CND monitor V9.1 (4 May 2022)
U.n. Cannabis scheduling vote: history & outcome
Commission on Narcotic Drugs
Reconvened 63rd session.
Vote on the scheduling recommendations of the World Health Organization regarding ‘cannabis and cannabis-related substances’ for ‘medical and scientific purposes.’
On 2 December 2020, governments voted on changes in the scheduling of medical cannabis products, in international law. This page presents full results of the vote + previous steps, history and info on the different contributions.
The votes that took place, and the recommendations of the WHO upon which they were based, do not concern “adult use” or “recreational use” and do not concern “hemp” or “industrial cannabis.” The recommendations concerned only the levels of policy control over “medical cannabis“ (medical CBD, medical THC, etc.).
When & where
United Nations, Vienna, Austria (partly virtual)
2 December 2020
Vote by 53 UN Member States (rotating)
The content on this page is under a CC-BY-SA 4.0 licence, except where noted otherwise. Authors: Kenzi Riboulet-Zemouli and Michael Krawitz, 2015-2021.
Table with the full results of the votes by country
Peer-reviewed journal article on the United Nations (de)scheduling process (2015-2021)
Riboulet-Zemouli K, Krawitz M (2022). “WHO’s first scientific review of medicinal Cannabis: from global struggle to patient implications”Drugs, Habits and Social Policy, ahead-of-print, 2022. DOI: 10.1108/DHS-11-2021-0060
Background “Cannabis” and “cannabis resin” are derived from the Cannabis plant, used as herbal medications, in traditional medicine and as active pharmaceutical ingredients. Since 1961, they have been listed in Schedule IV, the most restrictive category of the single convention on narcotic drugs. The process to scientifically review and reschedule them was launched by the World Health Organisation (WHO) on 2 December 2016; it survived a number of hindrances until finally being submitted to a delayed and sui generis vote by the UN Commission on Narcotic Drugs on 2 December 2020, withdrawing “cannabis” and “cannabis resin” from Schedule IV. Design/methodology/approach To evaluate WHO’s scheduling recommendations, the process leading to the Commission vote and subsequent implications at global, national and patient/clinician levels. Narrative account of the four-year proceedings; review of the practical implications of both rejected and accepted recommendations. Findings The process was historically unprecedented, of political relevance to both medical Cannabis and evidence-based scheduling generally. Procedural barriers hampered the appropriate involvement of civil society stakeholders. The landscape resulting from accepted and rejected recommendations allow countries to continue creating decentralised, non-uniform systems for access to and availability of “cannabis” and “cannabis resin” for medical purposes. Originality/value Perspective of accredited observers; highlight of institutional issues and the lay of the land; contrast of stakeholders’ interpretations and engagement.
Detailed report on the United Nations (de)scheduling process (2015-2021)
Riboulet-Zemouli K, Krawitz M, Ghehiouèche F (2021). History, science, and politics of international cannabis scheduling, 2015–2021. FAAAT editions.
On 21 April 2021, the herbal medicines “cannabis” and “cannabis resin” definitively ceased to appear in Schedule IV of the 1961 Single Convention on narcotic drugs (C61), where they had been listed since the entry into force of that treaty in 1964. The process to scientifically review and reschedule Cannabis-related controlled drugs had been launched by the World Health Organization (WHO) on 2 December 2016 and went through a number of hindrances until it finally got submitted to a unique voting process on 2 December 2020 at the United Nations Commission on narcotic drugs (CND). This report reviews the scientific assessments of Cannabis-related controlled drugs and cannabidiol (CBD) by the WHO’s Expert Committee on Drug Dependence (ECDD) and subsequent political discussions at CND that culminated with the 2 December 2020 vote, changing the scheduling of “cannabis” and “cannabis resin” under the C61. A digest of the four years of proceedings (2015-2021) is presented, showcasing elements that provide an understanding about the length and complexity of the processes involved. The report introduces previously-unpublished minutes, complements of information, details on stakeholders and their role, and highlights a number of bureaucratic and diplomatic issues; it compares the efforts undertaken by WHO and CND in terms of method, transparency, and involvement (or not) of interested parties, beyond governments.
The tables below originate from this report:
Main legal documents issued following the vote
2 December 2020: Decision 63/17 of the Commission on narcotic drugs; withdrawal of cannabis and cannabis resin from Schedule IV, 1961 Convention (6 languages)
Document E/2020/28/Add.1 containing the CND Decision 63/17 “Deletion of cannabis and cannabis resin from Schedule IV of the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol”
|Schedules of the 1961 Convention||
2 December 2020: Explanations of vote by Commission members on 2 December 2020 (English only)
Explanations of vote by Commission members on 2 December 2020: Afghanistan, Australia, Chile, Colombia, Cuba, Ecuador, Egypt, El Salvador, Germany (Joint statement, EU without Hungary), Jamaica, Japan, Mexico, Morocco, Pakistan, Russian Federation (Joint statement), Russian Federation (National statement), Turkey, Ukraine, and the United States.
|List of explanations of votes on UNODC website||English only|
2 December 2020: UNODC Press Statement regarding cannabis-related votes (English only)
Press Statement – 2 December 2020. CND votes on recommendations for cannabis and cannabis-related substances.
|UNODC Press Statement||English only|
21 January 2021: Notification to Governments by UN Secretary-General/UNODC (English only)
Document NAR/CL.3/2021 giving effect to the scheduling changes in accordance with article 3, paragraph 7, of the Single Convention on Narcotic Drugs of 1961, as amended by the 1972 Protocol, dated 21 January 2021.
|Schedules of the 1961 Convention||English only|
22 January 2021: The Schedules of the 1961 Single Convention, as modified (6 languages)
U.N. revokes 60-year ban – declares cannabis legitimate medicine
Outline of the recommendations of WHO voted on
(Recommendations on cannabis and cannabis-related substances from the 40th [June] and 41st [November] meetings of the WHO Expert Committee on Drug Dependence)
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Official contributions of NGOs
and CIVIL SOCIETY representatives
Written statement delivered by 55 NGO "Science-based scheduling for cannabis and other herbal medicines" (UN, December 2020)
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, all in special consultative-status with ECOSOC.
In addition, the following organizations, without ECOSOC status, support this statement: Azerbaijan: Public Organization Against AIDS. Belgium: Science for Democracy. Canada: Moms Stop The Harm. Colombia: Asociación Médica Colombiana de Cannabis Medicinal; Elementa DDHH; Vetcann. Czech republic: Asociace péče o seniory; Společnost Podané ruce. Georgia: Eurasian Women’s Network on AIDS; Women for health. Germany: International Association for Cannabinoid Medicines. Hungary: Rights Reporter Foundation. Italy: Eumans; Luca Coscioni Association. Kazakhstan: ALE Kazakhstan Union of People Living with HIV; Общественное объединение Амелия. Lithuania: Eurasian Harm Reduction Association. México: Integración Social Verter. Moldova: PULS. Netherlands: Cannagenethics Foundation; Correlation European Harm Reduction Network; Drugs in Debat. Poland: PREKURSOR Foundation for Social Policy. Portugal: GAT – Grupo de Ativistas em Tratamentos; YouthRISE;. Romania: Romanian Association Against AIDS. Russian Federation: RAndrey Rylkov Foundation for Health and Social Justice; RuNPUD. Serbia: Drug Policy Network South East Europe. Slovakia: ODYSEUS. Slovenia: Stigma Association for harm reduction. South Africa: Tshwane Region3 Traditional Health Practitioners. Spain: FAAAT; Observatorio Español de Cannabis Medicinal. Switzerland: Cannabis Consensus Schweiz; Swiss Society for Cannabis in Medicine. Thailand: Asia Catalyst. 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.
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.
* * *
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.
* * *
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.
* * *
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).
* * *
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.
Written statement delivered by 193 NGOs "Patients access to medical cannabis" (UN, December 2020)
Submitted by the European coalition for just and effective drug policies [special]; and co-sponsored by DRCNet Foundation [special]; Grupo de Mujeres de la Argentina – Foro de VIH Mujeres y Familia [special]; Law Enforcement Action Partnership [special]; National Advocates for Pregnant Women [special], NGOs in consultative status with the ECOSOC, and 178 other NGOs:.
In addition, the following 178 NGOs co-sponsored the statement: Albania: National-Albanian-Hemp-Industry-Association. Argentina: Cultivadores-Argentina; Cultivando-ConCiencia; Cultivemos. Australia: CommonUnity-Foundation; Coolbellup-community-school; Help-Lindsay-Beat-This-Brain-Tumour; MCUA; Queensland-Council-for-Civil-Liberties. Austria: ARGE-CANNA; Elternkreis-Wien-Verein, zur-Förderung-der-Selbsthilfe-für-Angehörige-von-Suchtkranken. Belarus: MS-Society-of-Belarus. Belgium: European-Industrial-Hemp-Association; Mambo-Social-Club; Mu-Sic-Foundation; Tire-Ton-Plant. Brazil: Latin-American-Industrial-Hemp-Association. Bulgaria: Restart-Bulgaria. Canada: Clinique-la-Croix-Verte; Moms-Stop-The-Harm; NORML-Canada; Patient-Access. Colombia: ASOMEDCCAM; ProCannaCol. Costa Rica: ACEID. Czech republic: CzecHemp; Legalizace.cz; Konopa; KOPAC. Ecuador: Cáñamo-Industrial-Ecuador. France: APAISER-S&C; Cannabis-Sans-Frontières; Club-Confluence; ECHO-Citoyen; Espoir-(im)patient; FAAAT; #jusquaubout; Le-sourire-de-Wael; NORML-France; Police-Contre-la-Prohibition; Principes-Actifs; SOS-Addictions. French-Polynesia: Institut-Polynésien-du-Cannabis; Tahiti-Herb-Culture. Germany: Arbeitsgemeinschaft-Cannabis-als-Medizin; Global-Marihuana-March-Freiburg; Gruene-Hilfe-Hessen; Grüne-Hilfe-Netzwerk; Hanf-Museum; Hanfparade. Greece: Iliosporoi-Network; MAMAKA-Mothers-for-Cannabis. Hungary: Hungarian-Medical-Cannabis-Association. India: Medicinal-Cannabis-Foundation-of-India; Wildleaf. Ireland: Help-Not-Harm. Israel: Green-Leaf-Party. Italy: Cannabis-Cura-Sicilia-Social-Club; Osservatorio-sulla-cannabis-CBD. Kazakhstan: Kazakhstan-Union-of-People-Living-with-HIV. Republic of Korea: Korea-Medical-Cannabis-Organization. Lao People’s Democratic Republic: Lao-Medical-Cannabis-Group. Luxembourg: Cannamedica-Luxembourg; Ligue-Luxembourgeoise-de-la-Sclérose-en-Plaques. Malaysia: Malaysia-Society-of-Awareness. Malta: Releaf-Malta. Mauritius: PILS. Mexico: Cannapeutas. Namibia: Cannabis-and-Hemp-Association-of-Namibia. Nepal: Dristi-Nepal. Netherlands: Cannabinoid-Association-Netherlands; Drugs-in-Debat; Drugs-Peace-Institute; Dutch-Drug-Policy-Foundation; Foundation-Patienten-Groep-Medicinaal-Cannabis-Gebruikers; Legalize!; Netherlands-Drug-Policy-Foundation; Piratenpartij; Tree-of-Life-Medical-Cannabis-Society; VOC-Nederland; Suver-Nuver. New Zealand: Auckland-Patients-Group; Green-Fairies; Integrative-Medicine-Otago; CCNZ; Medicinal-Cannabis-Awareness-New-Zealand; New-Zealand-Medical-Cannabis-Council; NORML-New-Zealand; NZ-Hemp-Industries-Association; The-Hemp-Foundation. Paraguay: Observatorio-Paraguayo-de-Cannabis. Peru: Cannabis-Gotas-de-Esperanza. Philippines: Sensible-Philippines. Portugal: apcanna; CannaCasa; CASOrganizados; Observatório-português-de-Canábis-Medicinal. Romania: Asociația-Națională-a-Producătorilor-de-Cânepă-Industrială. Sint-Eustatius: Roots-Foundation. Slovakia: Why-Not-Hemp? Slovenia: CannaGIZ; Društvo-AREAL; Društvo-zeliščarjev-Pomurje; FIST-human-rights-association; Institut-ICANNA. South Africa: Fields-of-Green-for-ALL. Spain: ARSU; Asociación-Cannabio-Medicina-y-Adicción-La-Aldeilla; Dosemociones; APDO; CATNPUD; FEDCAC; Flecha-Verde; Fundación-Renovatio; Los-Mejores-Humos; OECCC; Pla-d’Accions-sobre-Drogues-de-Reus; Unión-de-Pacientes-por-la-Regulación-del-Cannabis. Suriname: Spindoctor-Facilities. Switzerland: IG-Hanf-Schweiz. Trinidad-and-Tobago: Caribbean-Collective-for-Justice. Ukraine: Athena-Women-Against-Cancer; Cannabis-Freedom-March-Kyiv; HPLGBT; Korolivskiy-lis; Ukrainian-Association-of-Medical-Cannabis; Urban-Initiatives-and-Social-Transformations; Veterans-Pro-Medical-Cannabis. United Kingdom: Be:yond-Green; British-Hemp-Alliance; CANCARD; Cannabis-Trades-Association; CCGUIDE; Faircann-International; Hemp-Think-Tank; Northern-Ireland-Hemp-Association; Seed-our-Future-Campaign; UK-Medical-Cannabis-Clinicians-Society. United States: Academy-of-Cannabis-Education; A-Therapeutic-Alternative; Americans-for-Safe-Access; Anishinaabe-Agriculture-Institute; Association-of-Patient-Advocates; Balanced-Veterans; Berkeley-Patients-Group; California-NORML; Cannabis-for-Children-International; Cannabis-Health-Advocates; C.A.R.E.; Center-for-the-Study-of-Cannabis-and-Social-Policy; Decriminalize-Nature-Tucson; Drug-Policy-Forum-of-Texas; Ethical-Data-Alliance; Family-Council-on-Drug-Awareness; Full-Spectrum-Veteran; Hemp-for-the-Future; International-Medical-Cannabis-Patients-Coalition; Last-Prisoner-Project; Louisiana-Veterans-for-Medical-Cannabis; Marijuana-Policy-Project; Mendocino-Cannabis-Alliance; National-Cannabis-Industries-Association; New-England-Veterans-Alliance; National-Organization-for-Reform-of-Marijuana-Laws; Oaksterdam-University; Patients-Out-of-Time; Project-PC; Raha-Kudo-Design-for-Dying; Seattle-Hempfest; Society-of-Cannabis-Clinicians; Texas-Veterans-for-Medical-Marijuana; The-Grateful-Veteran; The-Veterans-Action-Council; TRUCE; Veterans-Alliance-for-Compassionate-Access; Veterans-Chapter-Pro-Cannabis-Medicinal-Inc.; Veterans-Ending-the-Stigma; Veterans-for-Medical-Cannabis-Access; Veterans-Initiative-22. Zimbabwe: Zimbabwe-Civil-liberties-and-Drug-Network.
Cannabis has been a mainstream medicine since the dawn of civilization. In 1902 and 1929 cannabis medicines were discussed at the International Conference on the Unification of Pharmacopœial Formulas for Potent Drugs which provided guidelines to harmonize cannabis medicines and provide patients with safe and standardized drugs for their treatments. By that time cannabis was well-accepted in clinical practice and reported in the Pharmacopœias of Austria, Belgium, France, Hungary, Italy, Japan, Netherlands, Switzerland, United Kingdom, United States of America as well as Mexico and Spain.
In 1958, the UN reported that cannabis was additionally in the Pharmacopoeias of Argentina, Brazil, China, Egypt, Finland, India, Portugal, Romania, the USSR, and Venezuela.
Many cannabis preparations are in ancient texts that compose the Ayurvedic Pharmacopœia (Charaka Samhita, Sushruta Samhita, Shargandhara Samhita) and in traditional Mediterranean Pharmacopœias of Umdat at-tabîb, Jami’ al-mufradat, Hadîqat al-azhâr or Tuhfat al-ahbâb. Cannabis is also present in traditional Chinese medicine since 神農本草經 (Shennong Bencaojing) and is an ancient medicinal plant of Russia and central Asia.
A 1997 WHO report recalls: “Traditional healers in Tanzania have also been known to use an extract from the cannabis plant for the treatment of ear-ache. Cannabis is a traditional psychoactive substance in sub-Saharan Africa, mainly used for ritualistic or medical purposes […] In some Asian countries cannabis is also added to food as a condiment and used in herbal medicines.”
Cannabis and its derivatives have proven useful for many citizens worldwide who suffer from anxiety, depression, post-traumatic-stress-disorders, glaucoma, pruritus, asthma, ADHD, Crohn’s-disease, epilepsy, and is particularly useful for relief of unremitting neurological pain.
When cannabis is used as a pain treatment, “given as an adjunct to opioids for chronic pain,” one of its best known characteristics is a “pill sparing effect,” which can help reduce the risk of opioid overdose and death. It is unacceptable that so little research has been done to further explore these capabilities. The current treaty placement of cannabis has stifled research: many Member States, that took the floor recently to support WHO recommendations because they would “promote research”, are implicitly agreeing with this premise.
Perhaps the greatest tragedy is that those countries most firmly opposed to WHO recommendations are undergoing “opioid overdose crises” that research into the cannabinoid-opioid interaction could help. Ironically, the countries that oppose the evidence-based outcome of WHO have shortages in medications to treat some of the very conditions cannabis has been proven useful for. Further tragedy is that many of the countries who oppose these recommendations, from Eurasia to the Americas and Africa, do so at the detriment of their own traditional use, and undermine their own sovereignty by simultaneously disrespecting their own culture, heritage, history and economic development.
Given that the use of medicinal cannabis is expanding despite the hurdles created by the Convention, a failure to implement the recommendations would trivialise the Conventions by showing they are neither fit to purpose of ensuring access to medicines nor are they able to adjust based upon compelling evidence. The treaty, lacking an evidence base, would become unable to protect the health and wellbeing of humankind.
Patients around the world are counting on you to seize the opportunity offered by WHO to update the treaties, doing all you can to ensure access to all useful medicines. Including cannabis medicines. Adopting WHO’s recommendations would lead to better medications being developed and more tools for doctors to alleviate suffering while simultaneously reinforcing the UN’s relevance. Since the recommendations are of optional national enforcement, and since even the INCB concluded that the recommendations will “clarify and streamline control requirements,” provoking no legal or administrative disruption, opponent countries might want to show the common and shared responsibility they often mention, by abstaining instead of obstructing the international community. Political doubts about a medical treatment can in no way justify rejecting science.
Cannabis remains “indispensable for the relief of pain and suffering and adequate provision must be made to ensure the availability of narcotic drugs for such purposes” just as the Single Convention boldly proclaimed back in 1961.
Patients in pain and suffering, struggling for their health, for access, and against the weight and the force of unfair and outdated laws are urging you to support these recommendations. The WHO acknowledged that cannabis is now well known to provide relief not available from other medications and with less negative side effects. Accepting these recommendations will support medicinal access and enable research that will benefit us all. A failure to accept these recommendations is not only a rejection of science but is an abandonment of the most vulnerable of our citizens.
Medical patients are particularly shocked and in deep distress with the statements expressed by some Member States that adopting WHO’s recommendations would “send the wrong message” about cannabis. Those comments seem to avoid considering what kind of message the perpetuation of a failed policy sends when it is directly undermining the rule of law, complicating the work of medical professionals, and constitutes an attack against the value of scientific evidence in our world.
These recommendations do not promote “legalization,” however, their rejection would certainly do just that. We would like the opponents of cannabis to consider that, if they succeed in undermining the adoption of these recommendations, they are not preserving the multilateral system.
Governments need to understand these recommendations balance the need for fighting abuse with the need to reduce suffering. Both worthy goals are connected: favoring one over the other will yield success with neither. It would be tragically ironic if a failure of the CND to implement these recommendations sets back advances in drug abuse treatment due to the difficulty in studying cannabis as it is currently scheduled. Certainly, the opiate reductions that patients have reported when using cannabis medicines as an adjunct pain treatment compels serious consideration.
On 2 December the CND will make a decision of historical and universal relevance. The UN system must assist CND members during this time of pandemic to ensure all votes can be cast and all voices heard. Patients are citizens of the world, we live on every continent and we are watching this vote with great interest and hope.
These WHO cannabis recommendations represent the first chance in our lifetime to correct the record. As we endeavor to protect human rights, ensure peace, security, health, prosperity and reverse the damage we have visited upon our environment we must be ready to admit our mistakes as well as commend our accomplishments. Cannabis was entered into the treaty system based upon misinformation and an absence of a rigorous scientific assessment and now that we have had a critical review of cannabis the system has now been made aware of the vast medical value and minimal risk of this age-old medicine; this truth compels action.
Support patient access to medicines!
Written statement delivered by Dr. Dingle Spence, Board Member of the International Association for Hospice & Palliative Care (UN, December 2020)
By Dr. Dingle Spence, IAHPC Board Member
Cannabis, marijuana, ganja, weed, pot – these are just a few names for this ubiquitous plant that is gaining in popularity for use as a medicine around the world. In this short submission, we examine a brief history of cannabis as medicine and the Jamaican experience with its use, in particular for cancer patients with palliative care needs.
Cannabis sativa is one of the most ancient psychotropic medicines known to humanity, and evidence for its use for medicinal and ceremonial purposes dates back at least 4,000 years.
Cannabis prescribed by doctors in the 1800s
Early evidence for its medicinal use is focused on applications for pain, insomnia, inflammatory conditions and digestive issues. Cannabis as medicine was first introduced to Europe in the mid-1800s and by the 1850s cannabis was listed in both British and American pharmacopoeia and could be prescribed by medical doctors. However, for a variety of complex reasons, cannabis was made illegal in both the United Kingdom of Great Britain and Northern Ireland and the United States of America in the 1920s and 30s, and was subsequently withdrawn from pharmacies.
Research continued despite ban
Despite these prohibitions, research into the plant continued, and in the 1980s the first cannabis receptor was discovered in humans. In 1992, the human endocannabinoid system was first described. The elucidation of the endocannabinoid system was paralleled by the discovery of the endogenous cannabinoid ligands, anandamide, very similar in structure to THC (tetrahydrocannabinol); and 2-arachydonoylglycerol, similar in structure to CBD (cannabidiol). THC and CBD are two of the principal components of the cannabis plant and of modern-day cannabis-containing medicines.
The whole-plant advantage
Over the past 30 years synthetic cannabinoids have been introduced to the market with varying reports of efficacy. There is now increasing evidence that whole plant extracts tend to be more clinically efficacious than both their synthetic counterparts and single molecule plant isolates. This may be due to the “entourage effect,” which posits that a variety of “inactive” metabolites in the whole plant may render its use more efficacious than isolated components.
Cannabis was first introduced to Jamaica in the 1850s by indentured servants brought from India during British rule of both nations. Cannabis has a long history of use as a medicine on the island, along with many other traditional herbal remedies, all part of our cultural pharmacopoeia. My father, who was a radiation oncologist, would often prescribe ganja tea to help patients with chemotherapy- and radiation-induced emesis, and would encourage those with poor appetite to use the tea as an appetite stimulant.
Cancer patients get relief from array of symptoms
In 2014, Jamaica’s “Dangerous Drug Act” of 1948 was amended to decriminalize cannabis use and make it legal for medicinal and sacramental purposes. Since then there has been a rapid rise in the use of, and demand for, cannabis-based medicines. Cancer patients in particular find THC and CBD containing medicines useful in relieving a variety of symptoms. These range from nausea and vomiting and anorexia, to relief of pain – particularly neuropathic-type pain – and for relief of anxiety and insomnia. In my own practice, I prescribe oil-based oral CBD and THC preparations for many of the above indications. A majority of my patients report clear improvement of symptoms and very few adverse effects. We “start low and go slow,” increasing by one to two drops at a time depending on the formulation available.
Undoubtedly, we are in need of many more high-quality observational and randomized controlled studies to more clearly elucidate the place of cannabis as medicine in oncology and palliative care settings. However, based on my current experience and the increasing body of evidence available, it will only be a matter of time before cannabis whole-plant extracts will become part of palliative care formularies in countries where its legal use is recognized.
Video statements delivered by 5 NGO representatives after the vote (UN, Vienna [virtually], December 2020)
Decembre 2nd, 2020: Four statements were delivered by Civil Society representativ es during the 63rd reconvened session of the CND:
- Luke Niforatos (Smart Approaches to Marijuana);
- Vicky Hanson (Interdisciplinary Centre for Cannabis Research);
- Memory Usaman (Rwanda Youth Impact);
- Dania Putri (Transnational Institute)
Video statements delivered by 6 NGO representatives during the consultations (UN, Vienna [virtually], October 2020)
- Dr. Joel Wren, Society of Cannabis Clinicians (Australia) – Statement, Video
- Margarita Sandra Garfias Hernández, Familias y Retos Extraordinarios AC (Mexico) – Statement, Video
- Pujan Sharma, Everest Green Crescent (Nepal) – Video
- Birgit Karner, Society for the Advancement of Global Understanding (Austria) – Video
- John Redman, Community Alliances for Drug Free Youth (United States) – Video
- Obioma Evelyn Agoziem, Centre for Corrections and Human Development (Nigeria) – Video
A report on the session can be found on the website of the Vienna NGO Committee on Drugs.
Statements delivered by a representative of patients who use cannabis for medical purposes (UN, Vienna, March 2020)
The community of military veterans in the United States has found Cannabis to be an invaluable medication that has helped us reduce our pill count from the mainstream hospitals system. Cannabis as an adjunct pain medicine has been proven to be an effective especially effective as an adjunct palliative treatment.
As a medical patient myself, I know firsthand how well Cannabis works. Our current medicinal access laws are the product of decades of efforts at the state and national level and provide over 1/2 of our population medicinal access to a variety of useful and effective Cannabis medications.
Patients in my country, the USA, have waited long enough. But patients in most of the world have suffered for a very long time. In 35 of the 53 voting members of the Commission the medical use of Cannabis is a traditional practice that is culturally accepted and documented by science and History.
The treaty is often the sole reason cited to justify such strict control and lack of availability of Cannabis for medical use. 59 years after Cannabis was scheduled in the absence of scientific evidence, the WHO spent many years studying Cannabis medicinal use before releasing recommendations and another year as the WHO has engaged the CND process. Although we understand the need for Member States to properly assess and understand the recommendations of the CND process, I ask you, dear delegates serving on this Commission on Narcotic Drugs, fulfil the mandate of the international drug control system to ensure access to medicines, medicines capable of relieving human suffering. We have waited long enough.
Thank you, Take care of yourself, and Ensure access for all.”
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17 min. video
Introduction to the issues at stake
COUNTRIES ENTITLED TO VOTE ON THE CANNABIS SCHEDULING RECOMMENDATIONS
(State Parties Members of the Commission on Narcotic Drugs at its 63rd session)
IMPACT ASSESSMENT OF THE RECOMMENDATIONS
WHO IS IN CHARGE?
His Excellency Mr. Mansoor Ahmad Khan, former Ambassador of Pakistan in Vienna (June 2018-August 2020), currently Ambassador of Pakistan in Kabul (since Septembre 2020). H.E. Ahmad Khan will continue chairing the CND from his position of Ambassador in Afghanistan.
The Extended Bureau of the Commission organizes and prepares in advance the different sessions of the CND, with the assistance of the SGB (see below). The importance of the work undertaken by the Extended Bureau has increased due to the pandemic and related difficulties in arranging meetings at the UN headquarters. It is currently composed as follows (tentative):
- Pakistan (Chair, APG),
- Poland (Vice-chair, EEG),
- Switzerland (Vice-chair, WEOG),
- Chile/Cuba (Vice-chair, GRULAC),
- Nigeria (Rapporteur, AG),
- Germany (EU presidency),
- Malaysia (Group of 77+China).
UNODC’s SGB (Secretariat to the Governing Bodies)
The United Nations Office on Drugs and Crime (UNODC), a regular UN agency, carries out the mandate given by the Conventions to the United Nations Secretary-General. It ensures the tasks of secretariat to the Commission on Narcotic Drugs via its Secretariat to the Governing Bodies (SGB), one of the sections of the Division for Treaty Affairs of UNODC. The Secretariat is currently headed by Ms. Jo Dedeyne-Amann.
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ALL POSITION EXPRESSED BY VOTING COUNTRIES AHEAD OF THE VOTE BETWEEN 2019 AND 2020,
FORMAL NEGOCIATIONS AND VOTING PROCEDURES,
ALL BACKGROUND INFORMATION
as of 1 Decembre 2020, has been archived.
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III.2007 CND requests an update on THC (CND decision 50/2) >>> III.2009 CND requests an update on cannabis (CND resolution 52/5) >>> XI.2016 Launch of the Review process by WHO (E/CN.7/2016/CRP.13) >>> II.2019 Publication of the results of the Reviews by WHO (Circular Letter) >>> XII.2016 First Delay by the CND (CND decision 62/14) >>> VI.2019 Intersessional CND meeting (public) #1 >>> IX.2019 Intersessional CND meeting (public) #2 >>> XI.2019 Intersessional CND meeting (public) #3 >>> III.2020 Second Delay by the CND (CND decision 63/14) >>> VI.2020 First Topical CND meeting (closed) >>> VIII.2020 Second Topical CND meeting (closed) >>> IX.2020 Third Topical CND meeting (closed) >>> IX.2020 Intersessional CND meeting (public) #4 >>> XII.2020 Vote, or other action taken, on the recommendations.
WHO recommendations (1/2) from the 40th ECDD meeting
23 July 2018
WHO recommendations (2/2) from the 41st ECDD meeting
24 January 2019
Voting procedure on the scheduling recommendations of the WHO on cannabis and cannabis-related substances at the reconvened 63rd session of the Commission on Narcotic Drugs
Chair’s proposal based on draft by Russian Federation
Revised proposed arrangements for the vote
63rd Commission on narcotic drugs, Reconvened session on 2 to 4 December 2020. Status: 6 November 2020.
Secretariat to the Governing Bodies.
Note by the Secretariat.
Consideration of the notification from the World Health Organization concerning scheduling under the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol, and the Convention on Psychotropic Substances of 1971.
Changes in the scope of control of substances: proposed scheduling recommendations by the World Health Organization on cannabis and cannabis-related substances.
Memo for the vote.
Changes in the scope of control of substances: proposed scheduling recommendations by the World Health Organization on cannabis and cannabis-related substances.
Compilation of all questions and answers on the WHO recommendations on cannabis and cannabis-related substances raised during the fourth and fifth intersessional meeting of the Commission at its sixty-second session.
WHO ECDD, 41st report
WHO ECDD, 40th report
WHO ECDD, 39th report
Brochure on the CND
Information about the United nations Commission on Narcotic Drugs (CND), a functional commission of the UN Economic and Social Council (ECOSOC).
Rules of Procedure of the Functional Commissions of the Economic and Social Council.
Brochure on Scheduling
Brochure on the scheduling functions of the Commission on Narcotic Drugs.