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This chapter looks at the past, present and future of international cannabis control required by the UN drug control conventions in the post-2016 United Nations General Assembly Special Session era with an eye on the next High Level Ministerial Segment (HLMS) at the UN Commission on Narcotic Drugs in 2019, and beyond. From a policy analysis perspective, the author meanders through the increasing tendency to legally regulate recreational cannabis markets notwithstanding the obligation enshrined in the UN drug control conventions to limit cannabis exclusively for ‘medical and scientific’ purposes. Taking into account relevant national and international developments, the chapter describes how the growing discomfort with the status of cannabis and the prohibitive and punitive approach stemming from the international drug control regime went through a process from soft to hard defections of the treaty obligations. The case of the Netherlands demonstrates the difficulty faced by reform-minded states in reconciling their wish for a different cannabis control mechanism with their obligations under international law, resulting in an incomplete regulation of its coffee-shop system, where small amounts of cannabis are tolerated for sale, but where the illicit supply to the shops remained unregulated. Subsequent more wide-ranging reforms to regulate cannabis from seed to sale in Uruguay, several US States and – in 2018 – in Canada, are clearly violating the obligations of the UN drug control conventions. Nevertheless, the HLMS will likely leave the elephant in the room untouched. The emerging paradigm shift regarding cannabis shows that a modernisation of the UN drug control regime is long overdue. This chapter discusses some of the options available.

This chapter discusses the genealogy and development of the ‘access abyss in palliative care and pain relief’ affecting 80 per cent of the world’s people. It argues that the larger context is an epistemic abyss constituted by incomplete information about the need for controlled medicines for pain relief, and that decades of drug policy based on supply control have prevented development of the necessary knowledge base in many countries. Transnational civil society organisations are working to map and bridge this abyss through education, advocacy and action. Deeper (original) systemic and tensions in the original multilateral drug control narrative produced the current epistemic/clinical abysses and now provide space for more participatory civil society involvement. Where the earlier narrative focussed on a fear-based drive to discipline and punish non-medical use of controlled substances, the evolving (and still contested) ‘world drug problem’ narrative foregrounds person centred, human rights based, public health approaches to drug policy that explicitly support improved access to internationally controlled essential medicines. Recommended policies can only be operationalised through a concerted ‘all hands on deck’ effort guided by the international law principle of ‘mutual and shared responsibility’ for improving access within the context of the 2030 Agenda for Sustainable Development. This calls for enhanced communication, concerted advocacy, collaboration and pluralist praxis to fill the often gaping abyss between ‘black letter law’ — what is actually written in the drug control conventions — and how member states learn to interpret and operationalise it.

The landscape for international drug policy is shifting rapidly as the tensions between the objectives, assumptions and activities that are being introduced at local level are tearing apart the assumptions on which the system was founded. Countries are divided into camps that pursue different aims with drug policy. In addition to an established distinction between those that seek to reduce drug harms and those pursuing a vision of a drug-free world, some UN member states have established licit markets for products that the conventions hold are available for medical and scientific purposes. This incongruence is matched by states in the other camp who apply capital and corporal punishment ostensibly in pursuit of a public health objective. These differences over underlying values, but also in the use of evidence, and interpreting the purpose of the drug control system are no longer reconcilable. While there is pressure on maintaining the system, it no longer serves an organic function and continues mainly for the benefit of constituent members. With the dissolution of US leadership, drug policy is no longer operating within an effective international framework.

Both Bolivia and Uruguay broke ranks with the global drug prohibition regime by introducing novel drug policies. State control of the production and supply of coca and cannabis represents a clear departure from both the spirit and the letter of the international drug conventions. Although, the rationale, processes and outcomes of policy change were distinctive in many regards, this chapter posits that there are conceptual resemblances. In both countries, the leadership of a charismatic and idiosyncratic president has to be considered. Furthermore, in both countries, mobilisation and activism were also decisive. Lastly, in both countries novel drug policy responded to specific problems that decision-makers faced. Approaching drug policy reforms in Bolivia and Uruguay in terms of personal leadership, mobilisation and policy problems provides a useful analytical first-cut to assess the continuity and change in drug policy observable elsewhere. Additionally, scrutinising the reasons and motivations for undertaking drug policy reform also allows to better understand each country’s behaviour on the international stage.

This chapter provides a critical exploration of the European Union’s impact on the 2016 United Nations General Assembly Special Session (UNGASS) proceedings and Outcome document. It demonstrates that the ability to produce a European ‘common position’ ahead of the UNGASS debates represents a significant step forward in the ability to ‘speak with one voice’ in the global illicit drug policy arena, and has played an important role in ensuring key issues such as human rights and public health remain on the agenda. In highlights, however, a European failure to engage with issues such as the continuing suitability of the international drug conventions to preside over the current climate of drug policy innovation and experimentation, and the unintended consequences of a ‘war on drugs’ approach. Ultimately, therefore, it argues that these failures will hamper the development of a more progressive and effective global drug policy.

This chapter explores the historical context of drug control in the United States, the ongoing regulation of the cannabis market at the State level and the role of the United States in the international negotiations related to the United Nations General Assembly Special Sessions (UNGASS) on drugs in 1998 and 2016. We continue by analysing the position, allies and activities of the United States before and during UNGASS 2016 to provide an understanding of possible scenarios related to the 2009 Political Declaration and Plan of Action review to take place via a High-level Ministerial Segment within the 2019 Commission on Narcotic Drugs meeting. While US drug policy is not expected to positively shift in the next few years, State-level regulation of cannabis is expected to continue and create pressure from below.

This chapter explores the norms and assumptions that frame and sustain international drug policy and the international drug control regime. Drug policy is conceptualised as a ‘policy fiasco’ that persists despite extensive evidence of goal failure. The absence of effective monitoring and evaluation, impact assessment, stakeholder participation and mainstreaming of rights-based approaches, conflict sensitivity and gender sensitivity is emphasised, substantiating the argument that drug policy is a case study of ‘institutional path dependence’. Drug policy has repeatedly missed targets for achievement of a ‘drug free world’. This is explained through reference to the counterproductive and ‘unintended consequences’ of a drug policy approach of criminalisation. The impacts of drug policy enforcement are shown to be negative, pernicious and disproportionately born by the poor, by vulnerable communities and those subject to discrimination on account of race, gender and class.

This chapter analyses major issues surrounding the Annual Report Questionnaire (ARQ) – the key mechanism through which the UN collects data on various facets of the world’s illicit drug market. As the ARQ is currently under review by the United Nations Office on Drugs and Crime (UNODC), the authors suggest ways to incorporate the gains made at the United Nations General Assembly Special Session (UNGASS) on the World Drug Problem.

The UNGASS Outcome Document has, to certain degree, enabled the international community to move away from the simplistic goals of a drug-free world enshrined in the 2009 Political Declaration and towards a more comprehensive health- and human rights-based approach. The UNGASS has also laid important groundwork for the 2019 Ministerial Segment, where member states will delineate the global drug control approach for the next decade. In this context, the issue of metrics and indicators has a critical political role to play as it will shape how member states will measure progress against their international drug control commitments.

Starting with a review of the ‘triple trouble’ – poor data quality, low response rates from Member States and other inconsistencies that have long persisted with the ARQ – the chapter moves on to offer substantive critiques on the content of the Questionnaire and ways to better incorporate issues related to health, human rights and development. The chapter concludes by providing guidance on possible synergies with the Outcome Document and the Sustainable Development Goals, bringing international drug control in line with the UN Charter.

The United Nations General Assembly Special Session on drugs has provided countries with internationally agreed recommendations to adapt their drug policies for more efficiency and better outcomes. This chapter focusses on the Russian Federation’s role in international drug policy, through an analysis of its national approaches and their design, as well as on its diplomatic efforts at the bilateral and multilateral levels to oppose drug policy reform. A systematic review of peer-reviewed, grey literature, policy documents, UN reports and news reports on the country’s response to drugs internally and externally was conducted between September and December 2017. Despite its efforts to oppose drug policy reform and the prioritisation of public health, the Russian Federation faces major epidemics of imprisonment and HIV. Internationally, while it has not been successful in addressing the ongoing reforms in Europe and the Americas, it has been effective in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm at the multilateral level.