Essential medicines and health products

WHO work on controlled substances

The WHO Expert Committee on Drug Dependence (ECDD)

What it does

The WHO Expert Committee on Drug Dependence (ECDD) consists of an independent group of experts in the field of drugs and medicines. The Committee is convened by WHO about once a year to review the public health impact of psychoactive substances and make recommendations to the international community.

How it works

When it meets, the ECDD assesses the potential health risks and benefits of specific substances according to a set of fixed criteria. These are:

  • Evidence of dependence potential of the substance
  • Actual abuse and/or evidence of likelihood of abuse
  • Therapeutic applications of the substance

Depending on the outcome of the assessment of a specific substance, the Committee may advise to:

  • Place the substance under international control (place it in one of the Schedules)
  • Transfer the substance from one Schedule to another (leading to more or fewer control measures)
  • Delete the substance from a Schedule (putting an end to control)
  • Keep the substance under surveillance out of a lack of evidence for actual abuse or dependency.

What happens after the ECDD has formulated its recommendations

The ECDD recommendations are presented by the Director General of WHO to the UN Secretary General and the United Nations Control Narcotic Board (CND).

The CND convenes each year in March in Vienna to review and analyze the global drug situation, considering the interrelated issues of prevention of drug abuse, rehabilitation of drug users and supply and trafficking in illicit drugs. It takes action through resolutions and decisions. The CND decides, on the basis of recommendations by the WHO, to place narcotic drugs and psychotropic substances under international control (see below).

The scheduling of psychoactive substances and what it means

Psychoactive substances are classified and placed under international control in compliance with three international conventions ratified by United Nations (UN) Member States, namely:

  • 1961 United Nations Single Convention on Narcotic Drugs
  • 1971 Convention on Psychotropic Substances
  • 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

The purpose of these classifications is to control and limit the use of these drugs to protect public health and minimize the diversion of precursor chemicals to illegal drug manufactures.

The scope of the 1961 Single Convention was limited to drugs with cannabis-, cocaine- and opium-like effects and did not cover the many new psychotropic substances discovered later.

The 1971 Convention is designed to control psychoactive drugs such as amphetamine-type stimulants (i.e. ecstasy), barbiturates, benzodiazepines, and hallucinogenics (like LSD).

The 1988 Convention places under national control substances frequently used in the illicit manufacture of narcotic drugs or psychotropic substances (so called precursors). It provides comprehensive measures against drug trafficking, including provisions against money laundering and the diversion of precursor chemicals. It provides for international cooperation through, for example, extradition of drug traffickers, controlled deliveries and transfer of proceedings. WHO has no formal role to play in the scheduling of substances covered by the 1988 convention.

Examples of scheduling under the 1961 and 1971 conventions

The 1961 United Nations Single Convention on Narcotic Drugs

Schedule Potential for harm Degree of control Examples of listed drugs
I Substances with addictive properties, presenting a serious risk of abuse Very strict: substances are subject to all measures of control applicable to drugs under this Convention (art 2.1) Cannabis and its derivatives, cocaine, heroin, methadone, morphine, opium
II Substances normally used for medical purposes and given the lowest risk of abuse Less strict Codeine, dihydrocodeine, propiram
III Preparations of substances listed in Schedule II, as well as preparations of cocaine Lenient, according to WHO, these preparations present no risk of abuse Preparations of codeine, dihydrocodeine, propiram
IV The most dangerous substances, already listed in Schedule I, which are particularly harmful and of extremely limited medical or therapeutical value Very strict, leading to a complete ban on the “production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical or scientific research Cannabis and cannabis resin, heroin, carfentanil

The 1971 Convention on Psychotropic Substances

Schedule Potential for harm Degree of control Examples of listed drugs
I Substances presenting a high risk of abuse, posing a particularly, serious threat to public health which are of very little or no therapeutic value Very strict: use is prohibited except for scientific or limited medical purposes LSD, MDMA, mescaline, psilocine, tetrahydrocannabinol (THC)m
II Substances presenting a risk of abuse, posing a serious threat to public health which are of low or moderate therapeutic value Less strict Amphetamines and amphetamine-type stimulants,dronabinol
III Substances presenting a risk of abuse, posing a serious risk to public health which are of moderate or high therapeutic value These substances are available for medical purposes Barbiturates, including amobarbital, buprenorphine
IV Substances presenting a risk of abuse, posing a minor threat to public health with a high therapeutic value The substances are available for medical purposes Tranquillisers, analgesics, narcotics, including allobarbital, diazepam, lorazepam, phenobarbital, temazepam

Improving access to controlled medicines

WHO strives for policies and programmes that balance access to essential and controlled medicines for all people in need and minimising misuse or diversion of these medicines. The availability of internationally controlled drugs for medical and scientific purposes remains low to non-existent in many countries and emphasises the need for international collaboration to improve access to these medicines.

The importance of access to controlled medicines for public health has been emphasized in several World Health Assembly Resolutions to improve access to controlled medicines for palliative care, for emergency and essential surgical care and anaesthesia and for epilepsy.

WHO carries out regular reviews of the efficacy and safety of medicines and updates the WHO Model List of Essential medicines accordingly. A number of controlled medicines are included in the WHO Model List and are considered essential for alleviating pain and suffering, enable surgery, treat mental health conditions, support dignified and comfortable end-of-life care, help people to overcome addiction, and to save lives.

WHO collaborates with countries to improve access to medicines, including controlled medicines. Work focuses on monitoring of availability and prices of medicines at health facility level, on forecasting and quantification, on capacity building of prescribers and dispensers, and on the development of balanced policies and legislation.