Science for Democracy, the Luca Coscioni Association and Eumans, are among the signatories of the appeal launched ahead of the United Nations historic decision on the rescheduling of cannabis early December 2020. Together with other ECOSOC accredited organizations, a statement has been sent to the Members of the Commission on Narcotic Drugs that will need to take a decision on the recommendations issued in 2018 by the World Health Organization on cannabis that could relax international norms around the plant allowing its study and production for medical reasons.
Towards science-based scheduling of
Cannabis sativa and other controlled herbal medicines
Provisional Agenda-item-5 (E/CN.7/2020/1/Add.1), reconvened 63rd CND, submitted by Multidisciplinary Association for Psychedelic Studies; AIDS Foundation East-West; Ethiopia Africa Black International Congress Church of Salvation; Forum on Drug Policies; Help Not Handcuffs; International Center for Ethnobotanical Education, Research and Service; Latinoamerica Reforma Foundation; Students for Sensible Drug Policy; The Society of Reason; YouthRISE, all in special consultative-status with ECOSOC
Next year marks 60 years since adopting the Single Convention on narcotic drugs, aiming at “protecting the health and welfare” of humankind. Nevertheless, a decade ago, UN-Special-Rapporteur on the right to health reported: “current approach to controlling drug use and possession works against that aim.”
The many scientific advances since 1961 would have been hard to imagine back then. In the case of the international scheduling of medicines, “classifications were made with insufficient scientific support to substantiate those classifications, as credible evidence exists regarding the medical uses of a number of them, such as cannabis for the treatment of certain epilepsies,” as the UN CESCR reports.
Scheduling undertaken in the absence of science has stifled research into medical applications of cannabis. When “scientific research is impaired” we lose our right to enjoy the benefits of scientific progress and its applications.
The WHO recently undertook extensive and unprecedented scientific assessments of the uses of cannabis and its derivatives in medicine. Their conclusions acknowledge several conditions for which enough evidence supports clinical use. However, the current scheduling continues to hamper, not only research, but also the prescription, availability, and access to cannabis medicines for patients. Not taking action to facilitate access to these medicines for people who might need them for treatment is a “de facto denial of access to pain relief,” which, “if it causes severe pain and suffering, constitutes cruel, inhuman or degrading treatment or punishment.” This breaches the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” or right to health, set forth in the International Covenant on Economic, Social and Cultural Rights.
The Covenant mandates governments to “[create] conditions which would assure to all medical service and medical attention in the event of sickness.” Because, additionally, “addressing the discrepancy in the availability of narcotic drugs for medical purposes is one of the obligations of Governments in complying with the drug-control conventions,” “adequate provision must be made to ensure the availability of narcotic drugs for [medical] purposes,” including cannabis and its derivatives.
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In 1935 the League of Nations had the opportunity to scientifically review cannabis but chose not to: instead, they assessed preparations with strychnine and other potent substances, and deemed the mere presence of cannabis extracts was responsible for the harmful effects. In the 1950s WHO relied on weak and biased evidence such as “feeling among the South African police of a relationship between cannabis addiction and crime” to declare that “there should also be extension of the effort towards the abolition of cannabis from all legitimate medical practice.”
The first sound, independent, methodological and comprehensive scientific assessment occurred in 1990, for THC, and resulted in its rescheduling (from Schedule-I to Schedule-II of the 1971-Convention). But it was only in 2018 that the first-ever such science-based assessment was undertaken for pharmaceuticals and phytopharmaceuticals derived from Cannabis sativa.
The outcome of WHO’s assessments mandates an update of the seriously outdated scheduling status of cannabis, for the benefit of science, clinical-practice, and correcting the record with regard to the rights of indigenous peoples to plants that “have been used in traditional medicine in some countries for centuries.”
Treaties need to respect the history of humankind. In 2020, just like in 1920, cannabis medicines are a reality for hundreds of thousands of patients in most Member-States of the Commission. Cannabis medicines include phytopharmaceuticals (raw herbal formulas, extracts, tinctures and other prepared botanical drugs) as well as compounded pharmaceutical preparations (either from naturally-obtained compounds or synthetic cannabinoids as active pharmaceutical ingredients). All are valid. All can provide relief from pain and suffering, in specific indications. The diversity of formulas offers doctors and healthcare practitioners a broader range of therapeutic instruments to address the unique needs of each individual patient.
Ensuring access to and availability of these medicines while addressing their diversion and use-disorders remains a common and shared responsibility of all nations. Nevertheless, pharmaco-vigilance, efficient training, education, and frontline medical professionals play a significant role that international control doesn’t. Scheduling isn’t the alpha-and-omega of effectively addressing adverse effects.
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WHO recommendations –while pointing out that evidence shows cannabis medicines are lower risk than other substances in Schedule-I, 1961-Convention– suggests a consensual, depoliticized way forward, agreeable to all parties, that maintains a high-level of control and respects the sovereignty of Member-States, in an effort to meet their social, economic, and administrative concerns.
Governments are expected to make an effort to meet WHO’s global, public health concerns and science-led advice. Policy coherence is one of the commitments of the Sustainable Development Goals and of the complementary, mutually-reinforcing UNGASS2016 operational recommendations.
Updating scheduling based on science is the way for policy to cohere.
The recommendations are a test for the Conventions: they seek to make them effective and fit-for-purpose, by facilitating access and availability of controlled medicines with proven efficacy and safety and a well-documented history of use in both indigenous and Western systems of medicine. WHO sets the historical record straight, while enhancing human rights: to health, to benefit from science, to access medicines needed for one’s medical care, but also the prevailing rights of indigenous peoples and traditional communities.
Opposing the recommendations wouldn’t weaken WHO. It would deride the Commission and trivialize the Conventions. It wouldn’t stop the trend of national and local policy reforms allowing medical access to cannabis: all would continue to unfold outside the scope of the Conventions.
Civil society and patients will be fine either with a Convention-compliant system or with sui-generis systems taking advantage of the flexibilities in interpreting the treaties. Rejecting the recommendations would send a clear message: the treaty system is not fit for regulating natural traditional medicines that have shown beneficial and manageable therapeutic properties in centuries of experiential evidence, and are nowadays rediscovered by modern clinical research. This applies to cannabis under the 1961-Convention but also coca leaves, as well as psilocybin, mescaline, dimethyltryptamine under the 1971-Convention.
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In 2008, UNODC convened +600 NGOs from 116 countries in Vienna. They adopted an unprecedented consensus-statement where the Commission was asked, among others, to:
- develop a common standard against which demand, harm and supply reduction activities can be measured in terms of their efficacy and outcomes, including analysis of the unintended consequences of the drug-control system,
- ensure that those who are most affected by drug use and drug policies are meaningfully and actively involved in the development of policies and programs,
- evaluate its own work and policies and identify ways in which its effectiveness and impact might be improved, including decision making by vote in accordance with the rules of procedure of ECOSOC and its functional commissions, as appropriate,
- ensure that its decisions are guided by the best and most relevant data and evidence, including data on psychological health, the transmission of blood borne infections and data on compliance with human rights norms.
Instruments such as the SDGs and the reviews of the Annual Report Questionnaire help the system find ways towards common standards to measure efficacy and outcomes of drug policies. However, the other three areas have seen little progress so far. On b), the two-year discussions have not seen any consultation with patients or those affected by cannabis use or policies. If the Commission rejects WHO recommendations, it would be a clear failure to accomplish c) and d).
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Accepting WHO’s recommendations would be a first step in the partnership between governments and civil society to build tomorrow’s healthcare systems together.This is why we, scientists, researchers, public-health specialists, physicians, nurses, caregivers, join INCB and WHO in calling all Nations to support these recommendations as a step towards a rules-based international order led by evidence and human rights.
Colombia: Asociacion-Medica-Colombiana-de-Cannabis-Medicinal; Elementa-DDHH.
Czech republic: Asociace-péče-o-seniory; Společnost-Podané-ruce.
Georgia: Eurasian-Women’s-Network-on-AIDS; Women-for-health.
Italy: Eumans; Luca-Coscioni-Association, Science for Democracy
Kazakhstan: ALE-Kazakhstan-Union-of-People-Living-with-HIV; Общественное-объединение-Амелия.
Netherlands: Cannagenethics-Foundation; Correlation-European-Harm-Reduction-Network; Drugs-in-Debat.
Russian Federation: RuNPUD.
South Africa: Tshwane-Region3-Traditional-Health-Practitioners.
Spain: FAAAT; Observatorio-Español-de-Cannabis-Medicinal.
Switzerland: Cannabis-Consensus-Schweiz; Swiss-Society-for-Cannabis-in-Medicine.
Ukraine: ALLIANCE.GLOBAL; Sources-of-Public-Health; VOLNA.
United Kingdom: Drug-Science.
USA: International-Cannabis-Farmers-Association; Origins-Council; Society-of-Cannabis-Clinicians; Treatment-Action-Group.