effects of non-medical cannabis use, which is with the editor so it is going to come out. But I think staffing limitations and funding limitations also mean that we cannot go to a super comprehensive document, but that we focus on putting together and summarizing the evidence that has emerged since the last version was published. I think that should be out over the course of this year. Anything related to future work, I think that’s what we have said. We really have to make very hard prioritisation decisions at the moment, mainly due to austerity measures, funding cuts and also limited human resources available across WHO. But it doesn’t mean that we don’t continue working on this and when the new guidance is out, obviously we also hope to work with civil society and member states to help make it useful, disseminate it, and see how it can guide local policies. Thank you.

Zonta International: Women who use drugs experience more vulnerability, greater impairment and more severe medical and social problems than men. The progress of women to drug use disorders is more accelerated compared to men, and they have a relatively higher risk to acquire HIV and Hepatitis C when injecting drugs. What can WHO do to improve the situation of women who use drugs?

WHO: I will start from the infectious diseases side. WHO recognizes that women who use drugs face multiple and intersecting vulnerabilities including stigma and discrimination and gender-based violence. And there are significant barriers to accessing health services. All of these factors can increase the risk of HIV, hepatitis and other health harms. So, we promote the gender responsive approaches across prevention, treatment of drug use disorders, but also harm reduction services. And this includes ensuring that the full package of harm reduction interventions is accessible and responsible to the needs of women. WHO has developed specific guidance relevant to women who use drugs, including guidelines on the identification and management of substance use and substance use disorders in pregnancy in 2014. In addition, WHO and UNODC recently developed a technical brief on the prevention of mother to child transmission of HIV, hepatitis B and syphilis among women who use drugs, which highlights the practical approaches to improving access to integrated services for this population. At the same time, we recognize the important gaps in data and evidence as women who use drugs are often underrepresented in research and surveillance systems, specifically pregnant women, and the threatening of gender sensitive services. The meaningful engagement of women who use drugs and their networks will remain essential to improving health outcomes. I hope we answered your question.

ENCOD [merged with questions from Cannabis Cura Sicilia Social Club Aps, the Veterans Action Council, and the Alliance for Rights-Oriented Drug Policies]: What additional measures can WHO undertake to assist Member States in translating scientific assessments on medical cannabis into accessible, patient-centred public health policies, particularly within public healthcare systems?

WHO: Sorry, we also didn’t have this question on our list beforehand. I think this relates to the document that I just shared previously that we have published these recommendations on translating the evidence that we have on controlled medicines into policies at national level. This document is available and it’s applicable to all types of controlled medicines, including psychedelic therapies. I will say it extends to medical cannabis, so we would encourage these principles to be followed and to be implemented at national level, again considering both principles of access and equitable access for these medicines, as well as ensuring that appropriate safety measures are implemented at the same time.

World Woman’s Christian Temperance Union / Uganda Youth Development Link: With the potential funding cuts that are facing the WHO, what is the long-term outlook for support of the NGO’s that work towards shared goals.

WHO: I think that we have talked about the funding cuts and the implications, I think that it is very important that you do the advocacy you do, also with the health sector in your respective countries and networks, so that member states support WHO and the funding that may arise in that context. It is also important for the non-state actors, the NGOs that are in official relationship with WHO – who I am sure that you are close to and work closely with many of them, and then you can reach out to them to bring these issues formally to the WHO setting and not just in in CND context. So please feel free to do that so that the public health discussions on the drug issues are also a regularly part of the member state discussions of the World Health Organization. My last point is that we do have and produce a lot of documents with our limited capacities, but we do focus on that. We don’t have the means and the capacity again to bring that to the country level to do all the translation, to disseminate, to implement – but the documents are here and they are available. What we are trying to do, putting together the tools, is to see how we could make use of AI or other tools to generate a platform that will make those more available and allow you to find answers in your own context. If you have any ideas or suggestions on how to do that better, let us know. Our website is full, I don’t know how many documents we have are already. They are valid, they are useful. They need to be. I wish all countries will implement what we have already said without looking always at new things, but they are not known necessarily. So that could be a challenge and a question to you or from my side, how can we do better?

ENCOD: It seems that some vaccines are developed to cure from addictions, what are the WHO levels of knowledge and its recommendations?

WHO: Thank you for the question. I would say that, once sufficient evidence from randomized controlled trials on vaccines for substance use disorder is available, WHO then could analyse and review this information. WHO itself does not work on the generation of such evidence and for now we have no indication of sufficient maturation despite many years of research that went into vaccine development. That being said, I just want to reiterate that effective psychosocial and pharmacological treatment options for substance use disorders are of course available and recommended, for example opioid agonist treatment for opioid dependence. We do not count at the moment on effective medications for treatment of all substance use disorders, including stimulant dependence. Right now, in the framework of the WHO scale up initiative, we are starting a landscape analysis to map current research into pharmacological treatment options for stimulant dependence, for which so far no medication is approved or registered. And, as I said, today at 16:30 we have a side event on this so please come by and see us also there.

VNGOC: Thank you very much. We’re at the end, so I’d like to congratulate to all of you for being here today and I hope your questions were answered as you wish. I’d like also to thank you very much to the panel experts from WHO for being here today, and we hope we can continue having our support and cooperation in the future – not only with civil society, but also with the VNGOC. I’d like to wish everybody a happy and nice day. Thank you very much.