Speech of
Antonio Maria Costa
Director-General, United Nations Office at Vienna
and Executive Director Office on Drugs and Crime
At the
International Symposium on Cannabis
Stockholm, Sweden
7 March 2003
Ministers, Excellencies and participants, I greatly welcome this International Symposium on Cannabis and appreciate your invitation to address you today.
Cannabis Sativa is a most gentle looking, spontaneously growing plant with several practical applications already known in the ancient world. It contains, however, treacherously addictive substances that have turned the plant into an international problem. Like for other illicit drugs, cannabis is a global problem, not simply because it is traded everywhere, but because it cannot be countered by any single nation. The reality of this evil business is such that consumers in one region provide for the supply elsewhere; similarly, supply can generate its own demand across borders. For example, cannabis produced in Morocco is trafficked through most of northern Africa, the Balkans or the Iberic peninsula before creating the incentives for its retailing in far away markets.
Indeed, the cultivation, trafficking and abuse of cannabis are different aspects of the global problem of narcotic abuse, which calls for the widest possible co-operation across nations. By sharing information, opinions and experience, we may reach a common understanding. Indeed, this sharing of knowledge may help those who tend to underestimate and under-represent the dangers posed by abusing cannabis, to appreciate our point of view.
This Symposium is especially important to me and to my colleagues in the United Nations Office on Drugs and Crime in Vienna, as it gives us the opportunity to hear views, which will be useful in the preparation of the Ministerial Meeting of the Commission on Narcotic Drugs (CND) scheduled in mid-April this year. I am happy to bring to your attention some of the evidence the Office has gathered in the run-up to this Ministerial meeting, sharing some of the points we would like to put on the table for debate. The forthcoming Ministerial CND session represents the mid-term review (2003) of the decade-long effort by United Nations Member States to significantly reduce illicit drug production, trafficking and abuse by 2008: a commitment made during the 20th Special Session of the UN General Assembly (UNGASS) in 1998.
Since that Special Session of the General Assembly, and notably during recent years, governments' efforts to respond to an aggressively evolving illicit drug situation have gained new momentum. Best practices aimed at reducing demand and improving treatment have been fortified, adapted and more widely adopted. International co-operation, notably the sharing of information on, and joint action against, illegal sources and trafficking routes has gained new breadth and depth. The regions involved in illicit drug cultivation and production have kept changing, often the result of successes in interdiction and of new programs to promote voluntary crop diversification and alternative livelihoods.
As a result of these concerted actions, illicit drug consumption and production patterns have further evolved. Despite the lack of robust, internationally comparable data, it is possible to safely claim that in a number of countries drug abuse has shown a downward trend. Even more encouraging has been, in several Member States, the decline of reported drug-related deaths. This noteworthy outcome has been erroneously seized upon by some as evidence of a declining drug problem and as a reason for complacency: nothing could be further from the spirit and the word of the 1998 Special Session deliberations.
Our purpose is unassailable and is built on a premise most likely shared by all: the paramount importance of promoting and protecting the health and welfare of all. This is one of the fundamental tasks recognised by every society, and of course supported by the United Nations. Health for all can be achieved, inter alia, by limiting exposure to illicit drugs and by reducing the consumption of dependency-inducing legal substances, such as alcohol and tobacco.
While these trends have been mostly positive, in the recent past there have been other novel features worth considering. First and foremost, world public opinion has become much more aware of, and involved in appraising the risks and the consequences of drug abuse, urging governments to place all attendant forms of uncivil behaviour high on the public policy agenda. Indeed, almost universally, public opinion polls have listed the "evil trilogy" - drugs, crime and terrorism - as the most potent threats to society.
A second novel feature is the emerging contrast - at times a very acrimonious contrast indeed - between (i) public opinion's great awareness and overwhelming opposition to any attempt to underestimate the severity of the drug problem, and (ii) the spreading of a permissive culture that stresses the right to choose individual lifestyles (including abuse), and that proselytises differentiation among types of narcotics - as if some among these were less dangerous to health than others. Cannabis, and synthetic drugs like amphetamine-type stimulants, are some of these.
Third, the fight against dependence and abuse is progressing in areas other than illicit drugs. Public health history was made as countries recently completed negotiations at the World Health Organisation (WHO) for the Framework Convention on Tobacco Control, meant to reduce related deaths and illnesses. Occasional calls for the reconsideration (i.e. relaxation) of current drug control legislation are hardly consistent with member countries' stated objective of protecting present and future generations from the devastating consequences of nicotine addiction - itself not an illicit substance. The priority the international community is attributing to promoting stronger tobacco-control legislation and the cessation of tobacco use is twin to global efforts to maintain strong counter-narcotics legislation - which deals with substances under international control.
If we apply the spirit (and to a large extent even the words) of this Tobacco Control Convention, (agreed by 171 member states) to cannabis, it is clear what we need to do. We need to ensure that the centre of our attention is the health and the well being of our people. In our demo-cratic society the right to individual lifestyles needs to be preserved: it is the demos part of democracy. But such preservation takes place in the context of, and as a benchmark to, the right of society to pursue its common goals: this is the kratis part of democracy. When shared goals are threatened, this is where individual lifestyles reach their limit.
Medical vs. recreational cannabis
The figures for tobacco-related deaths are appalling. In the past half century (1950-2000) tobacco killed more than 60 million people in industrialised countries alone, more than all those who died in World War II, the most lethal of all conflicts. If current trends continue, tobacco will kill more than 100 million people in the first two decades of the 21st century.
Although these numbers are scary, the aim here is not to use them as a tactic to frighten people. It is important to remind people that, by its nature, cannabis contains all the lethal substances of tobacco, plus several others that are even greater threats to health.
At UNODC we estimate that during the 1990s, 147 million people worldwide smoked cannabis at least periodically. This is 3.4 percent of the population over 15 years of age. Prevalence rates are above the average in most industrialised countries as well as in Africa. The majority of the countries are reporting an increase in cannabis abuse, while just a few report a stable or declining trend. A persistently stable trend, but at a relatively high level, has been observed in North America and in some European countries.
The question that keeps coming to one's mind is rather simple: is there not a contrast, a real cultural collision between efforts by the international community to negotiate and agree on a Convention on Tobacco, because of the lethal consequences of its abuse, and the frequently heard calls to liberalize the production, trafficking and abuse of cannabis - a substance known to bring about even greater damage to health? There are many myths and stories going around about cannabis. It is important to clarify some of these and to discuss the scientific evidence: this will be done by the experts attending this Symposium. I would like to offer some key points to keep in mind during the discussion.
Between 1996 and 1999, four influential scientific reviews were published on the subject of cannabis by the Standing Committee on Medicine of the Health Council of the Netherlands (1996), the WHO (1997), the Science and Technology Committee of the UK House of Lords (1998) and the United States Institute of Medicine (1999). I cannot go into detail, but all of them concluded that there was not enough scientific evidence for cannabis to enter the pharmacopoeia as a registered medicine. The Dutch Standing Committee "...concluded that evidence is insufficient to justify the medical use of marijuana". WHO concluded that cannabis impairs cognitive development and psychomotor performance.
A number of countries are evaluating the potential medical usefulness of cannabis. If the results of objective scientific research show that cannabis is medically useful in certain conditions, it would be good news for the affected patients.
I am not sure I understand the controversy about the medical virtues of cannabis: First, if and when they are ascertained, society should definitely make use of them. Who could oppose the advances of medicine? Who would stand in the way of reducing suffering? The concern is to prevent that, by proclaiming the (medical) virtues of cannabis, a back door is opened to its wider (recreational) consumption. Society would end up regretting such abuse, just as we now regret tobacco addiction.
If proven to be medically useful - and this is the second point - cannabis should be treated like any other medicine, namely as a pharmaceutical preparation to be prescribed for specific symptoms in accordance with properly determined dosages and standards. In other words, either we are serious about the medical properties of cannabis (and we, in this hall, take the question very seriously) or it is just a matter of using such properties as a Trojan horse to reach other goals - namely, the de facto decriminalisation of its production and trafficking. In this case, I would be strongly negative.
The international drug control treaties are a world asset, negotiated to protect the health of our societies. Three centuries ago, when tobacco consumption started to spread and eventually became today's scourge, the sort of international consensus that eventually brought about the drug control treaties was not in place - was not even conceivable. To those who would like to dispose of the UN drug conventions, I would like to ask: if the United Nations had existed at the dawn of the tobacco era, would it not have been wise to produce a convention similar to the ones designed for narcotics?
When this question is posed, the universal answer is always affirmative: in other words, while it is impossible to conceive of prohibiting the consumption of tobacco today, it would certainly have been wise to have banned it a few centuries back. So, it could be asked, why do people try to put the clock back and weaken the UN drug control conventions, established to fight an even greater threat to our health?
As mentioned earlier, it was the need to protect the health and development opportunities of people and communities that inspired the international community to adopt the conventions that regulate the supply of drugs for medical and scientific purposes and prevent their illicit production, trafficking and consumption.
Are the conventions then working?
Some sceptics claim that the illicit drug control conventions are not working. They quote the enormous resources that are invested in drug control, and the fact that drug abuse continues to increase in many countries.
We will never know for sure what would have happened in the absence of drug control. But if we look at the costs and the magnitude of the problems generated by alcohol and tobacco consumption, we can be sure that containing drug abuse is at least worth our while. Worldwide, if the statistics mean anything, we believe that half as many people die of alcohol related illnesses, than of tobacco related ones. Even more telling are the casualties related to drugs: they are less than 1/10 of those caused by alcohol (the proportion between narcotics and tobacco is therefore 1:20).
Just as the damage to health caused by alcohol and tobacco is well known, so too are the negative consequences of drug abuse. Removing controls would undoubtedly trigger a huge increase in the number of people abusing drugs, including cannabis. The cost accounting is simply done: the inevitable increase in the abuse of cannabis and the resulting harm to individuals and society outweigh possible benefits from the pleasure of its use in a recreational context (medical use, therefore, apart).
First, past experience tells us that when a substance is made freely available, there is an increase in consumption - with unpredictable health and social consequences. And once the negative effects emerge, it is extremely difficult to go back to the control system.
Fourth, there is a question of logic. The dislike of illegal activities should not lead us into the temptation of legalising them, under the mistaken assumption that they disappear. This reminds of a Hollywood sheriff who, unable to catch thieves, concluded: "if we legalise bank robbery, then there will be no bank robbery". How can we say that drug liberalisation will be a success, if tens of thousand of people will die from it?
The universally adhered to drug control conventions represent the collective will of nations and represent interconnected commitments by Member States. Abrogation of those commitments by some states would unfairly burden others, which are expending scarce resources on preventing illicit cultivation and trafficking. This point is frequently put forward by African countries, which should command our highest respect for their efforts to combat cannabis production and abuse, despite the obvious paucity of their resources.
Some people say that promoting and protecting the health of people is not achievable because drug abuse prevention does not work. In many situations it is indeed difficult to demonstrate clear progress in this area. There are problems with the way data are collected, and the baseline from which one starts. As said above, next month Member States will meet in Vienna to review the progress made since the 1998 General Assembly Special Session.
The picture that is emerging from the preparatory work is a mixed one. Countries have increased their activities in demand reduction but at the same time, there has been an increase in the abuse of drugs in some countries. Where data are available and there have been long-term investments in prevention programs based on recognised best practice, some encouraging results are emerging.
For example, in the United States overall drug abuse has gone down 50 percent since the late 1970s. Despite an upsurge in the late 1990s, prevalence remains below the level of the late 1970s. In Europe, efforts to respond to the ecstasy epidemic have considerably reduced prevalence rates in some countries.
However, if we want to be successful we must recognize that sometimes our prevention efforts are not always in line with effective approaches. And the spread of cannabis abuse requires some innovative thinking. The experience of several decades of drug abuse prevention shows that three general elements should be included in prevention programs:
(i) It is essential to address the values and expectations that young people associate with drug abuse. We must recognise, for example, that cannabis is perceived by many young people as a non-harmful substance and our prevention efforts should address this issue effectively and convincingly;
(ii) Young people need to develop life skills and social competencies to increase their capacity to make informed and healthy choices; We need to provide them not only with information on cannabis, but also with tools and resources to enable them to resist peer pressure, to increase their confidence and to manage stressful situations without turning to drugs.
(iii) We need to create an environment where children and young people have opportunities to be involved in healthy activities and where substance abuse is not promoted by peers, family, the media and other influential actors in the community. We need to ensure that they do not receive conflicting messages. We must demand responsible behaviour from the media and role models in relation to drug abuse.
Where consistent and sustained preventive interventions have been undertaken, positive results are gradually showing. The signs of stabilisation and even decrease in patterns of abuse reported from some countries are a clear indication that comprehensive prevention strategies targeted at young people can, and do, work.
At the Office on Drugs and Crime, we will continue to work with Member States, NGOs, teachers and youth groups. But it is necessary to invest sufficient resources, to be prepared to wait for some time to elapse before results become visible, and to use tested and validated principles and approaches in the design and implementation of prevention strategies and programs.
It is not an easy task but we count on your support to be able to make a difference in people's lives, and to be able to say by 2008 that we have achieved our goals.