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II. OPERATION OF THE INTERNATIONAL A. Status of adherence to the international drug control treaties 1. Single Convention on Narcotic Drugs of 1961 43. As at 1 November 1997, the number of States parties to the Single Convention on Narcotic Drugs of 1961 (7) or to that Convention as amended by the 1972 Protocol stood at 160, of which 145 were parties to that Convention in its amended form. Since the Board last published its report, Kazakhstan and Tajikistan have become parties to the 1961 Convention and to that Convention as amended by the 1972 Protocol. In addition, Lebanon, already a party to the 1961 Convention, has become a party to that Convention in its amended form. 44. Of the 31 States that are not yet parties to the 1961 Convention or to that Convention as amended by the 1972 Protocol, 10 are in Africa, 5 are in the Americas, 7 are in Asia, 3 are in Europe and 6 are in Oceania. 45. The Board hopes that the States concerned will not only take speedy action to become parties to the 1961 Convention, but also will enact the national legislation and regulations necessary to conform to that Convention. The Board believes that accession to the 1961 Convention could soon result from mechanisms already in place in States such as Azerbaijan, Belize, Bhutan, El Salvador, Grenada, Guyana, Saint Vincent and the Grenadines and United Republic of Tanzania, which have already become parties to the more recent international drug control treaties (the 1971 Convention or the 1988 Convention). Since all of the above-mentioned States are benefiting from international assistance, they should show clearly their commitment to international drug control by acceding to the 1961 Convention. 46. Some other States, namely Afghanistan, Algeria, Belarus, Chad, Morocco, Myanmar, Nicaragua, Pakistan, Saudi Arabia, Turkey, Ukraine and Zambia, already parties to the 1961 Convention, have not yet ratified the 1972 Protocol amending that Convention. The Board expects that the ratification will take place soon since these States have all acceded to the more recent international drug control treaties, namely the 1971 Convention and the 1988 Convention. Besides their pending accession to the 1972 Protocol, the Islamic Republic of Iran should accede to the 1971 Convention, the Lao People's Democratic Republic should accede to the 1988 Convention and Liechtenstein should accede to both the 1971 Convention and the 1988 Convention. 2. Convention on Psychotropic Substances of 1971 47. As at 1 November 1997, the number of States parties to the 1971 Convention stood at 152. Since the last report of the Board, Austria, Indonesia, Kazakhstan, Lao People's Democratic Republic, Oman and Tajikistan have become parties to the 1971 Convention. 48. Of the 39 States that have yet to become parties to the 1971 Convention, 12 are in Africa, 10 are in Asia, 6 are in Central America and the Caribbean, 4 are in Europe and 7 are in Oceania. Some States, namely Azerbaijan, Belize, Bhutan, El Salvador, Haiti, Honduras, Iran (Islamic Republic of), Kenya, Nepal, Saint Lucia, Saint Vincent and the Grenadines and United Republic of Tanzania, which have not yet acceded to the 1971 Convention, have already become parties to the 1988 Convention. The implementation of the provisions of the 1971 Convention is, however, a prerequisite for achieving the objectives of the 1988 Convention. The Board requests the States concerned, if they have not already done so, to implement the provisions of the 1971 Convention. The Board hopes that all the States concerned will soon accede to the 1971 Convention. 3. United Nations Convention against Illicit Traffic in Narcotic Drugs 49. Since the last report of the Board was issued, Austria, Benin, Hungary, Iceland and Kazakhstan have acceded to the 1988 Convention. As at 1 November 1997, a total of 142 States and the European Community, or 74 per cent of all countries in the world, were parties to the 1988 Convention. 50. The Board welcomes the fact that a growing number of Governments have taken steps to establish the necessary mechanisms to implement the provisions of the 1988 Convention and to accede to it. Of the 49 States that have not yet become parties to the 1988 Convention, 16 are in Africa, 14 are in Asia, 11 are in Oceania and 8 are in Europe; however, in the Americas, all States have become parties to that Convention. Among the States that are not parties to it are some major manufacturing, exporting and importing countries, which are indicated in the 1997 report of the Board on the implementation of article 12 of the 1988 Convention.(8) The Board requests the Governments of all States that have not yet done so to take, as a matter of priority, all the measures necessary to accede to the 1988 Convention as soon as possible. Lengthy scheduling procedure under the 1971 Convention 51. In 1997, 111 substances were listed in the four schedules of the 1971 Convention. Six of those substances were placed under international control by the Commission on Narcotic Drugs in March 1995.(footnote 2) The Board is concerned that some Governments have not yet brought existing domestic regulations for those substances in line with the provisions of the 1971 Convention, as required in article 2, paragraph 7, of that Convention. The Board requests the Governments concerned to ensure adequate control of those substances without further delay. 52. The Board has stated on various occasions that the scheduling process under the 1971 Convention is too lengthy and that Governments have been hesitant to send notifications for the inclusion of new substances in the schedules of that Convention. Unscrupulous chemists and drug traffickers often exploit this situation by offering drugs similar to those under international control, thereby escaping prosecution. Some Governments have established national scheduling mechanisms for analogues of substances under international control and for other new synthetic drugs, in particular amphetamine-type stimulants, to deal with this problem. The Board is concerned that this development could lead to the establishment of a variety of different national control systems, a situation that could be exploited by drug traffickers. The Board, therefore, welcomes Economic and Social Council resolution 1997/41, section I, in which the Council invited Governments, inter alia, to cooperate in ensuring the compatibility of such national scheduling mechanisms. 53. The Board requests all Governments to support the World Health Organization (WHO) and the Commission in reviewing the request by Spain, submitted to the Secretary-General in March 1997, to substantially extend the scope of control of Schedules I and II of the 1971 Convention. 54. The Board reiterates its view that the best solution to problems of scheduling under the 1971 Convention would be the amendment, by simplified procedure (article 30, paragraph 1 (b)), of the provisions of that Convention on scheduling to conform with those of the 1961 Convention.(9) Notification by the Government of the United States of America on the possible inclusion of phenylpropanolamine in Table I of the 1988 Convention 55. In September 1997, the United States Government notified the Secretary-General in accordance with article 12, paragraph 2, of the 1988 Convention, furnishing him with information that may require the inclusion of phenylpropanolamine in Table I of that Convention. Phenylpropanolamine has been targeted as a precursor by drug traffickers because it may be used as a replacement for ephedrine or pseudoephedrine in illicit drug manufacture. Unlike ephedrine and pseudoephedrine, phenylpropanolamine results in the formation of amphetamine, and not methamphetamine. B. Cooperation with Governments Statistical reports on narcotic drugs and psychotropic substances 56. Approximately 170 States and territories annually provide the Board with statistical reports on narcotic drugs and psychotropic substances. The timely submission, comprehensiveness and reliability of the reports indicate the extent to which Governments have implemented the provisions of the 1961 Convention and the 1971 Convention. 57. In carrying out the responsibilities assigned to it under the international drug control treaties, the Board maintains a continuing dialogue with Governments. The information provided by Governments enables the Board to study the licit movement of narcotic drugs and psychotropic substances, thereby ensuring that all Governments strictly observe the provisions prescribed under the conventions to limit to medical and scientific purposes only the manufacture of, trade in and distribution and use of controlled substances.(10) 58. The rate of submission of statistical returns for narcotic drugs and psychotropic substances has increased compared with the submission rate of previous years. The Board notes with satisfaction that the Turks and Caicos Islands and the following States considerably improved their cooperation in 1996 and 1997: Angola, Cambodia, Democratic Republic of the Congo, Eritrea, Gambia, Ghana, Mozambique and Viet Nam. 59. While most States parties to the 1961 Convention and the 1971 Convention have regularly submitted annual statistical reports, the Board is concerned by the fact that some have failed for several years to furnish the required reports. Most of those States parties have received various forms of technical assistance from the Board and the United Nations International Drug Control Programme (UNDCP). Regrettably, a few of those States parties have not responded to the Board's call for the implementation of treaty obligations and did not resume cooperation with the Board. Therefore, the Board is considering invoking article 14 of the 1961 Convention and article 19 of the 1971 Convention with respect to those States parties. Reports on precursors 60. Pursuant to article 12, paragraph 12, of the 1988 Convention, Governments are required to report on substances frequently used in the illicit manufacture of narcotic drugs and psychotropic substances. 61. It is of serious concern to the Board that a number of States parties to the 1988 Convention do not comply with their treaty obligation to provide, in a timely fashion, the necessary information. As at 1 November 1997, only 51 per cent of all States parties submitted data for 1996. As the Board has repeatedly stated, no reporting or late reporting is an indicator that the framework and systems for adequate control may not be in place. It also creates difficulties for the Board in analysing the precursor control and trafficking situation worldwide and in recommending appropriate action to Governments. 62. More than 50 States and territories have provided data on the licit movement of precursors for 1995 or 1996; some major manufacturing, exporting and transit countries in the Americas, Asia, Europe and Oceania have reported such data for both years. The Board will continue its dialogue with other major manufacturing and exporting countries (and, in particular, with the European Commission), which are still not in a position to provide that type of information, as such information is indispensable to the development of the capacity of the Board to advise Governments on preventing the diversion of precursors into illicit channels. 63. Information on shipments that have been stopped because of sufficient evidence that they contain substances that may be diverted into illicit channels is needed to monitor drug trafficking trends and to preventing attempts to divert the substances from other sources. Therefore, starting in 1996, the Board has included in form D a new part with a request for data on stopped shipments. As mentioned in its 1997 report on the implementation of article 12 of the 1988 Convention,8 the Board acknowledges those Governments that have reported data on stopped shipments and requests all other Governments to provide such data to it, where applicable. Estimates for narcotic drugs 64. Annual estimates of narcotic drug requirements for 1998 were received from 152 States and territories. As the 1998 annual estimates of narcotic drug requirements in respect of 57 States and territories were not received in time for its examination and confirmation during its sixty-third session, the Board had to establish those estimates in accordance with article 12, paragraph 3, of the 1961 Convention. The Board notes with concern that, in spite of repeated reminders sent to Governments, no annual estimates of narcotic drug requirements are received from 55-60 States and territories every year. The Board urges the Governments concerned to make efforts to monitor more closely the activities related to narcotic drugs in their countries and to provide the Board with the information required by the 1961 Convention. The failure of Governments to determine amounts of drugs required for medical purposes indicates the absence of the required monitoring of companies and persons dealing with them. It represents a risk in that drugs manufactured and traded in the country concerned may ultimately be diverted to illicit channels in the country itself or elsewhere, that inappropriate prescribing practices will remain undetected and that the non-availability of such drugs for medical purposes will cause undue suffering among persons with illnesses. 65. No annual estimates of narcotic drug requirements have been received for the last three consecutive years from the following 16 States: Angola, Bosnia and Herzegovina, Cameroon, Comoros, El Salvador, Gabon, Kenya, Liberia, Marshall Islands, Mauritania, Romania, Rwanda, Sierra Leone, Somalia, Vanuatu and Zambia. The Board understands that some of these States, because of their political and economic situation, are not yet in a position to cooperate. Nevertheless, the Board hopes that States that are not yet able to comply with requirements of the 1961 Convention will soon remedy the situation, if necessary by requesting assistance in establishing the required control mechanism. 66. The Board notes with satisfaction the efforts that have been made by the Governments of Albania, Namibia, Republic of Moldova, Sudan and Tuvalu to apply provisions of the 1961 Convention by furnishing annual estimates of narcotic drug requirements for 1998. The Board appreciates those efforts and looks forward to further cooperation in the control of the licit movement of narcotic drugs. 67. A well-functioning drug control administration should have complete information on the operational system for the supply of drugs, including the planning, distribution and use of narcotic drugs in its country, and should be able to judge whether the quantities requested by manufacturers or importers are in line with the actual medical requirements. In 1997, the number of supplementary estimates furnished by Governments continued to be about 700. The frequent submission of supplementary estimates may be an indicator of a Government's response to sudden and unexpected growth in medical needs. It may, however, also indicate that the government administration concerned has not adequately planned the medical use of such drugs or may not even be aware of actual requirements. Governments should critically examine their methods of assessing medical needs and make the changes required to ensure that future estimates accurately reflect their medical needs, in order to avoid as much as possible the need for supplementary estimates. Assessments for psychotropic substances 68. Assessments of annual domestic medical and scientific requirements (simplified estimates) have been submitted by Governments pursuant to Economic and Social Council resolution 1981/7 with respect to substances in Schedule II of the 1971 Convention and Council resolution 1991/44 with respect to substances in Schedules III and IV of that Convention. The assessments remain valid for a period of three years, unless an amendment is received in the interim. 69. With the exception of eight Governments, namely Bahamas, Bosnia and Herzegovina, Comoros, Gabon, Grenada, Liberia, Palau and the former Yugoslav Republic of Macedonia, all Governments and territories have submitted to the Board assessments for substances in Schedule II. Assessments for substances in Schedules III and IV have been received for 162 States and territories. In addition, 10 Governments have submitted assessments for at least some substances in Schedule III or Schedule IV. 70. In 1997, some Governments issued import authorizations for quantities of psychotropic substances that were greater than the assessments reported to and published by the Board. When informed about such inconsistencies by exporting countries, the Board has drawn these cases to the attention of the importing countries concerned and requested them to update the assessments. The Board requests all Governments to establish mechanisms to ensure that their assessments are in line with their actual legitimate requirements and that no imports exceeding assessments are authorized. If necessary, Governments should amend their assessments and inform the Board accordingly. 71. The Board was requested by the Economic and Social Council, in resolution 1996/30, to establish assessments of annual licit domestic requirements for countries that had not yet submitted such assessments. In 1997, the Board established those assessments for the first time. All Governments concerned are invited to review assessments established for their countries and to provide the Board with any comments that they may have on the appropriateness of the assessments. The Board urges those Governments to establish their own assessments as soon as possible. 2. Prevention of diversion into the illicit traffic Diversion of drugs and chemicals into illicit channels Narcotic drugs 72. During the past three years, only four cases, all related to the disappearance at airports of entire consignments of narcotic drugs or parts thereof (fentanyl, dihydrocodeine) have come to the attention of the Board. That is proof that, over 30 years after the entry into force of the 1961 Convention, the international narcotic drug control system continues to work satisfactorily, primarily because of the system of estimates and statistical returns, which enables the Board to approve or establish upper limits for narcotic drug requirements for each country that are binding on the Government of that country and to monitor worldwide the transactions within those limits. In some parts of the world, however, diversion from domestic distribution channels remains a problem. For example, the abuse of codeine preparations continues to be widespread in South Asia and in south-east Asia. Psychotropic substances 73. No significant cases involving the diversion of psychotropic substances in Schedule II from licit international trade have been detected since 1990. It appears, therefore, that preparations containing amphetamines, fenetylline and methaqualone in the illicit traffic in various regions of the world are almost entirely from clandestine manufacturers and not from the licit pharmaceutical industry. 74. The application of additional control measures for international trade in substances in Schedules III and IV, as recommended by the Board, has not yet become universal. In analysing statistics on international trade and other information received from Governments, the Board has detected several cases involving the large-scale diversion of those substances into illicit channels. In recent years, the amount of stimulants, sedatives and hypnotics diverted into illicit channels has totalled several tonnes, representing hundreds of millions of tablets. The most frequently diverted substances are certain benzodiazepines (diazepam, chlordiazepoxide and nitrazepam), phenobarbital, phentermine and pemoline. Those substances are diverted mainly into various countries in Africa and Asia. The most frequently applied diversion method was the use of falsified import authorizations. 75. Of the psychotropic substances in Schedules III and IV that are diverted into illicit channels, a significant proportion is destined not for drug abusers but for distribution through informal, "parallel" markets in countries with inadequate supplies of those substances for medical use (see paragraph 163 below). 76. The actual amount of psychotropic substances in Schedules III and IV being diverted from international trade is probably much larger than the amount involved in detected diversion cases. The analysis by the Board of licit international trade in psychotropic substances is complicated by the fact that a few important exporting countries have not yet applied the control measures required by the 1971 Convention for several substances listed in Schedules III and IV and do not report to the Board on their exports (see paragraph 116, below). 77. Seizure data reported by Governments confirm that diversion from licit domestic distribution channels represents an important source of illicit supply of several psychotropic substances, in addition to their diversion from international trade. The substances most frequently diverted from domestic distribution channels include stimulants (amfepramone, methylphenidate, phentermine), hypnotics (flunitrazepam, temazepam), anxiolytics (chlordiazepoxide, diazepam) and analgesics (buprenorphine). The substances are sold by traffickers for local abuse or are smuggled into other countries where illicit markets for the substances exist. 78. The Board requests all Governments to examine the effectiveness of their national control systems for licit domestic distribution of narcotic drugs and psychotropic substances. Governments should raise their law enforcement authorities' awareness of the diversion of narcotic drugs and psychotropic substances from licit distribution channels and should ensure that such diversion is established as a criminal offence under domestic law and that the sanctions applied are commensurate with the gravity of the offences. 79. The Board trusts that the Governments of countries with large domestic pharmaceutical markets, such as China and India, will pay particular attention to these matters. In recent years, amfepramone tablets licitly manufactured and distributed in China were seized in a neighbouring country during smuggling attempts. Seizures of buprenorphine preparations licitly manufactured and distributed in India have been reported by several countries in Asia. 80. The Board invites Governments of countries where a significant seizure, or a series of smaller seizures, of a pharmaceutical product containing a narcotic drug or a psychotropic substance has been made to provide relevant information to the Government of the country where the diversion of the products occurred, if that country can be identified. The Government of a country receiving such information should initiate investigations with a view to identifying and prosecuting the persons involved in the diversion. If appropriate, Governments should establish joint teams to carry out investigations. The Board offers its services to Governments to facilitate the transfer of information between their competent authorities. 81. In 1997, the Board undertook a survey on the control of the manufacture and domestic licit distribution of flunitrazepam in Latin America. The survey was carried out in close cooperation with the Governments of several Latin American countries. 82. According to the information received, diversion from manufacturers is not a major source of supply of flunitrazepam to the illicit market, in view of the small number of manufacturers and their strict control by the authorities. Diversion does, however, occur at the wholesale and retail levels, mainly because of serious inadequacies in the pharmaceutical inspection systems in some countries. The problem is particularly serious for countries with large numbers of wholesale companies and retailers. A reduction in the number of distributors authorized to deal in flunitrazepam has proved to be an effective measure to reduce diversion. The Governments concerned should also endeavour to increase resources available to pharmaceutical inspection in order to enforce controls for which legal provisions have been made. Precursors 83. The findings of cases that have been uncovered show that traffickers benefit from loopholes in the monitoring of substances. The Board therefore reiterates its request to Governments to re-examine the scope of their controls over international trade and to make amendments if necessary. 84. The seizure data available so far are mainly available on precursors used in the illicit manufacture of amphetamine, methamphetamine and amphetamine-type stimulants related to methylenedioxyamphetamine (MDA) and methylenedioxymethamphetamine (MDMA, commonly known as "ecstasy"). They have also been reported for key chemicals used in the clandestine manufacture of heroin and cocaine, mainly acetic anhydride, which is used for the illicit conversion of morphine to heroin, and those reagents and solvents used in the illicit manufacture of cocaine. 85. The Board wishes to express its concern that, in some regions, the number of seizures reported by Governments is not commensurate with the suspected extent of illicit drug manufacture and diversion. That problem has been particularly acute in western Europe, where amphetamine-type stimulants are widely abused and where most of the world's illicit manufacture of those drugs occurs, and in Latin America and south-east Asia, where illicit heroin manufacture takes place. 86. At the same time, where diverted chemicals have been seized at clandestine laboratory sites, efforts have not always been made to identify the sources of the chemicals seized or the methods and routes by which they may have been diverted. A further complicating factor in establishing how diversions have occurred has been that the controls in place, including import and export controls, in some countries en route and at the destinations, do not always allow for effective monitoring. 87. The cases that have been uncovered also show the frequent use of pharmaceutical products containing ephedrine or pseudoephedrine in the illicit manufacture of methamphetamine; and essential oils containing safrole, in particular sassafras oil, are used in the illicit manufacture of amphetamine-type stimulants related to MDMA ("ecstasy"). Other mixtures also include solvent blends and thinners and dilute acids and potassium permanganate solutions used to process cocaine. 88. In view of the frequent use of mixtures and the related problems of monitoring and control, the Board recommends the following with a view to enhancing current controls over mixtures: sassafras oil, because of its high safrole content and because it may be used easily in illicit drug manufacture, should be considered safrole itself and referred to as "safrole in the form of sassafras oil"; it should be controlled in the same way as safrole in its pure form. In addition, to provide for the proper control of pharmaceutical preparations containing scheduled substances, the Board has recommended that such pharmaceutical preparations, if technically they can be readily used in the illicit manufacture of controlled substances, should be controlled in the same way as the scheduled substances that they contain. Successful prevention of diversion Narcotic drugs 89. The worldwide application of the system of estimates and the import-export authorization system easily and immediately leads to the detection of attempts at diversion. In 1997, no attempts to divert narcotic drugs from manufacture and international trade came to the attention of the Board. However, the diversion of narcotic drugs from some inadequately functioning domestic distribution channels continues to occur. Psychotropic substances 90. In 1997, the Board and the competent authorities of several exporting countries carried out joint inquiries into the legitimacy of more than 80 commercial orders, thereby preventing the diversion of large quantities of psychotropic substances, including stimulants (phentermine), anxiolytics (chlordiazepoxide, diazepam), anti-epileptics (phenobarbital) and analgesics (buprenorphine). 91. One recent example shows the importance of the cooperation of Governments with each other and with the Board. The authorities of India drew the attention of the Board to an order for 1,800 kg of diazepam placed in India by a trading company from Singapore. After the Board inquired about the legitimacy of the order, the trading company in question informed the competent authorities of Singapore that it intended to re-export the diazepam to a company in Indonesia. Investigations in that country revealed, however, that the final consignee of the diazepam was a fictitious company and that the consignment might have been destined for another country. If diverted, the 1,800 kg of diazepam would have been sufficient for the illicit manufacture of several hundreds of millions of tablets (see paragraph 75 above). 92. The Board requests all Governments to undertake investigations into activities of companies involved in cases of attempted diversion in order to identify and prosecute individuals who have planned and intentionally facilitated such diversion attempts. Precursors 93. The Board appreciates that an increasing number of Governments are following its recommendations and using working mechanisms and standard operating procedures for the rapid exchange of information to verify the legitimacy of international and national commercial transactions in precursors. 94. As a result of closer and increasing cooperation among numerous Governments and with the Board, large quantities of precursors were prevented from being diverted from licit manufacture and trade to clandestine drug manufacture. 95. The Board welcomes the fact that an increasing number of Governments have provided information on shipments of precursors and chemicals that were stopped, suspended or voluntarily cancelled because of suspicious circumstances. It reiterates its request to all States to communicate to other Governments and the Board, in a timely manner, relevant details of cases involving diversion or attempted diversion that they have uncovered or cases involving stopped and suspicious shipments to which they have been alerted. The details should include, as a minimum, the type and quantity of the substance in question and the method and route used or intended to be used by the traffickers. Preferably, the reporting of uncovered cases involving diversion or attempted diversion should be done as soon as possible to enable other relevant Governments to be alerted and to prevent similar cases involving diversion from occurring. 96. Suspicious transactions have been identified for a growing number of substances, from which a number of different drugs abused in various parts of the world could have been illicitly manufactured; examples of such cases are provided below. Many recent cases of diversion and attempted diversion have involved very large quantities of chemicals. 97. Attempts to obtain large quantities (typically 200 tonnes or more) of scheduled solvents, in particular methyl ethyl ketone (MEK), have come to the attention of the Board. The Board is also aware of stopped shipments of MEK to Colombia totalling almost 880 tonnes, enough to produce at least 50 tonnes of cocaine (approximately 250 million doses). It is estimated that the total quantity of solvents stopped or seized (the equivalent of more than 4 million litres) would have been sufficient to produce some 200-250 tonnes of cocaine for the illicit market. (Approximately 800 tonnes of cocaine are estimated to be illicitly produced in South America each year.) 98. As a result of government action, some 360 tonnes of acetic anhydride destined to be used in the illicit manufacture of heroin were stopped, seized, or prevented from being diverted. That quantity would have been sufficient to make almost 150 tonnes of heroin. That quantity represents a significant proportion of the total amount of chemicals required by traffickers to manufacture the heroin available on the illicit market, estimates of which range between 430 tonnes and 530 tonnes. 99. Stopped shipments reveal that there is widespread trafficking in very large quantities of precursors used in the illicit manufacture of amphetamine and amphetamine-type stimulants related to MDMA. While the routes and methods of diversion uncovered appear to be particularly diverse and complex, it is unclear whether they represent new routes and methods, or are established routes which have been identified for the first time. Again, the quantities of precursors prevented from being diverted are significant. For example, a stopped shipment of 10 tonnes of 1-phenyl-2-propanone (P-2-P) would have been sufficient to manufacture up to 5 tonnes of amphetamine (the equivalent of up to 500 million street doses), and a prevented diversion of 5 tonnes per month of 3,4-methylenedioxyphenyl-2-propanone (3,4-MDP-2-P) would have been enough to manufacture almost 25 tonnes of MDMA per year (the equivalent of approximately 250 million street doses). 100. Finally, just as traffickers have attempted to obtain ephedrine and pseudoephedrine in tablet form because tightened controls have made it difficult to obtain the pure substances, so they have explored the use of substitute precursors. The most recent significant development, seen in North America, is the use of phenylpropanolamine as a starting material in illicit drug manufacture. 1. Timely endorsement of export authorizations by importing countries 101. The Board has noted with concern that an increasing number of importing countries have failed to return the endorsed copies of export authorizations for narcotic drugs and psychotropic substances to the Governments of the exporting countries or have done so with undue delay. 102. Violation of the corresponding treaty provision might impede the investigation of possible diversion of consignments of narcotic drugs from international trade into illicit channels. The Board therefore urges the Governments of the importing countries concerned to take all measures necessary to ensure prompt compliance with the provisions of article 31, paragraph 7, of the 1961 Convention and article 12, paragraph 1 (e), of the 1971 Convention. Governments approached by the Board on this matter might find it necessary to also review the efficiency of their special administrations, established pursuant to article 17 of the 1961 Convention and article 6 of the 1971 Convention, in order to fully satisfy the treaty obligations. 2. Expiration dates of export authorizations 103. The Board has noted that several Governments of countries exporting narcotic drugs and psychotropic substances have repeatedly issued export authorizations with expiry dates beyond those of the corresponding import authorizations. 104. Although there is no provision in the 1961 Convention that confers on a party the explicit obligation to issue export authorizations whose validity does not exceed that of the corresponding import authorizations, there are provisions, such as those contained in article 31, paragraphs 1 (a), 5 and 7 (a), of that Convention, which constrain the ability of a party to issue such export authorizations. 105. All Governments concerned are therefore requested to ensure that export authorizations are issued for periods within the validity of the corresponding import authorizations. 3. More efficient control over poppy straw 106. The Board, in Effectiveness of the International Drug Control Treaties,(11) which was published as a supplement to its report for 1994, and in its report for 1996,(12) highlighted the need for enhanced controls over poppy straw in line with the relevant Economic and Social Council and General Assembly resolutions and in order to avoid abuse of preparations obtained from poppy straw in some countries producing poppy straw, particularly in certain eastern European countries. There is considerable abuse of poppy straw extracts not only in a number of those eastern European countries where poppy cultivation has been formally prohibited, but also, though to a lesser extent, in several countries in which the opium poppy is licitly cultivated on a larger scale for the production of seeds and the extraction of alkaloids as a by-product. 107. In view of the above, the Board has undertaken a review of the control of poppy straw. Information furnished to the Board suggests that national control over licit poppy cultivation in many countries is not sufficient to prevent the abuse of poppy straw extracts. Furthermore, the prohibition of poppy cultivation in many other countries is not adequately enforced. The Board calls on the Governments of the countries concerned to address themselves to those situations. 108. In countries that also cultivate poppy for the extraction of alkaloids there appears to be a need for enhanced control of poppy cultivation sites. In particular, the Board wishes to encourage those Governments that have not yet done so to consider introducing a general licensing system similar to the control system established in the main countries producing poppy straw material, namely Australia, France, Spain and Turkey, in line with article 25 of the 1961 Convention. 109. A general licensing of poppy cultivation would also permit States to better fulfil their reporting obligations under the 1961 Convention. A number of Governments that have recently reported cultivation of the opium poppy for purposes other than the production of opiate raw materials have not furnished to the Board estimates and statistical data on the area of cultivation as required under article 19, paragraph 1 (e), and article 20, paragraph 1 (g), of the 1961 Convention as amended by the 1972 Protocol. 4. Control over international trade 110. The control system for licit international trade in narcotic drugs and psychotropic substances in Schedules I and II of the 1971 Convention continues to work satisfactorily. 111. The Board is pleased to note that most Governments have already established effective mechanisms for the control of international trade in psychotropic substances in Schedules III and IV. The Governments of many exporting countries consult the Board regarding the legitimacy of suspicious import orders. The Board would like to commend, in particular, the competent authorities of Denmark, France, Germany and India for the vigilance shown in the control of exports and their close cooperation with the Board. 112. The control measures for international trade in substances in Schedules III and IV, as laid down in the 1971 Convention, have in practice not prevented drug traffickers from diverting those substances from licit manufacture and trade. Therefore, in the past 10 years, the Board has repeatedly urged all Governments to apply additional control measures to international trade in those substances. The measures recommended by the Board include controlling the import and export of substances in Schedules III and IV by means of the system of import and export authorizations and by a system of assessments (simplified estimates). Governments have been invited to include in their annual statistical reports to the Board details on countries of origin of imports and countries of destination of exports of those substances. All those recommendations have been repeatedly endorsed by the Economic and Social Council in its resolutions, the most recent being resolutions 1993/38 and 1996/30. 113. The Board notes with satisfaction that most Governments have already implemented its recommendations. At present, export and import authorizations are required by national legislation for all substances in Schedule III in nearly 140 countries and territories and for all substances in Schedule IV in 120 countries and territories. In more than 50 additional countries and territories, the requirement of import authorizations has been introduced for at least some substances in Schedules III and IV. Information on the implementation of the system of assessments (simplified estimates) is included in paragraphs 68-71. Nearly 90 per cent of Governments have provided the Board in their annual statistical reports with details on the countries of origin of imports and the countries of destination of exports for all psychotropic substances. 114. Experience has shown that, until the additional control measures for international trade have been applied in all countries, their effectiveness will remain limited and the diversion of those substances will continue. The Board, therefore, reiterates its recommendation to Governments to make the additional control measures a treaty obligation by amending the 1971 Convention under the simplified procedure (article 30, paragraph 1 (b)). 115. The Board noted the results of the Pan-European Ministerial Conference on the theme "Meeting the drug challenge with a coordinated response", held at Tromsø, Norway, from 15 to 16 May 1997. That Ministerial Conference, which was organized by the Pompidou Group of the Council of Europe, supported calls for the examination in 1998 by the General Assembly at its special session of amendments of the 1971 Convention to establish an import and export authorization system for substances in Schedules III and IV and a simplified estimate system for substances in Schedules II, III and IV. The Board welcomes this recommendation and trusts that the General Assembly at its special session will support the adoption of the amendments. 5. Shortcomings in the control of international trade in psychotropic substances 116. A few parties to the 1971 Convention do not yet control international trade in several substances listed in Schedules III or IV of that Convention and do not report to the Board on exports and imports of those substances. For many years, the Board has repeatedly reminded the Governments of those States of their failure to comply with those treaty obligations and of the risk involved, as such a situation can be exploited by drug traffickers. The Board again calls on the Governments concerned to put into force effective controls for all psychotropic substances in Schedules III and IV without further delay. The Board is considering invoking article 19 of the 1971 Convention in respect of those parties, which are major manufacturers and exporters of psychotropic substances. 117. The Board is concerned that the competent authorities of some countries, including Haiti, Mali, Suriname and Zambia, have failed to respond to repeated requests for the confirmation of the legitimacy of import orders placed abroad by companies from those countries. The orders were considered suspicious for various reasons by the competent authorities of exporting countries. Such lack of cooperation by the competent authorities with the Board may jeopardize the investigation of attempts at diversion or may cause delays in the import of drugs required for legitimate purposes. The competent authorities of the countries concerned are urged to promptly resume their cooperation with the Board. 118. The Board notes that some exporting countries are not yet verifying import orders for psychotropic substances against assessments of importing countries. Such assessments are disseminated regularly by the Board to all Governments. Large quantities of psychotropic substances were approved for export by some Governments in Asia and Europe in spite of the fact that those quantities were higher than the assessments of legitimate requirements of the importing countries. The Board reiterates its request to all Governments to consistently use assessments of annual legitimate requirements of importing countries as a guide when reviewing the legitimacy of import orders and to consult the Board in all cases when import authorizations or other supporting documents authorize imports in excess of the assessment. Such cooperation between Governments and the Board is essential to identifying attempts by traffickers to divert psychotropic substances by means of falsified import authorizations, the most frequently used method of diversion. 119. In 1997, some Governments in Africa, Asia and Europe informed the Board of the detection of consignments of psychotropic substances, mainly various benzodiazepines, that had been exported to those States without the import authorizations required under their national legislation. Such exports have mainly been effected from countries in Europe that have not yet started to control their international trade in all substances in Schedules III and IV by using the system of import and export authorizations. 6. Advertising through the Internet 120. In its report for 1996, the Board expressed its concern about the use of the Internet for the promotion of stimulants used as anorectics.(13) The Board notes with appreciation that the issue of the use of the Internet for marketing pharmaceutical products, including controlled substances, has become the subject of discussion at various national and international forums. The Board shares the views of those who are concerned that the Internet could be misused to illegally distribute controlled substances since sales may be effected on the Internet with a high degree of anonymity. Such misuse of the Internet has already occurred in some countries. 121. The Board noted with appreciation the resolution adopted by the World Health Assembly at its fiftieth session, in which the Assembly urged its member States to take action against the uncontrolled sale of pharmaceutical products on the Internet. The Board welcomes the decision of WHO to further investigate this issue, drawing on the experience of experts from various fields, including law enforcement agencies, consumer groups and the pharmaceutical industry. The Board requests all Governments to monitor promotional and sales activities on the Internet regarding substances under international control, in order to detect possible violations of provisions of the international drug control treaties. 7. Further action required on exchange of information on precursors 122. From 30 June to 4 July 1997, the Board convened at Vienna a meeting on information exchange systems for precursor control, in order to enhance government action required under the 1988 Convention to prevent the diversion of precursors. Among the results of that meeting was an agreed set of procedures for sharing information, based on previous recommendations of the Board, that may be applied voluntarily by Governments (see E/INCB/1996/4, annex V). The approach of institutionalizing standard procedures to facilitate the necessary exchange of information was endorsed by Governments at the first informal open-ended inter-sessional meeting, held at Vienna from 7 to 9 July 1997 by the Commission on Narcotic Drugs acting as preparatory body for the special session of the General Assembly to be held in June 1998. 123. Some Governments have expressed concern over the issue of sharing information, because of the commercial or operational sensitivity of some information. The Board understands their concern; however, the information required is not sensitive. Some Governments have also been reluctant to share information, arguing that it is not explicitly required under article 12 of the 1988 Convention. The Board reminds Governments that the monitoring systems that they must establish to identify suspicious transactions in international trade require the sharing of information, as the systems will not function without it. It is not possible, for example, to trace the international movement of precursors unless some form of notification prior to export is given. The working mechanisms and operating procedures described by the Board and the arrangements made at the meeting in July 1997 provide, within the framework of article 12, for such a practical and workable system. 124. Governments should now put in place those mechanisms and procedures and apply them to ensure more universal cooperation in precursor control. The Board trusts that the European Commission, which has expressed particular concern over the issue of information exchange, will, in cooperation with the competent authorities of member States of the European Union, make the necessary arrangements to allow for such exchange or propose alternative solutions to enable it to fulfil all of its obligations under article 12 of the 1988 Convention. 8. Legislative basis for the control of precursors 125. The Board reiterates its request to Governments to enact legislation that will allow the monitoring and control of international trade and domestic distribution of precursors in order to prevent their diversion. Such action should be taken parallel to administrative action taken in the area of information exchange, which may be initiated without a legislative foundation. 126. The Board wishes to remind all Governments of the need to have in place appropriate sanctions against precursor-related offences, in order to deter criminal activity. 127. In view of the increased use of non-scheduled substances in illicit drug manufacture and the preparation of the limited international special surveillance list (see paragraphs 128-130 below), the Board recommends that, where illicit manufacture is involved, Governments should adopt penal, civil or administrative measures for punishing, in accordance with legislative provisions, as a criminal offence in the sense of article 3 of the 1988 Convention, the unlawful conduct of individuals or companies in connection with the diversion of substances used in illicit drug manufacture. Legislation should refer to the intention to manufacture drugs illicitly with chemicals, regardless of whether they are under national control or not. 9. Limited international special surveillance list of chemicals 128. Information provided on seizures of substances not listed in the tables of the 1988 Convention has shown the continued use by traffickers of substitute chemicals for many of the scheduled substances. Most of those reported have been salts and solvents used in the illicit production of cocaine in countries in South America. Others are specific chemicals required for the illicit manufacture of, among other things, amphetamine-type stimulants and methaqualone. 129. Phenylpropanolamine is one of a number of substances identified by the Board for possible inclusion in the limited international special surveillance list to be established in conformity with Economic and Social Council resolution 1996/29. The aim of the list is to aid competent authorities in preventing the diversion of substances that are not currently listed in the tables of the 1988 Convention but have been identified as being used as substitutes for scheduled substances. 130. Now that a provisional list has been drawn up, the Board will convene its Advisory Expert Group to decide which chemicals on that list should be included on the limited international special surveillance list and to draw up appropriate monitoring measures. 131. The Board has noticed that trafficking groups frequently divert chemicals into illicit channels through free ports and free zones, which international drug control treaties require to be controlled in the same way as other parts of the countries. Traffickers chose free ports and free zones because lack of coordination between the authorities in such areas and the regulatory authorities often results in insufficient control over substances channelled through such areas, thus providing a loophole. 132. The Board is increasingly becoming aware of the problems that Governments are facing in monitoring the licit trade in narcotic drugs, psychotropic substances and precursors channelled through free zones. As indicated in its report for 1996,(14) it has taken a first step, preparing, in cooperation with Governments, a list of all free zones in the world. The list includes contact addresses and telephone and fax numbers in order to enable the competent authorities concerned to ensure appropriate surveillance of specific shipments. 133. The Board regrets, however, that, for the time being, the list of all free zones cannot be regarded as comprehensive because of the lack of replies from Governments to the request by the Board. Governments throughout the world were requested to communicate to the Board the relevant details of their free zones. To date, the Board has received only 69 replies: 17 Governments have stated that they do not have free trade zones, 48 have sent the requested information and 4 have sent partial data. It is noted with concern that 133 Governments have not yet replied. A provisional list, containing the information received so far, will be sent to Governments for further completion, verification, amendment and initial use. D. Ensuring the availability of drugs for medical purposes 1. Supply of opiate raw materials and demand for opiates 134. The Board, in compliance with the functions provided to it under the 1961 Convention and the relevant Economic and Social Council resolutions,(footnote 3) examines on a regular basis the issues affecting the supply of opiate raw materials and the demand for opiates for licit requirements and the means of maintaining a lasting balance between the two. The most recent results of that examination are presented below. Consumption of opiates 135. In 1996, global consumption of opiates, which had exceeded 210 tonnes in morphine equivalent for the first time in 1991, again reached 237 tonnes, the same level it had reached in 1993 and 1995. 136. Codeine accounts for the bulk of opiate consumption and is mainly consumed in the form of preparations included in Schedule III of the 1961 Convention, as an analgesic or cough suppressant. Overall consumption has increased slightly over the years. In 1996, 185.6 tonnes of codeine in morphine equivalent were consumed, representing 79 per cent of the total consumption of opiates. The major user countries continued to be, in descending order, United States, France, United Kingdom of Great Britain and Northern Ireland, Canada, India, Germany and Australia. Those countries accounted for 65 per cent of global codeine consumption in 1996. 137. The increasing levels of dihydrocodeine and morphine consumption observed over the past two decades have also contributed to the increase in the global consumption of opiates. In 1996, 30.6 tonnes of dihydrocodeine in morphine equivalent were consumed, compared with 11 tonnes in 1980 and 20 tonnes in 1990. The consumption of morphine has increased significantly, particularly in recent years, reaching the record level of 16.2 tonnes in 1996. The Board welcomes this development, morphine being a valuable substance for the management of severe pain. In addition, opium consumption, which had remained stable at around 3 tonnes in morphine equivalent during the period 1983-1993, rose to 6.3 tonnes in 1996. 138. Judging from the trends of recent years, annual aggregate consumption of opiates is likely to rise gradually in the next few years, with some fluctuations. Production of opiate raw materials 139. As shown in the table below, after having reached 290 tonnes in morphine equivalent in 1995, a record high level at that time, global production of opiate raw materials fell considerably, to 237.1 tonnes in 1996, mainly because of the significant decrease in the area harvested in Turkey. In 1997, however, based on the provisional statistical data provided by the major producing countries, global production of opiate raw materials may reach a new record level of 298.2 tonnes in morphine equivalent. 140. Production of opiate raw materials in India exceeded 100 tonnes in morphine equivalent in 1997, a substantial rise over the 1996 level and the highest level since 1983. By producing 74.5 tonnes in morphine equivalent in 1997, Australia continued to top the list of countries producing poppy straw for the extraction of alkaloids. The combined production of Australia and India, approximately 179 tonnes in morphine equivalent, accounted for more than 60 per cent of the world total in 1997. In France, because the area under opium poppy cultivation increased, from an annual average of 4,000 hectares in the period 1983-1994 to almost 7,000 hectares in 1997, partly as a result of a production agreement with Spain, production in France rose to 55.7 tonnes in morphine equivalent; that was the largest amount recorded in France in the past 15 years. In Turkey, of the 70,000 hectares estimated for 1997, only 29,681 hectares were harvested and total production was 41.6 tonnes in morphine equivalent. Spain experienced another poor harvest, obtaining only 2 tonnes in morphine equivalent from a harvested area of 1,002 hectares. 141. In response to the need to build up sufficient stocks of opiate raw materials to ensure adequate supply in years of poor harvest, Australia, France and Turkey have further increased their estimates for the areas to be under opium poppy cultivation in 1998, to 102,500 hectares; that represents an increase of 15 per cent over the 1997 level. In contrast, India has reduced its estimate for 1998 to 30,000 hectares compared with 32, 000 hectares for 1997, in view of the fact that its opium stocks have built up again (77.2 tonnes). However, because of a further increase in the minimum qualifying yield that farmers need to achieve in order to keep their licence, the 1998 production in India may attain another new record level of 116 tonnes in morphine equivalent. In Spain, the estimate for 1998 is at the same level as that of 1997, however, production in 1998 may be double the average of the previous three years if normal weather conditions prevail. Production of opiate raw materials,a consumption of opiates and balance between the two, 1984-1998
Note:
142. Based on the 1998 estimates furnished by the major producing countries and their previous years' performance, global production in 1998 is projected at approximately 370.4 tonnes in morphine equivalent, assuming that weather conditions will be favourable. Balance between the production of opiate raw materials and the consumption of opiates 143. In 1995, because of a substantial increase in production in India and Turkey, global production of opiate raw materials exceeded total consumption by about 53 tonnes in morphine equivalent. In 1996, however, the amount produced was only slightly greater than the amount consumed. For 1997, a surplus of 58 tonnes in morphine equivalent is expected, whereas for 1998 the projected surplus will be about 130 tonnes. Exports and imports of opiate raw materials 144. Opium exports from India increased slightly in 1996, amounting to 52.8 tonnes in morphine equivalent, compared with 49 tonnes in 1995; however, that figure was still below the annual average for the period 1990-1995 (60.2 tonnes). 145. In 1996, the three major opium importers, France, Japan and the United States, increased their imports and the United Kingdom resumed its import of opium, with 2 tonnes in morphine equivalent. Hungary, for the first time, imported opium in significant quantities, amounting to 5 tonnes in morphine equivalent, in order to supplement its domestic production of poppy straw. No import of opium has been reported by the Russian Federation since 1994. According to the Russian Government, domestic demand has been met in the past three years by releasing opium from special government stocks.(footnote 4) 146. Total exports of concentrate of poppy straw have steadily increased. The 114 tonnes supplied in 1996 represent the second highest amount in the last two decades. Australia was the major supplier of concentrate of poppy straw in 1996, supplying 44 per cent of the world total in that year, while Turkey's share dropped to 40 per cent, compared with 57 per cent in 1995. Stocks of opiate raw materials 147. As a result of increased production over the past two years, stocks of opium held by India at the end of 1996 increased to 77.2 tonnes in morphine equivalent, of which 56.9 tonnes were of commercial grade. In contrast, the stocks of concentrate of poppy straw held by Turkey declined considerably over the last few years, from 51 tonnes in morphine equivalent in 1993 to 6.5 tonnes in 1996, the lowest amount recorded since 1984. The combined stocks of concentrate of poppy straw held by Australia and France increased slightly, to 13.3 tonnes in morphine equivalent, while Spain only held stocks of less than 200 kg in morphine equivalent at the end of 1996. 148. The Board notes that information, including advance statistical data furnished on the licit cultivation of opium poppy, and on the production and stocks of opium and poppy straw for the manufacture of narcotic drugs was not always complete or provided in a timely manner. As such information is a basic and important element for the projection of the global production of opiate raw materials, the Board urges the Governments of producer countries to make the efforts necessary to ensure that the required information is as accurate as possible and submitted in a timely manner, with a view to enabling the Board to make more meaningful projections and provide Governments with more reliable data. 149. Pursuant to Economic and Social Council resolution 1996/19, on demand for and supply of opiates for medical and scientific needs, an informal consultation was organized during the fortieth session of the Commission on Narcotic Drugs in March 1997. It was concluded that the increased areas for opium poppy cultivation in 1997 in the major producing countries had brought about a positive impact on the present situation regarding stocks of opiate raw materials. However, the current stock level in respect of concentrate of poppy straw was still not sufficient to meet the world demand should there be a poor harvest. 2. Consumption of psychotropic substances Consumption of central nervous system stimulants 150. Stimulants controlled under the 1971 Convention are used for the treatment of attention deficit disorder (ADD) and narcolepsy and as anorectics in the treatment of obesity. Until the early 1970s amphetamines were widely used as anorectics; however, that use has since been discontinued or reduced to the point that it involves only very small quantities. The medical use of phenmetrazine has been discontinued worldwide while fenetylline is prescribed in only a few countries, in very limited quantities. Methylphenidate is increasingly being used in many countries for the treatment of ADD. Dexamfetamine and pemoline are also used for that purpose in some countries. Several amphetamine-type stimulants in Schedules III and IV of the 1971 Convention are used as anorectics. Use of methylphenidate for the treatment of attention deficit disorder 151. In its reports for 1995 (15) and 1996, (16) the Board expressed its concern about the growing consumption of methylphenidate, in particular in the United States, which accounts for almost 90 per cent of world consumption of that substance. The Board has noted the results of a conference organized by the Drug Enforcement Administration of the United States on the theme "Stimulant use in the treatment of ADHD" in December 1996. The consensus of the participants in the conference confirmed the views of the Board that there are cases of improper diagnosis of ADD. The conference also confirmed reports of diversion of methylphenidate from domestic distribution channels into illicit channels. The Board appreciates action taken by the competent authorities in the United States to ensure adequate control of the manufacture of and trade in methylphenidate and to draw the attention of the public and the medical community to the risks of treating children with stimulants. As a result of those efforts, the increase in the consumption of methylphenidate in 1996 was somewhat below the level expected by the United States authorities. However, since the level of consumption of methylphenidate and the rate of its increase are still alarming, the Board trusts that the authorities of the United States will continue their efforts in that area. 152. In addition to the improper diagnosis mentioned in paragraph 151 above, according to information received by the Board from WHO, the use of different diagnostic definitions and criteria in different countries probably accounts for significantly different prevalence rates of ADD and, consequently, large variances in the use of methylphenidate. In the United States, diagnostic definitions of and criteria for ADD have been broadened twice in the last 10 years.(footnote 5) Starting in 1987, the presence of hyperactivity ceased to be an absolute requirement in identifying the disorder. According to diagnostic criteria established by WHO, which are utilized in a number of other countries, hyperactivity is considered an essential symptom of the disorder. In a study carried out in the territory of Hong Kong (footnote 6) and published in 1996,(17) it was found that, for the same school population, the disorder as currently defined in the United States could be diagnosed 10 times more often than the disorder as defined by WHO. 153. WHO can only evaluate the prevalence of ADD and diagnostic criteria for that disorder if several studies on different diagnostic definitions for ADD and their prevalence rates are undertaken. The Board therefore requests the Governments concerned to undertake such studies and to provide WHO and the Board with their results. The Board invites the authorities of the United States to give adequate attention to the evaluation of diagnostic definitions and criteria at the national consensus meeting on methylphenidate that is expected to be held by United States governmental agencies in 1998. 154. The Board reiterates its request to all Governments to exercise the utmost vigilance in order to prevent over-diagnosing of ADD in children and medically unjustified treatment with methylphenidate and other stimulants. Consumption of stimulants as anorectics 155. In its report for 1996, the Board expressed its concern about the high consumption of stimulants in Schedule IV of the 1971 Convention, which are used as anorectics, in some countries in the Americas.(18) The Board notes with appreciation that the Governments of Argentina, Brazil and Chile have adopted measures to reduce the consumption of anorectics to a medically sound level. In Brazil and Chile, special prescriptions for anorectics have been introduced and the use of prescription formulas containing more than one psychotropic substance was prohibited. In Chile, the consumption of anorectics has already substantially decreased. Stricter policies on control of anorectics have also been introduced in some European countries, in response to recommendations adopted in 1996 by the Committee for Proprietary Medicinal Products of the European Union. In France, where a strict prescribing status for anorectics had been introduced already in 1995, consumption levels of those substances considerably decreased in 1996. 156. In the United States, the consumption of anorectics under international control sharply increased in 1996 and continued to rise in 1997. That was mainly due to growth in the use of phentermine, particularly in combination with fenfluramine. In its report for 1996,(19) the Board expressed its concern about promotional activities proclaiming the benefits of this combination treatment, commonly referred to as "phen/fen". 157. In September 1997, the authorities of the United States requested the manufacturers of fenfluramine and dexfenfluramine, which are both anorectics not under international control, to voluntarily withdraw those substances from the market. That request had been prompted by reports on the serious adverse effects on health of those substances. The manufacturers have agreed to comply with that request. Fenfluramine and dexfenfluramine preparations have also been withdrawn from the market in a number of other countries. 158. The Board welcomes that action by the authorities of the United States. The Board invites the authorities of that country to also examine the current use of other anorectics and to monitor their prescription. Such monitoring would be of particular importance in the case of phentermine, since the withdrawal of fenfluramine and dexfenfluramine could lead to a further increase in the use of phentermine as a substitute for those substances. 159. Consumption levels of anorectics in other regions of the world are lower than in the Americas. Increasing use and abuse of stimulants have, however, been reported in several countries in all regions. The Board reiterates its request to Governments of countries in which controlled anorectics are prescribed in very high quantities to closely monitor the situation to prevent their overprescribing, which could lead to the abuse of those substances for their stimulant properties. Additional efforts should be devoted to educational campaigns to inform the medical and pharmaceutical community and the general public of the dangers of indiscriminate stimulant use. The Board also reiterates its request to the media to become involved in promoting a more responsible attitude to the use of stimulants as anorectics. Consumption of other psychotropic substances 160. Most other substances controlled under the 1971 Convention are used as sedatives and hypnotics, anxiolytics and anti-epileptics. Consumption of those substances included in Schedule II of the 1971 Convention has been discontinued or substantially reduced in all countries. Medical practice utilizes substances in Schedules III and IV, some of them to a large extent. Diazepam, a benzodiazepine utilized mainly as an anxiolytic, and phenobarbital, a barbiturate mainly used as an anti-epileptic, are the most widely consumed psychotropic substances. Those substances are on the list of essential drugs established by WHO. With the exception of phenobarbital, the use of barbiturates has been declining. The consumption of non-barbiturate anxiolytics, such as meprobamate, has also been substantially reduced. Those substances have mainly been replaced by benzodiazepines. 161. In a number of countries, the increasing medical availability of benzodiazepines has led to their increasing abuse. In its report for 1994,(20) the Board drew the attention of Governments to the abuse of benzodiazepines by multiple drug abusers. Since then, several countries have adopted stricter control policies with respect to those substances. The Board invites Governments of countries with high levels of consumption of benzodiazepines and increasing abuse of such substances to conduct, in cooperation with non-governmental organizations involved in treatment and rehabilitation, comprehensive surveys in order to determine the size of the population abusing those substances. 162. Information received by the Board from several countries indicates that some general practitioners prescribe benzodiazepines for unnecessarily long periods and for symptoms that may not require such treatment. Several countries in Europe have recorded a very high benzodiazepine consumption, with levels substantially exceeding those in comparably developed countries in other regions. The Board encourages the Governments concerned to monitor consumption levels of benzodiazepines and to raise awareness of medical practitioners for the rational use of those substances. The Board notes that, in some regions, benzodiazepines are occasionally supplied by pharmacies without prescriptions. The Board requests all Governments to ensure adherence to prescription requirements for all psychotropic substances, including benzodiazepines. 163. While developed countries have recorded high levels of consumption of sedatives and hypnotics, anxiolytics and anti-epileptics, a large number of developing countries have reported extremely low medical use of those substances. Several of those countries, especially in Africa, are countries into which large quantities of those substances are smuggled. The Board notes with concern that inadequate licit supply of some essential psychotropic substances can lead to their provision through informal distribution channels that are not subject to official control and do not provide adequate medical counselling to consumers. The Board urges Governments of the countries concerned to re-examine their needs for psychotropic substances and to ensure adequate supply of those substances for medical purposes. The Board invites WHO to support those countries in their endeavour. 1. Although article 3, subparagraph 1 (c) (iii), refers to "publicly inciting or inducing", incitement or inducement occurring privately should also be addressed in domestic legislation and, in certain contexts, may be considered as constituting the offence of "facilitating and counselling the commission of an offence", which is covered under article 3, subparagraph 1 (c) (iv). 2. Etryptamine and methcathinone were added to Schedule I (Commission decision 1 (XXXVIII)), zipeprol was added to Schedule II (Commission decision 2 (XXXVIII)) and aminorex, brotizolam and mesocarb were added to Schedule IV (Commission decision 3 (XXXVIII)). In addition, flunitrazepam was transferred from Schedule IV to Schedule III (Commission decision 4 (XXXVIII)). 3. Council resolutions 1979/8, 1980/20, 1981/8, 1982/12, 1983/3, 1984/21, 1985/16, 1986/9, 1987/31, 1988/10, 1989/15, 1990/31, 1991/43, 1992/30, 1993/73, 1994/5, 1995/19, 1996/19 and 1997/38. 4. The 1961 Convention defines special stocks as the amounts of drugs held in a country or territory by the Government of such country or territory for special government purposes and to meet exceptional circumstances; and the expression "special purposes" is construed accordingly (article 1, paragraph 1 (w)). 5. The disorder was designated as attention deficit disorder with hyperactivity (ADDH) in 1980 and, subsequently, as attention deficit/hyperactivity disorder (ADHD). 6. On 1 July 1997, the territory of Hong Kong became the Hong Kong Special Administrative Region of China.
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