World Health Organisation Cannabis Recommendations: Is this the dawn of a new era of accepted cannabis medicines?

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The process of cannabis prohibition at an international level began in the first decade of the 1900s. In the previous hundred years, various countries had a wide range of medicinal cannabis treatments available while others had restrictions on the plant, for very different reasons than those of campaigners for the war against drugs in the last 50 years.

Image: 1961 Single Convention Cannabis Scheduling, FAAT

Between 1925 and 1961, some powerful pharmaceuticals and illicit drugs were being assessed and scheduled, generally, there was a corresponding scientific assessment to elucidate the actions and potential adverse effects of these substances. However, during this time of extensive research, cannabis did not receive the same investigation with politicians and global leaders categorical determining it was a danger to society.

Thus cannabis was included under Schedule I and IV of the 1961 Single Convention on Narcotic Drugs. Classifying cannabis in a drug class of the highest potential to cause damage, abuse and with little to no medical or therapeutic value. Ten years following Δ-9-tetrahydrocannabinol (THC) was included as Schedule II in the 1971 Convention on Psychotropic Substances.

These global, mostly respected regulations have crippled medical cannabis access, research, and development. Things are changing…

Timeline
In November 2016 the World Health Organization (WHO) launched a process to determine the uses and potential harms of cannabis and derivatives. The Expert Commission on Drug Dependence (ECDD) was commissioned to conduct the assessment. In November 2017 they presented a pre-review of CBD analysis and their initial comments indicated that CBD was unduly scheduled, and has potential as a therapeutic agent.

By June 2018 a critical review of CBD was announced, stating pure CBD would not be included in the final cannabis review where it was recommended that CBD should be removed from all schedules. This acknowledgment of clinical benefits of CBD and the lack of adverse side effects or potential for abuse now leaves no legitimate basis for it to remain scheduled.

At the same meeting in mid-2018, the pre-review for cannabis, cannabis resins, extracts, THC and other isomers were released. At this stage advocates and industry were feeling positive, the next step was to wait for the meeting to reconvene at the end of 2018. The WHO was expected to present the findings of the critical review to member-states in December, however, as widely publicized the WHO delayed this presentation.

Now, with the latest announcement that member states have received the critical review on cannabis and the WHO recommendations, discussion and interest on rescheduling have piqued again.

“The evidence presented to the Committee did not indicate that cannabis plant and cannabis resin were particularly liable to produce ill-effects similar to the effects of the other substances in Schedule IV of the 1961 Single Convention on Narcotic Drugs. Also, preparations of cannabis have shown therapeutic potential for the treatment of pain and other medical conditions such as epilepsy and spasticity associated with multiple sclerosis. In line with the above, cannabis and cannabis resin should be scheduled at a level of control that will prevent harm caused by cannabis use and at the same time will not act as a barrier to access and research and development of cannabis-related preparation for medical use.”

-ECDD comments on cannabis and cannabis resin

Recommendations suggest cannabis be removed from Schedule IV of the 1961 Convention as well as entirely from the 1971 Convention on Psychotropic Substances, and this would leave cannabis scheduled only under the 1961 Convention as Schedule I, with certain preparations of decarboxylated flower and resins to be categorized under Schedule III.

What does this mean?

Politically and socially this is a huge admission. Essentially acknowledging that the last 50 years of prohibition has not been based on scientific evidence or unbiased harm/benefit analysis, endorsing this once malaligned plant for its therapeutic and medicinal value.

“The placement of cannabis in the 1961 treaty, in the absence of scientific evidence, was a terrible injustice… It is time for us all to support the World Health Organization’s recommendations and ensure politics don’t trump science.”

-Michael Krawitz, Veterans for Medical Cannabis Access

Adult or recreational use will continue to be illegal under international law. While countries such as Canada and Uruguay will still be acting against treaties with regards to their allowance of recreational cannabis, the international illegality of having a medical cannabis program has now decreased.

Should changes be approved, it is likely a stream of countries will loosen their cannabis prohibition laws. The recognition of cannabis benefits and potential by a globally recognized and respected body such as WHO will have a significant impact, countries that may have been holding back on medicalization have now been unofficially permitted to press forward.

What’s next
The next meeting has been scheduled for March 2019, where the UN Commission on Narcotic Drugs member countries are set to be formally presented with the conclusions of the critical review and are expected to vote on the rescheduling of cannabis. However, many feel this may be unlikely. Given the delays so far, it is predicted that members will be granted more time to review and deliberate their vote.

Despite estimates indicating we may be waiting until mid-late 2020 for a final answer or definitive rescheduling, industry and patients alike are keeping their hopes up for the green light sooner rather than later.

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