Video 7: The case for a revision of the international scheduling of drugs

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来自 University of Geneva 的课程

Drugs, drug use, drug policy and health

1 个评分

University of Geneva

Drugs, drug use, drug policy and health

1 个评分

This MOOC is the first of its kind, since it addresses critical issues related to drugs from a multidisciplinary, health and human rights-based approach. Throughout the course you will cover a range of questions including what are drugs and why they controlled? What are the benefits and harms of taking drugs? How public health policies can address drug use? You will also learn about the intricacies of the international drug control framework and the negative consequences of widespread prohibitionist drug policies around the world. Finally, you will examine ways of furthering drug policy reform. The topics will be presented by over 40 speakers from scientific, academic and institutional backgrounds, spokespersons of civil society as well as people who use drugs presenting their views. By the end of the course you will have: - a strong understanding of the major health issues related to drug use and drug policy; - a clear vision of why drug policy is debated today; - and, if you so wish, you will be equipped to engage in the drug policy reform movement at your local or regional level.

从本节课中

MODULE 5: Medical access to opioids for the management of pain and to other controlled medicines

Welcome to Module 5 which looks at access to controlled medicines. During this week, you will learn how the international scheduling of drugs works; be presented with some of the main barriers to access to essential medicines and look specifically at the case of the opioid epidemic which is ravaging through the United States at the moment. The medical use of cannabis and cannabinoids is also a highlight of this week and one that is particularly relevant in a number of countries around the world at present. By the end of this Module you will be able to: • Describe the scheduling of controlled medicines; • Recognize the barriers to access to controlled medicines and discuss the challenges posed by prescription drugs epidemics; • and examine the current issues around the medical use of cannabis and cannabinoids. We hope you enjoy this week, which is slightly different to the other Modules in terms of its specific topic but adds a lot of important information in terms of understanding the international drug control framework and issues related to drugs, drug use and policies as well as possible. Best wishes,The Drugs, Drug Use, Drug Policy and Health team

Video 4: The barriers to access to essential medicines6:27

Video 5: The special case of the opioid epidemic in the United States6:25

Video 6: Medical use of cannabis and cannabinoids6:47

Video 7: The case for a revision of the international scheduling of drugs6:57

与讲师见面

Michel Kazatchkine
Senior Fellow
Global Health Center, Graduate Institute for International Affairs and Development, Geneva
Barbara Broers
Professor (in Addiction Medicine)
Community Health Departement, Geneva University Hospitals
Aymeric Reyre
Senior Lecturer
Faculty of Medicine, Paris 13 University
Jennifer Hasselgard-Rowe
Researcher and Lecturer
Institute of Global Health, University of Geneva

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.

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