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 | | II. Operation of the international drug control system A. Status of adherence to the international drug control treaties Single Convention on Narcotic Drugs of 1961 44. As at 1 November 1998, the number of States parties to the Single Convention on Narcotic Drugs of 1961 or to that Convention as amended by the 1972 Protocol note 10 stood at 166, of which 152 were parties to that Convention in its amended form. Since the Board published its report for 1997, El Salvador, Djibouti, Grenada, Namibia, Palau and Viet Nam have become parties to the 1961 Convention as amended by the 1972 Protocol. In addition, Saudi Arabia, already a party to the 1961 Convention, has become a party to that Convention in its amended form. 45. Of the 25 States that are not yet parties to the 1961 Convention or to that Convention as amended by the 1972 Protocol, there are 8 in Africa, 3 in the Americas, 6 in Asia, 3 in Europe and 5 in Oceania. Azerbaijan and Georgia remain, to date, the only two States that once formed part of the former Union of Soviet Socialist Republics that have not yet indicated their intent to succeed or accede to the 1961 Convention. The Board once more calls on all the States concerned not only to take prompt action to become parties to the 1961 Convention, but also to enact the necessary legislation and regulations that may be required to implement its provisions. 46. Some States, namely Azerbaijan, Belize, Bhutan, Guyana, Saint Vincent and the Grenadines and the United Republic of Tanzania, which have already become parties to the most recent international drug control treaty, the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988, have not yet become parties to the 1961 Convention. The Board reminds those States that the full implementation of the 1988 Convention is not possible without implementing the provisions of the 1961 Convention. The Board urges the Governments concerned to review the issue. 47. Afghanistan, Algeria, Belarus, Chad, Iran (Islamic Republic of), the Lao People's Democratic Republic, Morocco, Myanmar, Nicaragua, Pakistan, Turkey, Ukraine and Zambia continue to be parties to the 1961 Convention in its unamended form only. They have all acceded to the 1971 Convention and/or to the 1988 Convention. The other State party to the 1961 Convention that has not yet ratified the 1972 Protocol is Liechtenstein. All States concerned should report to the Board their reasons for not having become parties to the 1972 Protocol; if there are no reasons, they should accede or ratify the 1972 Protocol without further delay. Convention on Psychotropic Substances of 1971 48. As at 1 November 1998, the number of States parties to the 1971 Convention stood at 158. Since the last report of the Board was published, El Salvador, Georgia, Mozambique, Namibia, Palau and Viet Nam have become parties to the 1971 Convention. 49. Of the 33 States that have yet to become parties to the 1971 Convention, there are 10 in Africa, 5 in the Americas, 8 in Asia, 4 in Europe and 6 in Oceania. Some States, namely Azerbaijan, Belize, Bhutan, Haiti, Honduras, Iran (Islamic Republic of), Kenya, Nepal, Saint Lucia, Saint Vincent and the Grenadines and the 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, like the implementation of the provisions of the 1961 Convention, is important 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 trusts that all those States will soon accede to the 1971 Convention. 50. Since the last report of the Board was issued, Georgia, Iraq, Lithuania, Mozambique and Viet Nam have acceded to the 1988 Convention. A total of 148 States, or 77 per cent of all countries in the world, and the European Community were parties to the 1988 Convention as at 1 November 1998, nearly 10 years following its adoption. 51. The Board is pleased to note the high rate of accession to the 1988 Convention in the first 10 years following its adoption, which is approximately twice as high as the rate of accession to the 1961 Convention note 11 and the 1971 Convention note 12 in the first 10 years after their adoption. Of the States that have not yet become parties to the 1988 Convention, there are 15 in Africa, 10 in Asia, 7 in Europe and 11 in Oceania. The Board requests all those States that have not already acceded to the 1988 Convention to take, as a matter of priority, steps to establish the necessary mechanisms to implement fully the provisions of that Convention and to become parties to it as soon as possible. B. Cooperation with Governments Reports to the Board
52. In carrying out the responsibilities assigned to it under the 1961 and 1971 Conventions, the Board maintains a continuous dialogue with Governments. The statistical data and other information received from them are used by the Board in analyses of the licit manufacture of and trade in narcotic drugs and psychotropic substances worldwide, in order to identify whether Governments have strictly enforced treaty provisions requiring them to limit the licit manufacture of, trade in and distribution and use of those substances to medical and scientific purposes. 53. In accordance with the provisions of article 20 of the 1961 Convention, 142 States and territories furnished complete quarterly trade statistics for 1997 and 28 furnished partial information; however, 41 did not submit any data. There was a noticeable improvement in the rate of submission compared with the previous year, when 117 countries and territories submitted complete statistical information, 57 furnished partial information and 35 did not submit any data. Annual statistical data for 1997 were received from 146 States and territories. 54. As at 1 November 1998, a total of 154 States and territories had furnished to the Board annual statistical reports on psychotropic substances in accordance with article 16 of the 1971 Convention. That figure represents 74 per cent of the 209 countries and territories requested to submit such reports. The total number of reports received for 1998 was approximately the same as the number of reports received for 1997 at the same time of the year. 55. While most States parties and non-parties to the 1961 and 1971 Conventions have always submitted annual statistical reports, the cooperation of some has been irregular. The number of Governments not reporting regularly has been particularly high in Africa and Oceania. The Board, in close cooperation with the United Nations International Drug Control Programme (UNDCP), has continuously endeavoured to provide assistance to those States. The Board notes with satisfaction that some Governments, including the Governments of the Central African Republic, Kenya and Sierra Leone, have improved their reporting on psychotropic substances. 56. The timely submission, comprehensiveness and reliability of the statistical information provided are important indications of the extent to which individual Governments have implemented the provisions of the 1961 and 1971 Conventions. The Board continues to be concerned that only about 40 per cent of all Governments furnished their statistical information for narcotic drugs and psychotropic substances by the required deadlines. The Board, therefore, calls once more on all Governments to step up their efforts to comply fully with their obligations under the 1961 and 1971 Conventions by furnishing timely and accurate reports.
57. The timely and comprehensive reporting of information to the Board as required by the 1988 Convention is an indicator of the existence of adequate mechanisms to monitor precursors and of the appropriate coordination of government bodies responsible for data collection. As at 1 November 1998, a total of 104 States (including 9 member States of the European Union) and territories had submitted information for 1997 pursuant to article 12 of the 1988 Convention. That figure represents only 50 per cent of the 210 countries and territories that have been requested to provide the information, a rate of return similar to that of previous years (51 per cent in 1996). 58. While many non-parties to the 1988 Convention are already submitting the information required under that Convention, it is of serious concern to the Board that again nearly one half of the parties to that Convention have failed to submit the requisite data for 1997 and several parties, such as Argentina, Canada, Venezuela and Yugoslavia, have not provided such data for at least the last two years. The Board notes also with regret that, for 1997, the European Union has not submitted that information on behalf of the member States of the European Union. The Board urges all States that have not yet done so and the European Commission to submit the required information as soon as possible. 59. The Board is pleased to note that 64 Governments have provided data on licit trade in, uses of and requirements for substances listed in Tables I and II of the 1988 Convention. The Board particularly appreciates the reports of 29 Governments that have regularly sent information for the years 1995-1997, including States that have extensive trade in precursors. The Board welcomes the fact that many major manufacturing and exporting States and territories now provide data on exports of precursors. The Board is also pleased to note that a number of other Governments, including, in particular, Governments in areas where illicit drug manufacture takes place or in trans-shipment areas, have provided data on imports of and licit requirements for precursors. The Board invites Governments that have not yet done so to provide information on licit trade in scheduled substances. note 13
60. Annual estimates of narcotic drug requirements for 1999 were furnished by 161 States and territories. As the 1999 estimates of narcotic drug requirements in respect of 48 States and territories were not received in time for examination and confirmation by the Board during its sixty-fifth session, in November 1998, 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 reminders being repeatedly sent to Governments, no annual estimates of narcotic drug requirements are received from, on average, around 50 States and territories every year. The Board urges the Governments concerned to make efforts to monitor more closely the activities related to their domestic requirements for narcotic drugs and to provide the Board with the information required by the 1961 Convention. 61. The failure of Governments to determine amounts of drugs required for medical purposes may indicate that appropriate information was not collected or otherwise provided by domestic health institutions and/or shortcomings in the capacity to monitor the companies and persons involved in supplying drugs. While those problems increase the risk of a shortage of drugs for medical treatment, including pain relief, it also creates a risk that drugs manufactured and traded in a country may ultimately be diverted to illicit channels in that country or elsewhere because of lack of monitoring. 62. No annual estimates of narcotic drug requirements have been received for at least the last three years from 14 States, including Bhutan, El Salvador, the Marshall Islands, Mauritania, Romania and Vanuatu. The Board understands that the other nine States, because of their political and economic situations, are not yet in a position to cooperate fully. Nevertheless, the Board hopes that States that are not yet able to comply with the requirements of the 1961 Convention will soon remedy the situation, if necessary by requesting assistance in establishing the required control mechanisms. 63. The Board notes with satisfaction that the Governments of Cameroon, Gabon, Sierra Leone and Zambia have furnished their estimates of narcotic drug requirements for 1999 after not having submitted them for several years. The Board appreciates the efforts of those Governments and looks forward to further cooperation with those and other Governments. 64. The worldwide aggregate of the morphine estimates for consumption now exceeds 25 tonnes. Morphine consumption is increasing in most developed countries. Two major reasons for this are the growth of palliative care for terminally ill patients (e.g. patients with cancer or acquired immunodeficiency syndrome (AIDS)) and the increase in the elderly population, which together will increase the number of patients needing pain relief treatment. At the same time, there has been a more extensive use of pharmaceutical preparations in oral form and in slow-release form, which require higher doses of morphine to produce the same effect but permit cancer patients or patients under palliative care to continue their treatment at home. 65. While the amount of morphine consumption has been increasing worldwide, the Board notes that several of the 161 States and territories that furnished estimates did not plan for any medical or scientific need for morphine in 1999. Furthermore, the Board noted that many States have reported a very low consumption level of morphine for 1997, the equivalent of less than one person out of 1 million having received the standard defined daily dose (DDD) of morphine. About 16 of those States have a population of more than 10 million inhabitants. That may be an indication that the authorities of those States, contrary to the recommendations of the World Health Organization (WHO), do not consider morphine among the essential analgesic drugs in their formularies or that they are precipitating serious shortages in the medical supply of morphine for pain relief. It may also indicate that some national drug control administrations still find impediments in the prescribing and dispensing of morphine by health professionals, a subject discussed in detail in a special report of the Board entitled Availability of Opiates for Medical Needs prepared on the basis of a survey initiated by the Board in 1995. note 14 66. Eighty-three States have furnished estimates for methadone. In addition to its use as an analgesic, methadone is also used for the treatment of opioid addiction. Nineteen of the 83 countries indicating the use of methadone in the treatment of opioid addicts continued with those programmes, according to explanations provided by those States. At least seven States have increased considerably their estimates for methadone for 1999 compared with their figures for previous years, most probably because of the expansion of those programmes (e.g. an increase of 85 per cent in Canada and 50 per cent in Poland). Ten States have furnished estimates for levoalphacetylmethadol (LAAM), an isomer of alphacetylmethadol that has been increasingly used for the treatment of addictions. 67. National drug control administrations are encouraged to develop mechanisms to manage the supply of narcotic drugs to cover as far as possible their countries' medical needs. They should have complete and reliable information on the types of drugs and the quantities needed and, at the same time, they should be able to determine if the quantities requested by manufacturers and/or importers are in line with actual medical requirements. Although the 1961 Convention allows the revision of estimates by means of supplementary estimates to cope with unforeseen circumstances, the greatest effort should be made to examine data obtained from companies from a public health perspective in the light of actual needs and to determine correct estimates in advance. Since 1990, the number of supplementary estimates furnished by Governments has fluctuated between 600 and 770. The frequent submission of supplementary estimates may be an indicator of a Government's response to growing medical needs. It may, however, also indicate that the administrative authority concerned has not adequately planned the medical use of such drugs or may even not be aware of actual requirements.
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 serve as guidelines for the competent authorities of exporting countries when approving exports of psychotropic substances. 69. With the exception of six Governments, namely the Bahamas, Bosnia and Herzegovina, the Comoros, Gabon, Grenada and Liberia, all States and territories have submitted to the Board assessments for substances in Schedule II. As at 1 November 1998, assessments for substances in Schedules III and IV had been received from 174 States and territories; in addition, 9 States had submitted assessments for at least some substances in either Schedule III or Schedule IV. 70. In 1997, pursuant to Council resolution 1996/30, the Board established assessments of annual licit domestic requirements for 51 States and territories that had not submitted such assessments. The Board notes with satisfaction that 16 of those States and territories established their own assessments in 1998. The Board invites all Governments that have not yet done so to review assessments established for their countries or territories and to provide the Board with comments on the appropriateness of those assessments. The Board reiterates its request to those Governments to establish their own assessments as soon as possible. 71. In 1998, the Board noted that some Governments had issued import authorizations for quantities of psychotropic substances in excess of the assessments reported by them to, and published by, the Board. In some cases, the difference between the quantity authorized for imports and the corresponding assessment was considerable. Investigations into the authenticity of such import authorizations by exporting countries and the Board require additional resources and may delay imports of consignments of substances urgently needed for medical purposes. The Board, therefore, 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. Prevention of diversion into the illicit traffic
72. In 1998, only one case involving the possible diversion of substances from licit international trade into the illicit traffic was brought to the attention of the Board: the partial disappearance of a consignment of fentanyl at a port of entry. Given the present volume of licit international trade in narcotic drugs worldwide, diversion remains negligible.
73. In 1998, the Board and the competent authorities of several exporting countries carried out joint investigations into the legitimacy of a considerable number of commercial transactions. As a result of this cooperation, large quantities of psychotropic substances were prevented from being diverted into illicit channels. The substances targeted by drug traffickers were stimulants (amfepramone, dexamfetamine), benzodiazepines (chlordiazepoxide, diazepam), phenobarbital and buprenorphine. 74. The most frequently used method of diversion was the falsification of import authorizations. The application of the system of assessments was the most effective tool used to identify such diversion attempts. 75. One recent example of attempted diversion involved the proposed export in 1998 of large quantities of chlordiazepoxide, ephedrine hydrochloride (a substance listed in Table I of the 1988 Convention) and diazepam (1,250 kg each) from Germany and China to Ghana, for eventual re-export to Gabon. The competent authorities of Germany drew the attention of the Board to that transaction because the quantities required significantly exceeded the estimated legitimate needs of Gabon. The German authorities also requested the Board to review the authenticity of an import authorization, purportedly from the authorities of Gabon, presented to them in support of the order. The subsequent enquiry with the authorities of Gabon revealed that the import authorization had been falsified and that the final consignee was fictitious. A related enquiry with the authorities in Ghana confirmed that the import of the substances into Ghana had also not been authorized. The competent authorities of Gabon and Ghana requested that the export of the substances in question be stopped, and the German and the Chinese authorities complied. If diverted, the substances involved would have been sufficient for the illicit manufacture of several hundred million tablets.
76. Licit international trade in psychotropic substances in Schedule I of the 1971 Convention has been limited to infrequent transactions involving no more than a few grams. No cases involving the diversion of those substances from licit international trade have ever been reported to the Board. There has been, for some time, almost universal application of strict control measures for substances in Schedule II. No significant cases involving the diversion of those substances from licit international trade have been uncovered since 1990, confirming that preparations containing hallucinogens, amphetamines, fenetylline and methaqualone on the illicit markets in various regions of the world are almost entirely from clandestine manufacture and not from the licit pharmaceutical industry. 77. In 1997 and 1998, the analysis by the Board of data on international trade in substances included in Schedules III and IV, followed by the investigation by Governments of suspicious transactions, led to the detection of several cases involving the diversion of those substances into illicit channels, including two cases in which quantities of more than 1 tonne of diazepam were involved. In most of the diversion cases identified, drug traffickers had succeeded in diverting psychotropic substances from a few important exporting countries that had not yet implemented basic control requirements of the 1971 Convention for some substances in Schedules III and IV or additional control measures recommended by the Board for international trade in those substances. In some of those cases, psychotropic substances had first been imported from countries with strict export controls. It is, therefore, clear that the failure of certain countries to implement effective controls has enabled drug traffickers to circumvent strict controls implemented in other countries. 78. The quantities of substances in Schedules III and IV identified in 1997 and 1998 as diverted (amphetamine-type stimulants and benzodiazepines) total several tonnes, enough to manufacture hundreds of millions of tablets. The quantities detected as diverted from international trade are probably much smaller than the total quantities actually diverted. The identification of cases involving diversion is hindered by the fact that a few important exporting countries do not yet report to the Board their exports of all psychotropic substances. 79. According to seizure data reported by Governments, diversion from licit domestic distribution channels represents an increasingly important source of the illicit supply of several psychotropic substances. The substances most frequently diverted from domestic distribution channels include stimulants (amfepramone, methylphenidate, phentermine), benzodiazepines (chlordiazepoxide, diazepam, flunitrazepam, nitrazepam and temazepam) and buprenorphine. The substances are sold by traffickers to abusers in the country of diversion or are smuggled into other countries where there are also illicit markets for the substances. 80. The methods used to divert psychotropic substances from domestic distribution channels include theft, pretended export, falsified prescription, inappropriate prescribing, and illegal supplying of substances without prescription. While each incident of diversion usually involves a very small amount of psychotropic substances, such incidents occur so frequently that the total quantity actually diverted is quite considerable. Single diversions involving a large amount can also occur. For example, in October 1997, drug traffickers stole various amphetamines totalling more than 400 kg from the stocks of a manufacturing company in France. 81. The Board notes with satisfaction that some Governments have recently introduced additional control measures to increase the effectiveness of their national control systems for the distribution of certain psychotropic substances. In some countries, such measures have been adopted in response to the diversion of psychotropic substances for abuse in other countries. The Board trusts that newly introduced control measures will prevent the diversion of buprenorphine to the illicit market in India and the smuggling of that substance out of the country. 82. The Board appreciates the measures adopted by several Governments in the Americas to stop the diversion of flunitrazepam from domestic distribution channels and the smuggling of that substance into the United States. The measures proven to be most effective include the restriction of the number of wholesale distributors and retail outlets, increased reporting requirements of wholesalers and retailers, close scrutiny by authorities of all trade transactions and the strict implementation of prescription requirements. The Board hopes that similar measures being implemented in the Czech Republic and Slovakia will prevent the smuggling of flunitrazepam from central Europe into countries in northern Europe. 83. The Board welcomes the close cooperation of the pharmaceutical industry with the law enforcement authorities in many countries aimed at preventing the diversion of flunitrazepam and the activities of the International Criminal Police Organization (Interpol) aimed at strengthening the cooperation of law enforcement authorities confronted with the problem of the diversion of and illicit traffic in that substance.
84. Information on cases involving diversion and attempted diversion and seizure data are not sufficient to draw a conclusion concerning the actual ratio of precursors diverted from international trade to those substances diverted from domestic manufacture and distribution channels. The ratio varies significantly depending on the substance and the regions involved. For example, acetic anhydride used in heroin manufacture in south-east Asia is understood to be mainly from smuggling within that subregion, while there is much evidence of acetic anhydride being diverted from international trade to the heroin-producing areas in the Golden Crescent. 85. The Board has for the first time been in a position to review data from a five-year period on cases involving diversion and prevented diversion and has obtained a more comprehensive picture of diversions from international trade channels. The diversions involved significant amounts of chemicals, particularly ephedrine: 824 tonnes of acetic anhydride; 85 tonnes of 1-phenyl-2-propanone (P-2-P); 48 tonnes of precursors used in the illicit manufacture of methylenedioxymethamphetamine (MDMA, commonly known as "ecstasy") and related drugs; 200 tonnes of ephedrine and pseudoephedrine; and thousands of tonnes of solvents and acids destined to Latin American countries for use in cocaine processing. The quantities involved would have been sufficient to manufacture 330 tonnes of heroin, 40 tonnes of amphetamine, 25 tonnes of MDMA, 130 tonnes of methamphetamine and hundreds of tonnes of cocaine. 86. In most cases, Governments have prevented the diversion by checking with other Governments the legitimacy of individual transactions before they take place. The number of diversions prevented by such action has increased rapidly in recent years. For example, attempted diversions have been identified, and shipments have been stopped, following enquiries about suspicious transactions. In a large number of other cases involving diversion, the transactions were deemed at first glance not to be suspicious and the diversion was discovered only after pre-export notices were sent. The most common methods of diversion that have been identified involve falsified import authorizations (or end-user declarations) and the use of "front" companies created solely to sell chemicals to drug traffickers. Effective cooperation with industry is essential, since many cases involving such diversion have been discovered after law-abiding companies have alerted law enforcement authorities to unusual orders. 87. In about 15 per cent of the cases, alerts provided by Governments on previously uncovered cases of diversion and attempted diversion have been instrumental in helping other Governments to identify suspicious orders involving essential chemicals. Those cases once again highlight the importance of Governments informing the Board and any other Governments concerned of any identified diversion, attempted diversion or suspicious order. The Board requests Governments to continue to provide such information, for instance, by using, whenever possible, the standard form developed by the Board for sharing information on individual transactions. Specific findings from cases of diversions are presented in the 1998 report of the Board on the implementation of article 12 of the 1988 Convention. note 15 Action plans adopted by the General Assembly at its twentieth special session 89. The General Assembly at its twentieth special session, held from 8 to 10 June 1998, adopted resolution S-20/4 A, containing an action plan against illicit manufacture, trafficking and abuse of amphetamine-type stimulants and their precursors, and resolution S-20/4 B, containing an action plan on the control of precursors. The Board welcomes those resolutions, recognizing that a key element emphasized in the resolutions is the need for concerted and uniform application, by all Governments, of the provisions of the 1971 Convention and of article 12 of the 1988 Convention and for strict compliance with the provisions and proposals of related resolutions of the Commission on Narcotic Drugs and the Economic and Social Council and with the recommendations of the Board related to the control of psychotropic substances and precursors. 90. The Board notes with satisfaction that the Governments represented at the twentieth special session of the General Assembly decided to deal with the problem of amphetamine-type stimulants in all its aspects and to give that problem higher priority. The Governments agreed to improve the technical basis of controls, particularly with regard to increasing the flexibility of the process of scheduling, and confirmed their determination to detect and prevent the diversion of amphetamine-type stimulants from licit into illicit channels, as well as the irresponsible marketing and prescribing of such substances. 91. As for precursors, the Governments agreed that they would provide to the Secretary-General, on request, some form of pre-export notices not only for all substances in Table I of the 1988 Convention, but also for acetic anhydride and potassium permanganate, key chemicals used in the illicit manufacture of, respectively, heroin and cocaine. The Governments also agreed that the same efforts should be made with regard to the remaining substances in Table II. In addition, the Governments accepted proposals to prevent the diversion of non-scheduled chemicals used in illicit drug manufacture and to consider punishing, as a criminal offence in the sense of article 3 of the 1988 Convention, the diversion of non-scheduled chemical substances with the knowledge that they are intended for use in the illicit manufacture of narcotic drugs or psychotropic substances and introducing related penal, civil and administrative sanctions. A summary of the key proposals for action by Governments included in resolution S-20/4 B is given in the 1998 report of the Board on the implementation of article 12 of the 1988 Convention.note 16 92. The Board will continue to monitor the progress made by Governments in implementing the measures outlined in the General Assembly resolutions, including the Declaration on the Guiding Principles of Drug Demand Reduction (Assembly resolution S-20/3, annex), and stands ready to assist Governments in matters that fall within its treaty functions. Control of intermediaries 93. In 1997, the Board completed a study on the feasibility of formulating specific guidelines on the control of intermediaries involved in international trade in psychotropic substances. The study, carried out in response to Economic and Social Council resolution 1996/30, showed that, while the formulation of general guidelines on the control of such intermediaries for worldwide application was feasible, specific guidelines would not be appropriate in view of the specificity of national situations. 94. The Board sought the views of almost 80 Governments in all regions of the world in connection with the above-mentioned study. The information received indicated that diversion involving intermediaries could be significantly reduced if the Board's recommendations for additional measures to control international trade in psychotropic substances and precursors, endorsed by the Economic and Social Council and by the General Assembly at its twentieth special session, were universally implemented. Those recommendations included the application of the system of import and export authorizations and the system of assessments for psychotropic substances and, in the case of precursors, the application of the procedures for the exchange of communications. 95. In addition, based on the above-mentioned study, the Board recommends as general guidelines on the control of intermediaries that all Governments should, taking into account their domestic situations, alert industry to the risks of diversion arising from the involvement of intermediaries. The conclusion of memoranda of understanding between industry and Governments may be a helpful starting point in that process. All intermediaries should be required to report suspicious transactions to the authorities, and Governments should establish sanctions for intermediaries involved in diversion, whether or not the diversion occurs within their territorial jurisdiction. The Board also recommends that Governments organize controlled deliveries, as provided for in article 11 of the 1988 Convention, in cases involving intermediaries, wherever possible. 96. The Governments should consider adopting the same control measures for intermediaries as for other operators involved in the licit trade in controlled substances. That would include licensing or registration, record-keeping requirements and the inspection, involving the records of intermediaries, of their premises and stocks. note 17 97. The Board will continue to monitor the involvement of intermediaries in the diversion of psychotropic substances and precursors. Scope of control
98. Increasing abuse of buprenorphine, a potent opioid in Schedules III of the 1971 Convention, has been reported for a number of years in countries in various regions, particularly in South Asia. In response to that trend, the Board suggested in its reports for 1995 note 18 and 1996 note 19 that WHO and the Commission on Narcotic Drugs review the status of the international control of buprenorphine. In view of the reports that the number of abusers of buprenorphine and the number of countries affected are increasing, the Board again urges WHO and the Governments of countries affected by its abuse to initiate the review of the status of buprenorphine without delay.
99. In 1998, the Board conducted an assessment of phenylpropanolamine for possible inclusion in Table I of the 1988 Convention, pursuant to a notification submitted by the Government of the United States in 1997.note 20 100. Phenylpropanolamine is suitable for use in the illicit manufacture of amphetamine and could therefore play an important role as a precursor. The Board is of the view that strict international control of that substance would limit its availability to traffickers and reduce the quantity of amphetamine that is illicitly manufactured. However, the Board has deferred for one year any decision on the scheduling of phenylpropanolamine, in order to allow time for a study to be carried out on the possible impact of scheduling under the 1988 Convention on the availability for medical use of pharmaceutical products containing that substance. Consequently, until the study is completed, the Board has included phenylpropanolamine in its limited international special surveillance list of non-scheduled substances. 101. Full details of the Board's assessment of phenylpropanolamine are contained in the 1998 report of the Board on the implementation of article 12 of the 1988 Convention.note 21 International trade in seized opiate raw materials or in substances derived therefrom 102. In 1998, the Islamic Republic of Iran exported significant amounts of codeine phosphate to countries in Europe and North America. The Islamic Republic of Iran has not reported licit production of opium since 1979 and has had no significant imports of any opiate raw material. The codeine in question is considered to have been manufactured from seized raw materials, most likely opium. 103. The Economic and Social Council, in its resolution 1998/25, on demand for and supply of opiates for medical and scientific needs, commended the Board for urging Governments to avoid unforeseen imbalances between licit supply of and demand for opiates caused by sales of products manufactured from seized and confiscated drugs. The Board, in its report for 1994, had drawn attention to the concern that a country might export opiates manufactured from seized opium, thereby adversely affecting the balance between the supply of and demand for opiates for medical and scientific needs, and had invited all Governments to avoid any proliferation of supply sources.note 22 The Board therefore calls on countries exporting, or considering the export of, seized drugs and/or products manufactured from such drugs to refrain therefrom and requests importing countries to take into account Council resolution 1998/25. 104. In 1998, attempts were made by a company manufacturing pharmaceuticals in Hungary to import large quantities of purportedly seized opium from countries in central Asia. Investigations revealed that such large quantities of opium had never been seized in the countries concerned. The Board notes the decision of the Government of Hungary not to authorize the transactions and hopes that the circumstances will be investigated. Cultivation of cannabis for medical and scientific research 105. The Board is aware that there is a need to investigate the possible medical uses of cannabis in treating glaucoma, in treating AIDS wasting syndrome and in alleviating the side effects of cancer chemotherapy, and that there is a growing interest in that issue among the medical community, the general public and the media. In 1998, the Governments of two countries, the Netherlands and the United Kingdom, approved research projects in that area, in addition to research started earlier in the United States. 106. The Board notes that sound scientific research into the possible therapeutic properties and medical uses of cannabis should be undertaken to obtain more reliable data on an issue that has so far been handled on a rather anecdotal basis. Any decision on the medical use of cannabis should be based on clear scientific and medical evidence. Political initiatives and public votes can easily be misused by groups promoting the legalization of all use of cannabis and/or the prescription of cannabis for recreational use under the guise of medical dispensation. 107. Furthermore, Governments considering engaging in cannabis cultivation and production and making licit the use of cannabis should also bear in mind all of the control requirements set by the relevant provisions of the 1961 Convention, as well as the security measures that may be needed to reduce the risks of cannabis being diverted or abused. Additional controls over international trade in psychotropic substances 108. Controls over licit international trade in narcotic drugs under the 1961 Convention, as well as the control systems for licit international trade in psychotropic substances in Schedules I and II of the 1971 Convention, continue to work satisfactorily. 109. The Board notes with appreciation that most Governments have established effective mechanisms for the control of international trade in psychotropic substances in Schedules III and IV of the 1971 Convention by implementing the treaty provisions and applying additional control measures recommended by the Board. 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 their vigilance in monitoring international trade in psychotropic substances. 110. The additional control measures recommended by the Board for international trade in substances in Schedules III and IV include controlling the import and export of substances in those schedules by means of a system of import and export authorizations and a system of assessments. Governments have also been requested to include in their annual statistical reports to the Board details on countries of origin of imports and countries of destination of exports. All those measures, without which the monitoring of international trade in psychotropic substances would be inadequate, have been repeatedly endorsed by the Economic and Social Council in its resolutions, the most recent being resolutions 1993/38 and 1996/30. The Board notes with satisfaction that the General Assembly at its twentieth special session, in its resolution S-20/4 A, recommended that States should implement those Council resolutions. 111. The Board welcomes the recent decision by the Governments of several countries, including countries that are key importers and exporters of psychotropic substances such as Austria, Denmark, Japan and Switzerland, to expand the system of import and export authorization to include all substances in Schedules III and IV. At present, export and import authorizations are required by national legislation for all substances in Schedule III in more than 140 countries and territories and for all substances in Schedule IV in 125 countries and territories. In more than 50 additional countries and territories, the requirement of import authorizations has been introduced for at least some substances. Significant progress has also been achieved in the implementation of the system of assessments (see paragraphs 68-70 above). Nearly 90 per cent of Governments have provided in their annual statistical reports to the Board details on the countries of origin of imports and the countries of destination of exports for all psychotropic substances. 112. Experience with the functioning of the international control system has shown that until those additional controls are applied in all countries, their effectiveness will remain limited and the diversion of psychotropic substances will continue, particularly through defaulting countries. The Board, therefore, again calls on the Governments of all countries that do not yet control the import and export of several psychotropic substances in Schedules III and IV via the system of import and export authorizations in particular developed countries such as Belgium, Canada, Singapore and the United Kingdom of Great Britain and Northern Ireland, to introduce such controls as soon as possible. 113. The Board appreciates that measures are being taken by Switzerland, which recently acceded to the 1971 Convention, to ensure that details on the countries of origin of imports and the countries of destination of exports for all psychotropic substances are included in its future statistical reports. No details on trade in psychotropic substances in Schedules III and IV were included in the annual statistical report for 1997 submitted by the United Kingdom. That State was, however, requested by the Board in 1993 to include in its future statistical reports information on the countries of destination of exports of all substances in Schedule IV, pursuant to the provisions of article 16, paragraph 5, of the 1971 Convention, which makes the submission of those details mandatory. The authorities of the United Kingdom have in the past complied with that requirement. The Board requests that they resume the submission of those details. 114. The Board regularly circulates to all Governments assessments of the legitimate requirements for psychotropic substances of all countries and territories. The Board is concerned that some exporting countries in Asia and Europe approved in 1997 and 1998 exports of large quantities of psychotropic substances despite the fact that those quantities exceeded the assessments of legitimate requirements of the importing countries, thereby increasing the risk of diversion of psychotropic substances into illicit channels. In one such case, an export authorization was issued in 1997 to a company in China for the export of 1,800 kg of diazepam to Singapore, although that country's assessment of its annual legitimate requirements for diazepam was less than 700 kg. Inquiries carried out in Singapore at the request of the Board revealed that the company indicated by the exporter as the importer of the diazepam had not been licensed to deal in psychotropic substances. The company denied any involvement in the transaction. The exported consignment has not been traced yet. 115. The Board appreciates the measures already taken by the authorities in China to prevent the reoccurrence of such a case. The Board again calls on all Governments to consistently use assessments of annual legitimate requirements of importing countries as a guide when reviewing the legitimacy of import orders for psychotropic substances. The competent authorities of exporting countries should confirm with the competent authorities of the importing country, prior to authorizing exports of psychotropic substances, the legitimacy of all orders for such substances exceeding the importing country's assessments. The Board is available to assist competent authorities of exporting countries in their efforts to communicate with the competent authorities of the importing countries, if necessary. More effective controls for precursors 116. Over the years, the Board has made a number of specific recommendations for action that Governments should take in order to prevent the diversion of substances in Table I or II of the 1988 Convention. The recommendations were made based on its examination of cases involving diversion and attempted diversion that had been uncovered. The recommendations were endorsed by the Commission on Narcotic Drugs and, subsequently, the Economic and Social Council. Having scrutinized the most recent cases brought to its attention, the Board finds that the recommendations made so far continue to be valid. It recognizes that Governments may need to take the actions proposed in a progressive manner, reviewing how they should implement each in the light of the changing circumstances faced by the competent authorities. The Board therefore invites all Governments to re-examine those recommendations with a view to refining the controls currently exercised. It also invites all competent authorities to provide to it any feedback from their experiences in applying the actions proposed. The 1998 report of the Board on the implementation of article 12 contains a summary of those recommendations.note 23
117. The Board is pleased to note that an ever-increasing number of Governments now utilize some form of pre-export notice for precursors to prevent their diversion, as recommended by the General Assembly in its resolution S-20/4 B. For example, the Board has been informed that member States of the European Union now regularly provide pre-export notices for all transactions involving substances in Table I of the 1988 Convention and for all transactions involving substances in Table II of that Convention that are destined for "sensitive" countries. Since some exporting countries find it helpful to receive official requests for such notices from the importing countries, the Board urges all Governments of importing countries to request pre-export notifications for substances in Table I by invoking article 12, paragraph 10 (a), of the 1988 Convention, and for acetic anhydride and potassium permanganate. The Board notes with appreciation that the Governments of Colombia, Ecuador and Turkey, countries that are situated in areas where the illicit manufacture of narcotic drugs takes place, and the United Arab Emirates, an important trans-shipment country, have requested pre-export notices for all substances in Table II, including acetic anhydride and potassium permanganate. 118. The Board is also pleased to note that the European Parliament, by revising a regulation and a directive of the European Economic Community, is considering the establishment of close cooperation between the competent authorities and industry aimed at identifying unusual transactions involving non-scheduled substances, which may be diverted for the illicit manufacture of narcotic drugs or psychotropic substances. 119. To ensure effective monitoring of shipments into and out of their territories, pre-export notices should also be requested by many exporting countries, including in Europe, where substances in Tables I or II of the 1988 Convention are imported for subsequent re-export. The Board therefore welcomes the steps now being taken by the European Commission to invoke article 12, paragraph 10 (a), for substances included in Table I. Furthermore, the Board re-emphasizes that, for pre-export notices to be effective in preventing diversion, timely feedback should be given by the importing countries concerned: they should either confirm that they have no objection to the transactions in question or request the authorities of the exporting countries to take appropriate action.
120. The Board in its previous reports repeatedly highlighted the dangers of a so-called "targeted approach", where Governments monitor only shipments to certain countries that are considered "sensitive". Bearing in mind that traffickers often use complex routes to avoid countries considered "sensitive" by exporting countries, the Board recommended that Governments should re-examine such controls and make amendments, where necessary.note 24 Some exporting countries, including in Europe, have become important sources of substances used in the illicit manufacture of drugs since only exports destined for "sensitive" countries are monitored effectively. The Board is pleased to note that the European Commission is now ready to study that issue. The Board urges all Governments that use a similar targeted approach to discontinue that practice and to carefully monitor all shipments and not just those to regions where illicit drug manufacture is known to take place.
121. The Board again reminds parties to the 1988 Convention that they should establish penal and/or administrative sanctions for the manufacture, transport or distribution of substances included in Table I or II, knowing that they are to be used in or for the illicit manufacture of narcotic drugs or psychotropic substances, as required under article 3 of the 1988 Convention. Those parties should also establish sanctions for non-compliance with the laws or regulations on monitoring the licit movement of those substances. 122. The Board reminds all Governments that have established such sanctions to apply those sanctions in all cases involving diversion or attempted diversion, as well as in cases involving wilful or repeated non-compliance with regulations for the control of essential chemicals, to act as a deterrent to criminal or negligent behaviour.
123. The Board expects that exporting countries will verify with the importing countries the legitimacy of individual transactions when an established pattern of trade appears to be changing in a way that raises concern, even if the intended shipments are purportedly destined for a known company. For such shipments, Governments should not automatically continue to send exports; they may find it necessary to suspend shipments or not to authorize future shipments until the necessary investigations are carried out. 124. At the same time, the de facto embargo of shipments without such verification should be avoided. In its 1994 report on the implementation of article 12 of the 1988 Convention,note 25 the Board added a word of caution to that effect, noting that, in deciding to stop an export shipment, competent authorities should make every effort to verify the legitimacy of individual transactions and identify the exact circumstances of the case. In particular, it noted that adequate monitoring, exercised judiciously, should not hinder legitimate trade in chemicals. It is essential, therefore, that in those cases where shipments are suspended, appropriate action is taken rapidly by all concerned to verify the legitimacy of the individual transactions.
125. Traffickers have sought to obtain chemicals that may be used as substitutes for those that are more closely monitored. They have identified and used new methods for processing or manufacture, requiring substances currently not listed in Table I or II of the 1988 Convention. They have also manufactured so-called "designer" drugs, many of which require as starting material substances currently not listed in Table I or II. Many of the non-scheduled substances reported to the Board have been salts and solvents used in the illicit processing of cocaine in some South American countries. Others are specific chemicals required for the illicit manufacture of, for example, amphetamine-type stimulants. 126. In 1998, the Board established a limited international special surveillance list of such non-scheduled substances, pursuant to Economic and Social Council resolution 1996/29, section I.note 26 The aim of the special surveillance list, and the associated recommendations for action by Governments, is to aid competent authorities in preventing the diversion of substances that are not listed in Table I or II of the 1988 Convention by providing a more flexible system of control, one that is able to respond quickly to emerging trends and situations. 127. From an initial list of about 500 substances, for which information existed regarding their use or potential for use in illicit drug manufacture, the Board has now identified 27 substances, including phenylpropanolamine (see paragraphs 99-101 above) for inclusion in the special surveillance list. It has also made recommendations for actions to be taken by Governments, including proposals for monitoring measures, with regard to the substances included on the list. The proposed monitoring measures have been devised to complement the more strict controls provided for in article 12 of the 1988 Convention for scheduled substances. The list and the recommendations for action have been distributed to all Governments. The Board has emphasized that the proposed monitoring measures should be applied to the substances on the special surveillance list, in close voluntary cooperation with the chemical industry. Further observations on the special surveillance list are contained in the 1998 report of the Board on the implementation of article 12.note 27 D. Ensuring the availability of drugs for medical purposes Demand for and supply of opiates
128. Global consumption of opiates, after exceeding 210 tonnes in morphine equivalent for the first time in 1991, has averaged 235.2 tonnes over the past five years. Annual aggregate consumption of opiates is also likely to fluctuate for the next couple of years at around 235 tonnes in morphine equivalent. 129. Codeine consumption alone constitutes around 75 per cent of total opiate consumption. It is used mainly as a cough suppressant in the form of preparations included in Schedules III of the 1961 Convention. In 1997, 173.9 tonnes of codeine in morphine equivalent were consumed. The main countries using codeine continued to be the United States and France, followed by the United Kingdom, Canada and India. 130. The upward trend in dihydrocodeine consumption observed over the previous two decades continued in 1997. The share of global opiate consumption accounted for by dihydrocodeine consumption increased gradually from an annual average of 8 per cent in the period 1983-1991 to 14 per cent in 1997. That was a result of increased utilization of dihydrocodeine for the manufacture of preparations in Schedule III in the main countries using the drug, such as Germany, Japan, the Republic of Korea and the United Kingdom. In absolute terms, 31.6 tonnes of dihydrocodeine in morphine equivalent were consumed in 1997, the highest level ever recorded. The consumption of morphine followed a similar pattern, reaching a new peak of 17.8 tonnes in 1997, compared with an average level of 2.2 tonnes per year prior to 1983. It seems likely that such pronounced upward trends in consumption will continue. 131. In contrast to those developments, global consumption of ethylmorphine declined continuously after 1978 and fell to 2.2 tonnes in morphine equivalent in 1997, the lowest level in 20 years. Pholcodine consumption remained above 7 tonnes in morphine equivalent for four consecutive years, from 1993 to 1996, and dropped to 6.2 tonnes in 1997.
132. Due to adverse weather conditions, the actual harvest in some of the main countries producing opiate raw materials was at a lower level than forecast, thus contributing to a decrease in stocks. 133. In view of the need to build up sufficient stocks of opiate raw materials and in order to meet the demand for opiates even in years of poor harvest, further efforts to increase production have been made by the main producing countries in the last two years. 134. In 1998, despite a significant decrease in India, overall production of opiate raw materials increased further, due to production increasing in Spain (by 5.2 tonnes), France (by 24.2 tonnes), Australia (by 29.7 tonnes) and, above all, Turkey (by 31 tonnes). According to provisional statistical data provided by those countries, global production in 1998 is estimated at approximately 289 tonnes in morphine equivalent (see table), which would be the second highest production level in 20 years. 135. Production of opiate raw materials in India dropped to 26.6 tonnes in morphine equivalent in 1998, a decrease of 73.7 tonnes compared with the preceding year and the lowest yearly production level ever recorded in that country. The shortfall was the result of a sharp decrease in the area harvested in the country in 1998: of the 30,714 hectares that were licensed, only 10,098 hectares were actually harvested, mainly because of unexpected bad weather conditions. 136. In contrast to that development, the production of opiate raw materials increased in Australia, France, Spain and Turkey, reaching the highest levels of production recorded in each of those countries during the past three years. Australia continued to top the list of countries producing poppy straw for the extraction of alkaloids, having produced 93.8 tonnes in morphine equivalent in 1998. It was followed by France, which produced 76.2 tonnes in morphine equivalent. Turkey increased its production to 69.3 tonnes in morphine equivalent in 1998 as a result of an increase in both the area actually harvested and the yield per hectare. Spain produced 7.1 tonnes in morphine equivalent in 1998, almost four times as much as it had produced in 1997 (1.9 tonnes). 137. In an effort to build up stocks to ensure an adequate supply of opiate raw materials in years of poor harvest, Australia has further increased its estimate for 1999 of the area to be under opium poppy cultivation, to 15,500 hectares. The area under opium poppy cultivation is at its highest level ever in that country. The estimates for 1999 for France (8,000 hectares) and Spain (6,000 hectares) remain the same as for the previous year. 138. In view of the expected depletion of opium stocks at the time of the 1999 harvest, India increased its area to 32,000 hectares to be under opium poppy cultivation in 1999, compared with 30,000 hectares in the previous year. With an average minimum qualifying yield of 39 kg per hectare established for the 1999 harvest, India's production is expected to attain a new record level of 112.3 tonnes in morphine equivalent. 139. Based on the estimates furnished by the major producing countries and their performance in previous years, global production of opiate raw materials in 1999 is expected to increase to approximately 360 tonnes in morphine equivalent under normal weather conditions.
140. The relatively low production level in 1996 had a negative effect on the balance between global production of opiate raw materials and consumption of opiates. However, global production of opiate raw materials exceeded total consumption by 30.2 tonnes in 1997 and by 49.2 tonnes in 1998. That was partly the result of an increase in production in all major producing countries except India in 1998. Exports and imports of opiate raw materials 141. The quantity of opium exported annually by India has averaged approximately 60 tonnes in morphine equivalent since the beginning of the 1990s. The United States and Japan have been the main opium importers. 142. France is also importing opium from India, but it continues to rely mainly on domestically produced raw materials for the extraction of alkaloids. Hungary and the United Kingdom are also importers of opium. The Russian Federation has reported no imports of opium for the fourth consecutive year. 143. Total exports of concentrate of poppy straw increased steadily between 1992 and 1995, when it attained a record high level of 133.5 tonnes in morphine equivalent. Since then, however, global exports have been on the decline, decreasing to 103.5 tonnes in 1997. The decline is mainly attributable to Turkey, which reduced its exports by 25.5 tonnes, and, to a lesser extent, to Hungary, which reduced its exports by 4.5 tonnes. 144. Australia remained the largest exporter of concentrate of poppy straw in 1997, exporting 46.5 tonnes in morphine equivalent and accounting for 45 per cent of the world total that year. The share of the world total accounted for by Turkey fell from 57 per cent in 1995 to 40 per cent in 1997.
145. Increased production during the period 1995-1997 led to a substantial replenishment in the stocks of opium held by India, which reached 100.7 tonnes in morphine equivalent at the end of 1997. That was more than twice the amount of opium stocks held by India at the end of 1994 (36.9 tonnes), when such stocks were at their lowest level in 20 years. Opium stocks will again be substantially reduced as a result of the bad harvest in 1998. The stocks of concentrate of poppy straw held by Turkey declined from 50.9 tonnes in morphine equivalent at the end of 1993 to 5 tonnes at the end of 1997, the lowest level recorded by Turkey since 1982. The combined stocks of concentrate of poppy straw held by Australia, France and Spain amounted to 9.4 tonnes in morphine equivalent at the end of 1997 and good harvests were reported in all those countries in 1998. 146. Pursuant to Economic and Social Council resolution 1998/25, the Board continues to urge Governments concerned to adjust global production of opiate raw materials to a level corresponding to actual licit needs and to avoid unforeseen imbalances between licit supply of and demand for opiates. An informal consultation meeting with the main States importing and producing opiate raw materials was held during the forty-first session of the Commission, in March 1998, pursuant to Council resolution 1997/38, on demand for and supply of opiates for medical and scientific needs. Consumption of psychotropic substances
147. Stimulants controlled under the 1971 Convention are used for the treatment of attention deficit disorder (ADD) (called attention-deficit/hyperactivity disorder (ADHD) in the United States) and narcolepsy and as anorectics in the treatment of obesity. Up to the early 1970s, amphetamines were extensively used as anorectics; however, such 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. Amphetamines 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.
148. Since 1993, the Board has closely followed developments in the use of methylphenidate for the treatment of children diagnosed with ADD. The main areas of concern for the Board have been trends in the diagnosis of ADD and in the prescription of methylphenidate for its treatment in the United States, which consumes more than 85 per cent of the world total. Recognizing, however, that developments in the United States could have an impact on other countries, the Board requested, already in its report for 1995,note 28 that all Governments exercise the utmost vigilance in order to prevent the over-diagnosis of ADD in children and, with that, medically unjustified treatment with methylphenidate or other stimulants. 149. Recently, the consumption of methylphenidate has grown in more than 50 countries, the majority of them reporting annual increases of over 100 per cent in the use of the substance. For most of those countries, that high growth rate did not yet result in high consumption levels of methylphenidate since their previous consumption levels were low. In some countries, however, consumption has been growing steadily for several years and could reach levels comparable to that of its use in the United States if the trend continues unabated. That group of countries includes Australia, Belgium, Canada, Germany, Iceland, Ireland, the Netherlands, New Zealand, Norway, Spain and the United Kingdom. The Board, therefore, reiterates its request to all Governments to monitor prescription levels of methylphenidate in order to identify possible over-diagnosis of ADD and to prevent medically inappropriate use of that substance. 150. A factor contributing to the increasing consumption of methylphenidate is the expansion of the population of patients treated with the substance. At the beginning of the 1990s, the majority of children treated were boys in primary school. Since then, the range of patients has been extended to include children, adolescents and adults. The proportion of female patients has also increased. According to recent reports, some children as young as one year old are being diagnosed with ADD in the United States. There has been an increase in the number of children under five years of age who are being treated with methylphenidate in that country. 151. The Governments of many countries experiencing a sudden rapid growth in the use of methylphenidate for the treatment of ADD do not have the necessary experience and background information to evaluate the medical justification for such an increase in its use. The Board has been requested on a number of occasions to provide Governments with guidelines or other information on how to identify or prevent over-diagnosis of ADD and medically unjustified treatment with methylphenidate or other stimulants. The Board, therefore, reiterates its request to WHO to evaluate the diagnostic criteria for ADD and the use of methylphenidate and other stimulants in the treatment of children and to bring the results of the evaluation to the attention of national public health authorities. The Board invites the Government of the United States to inform it of any progress made on that issue.
152. In its reports for 1996 note 29 and 1997,note 30 the Board included information on the alarmingly high consumption of amphetamine-type stimulants used as anorectics in some Latin American countries and increasing reports on illicit trafficking in and abuse of those substances. The Board is pleased to note that decisive measures taken in some of the most affected countries have yielded positive results. Legislative changes implemented in Argentina and Chile have led to a considerable reduction in the consumption level of amphetamine-type stimulants in those countries. The Board also welcomes the initiation of educational campaigns to inform the medical and pharmaceutical communities and the media in those and some other countries in that region about the risks of inappropriate use of anorectics. 153. In July 1998, a subregional meeting on the control of anorectics took place at Santiago, Chile. The meeting was organized by the Pan American Health Organization, the regional office of WHO for the Americas, and the Board, in cooperation with the Ministry of Health of Chile and UNDCP. As it was felt that interdisciplinary efforts would provide the most efficient use of scarce resources to identify possible remedial or preventive measures, the meeting brought together participants with competence in various fields from all countries in the Southern Cone (Argentina, Brazil, Chile, Paraguay and Uruguay) and from Bolivia and Peru. The meeting concluded with a number of practical recommendations regarding the following: improved regulatory measures; prohibition or restriction of the form in which anorectics are most widely used (prescription formulas); education of medical doctors, pharmacists and the general public; and means to obtain the support of the media. The Board welcomes such initiatives and hopes that the planned follow-up to that meeting in individual countries will be adequately supported by the Governments concerned and the relevant international organizations. 154. In the United States, the level of consumption of stimulants under international control as anorectics declined following a record level in 1996 but was still very high. That decline was mainly attributable to a significant reduction in the use of phentermine caused by the withdrawal from the market in the United States in September 1997 of fenfluramine, an anorectic not under international control. Fenfluramine had largely been utilized in combination with phentermine in the treatment commonly referred to as "phen/fen". The Board would like to reiterate its previous request to the authorities of the United States to continue to monitor the prescription of anorectics. 155. Recently, the consumption of stimulants used as anorectics has increased in some parts of Asia, particularly in the Hong Kong Special Administrative Region of China, Malaysia and Singapore, approaching levels formerly reported in the Latin American countries with the highest levels of consumption of those substances. There have also been reports on the abuse of stimulants used as anorectics in countries in Asia. The Board, therefore, requests the Governments concerned to carefully monitor the use of such substances so as to avoid their over-prescription and possible abuse.
156. Most other substances controlled under the 1971 Convention are used as anxiolytics, sedatives and hypnotics, and anti-epileptics. Consumption of those substances listed in Schedule II of the 1971 Convention has been discontinued or considerably reduced in all countries. Medical practice employs substances in Schedules III and IV, some of them to a very large extent. Diazepam, a benzodiazepine utilized mainly as an anxiolytic, and phenobarbital, a barbiturate mainly prescribed 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 decreasing. The consumption of non-barbiturate anxiolytics, such as meprobamate, has also been substantially reduced. Those substances have mainly been replaced by benzodiazepines. 157. The availability of psychotropic substances differs widely between regions. While developed countries have recorded high levels of consumption of anxiolytics, sedatives and hypnotics, and anti-epileptics, many developing countries have reported extremely low consumption of those substances. Significant quantities of psychotropic substances are smuggled into some of those countries, particularly in Africa. In those countries, lack of adequate licit supply of psychotropic substances can lead to situations where informal "parallel markets" not only cater to abusers of those substances but are also used by genuine patients unable to obtain required medication through licit distribution channels. The Board notes with concern that essential psychotropic substances are distributed through "parallel markets" that are not subject to any official control and do not provide adequate medical counselling to consumers. The Board reiterates its request to the Governments concerned to re-examine their needs for psychotropic substances and to ensure the adequate supply of those substances for medical purposes through adequately controlled distribution channels. The Board invites WHO to support those countries in their endeavour. 158. Various factors are at the origin of insufficient consumption of psychotropic substances in many developing countries, including persistent political and economic problems. In addition, in some countries, especially in Africa, the competent authorities for the control of licit psychotropic substances are not functioning adequately. As a result, importers in those countries experience difficulties in obtaining mandatory import authorizations to import essential medicines. For the same reason, exporting countries frequently find it difficult to verify the legitimacy of proposed imports as the authorities in the importing countries cited often fail to provide timely responses to enquiries or simply fail to respond. Such situations can lead to the postponement or even cancellation of shipments of psychotropic substances needed for medical purposes. The Board, therefore, requests the Governments concerned to ensure the functionality of their competent authorities for the control of licit psychotropic substances. The Board invites UNDCP to support such efforts, particularly in Africa. 159. In a number of developed countries, the widespread availability of benzodiazepines is a factor facilitating their increasing abuse. The Board reiterates its previous request to Governments of countries with high levels of consumption of benzodiazepines and their increasing abuse to conduct, in cooperation with non-governmental organizations involved in treatment and rehabilitation, comprehensive surveys to determine the size of the population abusing those substances. There are indications that, in several countries, some doctors prescribe benzodiazepines for unnecessarily long periods and for symptoms that may not require such treatment. The Board invites the Governments of countries in Europe that have recorded very high levels of benzodiazepine consumption, levels significantly exceeding those of comparably developed countries in other regions, to raise the awareness of medical practitioners of the need to use those substances in a more rational manner. 160. The Board notes with concern that, in some countries, benzodiazepines can frequently be obtained from pharmacies without prescriptions. The Board strongly requests all Governments to enforce adherence to prescription requirements for all psychotropic substances, including benzodiazepines. E. Measures to ensure the execution by Governments of the provisions of the 1961 Convention and the 1971 Convention 161. Article 14 of the 1961 Convention as amended by the 1972 Protocol and article 19 of the 1971 Convention enable the Board to take certain measures to ensure the execution of the provisions of those conventions. The Board has found that invoking those articles is helpful in ensuring the execution of the provisions of the 1961 and 1971 Conventions when its attempts at encouraging compliance through other means have been unsuccessful. Procedures under article 14 of the 1961 Convention and article 19 of the 1971 Convention 162. The procedures under article 14 of the 1961 Convention and article 19 of the 1971 Convention consist of three increasingly severe steps. The first step involves communicating to the Government concerned the Board's decision to invoke those articles, to make clear to that Government the grounds under which the articles are being invoked and to request from that Government explanations or the opening of consultations. The 1961 and 1971 Conventions specify the criteria that must be met in order to invoke the provisions: the Board must have objective reasons to believe that the aims of those conventions are being seriously endangered by the failure of any country or territory to carry out the provisions. The commentaries on the 1961 Convention note 30a and the 1971 Convention note 30b state that this clause should be interpreted to mean that lack of control or defective control in one country or territory must appear to endanger the effectiveness of control in another country or territory. The Board also has the right to propose to the Government concerned the opening of consultations if, without any failure in implementing the provisions of the Convention, a party or a country or territory has become, or if there exists evidence of a serious risk that it may become, an important centre of illicit cultivation, production or manufacture of, traffic in or consumption of narcotic drugs. 163. In the second step, if the Government concerned fails to give satisfactory explanations when called upon to do so or fails to adopt any remedial measures recommended by the Board pursuant to the Government's explanations, or there is a serious situation that requires cooperative action at the international level in order to be remedied, the Board may call the matter to the attention of the parties, the Economic and Social Council and the Commission on Narcotic Drugs through the publication of a report. 164. In the third step, if all of the above-mentioned actions have failed, the Board may, under article 14 of the 1961 Convention or article 19 of the 1971 Convention, recommend to the parties that they stop the import or export of narcotic drugs or psychotropic substances to the country or territory concerned, either for a designated period or until the Board is satisfied with the situation in that country or territory. 165. In view of the seriousness of these measures, several procedural safeguards exist for countries that are the object of action under article 14 of the 1961 Convention or article 19 of the 1971 Convention. Communications with the Government in question must remain confidential until the Board decides to go public and call the matter to the attention of the parties, the Economic and Social Council and the Commission on Narcotic Drugs. All decisions of the Board under those articles are taken by a two-thirds majority of the entire membership of the Board. A State that is the subject of action under the provisions of those articles must be invited to be represented at a meeting of the Board at which a question directly interesting it is considered under those articles. The views of the Government concerned must be published in reports of the Board directed to the Council, if the Government so requests. Lastly, if in any case a decision of the Board that is published under those articles is not unanimous, the views of the minority must be stated. For every State in respect of which it has invoked article 14 of the 1961 Convention or article 19 of the 1971 Convention, the Board establishes a file in which it keeps a record of all decisions taken, communications between it and the Government and developments in the State related to those decisions. Recent examples 166. The Board recently invoked article 19 of the 1971 Convention in respect of two States, both of them parties to the 1961 and 1971 Conventions, which had repeatedly delayed the promulgation of regulations to give effect to certain mandatory control measures under the 1971 Convention. The risk of psychotropic substances being diverted from licit international trade would be substantial in the absence of those mandatory controls, given the volume of trade involving the States in question. Following its invoking of article 19, the Board received replies from the Governments concerned in which it was stated that they would expedite measures to remedy the situation. The Board has therefore decided to suspend further action under article 19 for the time being and to review the situation at its sixty-sixth session, in 1999. 167. In addition, article 14 of the 1961 Convention and article 19 of the 1971 Convention were invoked in respect of four other States because of their persistent failure to furnish information required under the international drug control treaties and to respond to enquiries of the Board, despite numerous reminders and the international technical assistance, including training, given to them in the field of drug control. The Board notes that it has now begun a dialogue with the Governments of all of those States. The Board trusts that they will soon comply fully with their obligations under those conventions. 168. In a more serious case, the Board also invoked article 14 of the 1961 Convention and article 19 of the 1971 Convention with respect to a State that had ceased reporting to the Board, in particular on the cultivation of opium poppy on its territory, and that had not given a positive reply to the Board's request to send a mission or to the Board's enquiries, notwithstanding numerous opportunities given to it to clarify the drug control situation within its territory. The Board notes that the Government of that State has finally agreed to initiate a dialogue at a technical level. The Board hopes that the dialogue will lead to the acceptance of its proposal to send a mission to that country.
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