The global drug prohibition bureaucracy's watchdog group, the International Drug Control Board [22] (INCB) released its Annual Report 2013 [23] today, voicing its concerns with and wagging its finger at drug reform efforts that deviate from its interpretation of the international drug control treaties that birthed it. The INCB is "concerned" about moves toward marijuana legalization and warns about "the importance of universal implementation of international drug control treaties by all states."
For some years now, some European and Latin American countries have been expressing a desire to see change in the international system, and "soft defections," such as the Dutch cannabis coffee shop system and Spain's cannabis cultivation clubs, have stretched the prohibitionist treaties to their legal limits. But legal marijuana in Uruguay is a clear breach of the treaties, as Colorado and Washington may be. That is bringing matters to an unavoidable head.
After surveying the state of drug affairs around the globe, the 96-page INCB report ends with a number of concerns and recommendations, ranging from non-controversial items such as calling for adequate prevention and treatment efforts to urging greater attention to prescription drug abuse and more attention paid to new synthetic drugs. [Ed: There is some controversy over how to best approach prescription drug abuse and synthetic drugs. e.g. the type of attention to pay to them.]
But the INCB is clearly perturbed by the erosion of the international drug prohibition consensus, and especially by its concrete manifestations in legalization in Uruguay, Colorado, and Washington and the spreading acceptance of medical marijuana.
"The Board is concerned that a number of States that are parties to the 1961 Convention are considering legislative proposals intended to regulate the use of cannabis for purposes other than medical and scientific ones" and "urges all Governments and the international community to carefully consider the negative impact of such developments. In the Board's opinion, the likely increase in the abuse of cannabis will lead to increased public health costs," the report said.
Similarly, the INCB "noted with concern" Uruguay's marijuana legalization law, which "would not be in conformity with the international drug control treaties, particularly the 1961 Convention" and urged the government there "to ensure the country remains fully compliant with international law, which limits the use of narcotic drugs, including cannabis, exclusively to medical and scientific purposes."
Ditto for Colorado and Washington, where the board was "concerned" about the marijuana legalization initiatives and underlined that "such legislation is not in conformity with the international drug control treaties." The US government should "continue to ensure the full implementation of the international drug control treaties on its entire territory," INCB chided.
But even as INCB struggles to maintain the legal backbone of global prohibition, it is not only seeing marijuana prohibition crumble in Uruguay and the two American states, it is also itself coming under increasing attack as a symbol of a crumbling ancien regime that creates more harm than good with its adherence to prohibitionist, law enforcement-oriented approaches to the use and commerce in psychoactive substances.
"We are at a tipping point now as increasing numbers of nations realize that cannabis prohibition has failed to reduce its use, filled prisons with young people, increased violence and fueled the rise of organized crime," said Martin Jelsma of the Transnational Institute [24]. "As nations like Uruguay pioneer new approaches, we need the UN to open up an honest dialogue on the strengths and weaknesses of the treaty system rather than close their eyes and indulge in blame games."
"For many years, countries have stretched the UN drug control conventions to their legal limits, particularly around the use of cannabis," agreed Dave Bewley-Taylor of the Global Drug Policy Observatory [25]. "Now that the cracks have reached the point of treaty breach, we need a serious discussion about how to reform international drug conventions to better protect people's health, safety and human rights. Reform won't be easy, but the question facing the international community today is no longer whether there is a need to reassess and modernize the UN drug control system, but rather when and how."
"This is very much the same old stuff," said John Collins, coordinator of the London School of Economics IDEAS International Drug Policy Project [26] and a PhD candidate studying mid-20th Century international drug control policy. "The INCB views its role as advocating a strict prohibitionist oriented set of policies at the international level and interpreting the international treaties as mandating this one-size-fits-all approach. It highlights that INCB, which was created as a technical body to monitor international flows of narcotics and report back to the UN Commission on Narcotic Drugs, has carved out and maintains a highly politicized role, far removed from its original treaty functions. This should be a cause for concern for all states interested in having a functioning, public health oriented and cooperative international framework for coordinating the global response to drug issues," Collins told the Chronicle.
"The INCB and its current president, Raymond Yans, take a very ideological view of this issue," Collins continued. "Yans attributes all the negative and unintended consequences of bad drug policies solely to drugs and suggests the way to lessen these problems is more of the same. Many of the policies the board advocates fly in the face of best-practice public health policy -- for example the board demanding that states close 'drug consumption rooms, facilities where addicts can abuse drugs,'" he noted.
"If the board was really concerned about the 'health and welfare' of global populations it would be advocating for these scientifically proven public health interventions. Instead it chooses the road of unscientific and ideological based policies," Collins argued.
The INCB's reliance on ideology-driven policy sometimes leads to grotesque results. There are more than 30 countries that apply the death penalty for drugs in violation of international law. Virtually every international human rights and drug control body opposes the death penalty for drugs including the United Nations Office on Drugs and Crime, the UN Human Rights Committee, the UN's human rights experts on extrajudicial killings, torture and health, among many others.
Human rights experts were horrified and immediately wrote asking for clarification, to which the INCB responded, "The determination of sanctions applicable to drug-related offenses remains the exclusive prerogative of each State and therefore lie beyond the mandate and powers which have been conferred upon the Board by the international community," according to Human Rights Watch. [28]
Another area where the board's concern about the health and welfare of global populations is being challenged is access to pain medications. A key part of the INCB's portfolio is regulating opioid pain medications, and this year again it said there is more than enough opium available to satisfy current demand, although it also noted that "consumption of narcotic drugs for pain relief is concentrated within a limited number of countries."
The World Health Organization (WHO) agrees about that latter point. A 2011 study [29] estimated that around 5.5 billion people -- or 83% of the world population -- live in countries with 'low to non-existent' access to opioid pain relief for conditions such as cancer and HIV/AIDS. These substances are listed by the WHO as essential medicines, and the international drug control conventions recognise explicitly that they are 'indispensable' to the 'health and welfare of mankind.'
Adding to the paradox -- the global supply is sufficient, but four-fifths of the world doesn't have access -- the INCB calls on governments to "ensure that internationally controlled substances used for pain relief are accessible to people who need them."
What is going on?
"The INCB uses totals of requirements for opioid medicines compiled by the UN treaty signatory states," said Ann Fordham, executive director of the International Drug Policy Consortium [30], which keeps an eye on the agency with its INCB Watch [31]. "Unfortunately there is often a huge gap between these administrative estimates and the actual medical needs of their populations."
The prohibitionist slant of global drug control also creates a climate conducive to understating the actual need for access to pain relief in other ways, Fordham told the Chronicle.
"Many governments interpret the international drug control conventions in a more restrictive manner than is necessary, and focus their efforts towards preventing access to the unauthorized use of opioids rather than to ensuring their medical and scientific availability," she said. "This is a grossly unbalanced reading of the conventions, underpinned by fear and prejudice regarding opioids and addiction."
Although the agency has cooperated somewhat with the WHO in attempting to enhance access to the medicines, said Fordham, it bears some blame for rendering the issue so fraught.
"The INCB has continually stressed the repressive aspect of the international drug control regime in its annual reports and other public statements, and in its direct dealings with member states," she said. "The INCB is therefore responsible for at least some of the very anxieties that drive governments toward overly restrictive approaches. This ambivalence considerably weakens the INCB's credibility and contradicts its health-related advocacy."
Fordham joined the call for a fundamental reform of global drug prohibition, and she didn't mince words about the INCB.
"The entire UN drug control system needs to be rebalanced further in the direction of health rather than criminalization, and it is changing; the shift in various parts of the system is apparent already," she said before leveling a blast at Yans and company. "But the INCB is notable as the most hard line, backward-looking element, regularly overstepping its mandate in the strident and hectoring manner its adopts with parties to the treaties, in its interference in functions that properly belong to the WHO and in its quasi-religious approach to a narrow interpretation of the drug control treaties."
The INCB should get out of the way on marijuana and concentrate on its pain relief function, said Collins.
"The INCB should stay out if it," he said bluntly. "It is a technocratic monitoring body. It should not be involving itself in national politics and national regulatory systems. So it doesn't need to be either a help or hindrance on issues regarding cannabis reform. It has no reason to be involved in this debate. It should be focusing on ensuring access to essential pain medicines. These debates are a distraction from that core function and I would argue one of the reasons it is failing to meet this core function."
Sorry, INCB. Welcome to the 21st Century.