WHO’s Activity: Better Late than Never

Since the United Nation’s 1961 Single Convention on Narcotic Drugs, the World Health Organization (WHO), and its Expert Committee on Drug Dependence (ECDD) has had a mandate for cannabis and its derivates scheduling recommendations within the International Drug Control Conventions (IDCC) to control the risk to public health and insure medical availability of internationally controlled drugs.

In the outcome document of the 2016 special session of the UN General Assembly on the world drug problem (UNGASS 2016), the UN noted with concern that the availability of internationally controlled drugs for medical and scientific purposes, including the relief of pain and suffering, remains low to non-existent in many countries of the world.

The document highlighted the need to enhance national efforts and international cooperation at all levels to address that situation. This supposes to be executed by promoting measures to ensure drug availability and accessibility for medical and scientific purposes, within the framework of national legal systems, while simultaneously preventing their diversion, abuse, and trafficking. The document called for informed and coordinated scheduling decisions and reaffirmed the role of the World Health Organization (WHO).

In the 2019 Ministerial Declaration, the international community committed to strengthening the work of the Commission on Narcotic Drugs with the World Health Organization yet again, to continue facilitating informed scheduling decisions on the most persistent, prevalent, and harmful substances, while ensuring their availability for medical and scientific purposes.

WHO’s last year’s recommendations are the first milestone since 1954, as international advocates for medical cannabis Michael Krawitz and Kenzi Riboulet-Zemouli point out in their memo for the 4th inter-sessional meeting of the 62nd United Nations Commission on Narcotic Drugs.

In 1954, the WHO’s Committee was ‘pleased to note’ that the elimination of cannabis preparations had already begun, following their opinion there was no justification for the medical use of cannabis preparations.

They repeatedly issued this kind of statement during the 1950s and 1960s. As it is explained in the Crimson digest, a detailed briefing on the international scientific assessment of Cannabis, conducted by Kenzi Riboulet-Zemouli, Michael Krawitz, and Farid Ghehiouèche, the WHO started to take an interest in this subject in 1952, through its Expert Committee on Drugs Liable to Produce Addiction. At its 3rd meeting in 1953, the Committee discussed the use of cannabis preparations for medical purposes and decided cannabis preparations are practically obsolete. No review of the literature was made and preparatory documents of the meeting mentioned in the minutes were minimal. The following year, the Committee brought their decision relying on no more than „the feeling among the South African police of a relationship between cannabis addiction and crime” and „evidence that, as in other parts of the world, cannabis abuse is likely to be a forerunner of addiction to opiates”. Their 1954 opinion that „not only can there be no abatement in control procedures but there should also be an extension of the effort towards the abolition of cannabis from all legitimate medical practice” was the last time that WHO issued a statement regarding this issue until 2018.

In this 64 years long gap, more than 100 cannabinoids in the Cannabis sativa L. plant were identified, with numerous scientific researches conducted on their medical properties, and the first medicines containing cannabinoids were already gaining decades of legal use.

The pledges to the WHO to reconsider their opinion started in 2009 when the UN’s Commission on Narcotic Drugs asked for an updated report on cannabis. In 2014, the International Narcotics Control Board (INCB) invited WHO to evaluate the potential medical utility of cannabis and the extent to which cannabis poses danger to human health. During the 37th meeting of the ECDD in 2015, the experts requested data collection towards a preview at the future meeting. One year after, and after an important global mailing action of academics and civil society stakeholders to WHO leadership, the ECDD announced the launched the reviews in December 2016.

After six calls in total and sixty-six years later, this year at the United Nations Commission on Narcotic Drugs session in Vienna we might see Cannabis sativa L. get harmonized with practice applying to the scheduling of coca and opium derivates for the first time.

After all of this time, the fact that cannabis is going to be recognized as having potential medical benefit is fantastic in itself, but it’s difficult not to think about all the lives that could have been saved and improved if these developments in the legislative have happened earlier, bringing improvement to our global community’s health system and practices.

When you observe this issue from a point of global industry, it’s not only WHO to blame for this major delay, but also the UN itself. Even with the new recommendations from the WHO, the UN’s INCB recommends further restrictions on the production of CBD, which can be seen as a contradiction in itself. The INCB still holds that the flowering top of the hemp plant should be considered under control, even though it is exempted from the Convention when used for industrial and horticultural purposes, regardless of the THC or CBD content.  Also, their questioning of practical implementation and appropriate identification techniques for establishing 0,2% of THC in CBD and other cannabinoid products could lead to another delay in bringing long-awaited changes in the UN’s conventions. Let’s hope it won’t.

Reviewed by Sasha Bajilo, founder of ILESOL Pharmaceuticals, an industrial scale producer of CBD products and formulations. Expert on Hemp/Cannabis policy, member of the Croatian Ministry of Health regulatory commission for medical cannabis.