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Americans for Safe Access (ASA) has just learned that the World Health Organization’s Expert Committee on Drug Dependence (ECDD) decided to move forward with a process that may reclassify medical cannabis under international law. The debate about medical cannabis at the ECDD has been stalled for years, but persistent pressure by ASA members, staff and international allies has resulted in historic movement towards rescheduling. The influential committee will hold a special session to discuss medical cannabis in eighteen months.
ECDD recommendations are instrumental in changing the classification of medical cannabis under the United Nations (UN) Single Convention on Narcotic Drugs of 1961, as amended by the 1972 Protocol (the “UN Single Convention”). 185 nations have signed the UN Single Convention, which many politicians consider to be an obstacle to federal medical cannabis reform in the United States. This process could mean fundamental changes in the way the United States and other nations treat medical cannabis patients, research and regulations – changes that cannot be undone by one country or the new US Presidential Administration.
We learned about the ECDD decision from a report that was disseminated at the Commission on Narcotic Drugs (CND) meeting convened in Vienna November 30 through December 2, 2016, that was recently posted online. The report, entitled “Extract from the Report of the 38th Expert Committee on Drug Dependence, convened from 14 to 18 November 2016,” said in part:
"The committee recognized:
The emergence of new cannabis-related pharmaceutical preparations for therapeutic use Cannabis has never been subject to a formal pre-review or critical review by the ECDD. The Committee requested that the Secretariat prepare relevant documentation in accordance with the Guidance on the WHO review of psychoactive substances for international control to conduct pre-reviews for the following substances:
- Cannabis plant and cannabis resin
- Extracts and tinctures of cannabis
- Delta-9-tetrahydrocannabinol (THC)
- Cannabidiol (CBD)
- Stereoisomers of THC
The Committee recommended that these pre-reviews be evaluated at a specific ECDD meeting dedicated to cannabis and its component substances to be held within the next eighteen months from the 38th meeting.
The purpose of the pre-review is to determine whether current information justifies an Expert Committee critical review. The categories of information for evaluating substances in pre-reviews are identical to those used in critical reviews. The pre-review is a preliminary analysis, and findings at this stage should not determine whether the control status of a substance should be changed.”
ECDD decision disclosed in the CND memo will start a process that may ultimately lead to a fundamental change in international law. Committee staff will now prepare a series of pre-critical review documents for a special session meeting to be held on cannabis in eighteen months. Following that session, the ECDD may provide the first new scientific guidance on cannabis policy for the UN since 1935.
Changing the UN Single Convention
Cannabis, including medical cannabis, is currently classified as Schedule I and IV in UN Single Convention. This classification means it is a drug of abuse – not a medicine. This scheduling was determined based on a report created by the Health Committee of the League of Nations in 1935. The UN General Assembly must have a recommendation from the UN Commission on Narcotic Drugs (CND) to change the Scheduling of cannabis. The CND makes decisions on scheduling of substances based on recommendations from the ECDD.
The CND adopted Resolution 52/5 requesting an updated review of medical cannabis from the ECDD in 2009. The International Narcotics Control Board’s annual report likewise called on the WHO (including the committee) to uphold its obligation under the UN Single Convention to evaluate “the potential medical utility of cannabis and the extent to which cannabis poses dangers to human health…” in 2013. Despite these official requests, the ECDD has still not updated its information on medical cannabis, looked at the emerging science or considered evolving laws and policies in dozens of nations that have signed the UN Single Convention.
ASA Members Act
In 2015, ASA co-founded the International Medical Cannabis Patient Coalition (IMCPC) bringing together patient advocates from over 42 countries untied to change international cannabis policies. At the ECDD’s 37th Meeting that same year, ASA and IMCPC members addressed the committee in Geneva, calling for the members to act on the recommendations of CND and INCB by moving forwarded with the needed critical review document. Through ASA and IMCPC, patients have had international representation at the WHO and the United Nations and generated thousands of letters from over 75 countries to UN Ambassadors calling for reconsiderations of Cannabis’ scheduling.
An important part of the reclassification of a substance under the UN Single Convention is a document called a “critical review.” A critical review is prepared by experts in the field and critiqued for content and accuracy in a process called “peer review.” At ASA’s International Conference on Harmonization of Global Cannabis Policy March 18-23, 2016, in Washington DC, participants peer-reviewed Cannabis and Cannabis Resin Critical Review Preparation Document. This important paper was created by an international who’s who of cannabis experts including Jahan Marcu Ph.D., Tjaling Erkelens, Maria de los Angeles Lobos, Ph.D., Ethan Russo, MD, Roy Upton, Mahmoud Elsohly, Ph.D., Pavel Kubu, MD, Ethan Russo, MD, Pavel Pachta, Ph.D, Jason Schechter, Ph.D., and Phil Robson, Ph.D. to name a few.
Using over 300 references, the document thoroughly examines the vast research on the therapeutic value of cannabis, accurate accounts of toxicology and related public health concerns. The report also includes a summary of the variety of ways cannabis is controlled nationally and internationally, and the policies that are needed to make safe and legal access to medical cannabis available to all patients who would benefit from it. ASA presented the paper and cover letter to the CND, the US State Department, and ECDD in on the last day of our national conference.
Despite our efforts, the agenda for the ECDD meeting in November of this year contained a brief “update” on cannabis:
WHO has provided updates on Cannabis in 2014, 2015 and will again share updated evidence in 2016 at the Expert Committee on Drug Dependence meeting on 14-18 November. So far, material to formally review the status of cannabis as a scheduled substance is either insufficient or inconclusive. WHO will continue to review all available scientific evidence to determine whether the current scheduling status should change.
We held this response to be completely inadequate, given the scope of the new information provided to the committee. ASA and our allies at the International Medical Cannabis Patients Coalition (IMCPC) immediately sent a letter responding to the ECDD agenda, which read in part:
“I am writing to express my concern and disappointment about the provisional agenda for the 38th meeting of the Expert Committee on Drug Dependence (ECDD). The only reference of cannabis and cannabis resin is an “update”. In April, I reached out to you due to the role the World Health Organization (WHO), and its ECDD, have in the medical, scientific and public health evaluation of psychoactive substances under the international drug control treaties and requested the urgent need for a critical review of cannabis by this Committee.
For the ECDD to advise on the future control status of cannabis, the Committee will need to create a critical review of cannabis. We trust that the ECDD will be able to recommend to the CND, as a minimum, to exclude cannabis from Schedule IV of the 1961 Convention.
However, to move forward, the ECDD must include a pre-review of cannabis on the agenda of the 38th meeting trust that the members of the ECDD will modify the agenda of their 38th meeting accordingly.”
And that is what they did…
Our persistence paid off. In response to ASA’s critical review and the IMCPC letter of protest, the ECDD has agreed to begin the pre-review process and discuss science and policies related to medical cannabis at a special session in eighteen months. The committee staff will consider new information related to the cannabis plant, resin, extracts and tinctures. Staff will also consider the emerging science related to THC and CBD. The pre-review is a first step towards the formal critical review that will prompt a recommendation that the CND reclassify medical cannabis under the UN Single Convention.
This is a long process, and ASA is committed to seeing it through. International law may seem remote to patients struggling to achieve or defend safe and legal access to medical cannabis in the United States. It is not. US politicians often cite international treaties as a reason Congress and the Administration cannot move forward. This process may ultimately remove that barrier and point to a pathway towards a more rational and compassionate federal policy.