INTERCOUNTRY GROUP MEETING ON THE DEVELOPMENT
OF THE MENTAL HEALTH PROGRAMME
A m ~ a n , 2 4 - 28 September 1983 1 4 September 1983
WHO'S KESPONSE I'O INIb:RNI\T~ZIUA~ UKC'C Ci:NTROL TREATIEC
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IfiiO's responsibilities within the area of mediraments.
I will give now a brief review of the World Health Organization's responsibilities within the area of drugs. Article 2 of the WHO Constitution deals with the functions of the Organization in general terms as follows:-
"(a) to act as the directing and co-ordinating authority on international health work; ............
(u) to develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products"
The wording of Articles 21 and 22 of the WHO Constitution are also of great interest. They read as follows:
"Article 21 - The Health Assembly shall have authority to adopt regulations concerning:
............ (d) standards with respect to the safety, purity and potency of
biological, pharmaceutical and similar products moving in international commerce;
(e) advertising and labelling of biological, pharmaceutical and similar products moving in international commerce".
"Article 22 - Regulations adopted pursuant to Article 21 shall come into force for all Members after due notice has been given of their adoption by the Health Asseclbly except for such Members as may notify the Director-General of rejection or reservations within in period stated in the notice".
Thus the 1,Torld Health Assembly has the powers to adopt international drug regulations. Some of the technical activities of WHO in this area are good practices in the manufacture and quality control of drugs, international standards and requirements of biological substances, international specifications for drugs, guidelines for the testing and evaluation of drugs, international monitoring of adverse reactions to drugs, selection of essential drugs, dissemination of drug information through the drug information circulars to all Member States and through the drug information bulletin published quarterly.
The responsibilities of the World Health Organization in the field of drug abuse and dependence according to the numerous resolutions of the World Health Assembly and the interna~ional drug control treaties are:-
(i) to collaboratc with couiitries in planning, managing and evaluating programmes concerned x~ith the identification and magnitude of th(! problem, prevention of drug dependence. treatmetit and rc11;ihil i tatiou of those affected;
(ii) to collnbornte with countries in the training of health, soci,~l welfare, i d l ~ c ; ~ t i o n and ottier professions, involved 1 1 tile m a ~ l < , g ~ r n i . n t of d!-.lo dependence;
( i i i ) t o s t i m u l a t e , c o o r d i n a t e and promote r e s e a r c h r e q u i r e d f o r more e f f e c t i v e programmes;
( i v ) t o recommend t o t h e U n i t e d N a t i o n s Commission o n N a r c o t i c Drugs whe the r a s u b s t a n c e s h o u l d b e c o n t r o l l e d n a t i o n a l l y o r i n t e r n a t i o n a l l y and t h e l e v e l o f such c o n t r o l , based on t h e b e n e f i t and r i s k r a t i o ;
(v) t o g i v e a d v i c e i n t h e p l a n n i n g and i m p l e m e n t a t i o n of d r u g dependence programmes sponsored by U N a g e n c i e s and o t h e r i n t e r g o v e r n m e n t a l and non-governmental o r g a n i z a t i o n s .
3: The r e s p o n s i b i l i t i e s a s s i g n e d t o WHO under t h e v a r i o u s i n t e r n a t i o n a l d r u g c o n t r o l t r e a t i e s a r e among t h e o l d e s t a c t i v i t i e s t h e O r g a n i z a t i o n i n h e r i t e d a t t h e t ime o f i t s i n c e p t i o n . The lJorld H e a l t h O r g a n i z a t i o n s h a l l a d v i s e t h e Secre ta ry -Genera l of t h e UN a s t o t h e need f o r c o n t r o l o f n a r c o t i c and p s y c h o t r o p i c s u b s t a n c e s on t h e b a s i s o f t h e i r dependence l i a b i l i t y , and t h e c a u s i n g of a s s o c i a t e d p u b l i c h e a l t h and s o c i a l problems. A t t h e UN Commission on N a r c o t i c s , when t h e d e c i s i o n s a r e t a k e n t o c o n t r o l t h e s e s u b s t a n c e s , WO i s t h e main a d v i s o r y body a s f a r a s t h e m e d i c a l and p h a r m a c e u t i c a l a s p e c t s a r e concerned . During t h e p a s t s i x y e a r s , s i n c e t h e 1 9 7 1 Convent ion came i n t o f o r c e i n August 1976, W H O ' S D i r e c t o r - G e n e r a l h a s forwarded 45 n o t i f i c a t i o n s t o t h e t h e S e c r e t a r y - G e n e r a l o f t h e U N , 3 8 o f which r e l a t e d t o p s y c h o t r o p i c s u b s t a n c e s .
WHO carries o u t i t s f u n c t i o n s th rough v a r i o u s mechanisms. 2 2 e x p e r t commit tees have been convened, and seven rev iew mee t ings h e l d , t o r e v i e w p s y c h o a c t i v e s u b s t a n c e s , p r i n c i p a l l y p s y c h o t r o p i c d r u g s . WHO'S m a j o r e f f o r t s a r e r e l a t e d t o t h e development of methodology. L a t e l y t h e T e c h n i c a l Repor t S e r i e s no. 618 i s devo ted t o psychopharmacological methods,and no. 656 t o methods t o a s s e s s p u b l i c h e a l t h and s o c i a l problems. P u b l i c a t i o n by t h e F i n n i s h a u t h o r i t i e s , " P u b l i c H e a l t h Problems and P s y c h o t r o p i c Subs tances" by H e i k k i l a and Khan (1982) p r o v i d e s methods t o b e used i n many d e v e l o p i n g c o u n t r i e s where p s y c h o t r o p i c d r u g s a r e u s e d a b u n d a n t l y and a r e c a p a b l e o f c a u s i n g p u b l i c and s o c i a l problems. A document, "Drugs, d r i v i n g and t r a f f i c s a f e t y " , i s under p u b l i c a t i o n . T h i s i s b a s e d o n t h e p roceed ings of a mee t ing h e l d i n Washington DC by WHO and t h e US N a t i o n a l I n s t i t u t e s on Drug Ahuse i n 1981.
A c t i o n by WHO t o r e v i e w a s u b s t a n c e i s e i t h e r i n i t i a t e d by a p a r t y t o a conven t ion o r by 1Tt10 i t s e l f . WHO s e e k s t h e c o o p e r a t i o n of i t s Member S t a t e s t o p r o v i d e d a t a on t h e a b u s e l i a b i l i t y and t h e a c t u a l a b u s e o f a s u b s t a n c e o r , i n v a r i a b l y , a group of s u b s t a n c e s , a s w e l l a s t h e a s s o c i a t e d p u b l i c h e a l t h and s o c i a l problems. The c o o p e r a t i o n o f tire Uni ted Na t ions D i v i s i o n of X a r c o t i c Drugs, I n t e r p o l and t h e LqHO r e g i o n a l o f f i c e s h a s been s o u g h t . There i s s t i l l g r e a t scope f o r i m p r o v i n ~ t h i s t y p e of c o o p e r a t i o n by c o u n t r i e s w i t h IZRO. A f t e r t h e r e v i e w , a recomrnen- d a t i o n i s made t o t h e D i r e c t o r - G e n e r a l of WHO, who t h e n s e n d s a n o ~ i f i c a t i o n t o t h e S e c r e t a r y - C r n p r a l of tire Uni ted N a t i o n s . The U N Commissiorl on N a r c o t i c Drugs r ~ h i c t ~ i n v a r i a b l y ilieets i n Vienna e v e r y y e a r , d i s c u s s e s ii?lO1s recc~mnendnt ions , arxrl d e c i d e s b y a v o t e . For n a r c o t i c d r u g s a s i m p l c m a j o r i t y i s i ~ c e d e d . F o r 3 P ~ y ~ h o t r ~ P i c ( I I - u ~ a two-thi rd m a j u r i r y o f t h e
t o t a l membership o f t h e UN Commission o n N a r c o t i c Drugs i s r e r l ~ i i r e d f o r IJHO's recommendat ion t o b e a c c e p t e d . 'The mcclin~iis ir~ u!:e,l by \dl10 t o r e v i e w s u b s t a n c e s f o r i n t e r n a t i o n a l c o n t r o l i s t o be i l i s c u s s e d a t t h e forthcornin:: m e e t i n g o f t h e I.nI0 E x e c u t i v e Bo.ird i n J a n u a r y 1'384.
4 . LVIO g u i d e l i n e s i n t h e c o n t e x t of i n t e r n a t i o n a l d r u g c o n t r o l t r e a t y o b l i g a t i o n s a r e : -
t h e T h i r t y - t h i r d World H e a l t h Assembly, 1980 , a f t e r h a v i n g r ev iewed 1W0 work i n p r o g r e s s , a d o p t e d r e s o l u t i o n IJliA33.27 o n "Ac t ion i n r e s p e c t o f i n t e r n a t i o n a l c o n v e n t i o n s on n a r c o t i c and p s y c h o t r o p i c s u b s t a n c e s : Abuse o f n a r c o t i c and p s y c h o t r o p i c s n h s t n u c e s " . 111 t h a t r e s o l u t i o n , a f t e r acii- nowledg ing t h e r o l e and r e s p o n s i b i l i t i e s of TJIlO i n r e l a t i o n t o t h e a b u s e o f n a r c o t i c and p s y c h o t r o p i c s u b s t a n c e s , and h a v i n g n o t e d t h e r e q u e s t o f t h e U n i t e d N a t i o n s G e n e r a l Assembly i n r e s o l u t i o n 321124 (1977) t h a t , i n t h e e f f o r t t o r e d u c e d r u g a b u s e , WHO and o t h e r a p p r o p r i a t e a g e n c i e s and b o d i e s of t h e U n i t e d N a t i o n s d e s i g n mode l s f o r ' p r e v e n t i o n , t r e a t m e n t and r e h a b i l i - t a t i o n , a f f i r m e d t h a t d r u g a b u s e c o n s t i t u t e s a s e r i o u s h e a l t h h a z a r d o f s t e a d i l y g rowing p r o p o r t i o n s i n d e v e l o p i n g n a t i o n s a s w e l l a s i n d u s t r i a l i z e d c o u n t r i e s . The Assembly i n v i t e d Member S t a t e s , a s t h e y d e v e l o p e d t h e i r n a t i o n a l s t r a t e g i e s f o r " H e a l t h f o r a l l by t h e Year 2000". t o g i v e s e r i o u s c o n s i d e r a t i o n t o t h e i n c l u s i o n of components t h a t c a n d e a l e f f e c t i v e l y w i t h t h e g rowing i n c i d e n c e o f d r u g a b u s e . I t went on t o u r g e then1 t o d e v o t e more a t t e n t i o n t o t h e i n c i d e n c e o f d r u g a b u s e i n t h e i r own s o c i e t i e s , t h e i r r e g i o n s , and t h e w o r l d community, and p a r t i c u l a r l y t-o t h e d i s r u p t i v e e f f e c t t h a t d r u g a b u s e h a s o n t h e l i v e s and f u t u r e c a r e e r s o f young p e o p l e . The Assembly drew a t t e n t i o n t o t h e n e g a t i v e e f f e c t o f d n ~ g a b u s e on soc ioecoi lorn ic w e l l - b e i n g , t o t h e i n c r e a s i n g d i f f i c u l t i e s i n e n f o r c i n g l a w , and t o t h e need f o r m e a s u r e s aimed a t r e d u c i n g t h e demand f o r and i l l i c i t s u p p l y of d r u g s o f a b u s e i n t h e i r s o c i e t i e s .
I n i t s o p e r a t i v e paragrap11 7 ( 3 ) t h e World H e a l t h Assembly r e s o l u t i o n r e q u e s t s t h e ~ i r e c t o r - ~ ' e n e r a l " t o promote tlle i n i t i a t i o n and s t r e n g t h e n i n g o f n ia t io i ia l and i n t e i - n a t i o n a l proyramines f o r t i le assessment, s c l i e d ~ i l i n - , c o n t r o l and a p p r o p r i a t e u s e o f n a r c o t i c and p s y c h o t r o p i c s u b s t a n c e s , i n c l u d i n g t h o s e of p l a n t o r i g i n , and t o s u p p o r t suc11 programmes by t l i e deve lopmen t o f a p p r o p r i a t e g u i d e l i n e s i n c o n s 1 , l t n t i o n w i t h t l ie ilh' D i v i s i o n of N a r c o t i c D r ~ . ~ g s , T n t c r n n t i o n n l K ; i r c o i i c s Cnl l t ro l Iionrd and o t h e r UN o r g a n s conce rned" .
IJHO, w i t h t h e f i n a n c i a l srrlipnrt of g r n n l : ~ From tlrc N e t l i e r l n n d s and IIXFDAC ( U n i t e d N:itiinns Funcl r I t C ) c n r r i c d o~ l f - a s t u < l ) ~ i n s e v e n c l l u n t r i ~ s , inc l l ld in ; ; (:iiiiia, i>f Llic actr131 s i t u a t i o n i n t l ) n s e colll!tl-ies I3ased on tliis i11furi::it ion niid ullit-r ! ; i i ~ i i I n i . i n f < > ~ - ~ : ~ n t i c > n , i : o o p c . r ; l t i n > ; w i c l i a l a r g e number o f b o d i e s , i n s t - i t u t i o n s and p e r s o n s , d i i t a i s heiii: conrpi l i i~l i n a p u b l i c a t i o n which w i l l b e r eady by tire end o f t h e y e a r i n E n g l i s h , and l a t e r i n F rench and Sp;lnisl i . 'Tliese g ~ i i d e l i i i e s w i l l , we l lope, b c u s e f u l t o t h e c o u u t l - i e s Whicll arc, 111 ;lnnin: t o r ; l t i . f y n trl!aLy, fn l - ex3nlple C h i n a , t o t h o s e who wi sh t o f i l l i n c e r t a i i ~ gaps i n t l i c ! i r n a t i o n a l r e s p o i i s e s t o a treat), t h e y h a v r a l r e ; i d y I - ; i t i f i i . d , and a l ~ o v e a11 t h e g u i r l e l i r i e s do c o v e r t h e w i d ~ r s u b j e c t o f I t i s ( : p: ;yc t lonct ive su l>s l a r i cc s
, , "f, . , c ; . , r !47 ., I p t i . c u l a r , d I i : 1 J I ; : 1. ".--. Rexed of Sweden, Dr Edmundsoii i > i i \ t ~ s t ~ - a l i n aurl :Ir S i m ~ ~ s o ~ i o i l i o ~ l l i n d c o l l a b o r a t e d wl io le- l iear ted ly w i r h t h e WHO S e c r e l i l r i n t i n im!1lemcnti1ig t h i s p r o j e c t .
5. The role of physicians and pharmacists in rational therapy with psychoactive substances.
It has been mentioned repeatedly, both at national and international forums, that doctors' prescribing habits are a major factor in facilitating the rational use of psychoactive drugs with dependence liability. The WHO Executive Board felt concerned, and in resolution EB69R.9 (January 1982), requested the Director-General of WHO in paragraph 1(5), "to intensify efforts aimed at improving prescription, delivery and utilization practices regarding psychoactive drugs, through educational programmes for physicians and other health workers, and other measures, seeking the cooperation of medical educational institutions, medical associations, the pharmaceutical industry and others in this endeavour". lJHO has already started to take action in this field. It has organized two meetings, one in London in 1980 and another in the Philippines in 1982, and will hold three other meetings this year. These meetings will bring together various members of the medical, pharmaceutical and dental professions. They will discuss the various components of the subject, and will try to find ways and means of facilitating the rational use of these drugs.