The WHO assessment by scientists who are experts in
psychoactive substances is a scientific procedure in theory.
Therefore, the scheduling which is based on
the ECDD's recommendations is rationally justified in theory.
Reality is that the Single Convention is almost 60 years old,
and when it came into force most of its schedules were copied from
older conventions dating back as far as 1912.
The psychotropic substances convention is newer, from 1971,
but that means that also in that convention,
are substances included almost half a century ago.
This is a problem because the science of
substance dependence has much developed in the past 50 years.
Moreover, the risks from the nonmedical use of these substances
depends very much on the social context in which they are used,
and this developed also overtime.
Thus today, our knowledge has increased and the way substances are used
may be different from when these substances were evaluated years ago.
However, most of the substances in
the conventions were not assessed since the scheduling.
Opium, cocaine, and morphine were even never reviewed
since the inclusion in the First Opium Convention in 1912.
Since the mid of the 1920's the League of Nations,
the predecessor of the United Nations,
started evaluating substances that were candidates for inclusion.
In this way, oxycodone and cannabis were reviewed for the last time in 1935.
But there are many more important substances that were not reviewed for decades.
Heroin 1949, coca leaf in 1965,
amphetamine and LSD in 1989,
and MDMA in 1985.
In 1992 and 2012,
the expert committee recommended the review of substances every 20 years,
but in spite of this review has rarely been
proposed for the agenda by the WHO secretariat.
In the past 10 years,
the WHO's processes for guidelines
making treatment recommendations have become fairly strict.
There's no WHO's short treatment guidelines document that will
be released today if it's not fully evidence-based.
However, this is a sharp contrast with the preparation of ECDD review reports,
which essentially followed methodology that was developed in the 1980s.
It is essentially a narrative review of
all the scientific literature of the substance under review.
For a guidelines document today,
WHO requires a systematic review.
Such an approach places
the included scientific publications in a context and identifies weaknesses and strength.
This makes that the most reliable publications get
more weight in the decision process than week research has.
An alter group of ECDD members and WHO staff, including myself,
proposed in 2012 to make systematic reviews for the medical and pharmacological aspects.
Furthermore, for the quality aspects it
recommended Delphi analysis for maximal expert consent.
This has not been implemented and fortunately.
The only change that has been made is
the introduction of peer review of the meeting documents.
I'm not saying that the system of prohibition of
psychoactive substances is the best way for the promotion of public health.
However, as long as the international community agrees to organize it this way,
the inclusion of substances it should be through rigorous scientific procedures,
and currently, these procedures are not based on the best science we have.
Even worse, there are substances which have a high prevalence of
nonmedical use but which were never reviewed or really fairly long ago.
This altogether, makes that the current system of
prohibition can hardly be considered legitimate.
Several of these substances are politically sensitive.
Moreover, the ECDD work is funded by
the Drug Control Department of a number of
countries which have an interest in the outcomes.
Therefore, for an organization like WHO,
it's very hard to recommend on substances that receive a lot of political attention.
Let's now have a look at the example of cannabis.
As I already mentioned,
cannabis was reviewed for last time by the League of Nations in 1935.
After 1947 when the WHO took
over from the League of Nations the expert committee discussed it,
but it never conducted a review.
When the ECCD recommended to put in place a process
to review each kind of substance every twenty 20 years in 2012,
cannabis was one the substances that was mentioned for
inclusion on the agenda of future meetings.
The same happened in 2014 and 2015 yet the WHO secretariat avoided to
propose a revival of cannabis as an agenda item for
all these meetings held in 2014,2015, and 2016.
Technically, it could have easily done so.
One can only guess what is behind this cold feet.
My own impression is this,
whatever the ECDD would recommend either recommend that current scuttling is good,
recommended to deescalate or even to remove cannabis from the conventions,
it would never be good.
WHO would always be criticized heavily from one side or the other side.
The only way to evade being criticized is not to make this so much needed assessments.
If my analysis is correct,
we can clearly see that the political life of the organization
and of its executives prevails over the interests of public health.
This is sad, but it's my experience that this is how governmental organizations work.