The UN Coca Leaf Review and Indigenous Peoples’ Rights: Can the WHO Meet the Moment? Coca Chronicles #5

At the end of November 2025, the WHO will release a ‘summary of assessments, findings and recommendations’ from ECDD’s October 2025 meeting, giving the Vienna-based Commission on Narcotic Drugs (CND) an initial opportunity to discuss the main conclusions at the reconvened CND session that will take place December 4-5, 2025. Under the rules of the 1961 treaty, if the WHO concludes that the coca leaf should remain in Schedule I, then it would not submit a recommendation for voting approval by the CND, since only proposals to change a substance’s classification, or to add new substances to the treaty schedules, are submitted for a vote.

According to the current timetable, the CND’s 53 Member States would further discuss the WHO’s findings during its March 2026 session, when they are expected to vote on any recommendations. Under the Single Convention, approval of scheduling recommendations requires a simple majority of CND members present and voting either in favor or against. Abstentions are not considered as votes for purposes of determining whether a recommendation has garnered the majority required for approval.1 So if all 53 CND members were to cast a ‘yes’ or ‘no’ vote on a particular WHO scheduling recommendation, passage would require 27 votes. However, absences and voting abstentions—which seem likely to occur in the case of voting on coca leaf—would lower the number of affirmative votes needed for passage. For example, if six members were to be absent or to abstain from voting, a recommendation could be approved by the CND with 24 votes in favor. If the WHO’s coca review process becomes prolonged (due to funding constraints or other reasons) or if the CND chooses to extend the time it needs to consider the eventual WHO report and recommendations, CND voting may be pushed to a later date. 

The classification of the coca leaf as a Schedule I narcotic has been the subject of controversy from the very start, so the WHO review now underway is not simply another scheduling procedure. Beyond the important scientific assessment that will be entailed, the coca review will also be a test case for the ability of the UN drug control regime to evolve beyond its racist and colonialist legacies, to address scheduling inconsistencies embedded in the drug treaty regime, and to align with basic human rights principles, including Indigenous rights. For the WHO specifically, the coca review presents an opportunity to help correct the serious error of placing coca in Schedule I of the 1961 treaty, an injustice for which the organization bears significant responsibility.

Whether the WHO proves capable of taking advantage of the opportunity that the critical review now affords will depend, in part, on how the WHO interprets its role and responsibilities within the UN drug treaty system, its broader institutional mandate, and its mission within the wider purview of the UN system and international law. The overall UN system has evolved considerably since the negotiation of the 1961 Single Convention, so the WHO should have ample room to accommodate understandings of its own mandate in ways broad enough to encompass the challenges posed by the coca review, particularly with respect to Indigenous rights.

Rising to the challenges posed by the coca review would also help position the WHO as it embarks on new initiatives such as the 2022 establishment of WHO’s Global Traditional Medicine Centre, which includes a unit on Biodiversity and Indigenous Knowledges, the Global Traditional Medicine Strategy 2025-2034, which was  approved at the 78th World Health Assembly in Geneva in May 2025, and the WHO Global Traditional Medicine Summit, to be held in New Delhi from December 2-4, 2025. The updated traditional medicine strategy highlights as one of its nine guiding principles Indigenous Peoples’ rights. In addition, WHO’s Gender, Rights and Equity Department is taking the lead on developing a Global Plan of Action on the Health of Indigenous Peoples, pursuant to World Health Assembly Resolution 76.16.

By contrast, if the WHO ends up adhering to an unduly narrow and outmoded interpretation of its mandate in conducting the coca review, it would risk throwing into question the validity of the review process and its resulting report and recommendations. Moreover, failure by the WHO to ensure that the coca review process is appropriately inclusive and multi-disciplinary would raise concerns over the readiness of the WHO to advance its other initiatives connecting health to human rights in general and to Indigenous Peoples’ rights in particular. The level of meaningful participation of Indigenous Peoples’ representatives and inclusion of UN expert mechanisms in the review process will therefore influence views of the legitimacy under international law of the WHO’s process and conclusions, as well as the legitimacy of decisions to be taken subsequently by the CND or by the UN’s Economic and Social Council (ECOSOC) based on the WHO’s review. 

In the six decades since the coca leaf’s classification as a Schedule I narcotic, the UN drug policy debate has evolved considerably, moving from a nearly complete focus on controlling illicit drug production and supply to a far broader consideration of not only drug supply and demand, but also human rights, gender, harm reduction, sustainable development and the environment. In the context of UN drug policy discussions centered in Vienna at the CND, raising human rights concerns was once virtually taboo. But that taboo has been swept away in the 21st Century, and by the time of the 2016 UN General Assembly Special Session (UNGASS) on drugs, human rights concerns had become a fixture on the global drug policy agenda. For example, the ministerial declaration that emerged from the CND’s 62nd session in 2019 affirmed governments’ commitment to ‘respecting, protecting and promoting all human rights, fundamental freedoms and the inherent dignity of all individuals and the rule of law in the development and implementation of drug policies.’

At the same time, the UN’s human rights bodies are increasingly active in the drug policy arena, both through their participation in the CND’s Vienna sessions and through monitoring and reporting on the many ways in which drug policies affect human rights around the globe. Perhaps most notably, in 2023 the Office of the High Commissioner for Human Rights issued a report on drug-related human rights challenges, identifying concerns such as the militarization of drug control, overincarceration, and unequal access to treatment and harm reduction. The High Commissioner for Human Rights, Volker Türk, has specifically highlighted the potential of the coca review to ‘revise drug policies for the better, with corresponding impact on the lives, livelihoods, and ancestral traditions of Indigenous Peoples the world over.’ Speaking at a 2024 CND side event about the coca review, Türk emphasized the ‘critical need to secure and support the meaningful participation of Indigenous Peoples throughout all stages’ of the review process.

Of particular relevance for the coca review, the UN system has also evolved considerably with respect to Indigenous Peoples, notably through the UN Human Rights Council’s 2001 appointment of a Special Rapporteur on the Rights of Indigenous Peoples, the 2002 launch of the Permanent Forum on Indigenous Issues (UNPFII) and the UN General Assembly’s 2007 adoption of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP). Following adoption of the UNDRIP, in 2007 the Human Rights Council created an Expert Mechanism on the Rights of Indigenous Peoples (EMRIP), and in 2014 the General Assembly requested that the Secretary-General develop a System-Wide Action Plan (SWAP) on the Rights of Indigenous Peoples to support implementation of the UNDRIP. The plan was elaborated by the Inter-Agency Support Group (IASG) on Indigenous Issues and finalized by the end of 2015.

Indigenous rights, moreover, have been linked explicitly to drug policy matters. Drug-related resolutions adopted recently by the Human Rights Council (52/24, April 2023) and by the General Assembly (A/RES/79/191, December 2024) have underscored the salience of the rights of Indigenous Peoples with respect to drug policy, including their right to participation in decision-making processes. The General Assembly’s 2024 resolution reaffirmed ‘that Indigenous Peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals, and that they also have the right of access, without any discrimination, to all social and health services and to participate in decision making processes, in accordance with the United Nations Declaration on the Rights of Indigenous Peoples.’

UN bodies dedicated to issues affecting Indigenous Peoples have drawn attention to the status of the coca leaf on several occasions. In 2009, UNPFII noted the Single Convention’s ban on coca chewing and recommended that ‘those portions of the Convention regarding coca leaf chewing that are inconsistent with the rights of indigenous peoples to maintain their traditional health and cultural practices, as recognized [in the UNDRIP] be amended and/or repealed.’ In May 2025, the Permanent Forum recommended that ‘Member States should acknowledge the critical role of Indigenous Peoples as guardians of their lands and territories; their traditional knowledge must be fully respected in environmental governance, including the protection and use of medicinal plants, such as the coca leaf and peyote, that hold profound religious, cultural and spiritual significance to Indigenous Peoples, and their ecosystems.’

The basic mandate given to the WHO under the 1961 Single Convention is to assess the scientific evidence on health effects, addictive properties and medicinal properties, with its assessment on those matters considered to be ‘determinative’ in subsequent scheduling decisions. It is nearly impossible to imagine that a modern scientific consideration would point to appreciable health risks and would fail to identify health benefits related to consuming coca leaf. The anticipated favorable assessment by ECDD regarding health risks and benefits would invalidate the 1950s-era arguments that originally led to coca’s Schedule I classification. A favorable health finding would be the necessary first step toward a possible WHO recommendation to reclassify coca or to delete it entirely from the treaty schedules.

Beyond the assessment of health risks and benefits, however, the ECDD’s scheduling conclusion will likely hinge on the question of coca’s ‘ease of convertibility’ to cocaine, and on whether arguments related to Indigenous Peoples’ rights are integrated into the ECDD process and analysis. Indeed, even back in 1992, when the ECDD ultimately chose not to conduct a formal review of coca’s classification, ECDD members ‘discussed the advisability of prohibiting under the international conventions plant products containing psychoactive substances that are traditionally used by indigenous populations.’ On balance, they felt ‘that the social problems resulting from the prohibition of these products under international controls might outweigh any health benefits,’ and recommended that the WHO ‘consider studying these patterns of use and their health and social implications.’ However, when the WHO indeed undertook an ambitious study—the 1992-1995 WHO/UNICRI Cocaine Project—the outcomes were too controversial to see the light of day, with pressure from U.S. officials in particular preventing the study from being published.  

There are some encouraging signs regarding inclusion in the review of arguments around Indigenous rights. First, among the research topics to be covered by the critical review, the ECDD secretariat added the topic of ‘traditional use’ under the standard heading of ‘therapeutic use’. The inclusion of ‘traditional use’ within the ‘therapeutic’ cluster of topics should help provide the basis for connecting the review with the broader WHO agenda of promoting ‘traditional medicines’ and ‘Indigenous health.’ Second, the review’s ‘epidemiology’ section includes consideration of topics that touch directly on important issues affecting Indigenous Peoples. Coverage of ‘non-medical use,’ would include ceremonial, spiritual and cultural uses of the coca leaf (all prohibited because of coca’s current scheduling). The ‘epidemiology’ section also calls for consideration of ‘current international controls and their impact’ as well as ‘current and past national controls,’ which should provide ample space and rationale for addressing the impacts on Indigenous rights of the current classification of the coca leaf in Schedule I of the Single Convention.

But there are also reasons for concern. First, the ECDD’s own understanding of its role seems to preclude that the review explicitly considers concerns regarding human rights, including rights of Indigenous Peoples. The ECDD secretariat has thus far hesitated to explicitly include any consideration of Indigenous rights in the WHO critical review process, claiming that its treaty mandate is strictly limited to making a scientific and medical assessment, and that ‘other factors’ such as human rights can only be taken into consideration by the CND. At a side event on the coca review during the Human Rights Council’s 57th session in September 2024, Deusdedit Mubangizi, WHO Director for Health Products, Policy and Standards, maintained: 

‘The role of the WHO, through the Expert Committee on Drug Dependence, is to evaluate the impact of psychoactive substances on public health by evaluating their dependence producing properties and potential harm to health, as well as considering their potential medical benefits and therapeutic applications. The Commission on Narcotic Drugs votes on the Expert Committee on Drug Dependence recommendations and at this time the Commission may bear in mind economic, social, legal, human rights, administrative and other factors it may consider relevant and make a scheduling decision with regard to the substances.’2

This interpretation risks disregarding the linkages that the WHO itself has been making between traditional medicines and Indigenous Peoples rights. Moreover, the notion that in any case CND member states can themselves consider these ‘other factors’ as they deliberate over the ECDD’s findings and recommendations creates a potential Catch-22. As explained above, CND members would only vote in the case of a recommendation from ECDD to change coca’s scheduling in the 1961 Single Convention, either by recommending its transfer from Schedule I to Schedule II, or by recommending deleting it entirely from the schedules.

If the ECDD were to conclude that the coca leaf should remain in Schedule I and that the status quo should prevail, no recommendation would be issued by the ECDD, and the CND would therefore not vote at all on coca’s status. In such a scenario, CND Member States would be free to discuss and debate as much as they wish such topics as human rights, Indigenous Peoples’ rights, and the injustices of coca remaining classified as a Schedule I drug. But the CND would not be able to bring the matter to a vote absent a ECDD recommendation. Similarly, were the Expert Committee to recommend transferring coca to Schedule II, CND Member States would be limited to voting for or against that specific recommendation. However much some CND members might wish to emphasize the relevance of Indigenous rights to decisions on coca’s status under the drug treaties, they would be unable to alter the recommendation made by the ECDD, and the possibility of deleting coca entirely from the schedules of the Single Convention as an outcome of the WHO critical review would apparently be foreclosed. 

It is important to note that such scenarios could give rise to an appeal to the UN Economic and Social Council (ECOSOC), which is empowered under Article 3(8) of the Single Convention to ‘confirm, alter or reverse’ CND scheduling decisions. For example, in a scenario whereby the CND votes to adopt or reject a WHO recommendation to transfer coca to Schedule II, any treaty Party (not only CND Member States) that disagrees could request that ECOSOC review the decision, including by considering deleting coca leaf from the schedules altogether.

Another reason for concern over the extent to which the WHO is incorporating issues affecting Indigenous Peoples in the critical review is the lack of clarity over whether the materials provided by the countries that requested the critical review are being accorded priority. A treaty Party-triggered review procedure grants special status to the arguments contained in the notification letter sent to the UN Secretary-General by the State requesting the review and to the information and the literature references provided in the supporting dossier sent by the requesting State. 

The Single Convention and the Commentary leave no doubt that the notification letter to the Secretary-General and the supporting dossier should be considered as the starting point and at the core of the critical review process, because those contain the reasons why the review is taking place. In that sense, such a review procedure differs from those that originate internally from within the WHO itself or from the mechanisms created for new psychoactive substances (NPS) in collaboration with the UN Office on Drugs and Crime (UNODC) and the International Narcotics Control Board (INCB), as was the case with all WHO reviews this past decade.

In addition to Bolivia’s original June 2023 notification letter to the UN Secretary-General, three dossiers have been presented thus far: Bolivia’s supporting dossier from June 2023; Colombia’s dossier submitted in December 2024; and a supplementary Bolivian dossier also submitted in December 2024. (Colombia’s dossier and Bolivia’s supplementary dossier are not yet publicly available.) The independence of the ECDD and its teams of contracted experts to carry out the review rests in their authority to independently evaluate the arguments and the scientific evidence provided by the state Parties asking for the review, and to check those arguments against any additional relevant information available. 

The ECDD can challenge and counter any argument provided in the dossiers based on independently collected additional evidence. However, the expert teams contracted to compile the critical review report, the ECDD secretariat, and the participants in ECDD’s October 2025 meeting where the review results are to be discussed and conclusions drawn regarding scheduling recommendations, should take fully into account all the arguments and evidence provided in the notifications and accompanying dossiers. The importance of this point is underscored by the issues raised in Bolivia’s notification letter, which makes specific requests regarding the scope of the critical review and the issues the ECDD should consider in their assessment: 

‘The Expert Committee will have to reassess and rectify its original biased position and utter a clear and updated view in the light of the scientific evidence and procedures concerning the medicinal and nutritional properties of coca leaf and its beneficial effects on health. Likewise, the Committee must evaluate the unlikely negative effects and addictive properties of coca leaf and the coherent application of the human rights obligations to which our indigenous peoples are entitled, with special consideration to their cultural rights and the use of native medicine and identity, which are guaranteed under current international law. Resolving the incoherence in the current classification would put an end to the violation of legitimate rights and to the criminalization of indigenous, cultural and Andean-Amazonian medicinal practices, and would allow the international community to benefit from the coca leaf in its natural state.’

This first-ever critical review of the coca leaf challenges the WHO to reflect critically on its own history and to align its crucial role in international drug policy making with its commitments regarding traditional medicine, engagement with Indigenous Peoples and respect for human rights. For Member States and for the UN system as a whole, the coca review process is at once a test and an opportunity to repair historical errors, address systemic inconsistencies, and evolve towards a more evidence and rights-based drug control system.

There are some encouraging signs that the WHO is taking the steps needed to rise to the challenge and to take advantage of the opportunity that the coca review presents. But there are also reasons for concern that the WHO process risks falling short, especially on the crucial questions of the Indigenous Peoples’ rights. If the WHO ultimately attempts to reinforce the status quo by leaving the coca leaf as a Schedule I drug or proposes the modest change of transferral to Schedule II, the debate and voting at CND is unlikely to be the end of the story. If the WHO process and CND debate prove inadequate for the full consideration of the issues, including Indigenous People’s rights, first an appeal to the ECOSOC and ultimately unilateral or group-wise fractures with the treaty regime would be the predictable next steps.