United Nations Drug Control

WHO: 'Six Horsemen ride out'
Taken from An Agenda for Vienna: Change of Course
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 established 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
documentDiscoverie 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".

Notes

1. The Global Burden of Disease; Alan D. Lopez, Epidemiology and Burden of Disease Team, World Health Organization. 2020 Focus 5, Brief
2, February 2001.
2. Action against drug abuse-Yes; A form of witch-hunt-No. Comments on the 'Six Horsemen and the WHO programme on substance abuse'.
A. Haworth, in: British Journal of Addiction, 86, 1991, pp.1391-1403.
3. WHO Expert Committee on Drug Dependence: Twenty-eighth Report, Geneva: W.H.O. Technical Report Series No. 836, 1993.
4. Harm Reduction, Human Rights and the W.H.O. Expert Committee on Drug Dependence. Robin Room, in: Patricia Erickson, Diane Riley,
Yuet Cheung and Pat O'Hare, eds., Harm Reduction: A New Direction for Drug Policies and Programs. Toronto: University of Toronto Press
1997. Pp. 119-130.
5. Publication of the largest global study on cocaine use ever undertaken. Press Release WHO/20, 14 March 1995.
6. WHO/UNICRI Cocaine Project, 5 March 1995 (unpublished Briefing Kit).
7. WHA48/1995/REC/3. Forty-Eighth World Health Assembly, Summery Records and Reports of Committees, Geneva 1-12 May 1995.