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History, science, and politics
of international cannabis scheduling,
2015–2021
Kenzi Riboulet-Zemouli , Michael A. Krawitz , and Farid Ghehiouèche
29 September 2021 | Licence CC BY-SA
Library of Congress, Prints & Photographs Division, photograph by Carol M. Highsmith [reproduction number, e.g., LC-USZ62-123456]
Suggested citation: Riboulet-Zemouli, K., Krawitz, M.A., and Ghehiouèche, F. (2021). History, science, and
politics of international cannabis scheduling, 2015–2021. Vienna: FAAAT editions. ISBN: 979-10-97087-50-0.
History, science, and politics
of international cannabis scheduling,
2015–2021
Kenzi Riboulet-Zemouli
Michael A. Krawitz
Farid Ghehiouèche
Published 29 September 2021
FAAAT editions; Vienna, Geneva, Paris, Barcelona.
© the authors, licence CC BY-SA
ISBN 979-10-97087-50-0
EAN 9791097087500
History, science, and politics of international cannabis scheduling, 2015–2021 1
1. INTRODUCTION 3
2. CONTEXT AND SIGNIFICANCE OF THE ACCEPTED RECOMMENDATION 8
2.1. AN UPGRADED REVIEW PROCESS 9
2.2. DID WHO GO FAR ENOUGH? 10
2.3. DID WHO GO TOO FAR? 11
3. CONTEXT AND SIGNIFICANCE OF THE REJECTED RECOMMENDATION(S) 12
3.1. RECOMMENDATION 5.5 ON CANNABIDIOL CONTROL 13
3.2. RECOMMENDATIONS 5.2, 5.3, 5.4 AND 5.6: AN ATTEMPT FOR POLICY COHERENCE &
SIMPLIFICATION 14
4. PROCEDURAL ISSUES 16
4.1. A LENGTHY PROCESS 16
4.2. A SUI GENERIS VOTING PROCEDURE 17
4.3. CND REPORT: THE DISCONNECT 18
5. CONCLUSION 19
ACKNOWLEDGEMENTS 20
REFERENCES 21
Table 1. Overview of the WHO ECDD’s cannabis-related recommendations and outcome of the 2 December
2020 votes at the CND. 5-6
Table 2. Full results of the 2 December 2020 CND votes on WHO ECDD’s cannabis-related recommendations
submitted to a vote. 7
Table 3. Comparison of the international scheduling status of cannabis-related controlled drugs before and after
the 1991 and 2021 changes, with the WHO’s recommended changes. 12-13
Annex I. List of stakeholders involved in WHO ECDD’s cannabis-related assessments, in Geneva (2016-2019) 29-32
Annex II. List of stakeholders involved in the review of WHO ECDD’s cannabis-related recommendations at
the Commission on Narcotic Drugs, in Vienna (2019-2021) 33
Annex III. Comprehensive chronology of the WHO ECDD’s cannabis review process, in Geneva, New-york
and Vienna (2016-2021) 34-40
History, science, and politics of international cannabis scheduling, 2015–2021 2
On 21 April 2021, the herbal medicines “cannabis” and “cannabis resin” definitively
ceased to appear in Schedule IV of the 1961 Single Convention on narcotic drugs (C61),
where they had been listed since the entry into force of that treaty in 1964. The process
to scientifically review and reschedule Cannabis-related controlled drugs had been
launched by the World Health Organization (WHO) on 2 December 2016 and went
through a number of hindrances until it finally got submitted to a unique voting process
on 2 December 2020 at the United Nations Commission on narcotic drugs (CND).
This report reviews the scientific assessments of Cannabis-related controlled drugs and
cannabidiol (CBD) by the WHO’s Expert Committee on Drug Dependence (ECDD) and
subsequent political discussions at CND that culminated with the 2 December 2020 vote,
changing the scheduling of “cannabis” and “cannabis resin” under the C61. A digest of
the four years of proceedings (2015-2021) is presented, showcasing elements that
provide an understanding about the length and complexity of the processes involved. The
report introduces previously-unpublished minutes, complements of information, details
on stakeholders and their role, and highlights a number of bureaucratic and diplomatic
issues; it compares the efforts undertaken by WHO and CND in terms of method,
transparency, and involvement (or not) of interested parties, beyond governments.
For a detailed account of the processes preceding the period reviewed in this report
(1952–2018), please refer to the Crimson Digest, vol. 1 (Riboulet-Zemouli et al, 2018).
1. INTRODUCTION
Cannabis L., an herbaceous plant used in
medicine for centuries (Bridgeman and Abazia,
2017; Crocq, 2020; Fankhauser, 2008; Mikuriya,
1969; Pisanti and Bifulco, 2018; Spence, 2020;
Zlas et al., 1993), became subject of
international law in 1925 amidst a still
relatively new international legal order that
was to “shape, and be shaped by, the drugs
issue” (McAllister, 2000, p.44; p.44). In
February of that year, in Geneva, as the Second
Opium Conference closed, the Cannabis plant
appeared in the “International Convention
relating to Dangerous Drugs” (Collins, 2020;
Kendell, 2003; McAllister, 2000, p.44; “The
cannabis problem,” 1962); the topic had only
been discussed during the First Opium
Conference of 1912 in the Hague (Mills,
p.152–155). A few months later, in Septembre
1925 in Brussels, the medicinal products of the
plant (the dried top parts of the plant, its resin
or extract, and its tincture) appeared within the
Second “International Agreement [...] on the
Unification of Pharmacopoeial Formulas for
Potent Drugs” (Riboulet-Zemouli, 2020b;
“Seconde conférence…”, 1925) after, cannabis
medicines has similarly only been briefly
considered in 1905 for the First Agreement
(Riboulet-Zemouli, 2020b, pp.13–14).
The dichotomy between a “dangerous”
drug requiring controls over its chain of supply
(as mandated by the 1925 Geneva Convention)
and a “potent” drug requiring standardization
via pharmacopoeial harmonization (as per the
1925 Brussels Agreement) persisted until the
adoption of the 1961 Single Convention on
narcotic drugs (C61) in March 1961 in
New-York. This later treaty, superseding all
previous international instruments related to
Cannabis (Lande, 1968; Mills, 2016), placed the
History, science, and politics of international cannabis scheduling, 2015–2021 3
plant under specific controls roughly following
the Geneva Convention (Collins, 2020) but,
more importantly, it diverted from the Brussels
Agreement by listing for the first time the
medicinal products of Cannabis within the
Schedule of drugs “that are particularly liable
to abuse and to produce ill-effects, and do not
have therapeutic advantages that offset these
effects” (WHO, 2019a, p.37): Schedule IV. This
opened a parenthesis in the history of
medicine where Cannabis L. and its
therapeutic derivatives “dwindled to practically
nothing” (Mikuriya, 1969, p.38) on pharmacy
shelves and in scientific research agendas
(Bewley-Taylor and Jelsma, 2011; Crocq, 2020;
Fankhauser, 2008, pp.10–11; Multidisciplinary
Association..., 2020; Nutt, 2019; Nutt et al.,
2013).
The placement of “cannabis and
cannabis resin” in Schedule IV of the C61,
which was inconsistent with the history of
uses of the plant in indigenous and Western
therapeutics, and ignored the science, was
reversed on 21 January 2021, with the entry
into force of Decision 63/17 (CND, 2020, p.5;
2021c; entry into force that became definitive
in 21 April, ninety days after the reception of
the notification [UNODC, 2020a, p.7; United
Nations Secretariat, 2021]) of the Commission
on Narcotic Drugs (CND –the “policymaking
body of the United Nations with prime
responsibility for drug control matters”
[UNGASS, 2016, pp.3,21] and only body with
the mandate to amend the 1961 Convention’s
schedules). Agreed upon on 2 December 2020
by a simple-majority vote of CND Member
States pursuant to a scientific evidence-based
recommendation by the World Health
Organization (WHO –the “only treaty body with
a mandate to carry out medical and scientific
assessment of substances” [WHO, 2018b] and
the only body able to trigger changes in
scheduling at the CND, on the basis of such an
assessment [WHO, 2010, pp.7–10; 2016]), the
withdrawal of “cannabis and cannabis resin”
from Schedule IV of the C61 and previous
cannabis scheduling discussions have given
rise to unprecedented procedural complexities,
delays, and has been characterized by a
certain amount of drama, and a disruptive
pandemic.
On 2 December 2020, four years to the
day after WHO announced the launch of the
Cannabis review procedure (CND, 2016a, p.8;
WHO, 2016c, pp.7–8), the CND accepted one
out of nine of the Cannabis-related
recommendations; one did not call for a vote,
three were rejected, and another four were not
put on the ballot (Tables 1 and 2; CND, 2020,
pp.5–7; CNDmonitor, 2020). Although only one
of WHO’s proposals was accepted, it
represents a landmark for Cannabis in (and as
a) medicine. It is also an important
incremental step towards the much needed
“scientific evidence-based review and
scheduling of the most prevalent, persistent
and harmful substances” called for by the
international community (UNGASS, 2016, p.15;
see also Ghehiouèche and Riboulet-Zemouli,
2016; Riboulet-Zemouli and Ghehiouèche,
2016; WHO, 2016a, p.9).
This report documents, relates, and
reflects on this process. The authors
participated in the UN and WHO processes,
whenever possible personally attended
meetings, collected data and evidence from all
aspects of the proceedings (whether publicly
accessible or not) and interacted with a broad
range of stakeholders involved at different
levels, between 2015 and 2021.
History, science, and politics of international cannabis scheduling, 2015–2021 4
Table 1. Overview of the WHO ECDD’s cannabis-related recommendations and outcome of the 2
December 2020 votes at the CND.
Not subject to a vote
Subject to a vote, but not
submitted to votation
Subject to a vote:
accepted
Subject to a vote:
rejected
WHO ECDD
recommendation
Issue date(s)
Action taken
by the CND
Action
reflected in
CND
report
Recommendation of the 40th ECDD meeting.
Preparations considered to be pure cannabidiol (CBD)
should not be scheduled within the international drug
control conventions
WHO ECDD meetings:
- Pre-review: 6–10 Nov.
2017a
- Critical review: 4–7
June 2018b
WHO
Director-General
communication:
23 July 2018c
Vote was not requiredg
idem.
Recommendation No. 5.1. of the 41st ECDD meeting.
Delete cannabis and cannabis resin from Schedule IV of
the 1961 Single Convention
WHO ECDD meetings:
- Pre-reviews: 4–7 June
2018b
- Critical reviews:
12–16 Nov. 2018d
WHO
Director-General
communication:
24 January 2019e
WHO
Director-General
corrections:
5 August 2020 f
Approved
27 yes, 25 no, 1
abstention.
Decision 63/17h
idem.
Recommendation No. 5.2.1. of the 41st ECDD meeting.
Add delta-9-THC to Schedule I of the 1961 Single
Convention
Rejected
23 yes, 28 no, 2
abstentions
Decision 63/18h
idem.
Recommendation No. 5.2.2. of the 41st ECDD meeting.
If 5.2.1 is adopted, delete delta-9-THC from Schedule
II of the 1971 Convention
Not submitted to a
vote
As per the special
procedure adopted in
CND Decision 63/16i
idem.
Recommendation No. 5.3.1. of the 41st ECDD meeting.
If 5.2.2 is adopted, add other isomers of THC to
Schedule I of the 1961 Single Convention
Not submitted to a
vote
As per the special
procedure adopted in
Decision 63/16i
idem.
Recommendation No. 5.3.2. of the 41st ECDD meeting.
If 5.3.1 is adopted, delete other isomers of THC from
Schedule I of the 1971 Convention
Not submitted to a
vote
As per the special
procedure adopted in
Decision 63/16i
idem.
Continued on the next page.
History, science, and politics of international cannabis scheduling, 2015–2021 5
Table 1. Continued
WHO ECDD
recommendation
Issue date(s)
Action taken
by the CND
Action
reflected in
CND
report
Recommendation No. 5.4. of the 41st ECDD meeting.
Delete extracts and tinctures of cannabis from
Schedule I of the 1961 Single Convention
WHO ECDD meetings:
- Pre-reviews: 4–7 June
2018b
- Critical reviews:
12–16 Nov. 2018d
WHO
Director-General
communication:
24 January 2019e
WHO
Director-General
corrections:
5 August 2020 f
Rejected
24 yes, 27 no, 2
abstentions.
Decision 63/19j
idem.
Recommendation No. 5.5. of the 41st ECDD meeting.
Give effect to the recommendation of the 40th ECDD
meeting [...] by adding a footnote to the entry for
cannabis and cannabis resin in Schedule I of the 1961
Single Convention to read “Preparations containing
predominantly CBD and not more than 0.2 per cent of
delta-9-THC are not under international control”
Rejected
6 yes, 43 no, 4
abstentions.
Decision 63/20j
idem.
Recommendation No. 5.6. of the 41st ECDD meeting.
Add preparations containing delta-9-THC* to Schedule
III of the 1961 Single Convention.
* produced either by chemical synthesis or as
preparations of cannabis, that are compounded as
pharmaceutical preparations with one or more other
ingredients and in such a way that delta-9-THC cannot
be recovered by readily available means or in a yield
which would constitute a risk to public health
Not submitted to a
vote on 2 December
As per the special
procedure adopted in
Decision 63/16i
Rejected by
consensus
As expressed in
Decision 63/21k
Acronyms. CBD: cannabidiol; CND: Commission on narcotic drugs of the United Nations; delta-9-THC:
delta-9-tetrahydrocannabinol; ECDD: Expert Committee on Drug Dependence; WHO: World Health Organization.
Notes. aWHO, 2018c, b2018d; cAdhanom Ghebreyesus, 2018; dWHO, 2019a; eAdhanom Ghebreyesus, 2019; fCND, 2020c,
pp.11–12; gCND, 2019a, p.3; hCND, 2020b, p.5, ipp. 3–4, jp.6, kp.7.
History, science, and politics of international cannabis scheduling, 2015–2021 6
Table 2. Full results of the 2 December 2020 CND votes on WHO ECDD’s cannabis-related
recommendations submitted to a vote.
Voting country
Recommendation
5.1
Recommendation
5.2.1
Recommendation
5.4
Recommendation
5.5
Afghanistan
No
Yes
No
No
Algeria
No
No
No
No
Angola
No
No
No
No
Australia
Yes
Yes
Yes
Yes
Austria
Yes
Yes
Yes
No
Bahrain
No
No
No
No
Belgium
Yes
Yes
Yes
No
Brazil
No
No
No
No
Burkina Faso
No
No
No
No
Canada
Yes
No
Yes
Yes
Chile
No
No
Yes
No
China (Popular Republic of)
No
No
No
No
Colombia
Yes
Yes
Yes
No
Côte d'Ivoire
No
No
No
No
Croatia
Yes
Yes
Yes
No
Cuba
No
No
No
No
Czech Republic
Yes
Yes
Yes
No
Ecuador
Yes
Yes
Yes
Yes
Egypt
No
No
No
No
El Salvador
Yes
No
Yes
No
France
Yes
Yes
Yes
No
Germany
Yes
Yes
Yes
No
Hungary
No
Yes
No
No
India
Yes
No
No
No
Iraq
No
No
No
No
Italy
Yes
Yes
Yes
No
Jamaica
Yes
Yes
No
No
Japan
No
No
No
No
Kazakhstan
No
No
No
No
Kenya
No
No
No
No
Kyrgyzstan
No
No
No
No
Libya
No
No
No
No
Mexico
Yes
No
Yes
No
Morocco
Yes
Yes
Yes
Abstention
Nepal
Yes
Abstention
Abstention
Abstention
Netherlands
Yes
Yes
Yes
No
Nigeria
No
No
No
No
Pakistan
No
No
No
Abstention
Peru
No
Yes
No
Yes
Poland
Yes
Yes
Yes
No
Russian federation
No
No
No
No
South Africa
Yes
Yes
Yes
Yes
Spain
Yes
Yes
Yes
No
Sweden
Yes
Yes
Yes
No
Switzerland
Yes
Yes
Yes
No
Thailand
Yes
Yes
No
Yes
Togo
No
No
No
No
Turkey
No
No
No
No
Turkmenistan
No
No
No
No
Ukraine
Abstention
Abstention
Abstention
Abstention
United Kingdom
Yes
Yes
Yes
No
Uruguay
Yes
No
Yes
No
United States of America
Yes
No
Yes
No
History, science, and politics of international cannabis scheduling, 2015–2021 7
2. CONTEXT AND SIGNIFICANCE OF THE ACCEPTED RECOMMENDATION
The international law régime currently in force
for Cannabis-related controlled drugs (CCDs)
is the one established by the C61 with the
placement of “cannabis” (dried tops, known in
traditional pharmacopeias as ganja,marijuana
or dagga) and “cannabis resin” (oleoresinous
exudate from the plant’s glandular trichomes,
also called charas or hashish) in Schedule I
and IV, and of “extracts and tinctures of
cannabis” (galenic preparations of the former)
in Schedule I (Collins, 2020; Curran et al.,
2016). In 1971, the placement of all the
isomers of tetrahydrocannabinol (THC) in
Schedule I of the Convention on psychotropic
substances of 1971 (C71) completed the legal
panorama of CCDs. However, this status
changed with CND Decision 2(XXXIV) of April
1991 that lowered the isomer delta-9 of
tetrahydrocannabinol (delta-9-THC) from C71’s
Schedule I to the less-requiring Schedule II
(CND, 1991) following WHO’s evidence-based
recommendations (Riboulet-Zemouli et al,
2018, pp.40–41; WHO, 2018d, p.39). Although
that Decision applies to both delta-9-THC
obtained in laboratory and pure delta-9-THC
isolated from the Cannabis plant (the
Conventions do not distinguish between
synthetic and plant-derived obtentions of a
scheduled drug), it has no practical effect for
botanical Cannabis medicines which remained
under unchanged controls as per the C61.
WHO’s Cannabis-related
recommendations issued in 2018 (Adhanom
Ghebreyesus, 2018) and 2019 (Adhanom
Ghebreyesus, 2019; CND, 2020c, pp.11–12) as
well as the scientific evidence-based and
methodology-reliant reviews that enabled them
(Mayor, 2019; WHO, 2018d; 2019a, pp.34–55)
were historically unprecedented (Curran et al..,
2016; Danenberg et al., 2013; Riboulet-Zemouli
et al, 2018) since herbal CCDs had never been
submitted to such formal review, contrary to
what treaties mandate (Danenberg et al., 2013;
WHO, 2010; 2016a). A number of stakeholders,
including the United Nations Committee on
Economic, Social, and Cultural Rights (2020,
p.13), emphasized that the placement of
“cannabis and cannabis resin” in C61’s
Schedule IV in 1961 had not been
substantiated in any sort of scientific
assessment. Observers (Clarke, 2018; Curran
et al., 2016; Krawitz et al., 2018, pp.9–10; Mills,
2016, pp.100–101; Multidisciplinary
Association…, 2020; Riboulet-Zemouli et al,
2018, pp.36–37) had also pointed out that
WHO’s 1954 recommendation that “there
should be efforts towards the abolition of
cannabis from all legitimate medical practice”
(WHO, 1955; see also FAAAT, 2019;
Riboulet-Zemouli et al, 2018), reiterated
throughout the 1950s, relied on “personal
views, experiences or anecdotes” (Danenberg
et al., 2013, p.180) and included more biased
sources (such as reports from the South
African Apartheid régime’s police, [Clarke,
2018; WHO, 1955, pp.12–13]) than medical
data, at the same time that they lacked any
methodology. Although the idea to ban
Cannabis from the realm of therapeutics had
long been driven by some Member States and
parts of the UN, the impetus initially came
from the office of United Nations
Secretary-General Trygve Lie (ECOSOC, 1951;
Lande, 1968; Mills, 2016), its incorporation into
the C61 was made credible by, and justified
through, the repeated WHO recommendations
of the 1950s.
Recommendation 5.1 can be
interpreted as a de facto repeal of the 1950s
position. If before 2019, WHO’s Expert opinion
of “medical cannabis” was that there should
be efforts towards its abolition from all
legitimate medical practice, then it should now
be inferred, at the very least, that efforts
towards its abolition should cease, and
instead, should go towards the reintroduction
of Cannabis in all legitimate medical practice.
History, science, and politics of international cannabis scheduling, 2015–2021 8
2.1. AN UPGRADED REVIEW PROCESS
On 2 December 2016, when WHO finally
launched the data collection process to
scientifically assess CCDs (CND, 2016a, p.8;
WHO, 2016c, pp.7–8) both methodology and
quality of work in relation with the review of
substances for international control and
recommendation mechanism had evolved
(WHO, 2010) at a level almost diametrically
opposed to that of the 1950s’ meetings and
subsequent reports drawn up on the back of an
envelope –although not immune to future
improvements (Danenberg et al., 2013; Hallam
et al., 2014). As WHO (2020) explains on its
website:
These recommendations are the outcome
of a multi-year review process conducted
by the Expert Committee on Drug
Dependence (ECDD), an independent
scientific advisory body to the WHO. Based
on scientific assessment, potential health
risk and therapeutic benefit, the ECDD
recommends the appropriate scheduling of
psychoactive substances within the
international drug conventions.
Of particular historical significance, the
assessments are reinforced in their singularity
by the fact that an entire ECDD meeting (that
included three new Experts, nationals of Chile,
Japan, and Thailand; see Annex I), was set up
in June 2018 and dedicated solely to Cannabis
and its products (see WHO, 2018d) and
upgraded data collection and analysis were
used (WHO, 2018c, pp.10–11).
In the last decades, CCDs had been
addressed on several occasions at ECDD
meetings as a minor, non-review agenda item
(Ghehiouèche and Riboulet-Zemouli, 2016;
Riboulet-Zemouli et al, 2018, pp.42–43). Yet,
with time passing, the need for a sound
assessment became pressing as
contemporary evidence accumulated (O’Grady,
2020; Pisanti and Bifulco, 2017; 2018; WHO,
2018c; 2018d). Official requests for WHO to
initiate the ECDD review process accumulated
during the last decade (Krawitz and
Riboulet-Zemouli, 2019, p.4; Ghehiouèche and
Riboulet-Zemouli, 2016) with a first binding
request (WHO, 2010, pp.10–13) received in
2007 for delta-9-THC (CND Resolution 50/2,
see: UNODC, 2019, pp.4,17) followed by a total
of six requests to review “cannabis and
cannabis resin”: from CND in 2009 (CND
Resolution 52/5, see: CND, 2009; WHO, 2016d,
p.32), the INCB in 2014 (INCB, 2014,
pp.93–94), the ECDD itself in 2015 (WHO,
2016d, p.32), from the Czech republic in 2016
at the 69th World Health Assembly (WHO,
2016b, p.248), the International Association for
Hospice and Palliative Care in 2016
(Ghehiouèche and Riboulet-Zemouli, 2016),
and finally the Caribbean Community in 2018
(Antoine and Douglas, 2018). The official
assessment process began with the issuance
of a request for proposals “for contributions to
the authorship of Pre-Review reports on
cannabis-related substances” (United Nations
Global Marketplace, 2017; WHO, 2016e), hiring
of a dedicated technical officer, and
establishment of a questionnaire to collect
data from Member States (WHO, 2018e). WHO
(2020) synthetizes the process that followed:
“Formal reviews were conducted during the
39th, 40th, and 41st ECDD sessions and
considered both the best available
scientific evidence and data from Member
States provided through the annual WHO
ECDD Member State questionnaire. In
addition, Member States, members of the
public, civil society groups, pharmaceutical
industry representatives, and other relevant
groups were also able to comment on the
ECDD assessments and recommendations
through Open Sessions at all ECDD
meetings.”
The open sessions that preceded the ECDD
meetings facilitated the participation of a
broad range of stakeholders: patients,
physicians, pharmaceutical industry
representatives, and researchers (WHO, 2017;
2018a; 2019a, pp.2–3). Open sessions started
being reflected in ECDD reports at the 40th
meeting. During the open session of the 41st
meeting, a Brazilian human rights activist
focused her intervention on a one-minute
recording of shooting resulting directly, she
commented, from a “war on drugs” to which
drug scheduling is not unrelated, inviting the
Experts to balance the harms of substances
under review with unintended negative
consequences of drug control. Ahead of the
40th meeting, a joint contribution of a hundred
civil society organizations (Krawitz et al., 2018)
pointed out bias and inconsistencies in the
History, science, and politics of international cannabis scheduling, 2015–2021 9
initial Pre-review reports (see: Arnold, 2018a;
2018b; 2018c; 2018d; Cannazza and Citti,
2018a; 2018b; 2018c; 2018d; Hill et al., 2018a;
2018b; 2018c; 2018d; Rehm et al., 2018a;
2018b; 2018c; 2018d; Wiley, 2018a; 2018b;
2018c; 2018d), that were acknowledged during
the meeting and almost entirely addressed in
the revisited Critical-review reports prepared
for the 41st meeting (Poovendran and De
Zwart, 2018a; 2018b; 2018c; 2018d). Ahead of
the meetings, the Experts had recalled “that
unpublished data, although considered
low-quality evidence, can be informative during
the meeting proceedings” (WHO, 2018c,
pp.10–11), a crucial element since the
knowledge of traditional medicinal plants is
sometimes maintained orally. WHO claims to
have incorporated “Scientific published and
unpublished data, hundreds of publications
reviewed and referenced” in addition to
“Member States’ data, UNODC and INCB Early
Warning Advisory System,” as well as the
European Monitoring Centre for Drugs and
Drug Addiction, Uppsala Monitoring Centre on
adverse medicines reactions, and Global
Surveillance and Monitoring System on
Substandard and Falsified Medicines (Forte,
2019). The two-year ECDD review process was
taken advantage of to gather the utmost
number of opinions, information, and science
in a satisfactory, gender and
geographically-balanced, independent manner.
The composition of the ECDD (see Annex I) did
not give rise to criticism; only the author of the
Pre-review pharmacology report received
scrutiny and criticism.
2.2. DID W.H.O. GO FAR ENOUGH?
ECDD recommendations received different
ratings among observers. Some qualified as a
“political decision” (Drugreporter, 2020) the
fact that the ECDD did not recommend moving
“cannabis and cannabis resin” out of Schedule
I, mentioning a “very questionable rationale”
(Smith, 2020). The ECDD indeed “did not
consider that cannabis is associated with the
same level of risk to health as that posed by
most of the other drugs placed in Schedule I”
(WHO, 2019a, p.41) suggesting that
maintaining CCDs in Schedule I is not
supported by science.
Yet, beyond progress made in
strengthening the place of science in the
Conventions’ scheduling assessment
mechanisms, the ECDD remains captive of the
treaty provisions framing its work (Danenberg
et al., 2013; WHO, 2010). C61’s Article 2(6)
states that “in addition to the measures of
control applicable to all drugs in Schedule I, [...]
cannabis [is subject to the provisions of]
article 28.” This Article de facto submits CCDs
to the régimes of both Schedule I and Article
28. Removing CCDs from Schedule I (possible
under Article setting the rules for changes in
the scheduling of substances) would likely be
left without effect, as Article 2(6) which
attaches CCDs (as well as “coca leaf” and
“opium”) to a Schedule I régime regardless of
eventual action taken by the CND pursuant to
Article 3, would have superseded it.
Reconciling a removal from Schedule I with
Article 2(6) seems to require a prior
amendment of said Article. The opportunity
and relevance of an ECDD recommendation to
move CCDs to Schedule II or out of the
Schedules are therefore questionable in light
of these treaty constraints.
On top of that, the treaties’ criteria for
substance scheduling, under which the ECDD
has to frame its reviews, are all but
scientifically sound and base the addition of
new drugs to the Schedules on their similarity
to CCDs (Danenberg et al., 2013; Hallam et al.,
2014; Lohman and Barrett, 2020;
Riboulet-Zemouli et al, 2018, pp.18–19). By
moving CCDs out of Schedule I what would the
consequences be for substances placed in
Schedule I as per their similarity with
“cannabis”? This context suggests that, far
from not going far enough, the ECDD,
conscious of its mandate and limitations, went
as far as it could go.
History, science, and politics of international cannabis scheduling, 2015–2021 10
2.3. DID W.H.O. GO TOO FAR?
Conversely, throughout 2019 and 2020, a
number of Member States repeatedly shared
fears that WHO’s recommendations were
going too far, feeling that they could be
“viewed as a shift and support for legalization
of the recreational use of cannabis” (see
“Nigeria” in CNDmonitor, 2020; and CND,
2020d, pp.2,5–6). A few days after the vote, on
5 December 2020, the Ambassador of the
Russian Federation in Vienna tweeted his
concerns that “‘#UN News’ misinterpreted the
decision of #CND and claimed that #cannabis
is no longer considered to be a risky drug. This
assertion doesn’t correspond to reality”
(Ulyanov, 2020). The title of the alluded UN
News press release was subsequently edited
from “UN commission reclassifies cannabis,
no longer considered risky narcotic”
(Archive.org, 2020a) to “UN commission
reclassifies cannabis, yet still considered
harmful” (Archive.org, 2020b) as were other
parts of the text such as the deletion of the
qualificative “long-heralded” in reference to
Cannabis’ “medicinal properties.”
While the perceptions of the decision
among the general public might need to be
scrutinized, pedagogy and explanations of the
decision could represent a better asset to
avoid misconceptions and confusion, than
blue-penciling. Explaining the scope of
Decision 63/17 involves underscoring that the
entire scheduling process is tailored to
evaluate the best régime of international
control to regulate substances for medical and
scientific purposes (UN, 1973, pp.49–51;
Rexed et al., 1984). The Schedule in which a
substance is placed only determines the legal
régime to be applied to its medical and
scientific purposes: separate legal dispositions
prevail for industrial use (a “purpose other than
medical and scientific ones”; C61, Article 2(9)),
and the Conventions call to combat the
purpose of “drug abuse” regardless of the
Schedule in which the drug being abused is
placed (UN, 1973, pp.110–114,402–403).
Hence, changes in the scheduling status of a
drug primarily affect the subset of regulations
to be applied to the medical and scientific uses
of that drug: prescription requirements,
dispensation parameters, licensing of
pharmacists and producers, etc. (detailed in
Rexed et al., 1984, pp.33–50; see also UNODC,
2020b, pp.8–13), not to its recreational uses.
Member States were aware of this, as the
representative of Nigeria at the CND declared
(Permanent mission of Nigeria..., 2020):
“We are not under any illusion that the
Recommendations are a receipt for
legalization of cannabis, but we understand
how the perception of our actions may
influence public attitude to non-medical
use of cannabis and related substances.”
By emphasizing issues related to the
non-medical and recreational uses of
Cannabis, that were not addressed by the
recommendations, the CND partly diverted the
discussions away from the topics of health,
access to medicines, and appropriate
regulatory and control frameworks that the
recommendations called for.
History, science, and politics of international cannabis scheduling, 2015–2021 11
3. CONTEXT AND SIGNIFICANCE OF THE REJECTED RECOMMENDATION(S)
The WHO Experts’ recommendations not only
recommended withdrawing “cannabis and
cannabis resin” from Schedule IV, in line with
the evidence. The ECDD also presented a
series of recommendations for further
changes in the scope of control of the different
CCDs under both C61 and C71 (Table 1), with a
two-fold objective: “reflect the emerging
therapeutic role of cannabis-based medicines
whilst continuing to prevent diversion, misuse,
and other public health-related harms that may
arise from cannabis use” (WHO, 2020). Had all
recommendations been adopted, the
scheduling status of CCDs would have been
dramatically simplified: recommendations 5.2
and 5.3 would have placed all CCDs in the
same Schedule, in one single Convention
–instead of the three schedules in two
Conventions (see Table 3). Recommendation
5.4 would have deleted unnecessarily
redundant and complex terminology, without
affecting controls. Recommendations 5.5 and
5.6 would have eased Member States’ options
in facilitating access to some medicines of
their convenience, with different tiers for
delta-9-THC or CBD-dominant CCDs.
Table 3. Comparison of the international scheduling status of cannabis-related controlled drugs
before and after the 1991 and 2021 changes, with the WHO’s recommended changes.*
Until 1991
1991-2021
After 21 April 2021
If all of WHO’s
recommendations had
been accepted
Régimes of control according to Schedule placement, Single Convention on narcotic drugs of 1961
Schedule I and Schedule IV
cannabis, cannabis resin
Schedule I and Schedule IV
cannabis, cannabis resin
Schedule I and Schedule IV
–
Schedule I and Schedule IV
–
Schedule I
extracts and tinctures of cannabis
Schedule I
extracts and tinctures of cannabis
Schedule I
cannabis, cannabis resin, extracts
and tinctures of cannabis
Schedule I
cannabis, cannabis resin, extracts
and tinctures of cannabis, and all
THC isomers
Schedule II
–
Schedule II
–
Schedule II
–
Schedule II
–
Schedule I and Schedule III
–
Schedule I and Schedule III
–
Schedule I and Schedule III
–
Schedule I and Schedule III
Preparations containing
delta-9-THC (produced either by
chemical synthesis or as
preparations of cannabis) that are
compounded as pharmaceutical
preparations with one or more
other ingredients and in such a way
that delta-9-THC cannot be
recovered by readily available
means or in a yield which would
constitute a risk to public health
Continued on the next page.
History, science, and politics of international cannabis scheduling, 2015–2021 12
Table 3. Continued
Until 1991
1991-2021
After 21 April 2021
If all of WHO’s
recommendations had
been accepted
Schedules, Convention on psychotropic substances of 1971
Schedule I
delta-6a(10a)-THC
delta-6a(7)-THC
delta-7-THC
delta-8-THC
delta-9-THC
delta-10-THC
delta-9(11)-THC
Schedule I
delta-6a(10a)-THC
delta-6a(7)-THC
delta-7-THC
delta-8-THC
delta-10-THC
delta-9(11)-THC
Schedule I
delta-6a(10a)-THC
delta-6a(7)-THC
delta-7-THC
delta-8-THC
delta-10-THC
delta-9(11)-THC
Schedule I
–
Schedule II
–
Schedule II
delta-9-THC
Schedule II
delta-9-THC
Schedule II
–
Schedule III
–
Schedule III
–
Schedule III
–
Schedule III
–
Schedule IV
–
Schedule IV
–
Schedule IV
–
Schedule IV
–
Not in the Schedules of neither the Single Convention on narcotic drugs of 1961 nor the Convention
on psychotropic substances of 1971
cannabidiol, cannabinol,
cannabigerol, and many other
phytocannabinoids; terpenes,
terpenoids and phenols;
chlorophyll; other
phytoconstituents of the
Cannabis
plant
cannabidiol, cannabinol,
cannabigerol, and many other
phytocannabinoids; terpenes,
terpenoids and phenols;
chlorophyll; other
phytoconstituents of the
Cannabis
plant
cannabidiol, cannabinol,
cannabigerol, and many other
phytocannabinoids; terpenes,
terpenoids and phenols;
chlorophyll; other
phytoconstituents of the
Cannabis
plant
cannabidiol, cannabinol,
cannabigerol, and many other
phytocannabinoids; terpenes,
terpenoids and phenols;
chlorophyll; other
phytoconstituents of the
Cannabis
plant and preparations of
delta-9-THC, of cannabis, or of
cannabis resin, containing
predominantly CBD, and not more
than 0.2 per cent of delta-9-THC
* Changes in the scope of scheduling are underlined
3.1. RECOMMENDATION 5.5 ON CANNABIDIOL CONTROL
WHO Director-General, Tedros Adhanom
Ghebreyesus, circulated two notifications in
relation to cannabidiol (CBD). The first one
(recommendation of the 40th ECDD meeting,
see Table 1) in July 2018 contained a strong,
non-negotiable, and non-votable statement:
“preparations considered to be pure CBD
should not be scheduled” (Adhanom
Ghebreyesus, 2018), implying that “pure CBD”
was not under international control, and
negating, by not recommending it, that it could
be listed in the Schedules at all. The phrasing
of the 2018 recommendation, however, implied
that any medicine that is not “pure” CBD could
still be considered under control as “cannabis
resin” or “extract of cannabis,” an issue with
regards to the trace-amount of other
cannabinoids that are often found in CBD
medicines, both as residues in the extraction
process and as by-products of synthesis. The
History, science, and politics of international cannabis scheduling, 2015–2021 13
second ECDD recommendation on CBD
(recommendation 5.5, see Table 1) stated the
objective to “give effect” to the July 2018
recommendation that CBD should not be
subject to the international drug control régime
(Adhanom Ghebreyesus, 2019).
Complex in its technical construction,
recommendation 5.5 was subject to in-depth
analysis during the two years of discussion at
the CND (CND, 2020f; CNDmonitor, 2020;
UNODC, 2019). Beyond the issues of what the
changes recommended entailed for CBD
control (Riboulet-Zemouli, 2020a; 2020c;
Riboulet-Zemouli and Krawitz, 2021, pp.21–22)
the discussions showed that the proposal
might have had unforeseen consequences,
such as “sidestepping the amendment process
outlined in the treaty itself [...] reserved
exclusively to Member States” (United States
Mission..., 2020), which probably motivated
the rejection of this recommendation more
than an opposition to the idea of clarifying
CBD-related control measures (see “European
Union” in CNDmonitor, 2020; Riboulet-Zemouli,
2020c).
3.2. RECOMMENDATIONS 5.2, 5.3, 5.4 AND 5.6: AN ATTEMPT FOR POLICY COHERENCE & SIMPLIFICATION
Behind a formally complex appearance, the
rest of WHO’s ECDD cannabis-related
recommendations (Adhanom Ghebreyesus,
2019; CND, 2020c, pp.11–12), none of which
were accepted, constituted a well-reasoned
proposal to effectively facilitate access and
availability of CCDs without imposing on
Member States to reform. Two
recommendations (5.5 and 5.6, see Table 1)
proposed to establish a simplified three-tiered
control system:
- Cannabis, cannabis resin, and all the
isomers of THC, would remain under a
Schedule I régime,
- Governments would have been able to
decide, on domestic criteria, to subject
selected CCD medicines (with more
than 0.2% delta-9-THC) to a Schedule III
régime,
- CBD medicines (with less than 0.2%
delta-9-THC) would be clearly placed
outside of the scope of international
control, similarly to “pure CBD.”
To achieve these goals, the ECDD
recommended to remove delta-9-THC from
Schedule II of C71 (recommendations 5.2.1)
and remove other THC isomers from Schedule
I of C71 (recommandation 5.3.1) while adding
all THC isomers to Schedule I of C61
(recommendations 5.2.2 and 5.3.2). While this
would have de facto increased the measures
of control applied to delta-9-THC medicines
(e.g., Marinol®, Syndros®), had all
recommendations been adopted by the CND,
countries where these medicines are marketed
would have had the possibility to consider
such medicines under a C61 Schedule III
régime, equivalent to the C71 Schedule II
régime for preparations (Rexed et al., 1984,
pp.35–37), thanks to recommendation 5.6. At
the same time, recommendation 5.6 would
have evened the playing-field between
synthetic and plant-derived medicines, by
allowing countries where herbal cannabis
medicines are marketed (e.g., Asmasol®,
Ayurvedic formulations, Bediol®, Cannador®,
Sativex®) to also apply a Schedule III régime.
Because recommendations 5.2, 5.3, and 5.6
were not adopted, plant-derived delta-9-THC
preparations continue to be subject to stricter
measures of control than synthetic
delta-9-THC preparations.
Another proposal, recommendation 5.4,
was a purely technical correction of a
terminological error present in the C61: the
entry “extracts and tinctures of cannabis”
corresponds to the exact same product as
“preparation of cannabis” and “preparation of
cannabis resin” (Riboulet-Zemouli, 2020b). The
ECDD considered that, because “preparation”
is defined in C61, contrary to “extracts and
tinctures of cannabis” deleting the latter would
improve policy coherence and simplify the
interpretation of the treaty (WHO, 2019a, p.53),
without affecting any control measure, since
preparations are to be controlled at the same
level that the drug they contain, and “extracts
and tinctures” are in Schedule I, at the same
History, science, and politics of international cannabis scheduling, 2015–2021 14
level that the drug they contain (see “INCB,
Analysis of the impact of the WHO
recommendations on the control requirements
of the international drug control system” in
CNDmonitor, 2020).
During the two years of discussion at
the CND, WHO representatives explained that
the recommendations had been thought of as
a whole, and were meant to be understood,
interpreted, and voted on jointly. But Member
States addressed them separately (United
States Bureau…, 2020; CNDmonitor, 2020) in
part due to the fact that voting procedures
differed depending on the CCD considered
(Facsimile..., 2020, pp.3–4), revealing
inconsistencies between stand-alone
recommendations that had not been foreseen
by the ECDD in its approach to the
recommendations as an interrelated
aggregate, and making difficult a broader
acceptance of the recommended changes.
History, science, and politics of international cannabis scheduling, 2015–2021 15
4. PROCEDURAL ISSUES
WHO Director-General’s letter that triggered the
CND voting process is dated 24 January 2019
(Adhanom Ghebreyesus, 2019; Facsimile...,
2020, p.2) less than three months ahead of the
regular session of the 62nd CND in March
2019 where the recommendations contained
in the letter were to be voted on. This triggered
a postponement of the vote by one year
(decision 62/14: CND, 2019b) and enabled the
Chair of the 62nd CND, Ambassador Mirghani
Abbaker Altayeb Bakhet of Sudan (Annex II), to
conduct “a dialogue, including two
intersessional meetings, with representatives
of WHO, INCB and the United Nations Office on
Drugs and Crime [UNODC] to address open
questions” (UNODC, 2020b) throughout 2019,
indistinctly discussing the recommendations
altogether or separately (UNODC, 2019), and
welcoming the participation of civil society
observers.
Central to the proceedings inside the
UN were the CND Chairs, seconded by Jo
Dedeyne- Amann, chief of the Secretariat to the
CND, part of the UNODC (2020c). The
members of CND’s “Extended Bureau”
grouping “the Chairperson, three
Vice-Chairpersons and one Rapporteur” plus
“the Chairpersons of the five regional groups,
the European Union and the Group of 77 and
China” (UNODC, 2020d) were also key.
The decision to address the
recommendations disjointly was taken in May
2020 under the insistence of Ambassador
Mansoor Ahmad Khan of Pakistan,
Ambassador Bakhet’s successor as Chair of
the 63rd CND session (CND Chair, 2020,
pp.1–2; Facsimile…, 2020, p.49; UNODC,
2020d), after a second postponement of the
vote was agreed on by CND in March 2020
(decision 63/14, CND, 2020a). If WHO’s
assessments are to be “determinative as to
medical and scientific matters” (WHO, 2016a,
p.2), the CND also “has broad discretionary
powers to take into account economic, social,
legal, administrative or other factors, but may
not act arbitrarily” (UNODC, 2020a, p.6). This is
what drove the second delay.
Under the chairmanship of
Ambassador Khan –that made full use of its
“brokerage” power (Blavoukos and
Bourantonis, 2013)– only one public
intersessional meeting was arranged (on 8
October 2020), however, six days of
inter-governmental “topical meetings” were set
up, where civil society observers were not
invited (CND Chair, 2020, p.3). While the Chair
had left open the possibility to invite “other
relevant intergovernmental organizations with
a mandate that is of particular relevance for
specific recommendations [...] upon request of
Member States” (CND Chair, 2020, p.3) no
other entity than UNODC and the INCB
participated in the topical meetings.
4.1. A LENGTHY PROCESS
If it took WHO two years to issue its
recommendations, CND took two more to craft
its response (Annex III). Conversely to the
efforts deployed by WHO to open and improve
the process, CND did not take full advantage of
the two delays to discuss the subject matter,
progressively restricted access to observers,
and dedicated a disproportionate amount of
time to finding out how the conditionality and
combination of vote between
recommendations could have played in
different voting scenarios (an activity usually
left to observers and the media). Ultimately,
these discussions were not entirely successful
as time and pandemic-related constraints did
not play in favour of a fully consensual
agreement, neither on the substance nor on
the procedure.
During summer 2020, Ambassador
Khan was unexpectedly moved from the
Permanent Mission to the United Nations in
History, science, and politics of international cannabis scheduling, 2015–2021 16
Vienna, to the Embassy of Pakistan in Kabul
(Embassy of Pakistan…, 2021; Khan, 2020) in
between two topical meetings while continuing
to chair the CND. The remote chairing of the
Vienna-based CND discussions on Cannabis
scheduling from Kabul between September
and December 2020, amidst the pandemic, did
not help provide the stability and normality
needed for such discussions.
4.2. A SUI GENERIS VOTING PROCEDURE
In late 2019, the UNODC, which manages the
secretariat to the CND, issued a series of fact
sheets (Facsimile..., 2020, pp.2–5) and later a
booklet (UNODC, 2020a) on the regular
scheduling procedures under C61 and C71. At
the same time, UNODC also required the UN
Office of Legal Affairs to assess whether the
vote on different recommendations could be
combined despite different majorities being
required under C61 and C71 for scheduling
changes (Facsimile..., 2020, pp.6–13). A first
proposal was presented by UNODC in March
(pp.14) and was subject to intense debates.
On 5 October 2020, Ambassador Khan put
forward a non-paper that failed to gain
consensual support. A few weeks later, “at the
time of the 43rd ECDD meeting, discussions
were ongoing at the CND to define and agree
on a voting procedure applicable [...] at the
63rd CND reconvened session” (WHO, 2021,
p.6). Proposals for alternative voting
procedures were submitted by Mexico
(Facsimile..., 2020, pp.22–24), the Russian
federation (pp.28–29), and on various
occasions by Ambassador Khan
(pp.15–21,30–40), before the final voting
scheme was adopted in Decision 63/16 by
silent procedure over the week-end (pp.41–42;
CND, 2020b, pp.3–4) two days before the vote.
A failure to have adopted the procedure in time
could have resulted in a third postponement of
the vote, desired by no party involved.
A direct result from the special voting
procedures included in Decision 63/16 is a
“deviation from rule 55 of the rules of
procedure of the Functional Commissions of
ECOSOC” (Facsimile..., 2020, p.8). While the
temporary suspension of rule 55, permitting to
reconsider a proposal previously rejected, is
allowed under rule 78 of that same document
(UN, 1983, pp.14,19) another different
deviation was inserted in the final report on the
reconvened 63rd CND session of December
2020 (CND, 2020b), which serves as official
record. By stating, in particular, that “the
Commission decided by consensus not to add
preparations containing
delta-9-tetrahydrocannabinol [...] to Schedule
III” (Decision 63/21; see CND, 2020b, p.v,7,17;
Table 1) the report contradicts the regular
voting procedure established in C61 and in
Rule 58 of the same ECOSOC functional
commissions document (UNODC, 2020b,
pp.5–7; UN, 1983, p.14) which only allows CND
to accept or reject WHO recommendations by
a vote. But rule 58 and the dispositions of the
Conventions are not superseded by Decision
63/16: accordingly, WHO recommendation 5.6
should have been acted upon by vote, and
should technically not have been “rejected by
consensus.” Video recordings of 2 December
2020 show indeed that CND did not actually
reject recommendation 5.6 by consensus:
instead, CND decided by consensus not to vote
on this recommendation. Although the
difference is crucial, it failed to be accurately
reflected in the CND report.
Decision 63/16 and the CND session’s
report state that the “voting procedure [...]
does not set a precedent for any future
decision-making” (CND 2020b, p.23), yet, it
calls into question the work of the
Commission as well as highlight flaws in its
reporting procedure.
History, science, and politics of international cannabis scheduling, 2015–2021 17
4.3. CND REPORT: THE DISCONNECT
Previous CND reports had already called
attention due to their failure to depict the
contents of the debates held during the
sessions. The report on the reconvened 59th
CND session of December 2016 (CND, 2016b,
pp.14–15) made no mention of the
announcement by WHO of the launch of the
Cannabis review process, and of a special
ECDD meeting to be held “within the next
eighteen months” (WHO, 2016c, p.8). Reports
also inconsistently reflect Extended Bureau
meetings.
The report on the reconvened 63rd
session fails to reflect the explanations of
votes (CND, 2020b; 2020h). The report on the
64rd CND session held in April 2021 (a few
months after the vote) again misrepresented
the discussion, mentioning only that “it was
underlined that Commission decision 63/17
did not legitimize the wider use of cannabis, in
particular its use for recreational purposes”
(CND, 2021b, p.6), as indeed some countries
expressed. Surprisingly, however, no other
mention of the topic appears in the report,
although its outcome was extensively
discussed by Member States during the
session, including a number of comments
exposing national advances in the reform of
medical cannabis laws (Secretaría Nacional,
2021; South African Embassy…, 2021b) and a
dozen countries positively recalled the vote
during the opening segment and general
debate (UNODC, 2021). Jamaica noted the
“landmark decision on the rescheduling of
cannabis (Permanent Mission of Jamaica…,
2021), South Africa “welcome[d] the decision
to delete cannabis and cannabis resin from
schedule IV of the 1961 convention” (South
African Embassy…, 2021a) just like New
Zealand (New Zealand Embassy…, 2021) which
also explained how they “see this as an
important step in the acknowledgment of the
medical and therapeutic properties of
cannabis, and in encouraging global research.”
France “saluted” the December 2020 vote in its
statement (Mission interministérielle…, 2021),
similarly to Uruguay (Permanent Mission of
Uruguay…, 2021) and Australia adding that the
changes in the scope of control over cannabis
“demonstrated the enduring relevance of the
international drug control regime, which aims
to protect public health and ensure the
well-being of society” (Australian Embassy…,
2021).
None of this is reflected in the 64th
CND’s report (CND, 2021a; 2021b), which
mentions Decision 63/17 only once and refers
to it in relation to “the wider use of cannabis,”
without making any mention to medical uses,
research, and the people behind: physicians
and patients.
History, science, and politics of international cannabis scheduling, 2015–2021 18
5. CONCLUSION
Schedule IV does not oblige countries to
prohibit or ban medical uses. It only strongly
encourages such an exceptional legal
measure, while providing it a legal umbrella. In
that sense, the removal of “cannabis and
cannabis resin” from Schedule IV of C61 is
more a symbolic correction of the historical
record (Bannister, 2021; FAAAT, 2020) and a
legitimation of the potential that CCDs
represent for healthcare, like many other
Schedule I medications already widely
prescribed and used in appropriate medical
settings. But it does not trigger any direct
change in the international controls applied to
CCDs. Yet, the votes represent a double
symbol. On the one hand, a “long-heralded
medicinal plant” is, again, legitimate in
medicine after a parenthesis of 57 years (since
C61 entered into force in 1964). On the other
hand, because WHO’s eight other proposals
were declined, the world is left with no other
regulatory guidance for healthcare systems,
physicians, pharmacists, and patients, other
than those built locally and those to yet come.
By refusing ECDD’s policy suggestions,
the CND, instead of hampering the
development of “medical cannabis programs”
on the ground, might actually have perpetuated
the model of sui generis, locally-oriented
access programs, such as those initiated in
the State of California in 1996 and followed by
dozens of other States in the USA and other
national jurisdictions. Under a Schedule IV
régime, a myriad of Cannabis plants were
legally grown and processed, traded,
controlled for quality, prescribed, and used by
patients –including in countries where the
Supreme or Constitutional court had granted
citizens the right to grow for self-medication.
This was possible thanks to the modern
shared approach of “respect [for] the
conventions; flexible interpretation; tolerance
for national policies” (Brownsfield, 2014) that
stems from the Conventions (Bewley-Taylor,
2003; Collins, 2018).
Re-legitimizing Cannabis and its
derivatives in medicine (and as a medicine)
while refusing to fully mainstream it might
represent a unique opportunity for public
health authorities to experiment with adapted
regulatory schemes, socially and culturally
sensible, it could contribute to the needed
economic relocalizations while preventing
larger, profit-driven investments from diverting
public health objectives; it will facilitate the
tailoring of conservation strategies when
endangered plant varieties or traditional
medical knowledge are at risk.
Beyond Cannabis, this report briefly
looked at the “normative deficit” that curtailed
WHO’s assessments and how the ECDD
Secretariat and Experts addressed it, and the
“democratic deficit” at the CND level that the
Cannabis scheduling process faced (Lohman
and Barrett, 2020). While the democratic
deficit calls for an articulation of a political
voluntarism with efficient diplomacy, the
normative issues and lack of a robust
science-based framework for ECDD experts to
unfold their work suggest a renewed approach
to the methods and criteria for assessment of
substances for international control, called on
for by Danenberg et al. (2013) and inspired in
recognized methods such as the Multi-Criteria
Decision Analysis proposed by Nutt and
colleagues (2007). But the fundamental bias in
relation with CCDs, as well as with the two
other traditional herbal medicines lacking
scientific assessments (coca leaf and opium)
yet serving as a criteria for placing other drugs
under international control, suggests that a
History, science, and politics of international cannabis scheduling, 2015–2021 19
broader reform of the framework provided by
the Conventions might be the next step
towards a real public health approach to, and
“scientific evidence-based review and
scheduling of the most prevalent, persistent
and harmful substances” (UNGASS, 2016,
p.15). This report might bring helpful insights,
in light of the renewed interest of international
drug control bodies for a number of traditional
plants, fungi, and their preparations, that are
not yet under control, like ayahuasca, ephedra,
iboga, khat, kratom, peyote, psilocibes, salvia
(INCB, 2013, p. 46).
For the time being, and since their
inception in 1946, both CND and WHO have
been able (although with difficulties) to admit
an historical mistake and take action, relying
on evidence, to correct it. Something that
many patients (European coalition..., 2020)
and healthcare professionals (Multidisciplinary
Association..., 2020; Spence, 2020; Vienna
NGO Committee..., 2020) have certainly been
able to celebrate. International law and a
rule-based order also depends on people being
able to celebrate it.
ACKNOWLEDGEMENTS
The authors wish to thank the people that
accepted to review the manuscript at various
stages; ECDD members and all the staff of
WHO Essential medicines and health products;
Hanka Gabrielová, Amy King, Simon
Anderfuhren-Biget, Gilles Forte, Willem
Scholten, David Nutt; Reynald Erardt, Thomas
Allen, Claude Da Re, Jacques Oberson, and Lee
Robertson (WHO & UN libraries); all
stakeholders met in Vienna and Geneva during
CND, ECDD, WHA sessions in the last decades,
and civil society groups and individuals that
provided supports of all kinds to this research.
Very special thanks to WHO’s security
personnel and the diplomatic police of the
Canton of Geneva. This research was
undertaken on a voluntary basis; travels to
United Nations meetings were crowdfunded
via donations to the non-profit FAAAT and via
www.patreon.com/teluobir
History, science, and politics of international cannabis scheduling, 2015–2021 20
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Annexes
History, science, and politics of international cannabis scheduling, 2015–2021 28
Annex I. List of stakeholders involved in WHO ECDD’s cannabis-related assessments, in Geneva
(2016-2019)
Stakeholder
Body (country)
Title
Gender
Involvement
Expert Committee on Drug Dependencea
Patrick Beardsley
Virginia Commonwealth University (United
States)
Professor of Pharmacology,
Toxicology
♂
Expert at the 39 th , 40th and 41st
meetings.
Rapporteur of the 39th and 40th
meetings
Bruna Brands
At the 39th and 40th meetings:
Faculty of
Medicine, University of Toronto (Canada)
At the 41st meeting:
Office of Drug Science
and Surveillance, Controlled Substances
Directorate, Health Canada (Canada)
At the 39th and 40th
meetings:
Professor of
Pharmacology and
Toxicology
At the 41st meeting:
Senior
Science Advisor
♀
Expert at the 39 th , 40th and 41st
meetings.
Chair of the 39th and 40th meetings
Ifeoma Toyin Ekwere
Department of Anaesthesiology, University
of Benin Teaching Hospital (Nigeria)
Senior Consultant
Anaesthesiologist
♀
Expert at the 39 th , 40th and 41st
meetings
Simon Elliott
Independent (United Kingdom);
King’s College (United Kingdom)
Consultant Forensic
Toxicologist;
Visiting Professor in Forensic
Toxicology
♂
Expert at the 39 th , 40th and 41st
meetings
Katia Gysling
Pontificia Universidad Católica (Chile)
Professor of Biological
Sciences
♀
Temporary adviser at the 39th meeting.
Expert at the 40th and 41st meetings
Raka Jain
National Drug Dependence
Treatment Centre, All India Institute of
Medical Sciences (India)
Professor of Chemistry
♀
Expert at the 39 th , 40th and 41st
meetings
Pamela Kaduri
Muhimbili University of Health and Allied
Sciences (Tanzania)
At the 40th and 41st meetings, additionally:
University of
Toronto (Canada)
Professor of Psychiatry
♀
Expert at the 39 th , 40th and 41st
meetings.
Rapporteur of the 41st meeting
Junishi Kitanaka
Hyogo College of Medicine (Japan)
Professor of Pharmacology
♂
Expert at the 40th and 41st meetings
Sutisa Nudmamud-Thanoi
Faculty of Medical Science, Naresuan
University (Thailand)
Professor of Anatomy
♀
Temporary adviser at the 39th meeting.
Expert at the 40th and 41st meetings
Afarin Rahimi-Movaghar
Tehran University of Medical Sciences (Iran)
Professor of Psychiatry;
Director, Iranian
National Centre for
Addiction Studies
♀
Expert at the 39 th , 40th and 41st
meetings.
Co-chair of the 41st meeting
Jason White
University of South Australia (Australia)
Professor of Pharmacology;
Head of the School of
Pharmacy and Medical
Sciences
♂
Expert at the 39 th , 40th and 41st
meetings.
Co-chair of the 39th and 40th meetings.
Chair of the 41st meeting
Lead co-author of the Pre-review report
on CBD (39th meeting)
Representatives of other International Organizationsb
Sevil Atasoy
INCB (Turkey)
Member of the Board
♀
39th meeting
Celso Coracini
UNODC
Crime Prevention and
Criminal Justice Officer
♂
40th meeting
Beate Hammond
INCB Secretariat
Drug Control and Crime
Prevention Officer
♀
39th and 41st meetings
Galina Korchagina
INCB (Russian federation)
Member of the Board
♀
40th meeting
Rossen Popov
INCB Secretariat
Deputy Secretary
♂
40th meeting
Justice Tettey
Laboratory and Scientific Section, Division
for Policy Analysis and Public Affairs,
UNODC
Chief
♂
39th, 40th, and 41st meetings
Jallal Toufiq
INCB (Morocco)
Member of the Board
♂
41st meeting
History, science, and politics of international cannabis scheduling, 2015–2021 29
World Health Organization (temporary)b
Mayyada al Wazaify
University of Jordan (Jordan)
Professor of Pharmacy
Practice
♀
Temporary adviser at the 41st meeting
Jonathon Arnold
School of Medical Sciences, University of
Sydney (Australia);
Lambert Initiative for Cannabinoid
Therapeutics (Australia)
Professor of Pharmacy;
Deputy Academic Director
♂
Temporary adviser at the 40th meeting.
Author of the toxicology sections of the
Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Shanna Babalonis
Center on Drug and Alcohol Research,
University of Kentucky (United States)
Assistant Professor of
Behavioral Science
♀
Co-editor of the Critical review report
on CBD (40th meeting)
Brock Bakewell
Thomas Jefferson University (United States)
Research Assistant
♂
Co-author of the therapeutic use
sections of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD
Simon Brandt
Liverpool John Moores University (United
Kingdom)
Associate Professor in
Bioactive Drug Chemistry
♂
Temporary adviser at the 41st meeting
Giuseppe Cannazza
University of Modena and Reggio Emilia
(Italy)
Researcher
♂
Temporary adviser at the 40th meeting.
Co-author of the chemistry sections of
the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Hye-Jin Cha
National Institute of Food and Drug Safety
Evaluation, Ministry of Food and Drug
safety (Republic of Korea)
Scientific officer
♀
Temporary adviser at the 39th meeting
Cinzia Citti
University of Modena and Reggio Emilia
(Italy)
Researcher
♀
Co-author of the chemistry sections of
the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Sandra Comer
Department of Psychiatry, Division of
Substance Use Disorders, Columbia
University (United States)
Professor of Neurobiology
♀
Temporary adviser at the 39th meeting
Omar S. M. Hasan
Centre for Addiction and Mental Health
(Canada)
Research analyst
♂
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Kevin P. Hill
Harvard Medical School (United States)
Associate Professor of
Psychiatry
♂
Temporary adviser at the 40th meeting.
Lead co-author of the therapeutic use
sections of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD
Jakob Manthey
Institute for Clinical Psychology and
Psychotherapy, Dresden University of
Technology (Germany)
Research assistant
♂
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD.
Co-author of the analysis of answers to
the questionnaire to Member States for
the 40th meeting (all substances).
Co-editor of the Critical review report
on CBD (40th meeting)
Astrid Otto
Centre for Addiction and Mental Health
(Canada)
Scientific editor
♀
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD.
Co-author of the analysis of answers to
the questionnaire to Member States for
the 40th meeting (all substances).
Co-editor of the Critical review report
on CBD (40th meeting)
Charles Victor Pollack
Lambert Center for the Study of Medicinal
Cannabis and Hemp, Thomas Jefferson
University (United States)
Founding Director
♂
Co-author of the therapeutic use
sections of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD
History, science, and politics of international cannabis scheduling, 2015–2021 30
Charlotte Probst
Centre for Addiction and Mental Health
(Canada)
Independent scientist
♀
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Jurgen Rehm
Centre for Addiction and Mental Health
(Canada)
Senior director and Senior
scientist
♂
Temporary adviser at the 40th meeting.
Lead co-author of the epidemiology
sections of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD.
Lead co-author of the analysis of
answers to the questionnaire to Member
States for the 40th meeting (all
substances).
Co-editor of the Critical review report
on CBD (40th meeting)
Julian Sauer
Centre for Addiction and Mental Health
(Canada)
Unknown
♀
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Judith Spahr
Lambert Center for the Study of Medicinal
Cannabis and Hemp, Thomas Jefferson
University (United States)
Administrative director
♀
Co-author of the therapeutic use
sections of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD
Vidhi Thakkar
Centre for Addiction and Mental Health
(Canada)
Research analyst
♀
Co-author of the epidemiology sections
of the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Agnes Vitry
University of South Australia (Australia)
Professor, School of
Pharmacy and Medical
Sciences
♀
Temporary adviser at the 41st meeting
Sharon L. Walsh
Center on Drug and Alcohol Research,
University of Kentucky (United States)
Professor of Behavioral
Science; Director, Center on
Drug and Alcohol Research
♀
Lead co-editor of the Critical review
report on CBD (40th meeting)
Jenny Wiley
RTI International (United States)
Fellow, Behavioral
Pharmacology
♀
Temporary adviser at the 40th meeting.
Author of the pharmacology sections of
the Pre-review (40th meeting) and
Critical-review (41st meeting) reports
on all substances, except CBD
Kim Wolff
King’s College (United Kingdom)
Director, Department of
Analytical, Forensic and
Addiction Science
♀
Temporary adviser at the 41st meeting
World Health Organization staffc
Tedros Adhanom Ghebreyesus
Office of the Director-General, WHO
Director-General
♂
No participation in the meetings.
Circulated ECDD final reports and
recommendations to United Nations
Secretary-General
Alma Alic
Office of Compliance, Risk Management
and Ethics, WHO
Ethics officer
♀
Wil De Zwart
Cluster
Access to Medicines, Vaccines and
Pharmaceuticals, WHO.
ECDD Secretariat
Technical officer to the
ECDD Secretariat
♀
Co-editor of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD
Gilles Bernard Forte
Cluster
Access to Medicines, Vaccines and
Pharmaceuticals, WHO.
ECDD Secretariat
Coordinator;
Secretary of the Expert
Committee on Drug
Dependence
♂
Central coordination and oversight of
the three meetings
Suzanne Hill
Department
Essential Medicines and Health
Products, WHO
Director
♀
Oversight of the three meetings
Stephanie Kershaw
Department
Essential Medicines and Health
Products, WHO
Technical officer
♀
Co-author of the Pre-review report on
CBD (39th meeting).
Co-author of the analysis of answers to
the questionnaire to Member States for
the 39th meeting (CBD).
History, science, and politics of international cannabis scheduling, 2015–2021 31
Eda Lopato
Department
Essential Medicines and Health
Products, WHO
Technical officer
♀
Until 2017. Did not participate in the
39th, 40th and 41st meetings
Dilkushi Poovendran
Cluster
Access to Medicines, Vaccines and
Pharmaceuticals, WHO.
ECDD Secretariat
Technical officer
♀
Co-author of the Pre-review report on
CBD (39th meeting).
Co-author of the analysis of answers to
the questionnaire to Member States for
the 39th meeting (CBD).
Co-editor of the Pre-review (40th
meeting) and Critical-review (41st
meeting) reports on all substances,
except CBD.
Vladimir Poznyak
Department
Mental health and Substance
Abuse, WHO
Coordinator
♂
Liaison with WHO’s work on the
“non-medical uses of cannabis”
Jakob Quirin
Office of the Legal Counsel, WHO
Associate Legal Officer
♂
Mariângela Batista Galvão Simão
Cluster
Access to Medicines, Vaccines and
Pharmaceuticals, WHO
Cluster Head;
Assistant Director-General
♀
Oversight of the process; liaison with
Director-General.
Presenters on cannabis at ECDD Open Sessionsd
Boris Banas
European Industrial Hemp Association
(Germany)
♂
Open session of the 39th meeting
Myrtle Clarke
Fields of Green for ALL (South Africa)
♀
Open session of the 40th meeting
Leticia Cuñetti
Nephrology and Urology Institute
(Uruguay)
♀
Open session of the 40th meeting
Francis D’Ambrosio
D’Ambrosio Medical Group (United States)
♂
Open session of the 41st meeting
Richard Dart
Rocky Mountain Poison & Drug Center
(United States)
♂
Open session of the 41st meeting
Raúl Héctor Elizalde Garza
Por Grace (Mexico)
♂
Open session of the 39th meeting
Margarita Garfias and her son
Familias y Retos Extraordinarios, AC
(Mexico)
♀
Open session of the 40th meeting
Franjo Grotenhermen
International Association for Cannabinoid
Medicines (Germany)
♂
Open session of the 40th meeting
Christopher Hallam
IDPC (United Kingdom)
♂
Open session of the 41st meeting
Jennifer Hasselgard-Rowe
IDPC (United Kingdom)
♀
Open session of the 40th meeting
Harm Hids
Chron Consult (Netherlands)
♂
Open session of the 40th meeting
Catherine Jacobson
Tilray, Inc. (Canada/United States)
♀
Open session of the 40th meeting
Michael A. Krawitz
Veterans for Medical Cannabis Access;
FAAAT think & do tank (United States)
♂
Open sessions of the 37th and 39th
meetings
Pritesh Kumar
PhytoSciences (United States)
♂
Open session of the 40th meeting
Shane Le Brun
Medical Cannabis Awareness (New
Zealand)
♂
Open session of the 40th meeting
Koichi Maeda
Japan Medical Marijuana Association (Japan)
♂
Open session of the 41st meeting
Sylvie Massart
n/a
♀
Open session of the 40th meeting
Dusan Nolimal
Institute of Public Health (Slovenia)
♂
Open session of the 39th meeting
Marie Nougier
IDPC (United Kingdom)
♀
Open session of the 39th meeting
David J. Nutt
Drug Science (United Kingdom)
♂
Open session of the 38th meeting
Gabriel Rada
Epistemonikos Foundation (Chile)
♂
Open session of the 40th meeting
Kenzi Riboulet-Zemouli
FAAAT think & do tank (Spain)
♂
Open session of the 41st meeting
Valeria Salech
Mamá Cultiva (Argentina)
♀
Open session of the 40th meeting
Tadhg Stopford
The Hemp Foundation (New Zealand)
♂
Open session of the 40th meeting
Zara Snapp
Instituto RIA (Mexico)
♀
Open session of the 40th meeting
Luciana Zaffalon
Brazilian Drug Policy Platform (Brazil)
♀
Open session of the 41st meeting
aParticipated in the ECDD meetings indicated; bDid not participate in ECDD meetings except when noted as “Temporary
adviser”; cPresented orally at the Open session where indicated, but did not participate in the rest of the ECDD meetings.
History, science, and politics of international cannabis scheduling, 2015–2021 32
Annex II. List of stakeholders involved in the review of WHO ECDD’s cannabis-related
recommendations at the Commission on Narcotic Drugs, in Vienna (2019-2021).
Stakeholder
Body (country)
Title
Gender
Involvement
Bureau of the Commission on Narcotic Drugs
Maria Assunta Accili
Sabbatini
Permanent Mission of Italy to
international organizations in Vienna
Ambassador
♀
3rd Vice-Chair of the 62nd CND
(2019)
Mirghani Abbaker Altayeb
Bakhet
Permanent Mission of Sudan to
international organizations in Vienna
Ambassador
♂
Chair of the 62nd CND (2019)
Wolfgang Amadeus
Bruelhart
Permanent Mission of Switzerland to
international organizations in Vienna
Ambassador
♂
2nd Vice-Chair of the 63rd CND
(after 11 June 2020)a
Ghislain D’hoop
Permanent Mission of Belgium to
international organizations in Vienna
Ambassador
♂
2nd Vice-Chair of the 63rd CND
(until 11 June 2020)a
Kazem Gharib Abadi
Permanent Mission of Iran to
international organizations in Vienna
Ambassador
♂
1st Vice-Chair of the 62nd CND
(2019)
Mansoor Ahmad Khan
Until September 2020: Permanent
Mission of Pakistan to international
organizations in Vienna
Until September 2020: Embassy of
Pakistan in Kabul, Afghanistan
Ambassador
♂
Chair of the 63rd CND (2020)
Dominika Krois
Permanent Mission of Poland to
international organizations in Vienna
Ambassador
♀
1st Vice-Chair of the 63rd CND
(2020)
Dubravka Plejic Markovic
Permanent Mission of Croatia to
international organizations in Vienna
Ambassador
♀
2nd Vice-Chair of the 62nd CND
(2019)
Gloria Navarrete
Permanent Mission of Chile to
international organizations in Vienna
Ambassador
♀
3rd Vice-Chair of the 63rd CND
(2020)
Emmanuel Ikechukwu
Nweke
Permanent Mission of Nigeria to
international organizations in Vienna
Counsellor
♂
Rapporteur of the 63rd CND (2020)
Alvaro Salcedo Teullet
Permanent Mission of Peru to
international organizations in Vienna
First Secretary
♂
Rapporteur of the 62nd CND (2019)
Secretariat to the Commission on Narcotic Drugs
John Brandolino
Division for Treaty Affairs, UNODC
Director
♂
Oversight
Jo Dedeyne- Amann
Secretariat to the Commission on
Narcotic Drugs, Division for Treaty
Affairs, UNODC
Chief
♀
Coordination; focal point.
António Guterres
United Nations
Secretary-General
♂
No participation in the Commission.
Circulated to Member States the
notification of WHO’s
Director-General containing ECDD
final reports and recommendations,
and the outcome of the vote of the
reconvened 63rd CND session
Presenters at the Topical meetings of the 63rd the Commission on Narcotic Drugs
Undocumented
An unknown number of experts invited by governments presented during the Topical meetings (an important part of
these experts were representatives of governmental medicines, pharmaceutical, law enforcement, or drug control
agencies).
aCND, 2020b, p.24.
History, science, and politics of international cannabis scheduling, 2015–2021 33
Annex III. Comprehensive chronology of the WHO ECDD’s cannabis review process, in Geneva,
New-york and Vienna (2016-2021)*
Date
Body
Event
Access to
observers
Decision/action
Documentation
14
November
2016
ECDD
38th meeting,
open session
Open
Presentation of oral and written contribution by pre-registered civil society
stakeholders.
Curran et al., 2016
14 to 18
November
2016
ECDD
38th meeting
Closed
“...the Committee noted that the current Schedule I of the 1961
Convention groups together cannabis and cannabis resin, extracts and
tinctures of cannabis. Cannabis plant and cannabis resin are also in
Schedule IV of the 1961 Convention. The Committee further noted that
there are natural and synthetic cannabinoids in Schedule I and Schedule II
of the 1971 Convention. The committee recognized:
- An increase in the use of cannabis and its components for medical
purposes
- 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 in order 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.”xb
Outcome report, 38th ECDD:
WHO, 2017b, pp.35–36.
2
December
2016
CND
Reconvened
59th session
Open
Presentation of an excerpt from the Report of the 38th ECDD to CND
members and observers, byECDD Secretariat (Dr. G. Forte, Dr. E.
Lopato).
Agenda: CND, 2016a, p.8.
Conference room paper: WHO,
2016c, pp.7–8.
8 to 10 May
2017
ECDD
2nd Informal
Working Group
Closed
Eee
Minutes: WHO, 2018c, pp.10–11
6
Novembre
2017
ECDD
39th meeting,
open session
Open
Presentation of oral and written contribution by pre-registered civil society
stakeholders.
Open session agenda: WHO,
2017a.
6 to 10
Novembre
2017
ECDD
39th meeting
Closed
Pre-review of CBD:
“In a variety of laboratory animal and human models,
preparations containing almost exclusively CBD do not have effects typical
of abuse potential. In animals, CBD increases intracranial self-stimulation
thresholds, suggestive of diminished reward activity, and does not produce
conditioned place preference. Importantly, it has placebo-like effects when
tested for its abuse liability in human subjects. Furthermore, CBD does not
have effects characteristic of THC. It does not produce the cannabimimetic
effects in the tetrad battery in mice, and does not substitute for the
discriminative stimulus effects of THC in rats. At present, there are no
case reports of abuse or dependence relating to the use of CBD.
Furthermore, no public health problems (e.g. impaired driving) have been
associated with the use of CBD.
CBD is not specifically listed in the schedules of the 1961, 1971 or 1988
United Nations International Drug Control Conventions. There is no
evidence that CBD as a substance is liable to similar abuse and produces
similar ill effects to substances in the 1961 or 1971 Conventions (including
cannabis and dronabinol (THC), respectively). The purpose of the
pre-review was to determine whether current information justifies a
critical review by the Expert Committee of information that may justify the
Pre-review report: Walsh et al.,
2017.
Outcome report, 39th ECDD:
WHO, 2018c.
History, science, and politics of international cannabis scheduling, 2015–2021 34
scheduling or a change in the scheduling of the substance in the 1961 or
1971 Conventions. As CBD is not currently a scheduled substance in its
own right (only as a component of cannabis extracts), current information
does not justify a change in this scheduling status nor does it justify
scheduling of the substance.
However, where CBD is produced for pharmaceutical purposes as an
extract of cannabis, cannabis extracts and tinctures are included in the
1961 UN Single Convention on Narcotic Drugs. The pre-review of
cannabis extracts and tinctures will take place at the fortieth ECDD
meeting in May 2018. Therefore it is also recommended that extracts or
preparations containing almost exclusively CBD (cannabidiol;
(1’R,2’R)-5’-Methyl-4-pentyl-2’-(prop-1-en-2-yl)-1’,2’,3’,4’-
tetrahydro-[1,1’-biphenyl]-2,6-diol) be subject to critical review at that
meeting.”
9
November
2017
WHO EMP
n/a
Requests for proposals for Author contributions to the 40th ECDD
meeting, by providing a total of 20 Pre-Review reports of Cannabis-Related
Substances (five scientific topics: chemistry, pharmacology, toxicology,
epidemiology, and therapeutic use, for each substance under review:
“cannabis and cannabis resin,” “extracts and tinctures of cannabis,”
“delta-9-THC,” and “isomers of THC”)
RfP: United Nations Global
Marketplace, 2017; WHO,
2016e.
Early 2018
WHO
n/a
n/a
Circulation of Questionnaires to collect data from Member States on
“cannabis and cannabis resin,” “extracts and tinctures of cannabis,”
“delta-9-THC,” “isomers of THC,” and “cannabidiol.”
Questionnaires: WHO, 2018e
4 June 2018
ECDD
40th meeting,
open session
Open
Presentation of oral and written contribution by pre-registered civil society
stakeholders.
Open session agenda: WHO,
2018a.
Report: WHO, 2018d, pp.6–8.
4 to 7 June
2018
ECDD
40th meeting
Closed
Critical review of CBD:
“CBD is one of the naturally occurring
cannabinoids found in cannabis plants. There are no case reports of abuse
or dependence relating to the use of pure CBD. No public health problems
have been associated with CBD use. CBD has been found to be generally
well tolerated and to have a good safety profile. Adverse effects of CBD
use include loss of appetite, diarrhoea and fatigue. Therapeutic applications
of CBD are being researched for a variety of clinical uses. Research in this
area is most advanced in the treatment of epilepsy. In clinical trials, one
pure CBD product has demonstrated effectiveness for treating some forms
of epilepsy, such as Lennox-Gastaut syndrome and Dravet syndrome,
which are often resistant to other forms of medication. CBD is not
specifically listed in the schedules of the 1961, 1971 or 1988 United
Nations International Drug Control Conventions. However, if prepared as
an extract or tincture, it is controlled under Schedule I of the 1961 Single
Convention on Narcotic Drugs. There is no evidence that CBD as a
substance is liable to similar abuse or leads to similar ill-effects to
substances controlled under the 1961 or 1971 Conventions such as
cannabis or Δ9 -THC, respectively. The Committee recommended that
preparations considered to be pure CBD should not be scheduled.”
Pre-review of cannabis and cannabis resin:
“Cannabis is defined as the
flowering tops or separated resin of the C. sativa plant. Cannabis contains
121 reported phytocannabinoids, the most prominent being Δ9 -THC and
CBD. Δ9 -THC is thought to be the principal intoxicant constituent of
cannabis. When used acutely, cannabis causes adverse effects such as
dizziness and impairment of motor control and cognitive function.
Cannabis use can impair driving. There are particular risks reported for
children, such as respiratory depression, tachycardia and coma. The
adverse effects of cannabis consumption are similar to those produced by
Δ9 -THC alone. Most of the adverse effects associated with cannabis result
from chronic use. Regular cannabis use is associated with increased risk of
mental health disorders such as anxiety, depression and psychotic illness.
Chronic regular cannabis use is particularly problematic for young people
as a result of its effects on the developing brain. Cannabis can cause
physical dependence in humans as evidenced by the onset of cannabis
withdrawal symptoms upon abstinence. Withdrawal symptoms include
mood changes, irritability and sleep impairment. Clinical diagnostic
guidelines such as DSM-5 and ICD-10 recognize cannabis use disorder. The
Committee considered information regarding the therapeutic indications of
cannabis and ongoing research into its possible medical applications.
Several countries permit the use of cannabis for the treatment of medical
conditions such as back pain, sleep disorders, depression, post-injury pain
and multiple sclerosis. Cannabis plant and cannabis resin are included in
Schedule I and Schedule IV of the 1961 Single Convention on Narcotic
Drugs. Substances that are included in both these schedules are
particularly liable to abuse and to produce ill-effects. Other substances that
Critical review report on CBD:
Walsh et al., 2018.
Pre-review reports on cannabis
and cannabis resin: Cannazza and
Citti, 2018a; Wiley, 2018a;
Arnold, 2018a; Hill et al., 2018a;
Rehm et al., 2018a; Expert Peer
Review 1, 2018a; Expert Peer
Review 2, 2018a.
Pre-review reports on extracts
and tinctures: Cannazza and
Citti, 2018b; Wiley, 2018b;
Arnold, 2018b; Hill et al., 2018b;
Rehm et al., 2018b; Expert Peer
Review 1, 2018b; Expert Peer
Review 2, 2018b.
Pre-review reports on
delta-9-THC: Cannazza and Citti,
2018c; Wiley, 2018c; Arnold,
2018c; Hill et al., 2018c; Rehm et
al., 2018c; Expert Peer Review 1,
2018c; Expert Peer Review 2,
2018c.
Pre-review reports on THC
isomers: Cannazza and Citti,
2018d; Wiley, 2018d; Arnold,
2018d; Hill et al., 2018d; Rehm et
al., 2018d; Expert Peer Review 1,
2018d; Expert Peer Review 2,
2018d.
Outcome report, 40th ECDD:
WHO, 2018d.
History, science, and politics of international cannabis scheduling, 2015–2021 35
are included in both Schedules I and IV are fentanyl analogues and other
opioids that are considered especially dangerous. The evidence presented
to the Committee did not indicate that cannabis plant and cannabis resin
were liable to produce ill-effects similar to the other substances in
Schedule IV of the 1961 Convention on Narcotic Drugs. The inclusion of
cannabis and cannabis resin in Schedule IV may not be consistent with the
criteria for inclusion in Schedule IV. The Committee concluded that there
is sufficient evidence to recommend a critical review of cannabis plant and
cannabis resin at a future ECDD meeting and to explore further the
appropriateness of their current scheduling within the 1961 Convention.”
Pre-review of extracts and tinctures of cannabis:
“Extracts and tinctures of
cannabis are substances that have been extracted from the C. sativa plant.
They include cannabis oils, teas and an extract with approximately equal
quantities of Δ9 -THC and CBD. These substances can be administered
through various routes including orally and by smoke inhalation. Evidence
on the dependence potential of extracts and tinctures of cannabis varies by
substance. There are no published studies that have evaluated the
dependence potential of mixtures of Δ9 -THC and CBD, but there is
limited evidence of a withdrawal syndrome upon abrupt cessation (for
example, sleep disruption and mood changes). Frequent use of the BHO
extract has been associated with physical dependence. The psychoactive
constituent, Δ9 -THC, present in most extracts has been separately
studied and has been shown to have dependence potential. Few published
studies have evaluated the abuse potential of cannabis extracts in animals
or humans. There are, however, studies that have investigated the abuse
potential of various components of extracts and tinctures of cannabis.
While particular components, such as Δ9 -THC, have demonstrated abuse
potential, other components in these preparations, such as CBD, have not.
The Committee recognized that the term “extracts and tinctures” as cited
in the 1961 Single Convention on Narcotic Drugs encompasses
preparations that have psychoactive properties as well as those that do
not. The Committee also recognized that the psychoactive properties of
these preparations are due principally to Δ9 -THC, which is currently
scheduled in the 1971 Convention on Psychotropic Substances. Among the
substances that are not psychoactive in the preparations that are derived
as extracts or tinctures of cannabis are some that have promising
therapeutic indications, such as CBD. Cannabis extracts and tinctures are
placed in Schedule I of the 1961 Single Convention on Narcotic Drugs. The
Committee noted that the category “extract and tinctures of cannabis”
encompasses very diverse formulations with varying ratios of cannabis
components, in particular Δ9 -THC, and with or without psychoactive
properties. The Committee therefore concluded that there is sufficient
information to recommend a critical review of extracts and tinctures of
cannabis at a future ECDD meeting to address the necessity of continuing
to include the term “extracts and tinctures of cannabis” in the 1961
Convention.”
Pre-review of delta-9-THC:
“Δ9 -tetrahydrocannabinol (Δ9 -THC ) refers
to four stereoisomers of Δ9 -THC. One of these stereoisomers is found in
the cannabis plant and is also known by the INN dronabinol; it has
recognized therapeutic uses. Chronic administration of Δ9 -THC can
induce physical dependence in laboratory animals and in humans. This has
been demonstrated by the presence of withdrawal effects in animals and
human subjects. The subjective effects of Δ9 -THC when administered
orally resemble those of cannabis. However, there is little evidence that
oral Δ9 -THC is used for non-medical purposes so as to cause a public
health problem. Δ9 -THC (dronabinol) has approval in a number of
countries for therapeutic indications including anorexia associated with
weight loss in patients with AIDS and for nausea and vomiting associated
with cancer chemotherapy. Δ9 -THC (dronabinol) is routinely administered
orally. Δ9 -THC and its stereoisomers are listed in Schedule II of the
Convention on Psychotropic Substances of 1971. In previous ECDD
reviews, Δ9 -THC, and especially dronabinol, had been considered in a
synthetic form as a pharmaceutical preparation. However, the Committee
recognized that Δ9 -THC, in particular, its active and naturally occurring
stereoisomer, dronabinol, today also refers to the main psychoactive
component of cannabis and cannabis-derived psychoactive products. In this
form, dronabinol produces similar ill-effects, dependence and abuse
potential to cannabis, which is placed under the 1961 Single Convention. A
substance liable to similar abuse and productive of similar ill-effects to
those of a substance already scheduled within the 1961 Convention would
normally be scheduled in the same way as that substance. The Committee
concluded that there is sufficient information to recommend a critical
review of Δ9 -THC at a future ECDD meeting in order to address the
History, science, and politics of international cannabis scheduling, 2015–2021 36
appropriateness of its placement within the Conventions.”
Pre-review of Tetrahydrocannabinol (Isomers of THC):
“There are
currently six isomers of THC listed in Schedule I of the 1971 Convention.
Of the six THC isomers reviewed here, the abuse potential of only two,
Δ8 -THC and Δ6a,10a-THC, have been evaluated in a few human studies.
These studies found that the acute intoxicating effects of these substances
are similar to those of Δ9 - THC, but they are less potent. There are no
reports that THC isomers induce physical dependence. There are no
reported medical or veterinary uses of these isomers. There is no
evidence that any of these listed isomers are being abused or are likely to
be abused so as to constitute a public health or social problem. However,
the Committee noted the potential difficulty of differentiating these six
isomers (listed in Schedule 1 of the 1971 Convention) from Δ9 -THC
(listed in Schedule II of the 1971 Convention) using standard methods of
chemical analysis owing to their chemical similarities. The Committee
further noted that this is an important factor to consider in the scheduling
of these isomers. The Committee concluded that there is sufficient
information to recommend a critical review of the isomers of THC at a
future ECDD meeting and to explore further the relevance of their
current scheduling within the 1971 Convention.”
23 July
2018
WHO
Director
General
n/a
n/a
Circulation of a Notification containing the outcome of the Critical review
of CBD and of the Pre-reviews of “cannabis,” “cannabis resin,” “extracts
and tinctures of cannabis,” “delta-9-THC,” “isomers of THC,” and “CBD
preparations,” undertaken at the 40th ECDD meeting.
Adhanom Ghebreyesus, 2018;
CND, 2019a, p.3.
29 August
2018
UN
Secretary
General
n/a
n/a
Circulation of a Note Verbale to Member States, containing the
Notification from WHO Director-General dated 23 July 2018.
CND, 2019a, p.3.
12
Novembre
2018
ECDD
41st meeting,
open session
Open
Presentation of oral and written contribution by pre-registered civil society
stakeholders.
Report: WHO, 2019a, pp.1–3.
12 to 16
Novembre
2018
ECDD
41st meeting
Closed
Critical review of cannabis and cannabis resin:
“The Committee
recommended that cannabis and
cannabis resin be deleted from Schedule IV of the 1961 Single Convention
on Narcotic Drugs. ”
Critical review of delta-9-tetrahydrocannabinol (Δ9 -THC; dronabinol):
“
The Committee recommended that dronabinol and its stereoisomers
(delta-9- tetrahydrocannabinol) be added to Schedule I of the 1961 Single
Convention on Narcotic Drugs.
As indicated in the Guidance on the WHO review of psychoactive
substances for international control, to facilitate efficient administration of
the international control system, it is not advisable to place a substance
under more than one Convention. Accordingly:
The Committee recommended the deletion of dronabinol and its
stereoisomers (delta-9-tetrahydrocannabinol) from the 1971 Convention
on Psychotropic Substances, Schedule II, subject to the Commission’s
adoption of the recommendation to add dronabinol and its stereoisomers
(delta-9- tetrahydrocannabinol) to Schedule I of the 1961 Single
Convention on Narcotic Drugs.”
Critical review of Tetrahydrocannabinol (isomers of THC):
“The
Committee recommended that tetrahydrocannabinol (understood to refer
to the six isomers currently listed in Schedule I of the 1971 Convention on
Psychotropic Substances) be added to Schedule I of the 1961 Single
Convention on Narcotic Drugs, subject to the Commission’s adoption of
the recommendation to add dronabinol (delta-9- tetrahydrocannabinol) to
Schedule I of the 1961 Single Convention on Narcotic Drugs.
As indicated in the Guidance on the WHO review of psychoactive
substances for international control, to facilitate efficient administration of
the international control system, it is not advisable to place a substance
under more than one Convention.
The Committee recommended that tetrahydrocannabinol (understood to
refer to the six isomers currently listed in Schedule I of the 1971
Convention on Psychotropic Substances) be deleted from the 1971
Convention on Psychotropic Substances, subject to the Commission’s
adoption of the recommendation to add tetrahydrocannabinol to Schedule
I of the 1961 Single Convention on Narcotic Drugs.”
Critical review of Extracts and tinctures of cannabis:
“The Committee
recommended deleting “extracts and tinctures of cannabis” from Schedule
I of the 1961 Single Convention on Narcotic Drugs.
The Committee acknowledged that the fact that diverse preparations
with a variable concentration of Δ9 -THC are controlled within the same
entry “extract and tinctures” under the same Schedule, is a challenge for
Critical review reports on
cannabis and cannabis resin:
Poovendran and De Zwart,
2018a.
Critical review reports on
extracts and tinctures:
Poovendran and De Zwart,
2018b.
Critical review reports on
delta-9-THC: Poovendran and
De Zwart, 2018c.
Critical review reports on THC
isomers: Poovendran and De
Zwart, 2018d.
Outcome report, 41st ECDD:
WHO, 2019a.
History, science, and politics of international cannabis scheduling, 2015–2021 37
the authorities responsible for implementing control measures in their
respective countries.”
Critical review of cannabidiol preparations:
“The Committee
recommended that a footnote be added to Schedule I of the 1961 Single
Convention on Narcotic Drugs to read: ‘Preparations containing
predominantly cannabidiol and not more than 0.2 per cent of
delta-9-tetrahydrocannabinol are not under international control.’”
Critical review of pharmaceutical preparations of cannabis and delta-9-
tetrahydrocannabinol (dronabinol):
“The Committee recommended that
preparations containing delta-9-tetrahydrocannabinol (dronabinol),
produced either by chemical synthesis or as a preparation of cannabis, that
are compounded as pharmaceutical preparations with one or more other
ingredients and in such a way that delta-9-tetrahydrocannabinol
(dronabinol) cannot be recovered by readily available means or in a yield
which would constitute a risk to public health, be added to Schedule III of
the 1961 Convention on Narcotic Drugs.”
24 January
2019
WHO
Director
General
n/a
n/a
Circulation of a Notification containing the outcome of the Critical reviews
of “cannabis,” “cannabis resin,” “extracts and tinctures of cannabis,”
“delta-9-THC,” “isomers of THC,” and “CBD preparations,” undertaken at
the 41st ECDD meeting.
Adhanom Ghebreyesus, 2019;
CND, 2020c, p.1,5–10.
29 January
2019
“[Informal circulation of] the notification and the information submitted by
WHO in support of those recommendations to all permanent missions to
the United Nations in Vienna”
CND, 2020c, p.2.
1 February
2019
UN
Secretary
General
n/a
n/a
Circulation of a Note Verbale to Member States, containing the
Notification from WHO Director-General dated 24 January 2019.
CND, 2020c, p.2.
18, 20 and
21 March
2019
CND
Extended
Bureau
Meetings
Closed
Meeting “to consider matters related to the organization of work.”
CND, 2019b, p.78
19 March
2019
CND
62nd session
(9th meeting)
Open
Adoption of
Decision 62/14:
“The Commission on Narcotic Drugs [...]
decided to postpone the voting on the recommendations of the World
Health Organization regarding the critical review of cannabis and
cannabis-related substances, which were transmitted to the
Secretary-General after the three-month period established pursuant to
Commission resolution 2 (S-VII) of 8 February 1982 [...] in order to
provide States with more time to consider the recommendations.”
Background note: CND, 2019a.
Report: CND, 2019b, pp.39,62
24 June
2019
CND
62nd session,
4th
intersessional
meeting
Open
Discussion of all recommendations, on the basis of the questions
submitted by Member States to WHO, INCB and the UNODC Division
for Treaty Affairs during the first half of 2019
CND, 2020c, p.2; 2020f;
UNODC, 2019.
23
Septembre
2019
CND
62nd session,
5th
intersessional
meeting
Open
Discussion of all recommendations, on the basis of the complementary
questions submitted by Member States to WHO, INCB and the UNODC
Division for Treaty Affairs during summer 2019.
Member States agree to continue discussions during the reconvened 62nd
session.
CND, 2020c, p.2; 2020f;
UNODC, 2019.
12
December
2019
CND
Reconvened
62nd session
Open
Discussions of the recommendations under agenda item 9.
CND, 2020c, p.3.
11
February
2020
United
Nations
Office of
Legal Affairs
n/a
n/a
Circulation of an
Interoffice memorandum
answering to “questions posed
by the extended Bureau.” Among others, the Office of Legal Affairs
“explained that the CND may decide to deviate from the default
procedure “voting on each recommendation separately”, i.e. the
Commission could vote jointly on two or more recommendations, if it
decides to do so” that “a procedural decision would be required before
the actual vote on the scheduling recommendation” and “that it was up to
the Commission to decide on the majority required, in the case a
recommendation under the 1961 Convention was voted on jointly with a
recommendation under the 1971 Convention.”
Facsimile…, 2020, pp.6–13,18
17
February
2020
CND
63rd session, 1st
intersessional
meeting
Open
Discussions of the recommendations and of the opportunity to vote during
the 63rd session.
28
February
2020, p.m.
CND
63rd session,
informal
pre-session
consultations
Closed
Pre-agreement by consensus on the draft of CND Decision 63/14 (Draft
decision L.8)
CND, 2020e.
3 and 5
March 2020
CND
Extended
Meetings
Closed
Meeting “to consider matters related to the organization of work.”
CND, 2020a, p.56.
History, science, and politics of international cannabis scheduling, 2015–2021 38
Bureau
4 March
2020
CND
63rd session
(6th meeting)
Open
Adoption of
Decision 63/14:
“The Commission on Narcotic Drugs [...]
recalled its mandate to vote on scheduling recommendations as laid out in
the international drug control conventions and decided to continue during
its current sixty-third session the consideration of the recommendations of
the World Health Organization on cannabis and cannabis-related
substances, bearing in mind their complexity, in order to clarify the
implications and consequences of, as well as the reasoning for, these
recommendations, and decided to vote at its reconvened sixty-third
session in December 2020, in order to preserve the integrity of the
international scheduling system.”
Background note: CND, 2020g.
Comments by countries: CND,
2020d.