WHO: 'Six Horsemen ride out'

Taken from: Change of Course: An Agenda for Vienna
Drugs & Conflict Debate Papers 6, March 2003

The World Health Organization (WHO) has a particular role in the making of UN drug policy, relatively separate from the hardcore triangle UNDCP-INCB-CND. Its role is restricted to recommending, on the basis of health considerations, under which schedule of the 1961 and 1971 conventions particular substances should be categorised. This is a task for which the WHO convenes an Expert Committee on Drug Dependence every two years. The WHO only can make recommendations, the CND decides. From the beginning, the WHO has been at odds with the stablished drug control system, never finding a rationale to live with the existent illicit-licit distinction. Its mandate to look purely at health impacts leads the WHO consequently to refer to "psychoactive substances, including alcohol and tobacco". The latter two constitute a far bigger headache to them than the illicit drugs placed under the schedules of the drug control conventions. Their own statistics show, for example, that all illicit drugs taken together are estimated to cause 0.6% of lost "Disability-Adjusted Life Years", compared with 6.1% caused by alcohol and tobacco.1

In 1990, at the beginning of the Decade Against Drug Abuse, the WHO established its Programme on Substance Abuse (PSA), appointing six staff members to strengthen WHO's contribution to the field. The British Journal of Addiction applauded the decision with an editorial under the title "Six Horsemen ride out". One of the commentators in the journal welcomed the PSA "because now attention can be directed to correcting the balance, formerly too heavily weighted on the side of supply reduction and drug laws enforcement, whose practitioners have often reminded one, in the intensity of their belief in the 'wickedness', not only of traffickers but of the chemicals themselves, of those honest brokers (dispensers) of justice who condemned so many innocent old women to death as witches".2 He referred to the historical document Discoverie of Witchcraft, published in 1584 to protest the rising tide of persecution of innocents by a superstitious clergy, a book condemned to be burned by King James I of England. The author saw an important function for the PSA in producing scientific facts to bring common sense to the drugs issue, which "I hope no-one would wish to burn". Subsequent events suggest that he was somewhat optimistic.

The enthusiastic PSA team decided to expand the mandate of the Expert Committee to cover a broader range of issues related to demand reduction. The 1992 Expert Committee therefore met with a dual mandate. Ten substances had to be reviewed for scheduling, but the experts were also asked "to look at the various strategies and approaches for reducing substance use and its harmful consequences". After debating the practice of traditional coca chewing in the Andes and Khat use in Africa, the committee "recommended studies looking towards possible changes in international control provisions concerning these traditional patterns of use". The Committee also concluded in its report that the "primary goal of national demand reduction programmes should be to minimize the harm associated with the use of alcohol, tobacco and other psychoactive drugs. ... for maximum effectiveness, national policies should be oriented to explicitly defined 'harm minimization' goals".3 This conclusion was reached "not without some grumbling", especially from the side of two committee members, Hamid Ghodse, then INCB president, and Philip O. Emafo, nowadays president of the Board. In the end though, they went along with the report, which "adopted a relatively wideranging view of harm reduction, so that, for instance, regulation of the supply was seen as among the potential harm reduction strategies".4

WHO: Cocaine Project

In 1992, the PSA launched the "WHO/UNICRI Cocaine Project", which according to a press release in March 1995 was the largest global study on cocaine use ever undertaken. "The sometimes unexpected conclusions of the study do not represent an official position of WHO".5 A Briefing Kit summarising the results of the study was circulated at the March 1995 CND meeting. The conclusions strongly conflicted with accepted paradigms, for example "that occasional cocaine use does not typically lead to severe or even minor physical or social problems ... a minority of people start using cocaine or related products, use casually for a short or long period, and suffer little or no negative consequences, even after years of use. ... Use of coca leaves appears to have no negative health effects and has positive, therapeutic, sacred and social functions for indigenous Andean populations." The largest future issue, according to the study, was whether the world "will continue to focus on supply reduction approaches such as crop destruction and substitution and law enforcement efforts in the face of mounting criticism and cynicism about the effectiveness of these approaches. ... There needs to be more assessment of the adverse effects of current policies and strategies and development of innovative approaches. … Current national and local approaches which over-emphasize punitive drug control measures may actually contribute to the development of health-related problems."6

Almost as soon as the Briefing Kit started to circulate in the UN corridors, USA officials used their full weight to prevent the release of the study. "The United States government has been surprised to note that the package seemed to make a case for the positive uses of cocaine," was the response of Neil Boyer, the USA's representative to the 48th meeting of the World Health Assembly in Geneva. He said that the WHO programme on substance abuse was "headed in the wrong direction" and "undermined the efforts of the international community to stamp out the illegal cultivation and production of coca". He denounced "evidence of WHO's support for harmreduction programmes and previous WHO association with organizations that supported the legalization of drugs." Then came a clear threat: "If WHO activities relating to drugs fail to reinforce proven drug-control approaches, funds for the relevant programs should be curtailed".7 It had its intended effect insofar as the results of the Cocaine Project were never published. The Briefing Kit had been a premature release of the summary results, before the full research outcomes had gone through the usual thorough review and editing process. Because of the commotion, however, no agreement on the list of peer reviewers could ever be found, so the process was never completed. Years of work and hundreds of pages of valuable facts and insights about coca and cocaine by more then 40 researchers were, in effect, "burned".