Director General
Dr. Lee Jong-Wook
World Health Organization
CH-1211 Geneva 27, Suisse
Dear Dr. Lee:
We have recently learned that the thirty-fourth Expert Committee On Drug Dependence (ECDD), which will meet in Geneva on 28-31 March, has included on its agenda a “final decision” on the rescheduling of buprenorphine, a medication used for pain relief and for the treatment of opiate dependence. We understand that under consideration is whether to place buprenorphine under the stricter 1961 Single Convention on Narcotic Drugs.
We believe that the rescheduling of buprenorphine will have serious public health and human rights implications and that WHO has not allowed sufficient time for full consultation and for scientific scrutiny of this proposal.
We urge that consideration of buprenorphine be postponed for a later meeting of the ECDD.
In keeping with WHO guidelines, postponement would allow proper scrutiny of the scientific, public health and social issues raised. A decision by the committee without such a review would appear to violate the spirit and intent of WHO’s guidelines (Guidelines for the WHO Review of dependence-producing psychoactive substances for international control, WHO/EDM/QSM/2000.5).
At the request of the International Narcotics Control Board, buprenorphine was considered for rescheduling in 2002. At that time, the committee did not make a decision on rescheduling buprenorphine.
WHO guidelines note that the ECDD has to undertake a 'pre-review' and then a ‘critical review' as part of the process of considering a drug for scheduling. This does not appear to have happened ahead of the March 2006 meeting. The guidelines do not authorize holding data over from previous meetings. This is particularly important when significant new data become available. Further, in other instances where drugs have been considered for scheduling more than once, as with diazepam, critical data review has occurred in advance of each discussion.
This is far more than a technical issue. Buprenorphine is increasingly used world wide in the treatment of heroin dependence, especially in countries where medical prejudice or laws and regulations have restricted the availability of methadone. Further, buprenorphine has become an increasingly important component of HIV prevention and treatment efforts, used to reduce HIV risk and increase adherence to antiretroviral medications. In a time when contaminated injection equipment accounts for large numbers of HIV infections, and the largest share of infections in many countries of Asia and the former Soviet Union, the new reporting requirements and restrictions that will come with rescheduling may sharply decrease access to an effective measure to reduce risk of blood-borne illness.
We understand that some governments have objected to the short notice about the hearing. WHO Guidelines note that there also should be systematic collection of relevant information from non-governmental organizations. We are not aware that this has happened. The WHO website has no information about the agenda of the proposed meeting in March. We have not seen the data submitted to committee members that reflect current knowledge or practices. Communities and organizations impacted by the decision have not had the chance to comment. This is a marked and ironic contrast to the consultative process that WHO’s expert committee engaged in prior to addition of buprenorphine to WHO’s List of Essential Medicines in 2005.
We strongly urge you to share this letter with the chair and members of the WHO Executive Board when they meet from January 23-28, 2006 in Geneva.
Postponing discussion of buprenorphine to a later meeting of the ECDD will allow adequate public notice, scientific review of current data, and consultation with NGOs and others whose work will be affected by the ECDD recommendation. Any decision of the committee reached without due regard to openness, consultation and consideration of current data will be open to challenge. In the case of buprenorphine, a hasty decision to reschedule may also mean increased HIV infections, greatly limited access to opiate dependence and antiretroviral treatment, and more lives lost in violation of drug users’ fundamental rights to health and life.
Sincerely,
Prof. Gerry Stimson, Executive Director
International Harm Reduction Association
Daniel Wolfe, Deputy Director
International Harm Reduction Development Program
Open Society Institute
Mauro Guarinieri, Chair
Global Network of People Living with HIV and AIDS (GNP+)
Raminta Stuikyte, Executive Director
Central and Eastern European Harm Reduction Network
Joanne Csete, Executive Director
Canadian HIV/AIDS Legal Network
Joseph Amon, Director
HIV/AIDS, Human Rights Watch
Ton Smits, MPH, Executive Director
Asian Harm Reduction Network (AHRN)
Gregg Gonsalves, Director
Treatment and Prevention Advocacy, Gay Men’s Health Crisis
Nikos Dedes, Chair
European AIDS Treatment Group
cc: Mr. Antonio Maria Costa, Executive Director, UNODC
Dr. Hamid Ghodse, President, International Narcotics Control Board
Dr. Peter Piot, Executive Director, UNAIDS
International (continued)
Icro Maremmani, Marc Reisinger, Allesandro Tagliamonte, Directors
European Opiate Addiction Treatment Association
Asia Russell, Director International Policy
Health GAP (Global Access Project)
Craig McClure, Executive Director
International AIDS Society
Marco Perduca, Executive Director
International Antiprohibitionist League
Kieran Daly and Sumita Banerjee
International Council of AIDS Service Organizations
Maurizio Coletti, President
Itaca Europe, European Association
of Professionals working in the Drug Field
Kathleen M. Foley, M.D., Medical Director
International Palliative Care Initiative
Open Society Institute
Sergio Stanzani, President
Transnational Radical Party
Mark Harrington, Executive Director
Treatment Action Group
AFRICA
Zackie Achmat, Chairperson
Treatment Action Campaign (TAC)
SOUTH AFRICA
Henry Ddungu, Advocacy Manager
African Palliative Care Association
Kampala, UGANDA
MIDDLE EAST
Parviz Afshar, M.D., MPH, Director General
Health office of Iran Prisons Organization
IRAN
Kamiar Alaei, M.D., MPH
Pars Curative Research Institute for HIV/IDU/STD Prevention & Care
Kermanshah, IRAN
Bijan Nassirimanesh, Director
Persepolis NGO
Teheran, IRAN
Gideon Hirsch, M.D., Executive Director
Israel Aids Task Force
Tel Aviv, ISRAEL
EUROPE AND CENTRAL ASIA
Rezarta Meneri, Director
Association for Prevention and Rehabilitation from AIDS and Drugs
Tirana, ALBANIA
Leyla Imanova, Public Health Coordinator
Open Society Institute – Assistance Foundation Azerbaijan
Baku, AZERBAIJAN
Stijn Goossens, Co-founder and Spokesman
Breakline Peer Support and Steunpunt Antwerpse Druggebruikers
Antwerp, BELGIUM
Martine Hutsebaut
Debed VZW
Brussels, BELGIUM
Ante Ivančić M.D.
Istarski Domovi Zdravlja
Zagreb, CROATIA
Tomas Zabransky, M.D., Ph.D.
Center for Addictology
Charles University, 1st Medical Faculty, Psychiatric Clinic
Prague, CZECH REPUBLIC
Richter Jiri, Manager
Association of NGOs working in the field of drugs
Prague, CZECH REPUBLIC
Julia Vinckler, Member of the Board
NGO Convictus Eesti
Tallinn, ESTONIA
Emmanuel Trenado, Director
International Programmes
AIDES
France
Fabrice Olivet, Director
Auto Support des Usagers de Drogues
FRANCE
Mario Sanchez, Chef de Service
Clinique Montevideo
Institut Baron Maurice de Rothschild
Boulogne Billancourt, FRANCE
Patrick J. Aeberhard M.D.
Centre Cardiologique du Nord,
Saint-Denis, FRANCE
Dr. Beatrice Stambul
Medecins du Monde
Association Française de Réduction des Risques
Paris, FRANCE
Jean Marie Guffens
La Société Européenne Toxicomanies, Hépatites, Sida (SETHS)
Saint Tropez, FRANCE
Dali Usharidze
Center of Psychosocial Information and Counseling “New Way”
Tbilisi, GEORGIA
David Otiashvili, Director
Union Alternative Georgia
Tbilisi, GEORGIA
Peter Wiessner
AIDS Hilfe
Berlin, GERMANY
Hans-Guenter Meyer-Thompson, Editor
Association for Addiction Medicine
Hamburg, GERMANY
Karl Mann, M.D., Professor and Chairman
Dept. of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health University of Heidelberg
Heidelberg, GERMANY
Ilona Veres
Drug-prevention Foundation
HUNGARY
Balázs Dénes, Executive Director
Hungarian Civil Liberties Union
Budapest, HUNGARY
Icro Maremmani, President
Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS)
PietraSanta, ITALY
Amedea Lo Russo, President
Itaca Italia--Associazione Europea degli Operatori Professionali delle Tossicodipendenze
ITALY
Alessandra Cerioli, Coordinator
Italian Community Advisory Board
Bologna, ITALY
Stefano Carboni, Director
Harm Reduction Program
Italian League for Fighting HIV/AIDS
Turin, ITALY
Batma Estebesova, President
Harm Reduction Association of Kyrgyzstan
Bishkek, KYRGYZSTAN
Aisuluu Bolotbaeva, Public Health Programs Coordinator
Soros Foundation Kyrgyzstan
Bishkek, KYRGYZSTAN
Melis Musabaev, Director
NGO "Alive Water"
KYRGYZSTAN
Dmitry Usenko, President
Youth Legal Assistance Foundation
Soculuc, KYRGYZSTAN
Agne Marudinaite, Director of Administration
Coalition "I Can Live"
Vilnius, LITHUANIA
Darko Kostovski, Chairman of the Steering Committee
Macedonian Harm Reduction Network
MACEDONIA
Vlatko Dekov, Executive Director
NGO Healthy Options Project Skopje
Skopje, MACEDONIA
Zoran Poposki, Chairman of the Steering Committee
NGO HELP
Gostivar, MACEDONIA
Zarir Simrin, Executive Director
NGO Passage - Association for Protection of Drug User's Rights
Skopje, MACEDONIA
Keti Todorova, Chairman of the General Assembly
NGO TRUST
MACEDONIA
Petar Angelov, Manager
NGO ZONA
Kavadarci, MACEDONIA
Mr Marek Zygadlo, General Secretary
Krakow Association for Drug Users Support
Krakow, POLAND
Filomena Frazão de Aguiar, President,
Fundação Portuguesa "A Comunidade Contra a Sida"
Lisbon, PORTUGAL
Luis Mendão
Soma-APA NGO on Drug Policy Reform
PORTUGAL
Dr. Maria Georgescu, Executive Director
ARAS – Romanian Association Against AIDS
Constanta, ROMANIA
Yury Ivanov, Coordinator of Harm Reduction
AIDS Center
Tver, RUSSIA
Alena Peryshkina, Executive Director
AIDS Infoshare,
Moscow, RUSSIA
Sergey Oleinik
AntiSPID
Pskov, RUSSIA
Alexander Volgin
FrontAIDS
Moscow, RUSSIA
Sergey Koren
Kolodets Charity Foundation
Moscow, RUSSIA
Vyacheslav Tsunik
Kovcheg - AntiSPID
Rostov-on-Don, RUSSIA
Vladimir Mendelevich, Professor
Psychiatric Health Institute
Kazan, RUSSIA
Elena Belyaeva
Right to Life
RUSSIA
Vitaly Djuma, Executive Director
Russian Harm Reduction Network
Moscow, RUSSIA
Mikhail Kholmanskih
SVECHA PLWHA
St Petersburg, RUSSIA
Katarina Jiresova
Civic Association ODYSEUS
Bratislava, SLOVAK REPUBLIC
Andrej Kastelic, President
South Eastern European Adriatic Addiction Treatment Network
Coordination of Centers for the Prevention and Treatment of Drug
Addiction, Ministry of Health,
SLOVENIA
Joan Tallada, Executive Director
Grupo de Trabajo sobre Tratamientos del VIH (gTt)
Barcelona, SPAIN
Marta Torrens M.D., PhD
Hospital del Mar
Barcelona, SPAIN
Murtazokul Khidirov
Harm Reduction Association of Tajikistan
Dushanbe, TAJIKISTAN
Jean-Paul C. Grund, PhD, Senior Researcher
Centrum voor Verslavingsonderzoek
Utrecht, THE NETHERLANDS
Eberhard Schatz
Correlation Network
Amsterdam, THE NETHERLANDS
Oleg Voinarenko
“Awake” Substitution treatment clients group
Kherson, UKRAINE
S. Martynyuk-Gres
Ukrainian Association of Health Professionals
Kyiv, UKRAINE
Victor Serdyuk
Ukrainian Council on Protection of Clients Rights and Safety
Kyiv, UKRAINE
Olena Sichkar, Executive Director
Ukrainian Harm Reduction Association
Kyiv, UKRAINE
Andriy Klepikov, Executive Director
International HIV/AIDS Alliance in Ukraine
Kyiv, UKRAINE
Valeriy Pakhomov, Chairman of Board
Odessa Regional Charity Foundation "Future Without AIDS"
Odessa, UKRAINE
Leonid Vlasenko, President
Virtus Charity Foundation
Dnepropetrovsk, UKRAINE
Nataliya Kitsenko
"The Way Home" Charity Fund
Odessa, UKRAINE
Steve Rossell, Chief Executive
Cranstoun Drug Services
Surrey, UNITED KINGDOM
Astrid Honeyman, CEO
Diana, Princess of Wales Memorial Fund
London, UNITED KINGDOM
James Watkin
London Harm Reduction Coalition
London, UNITED KINGDOM
Polly Clayden
HIV i-Base London
London, UNITED KINGDOM
Dr. Carmen Aceijas, PhD, Research Associate
Centre for Research on Drugs and Health Behaviour
Department of Primary Care & Social Medicine
Imperial College
London, UNITED KINGDOM
Carmen Tarrades, Coordinator, Silent Voices Project
International Community of Women Living with HIV/AIDS
Londong, UNITED KINGDOM
Andria Efthimiou-Mordaunt, Director
John Mordaunt Trust
UNITED KINGDOM
Rick Lines, Executive Director
Irish Penal Reform Trust
Dublin, UNITED KINGDOM
Ian Harris
REFORM
Essex, UNITED KINGDOM
Sebastian Saville, Director
Release
London, UNITED KINGDOM
Kazim Khan
T3E
UNITED KINGDOM
Bill Nelles
The Alliance
UNITED KINGDOM
Danny Kushlick, Director
Transform Drug Policy Foundation
Bristol, UNITED KINGDOM
Neil Hunt, Director
United Kingdom Harm Reduction Alliance
UNITED KINGDOM
Andrey Shiryaev, Director
AIDS.Uz
UZBEKISTAN
ASIA/PACIFIC
Annie Madden, Executive Officer
Australian Injecting & Illicit Drug Users League
Canberra, AUSTRALIA
Professor Robert Power, Director
Centre for Harm Reduction
Burnet Institute for Medical Research and Public Health
Melbourne, AUSTRALIA
Anne Marmion
The Cyrene Centre and Community Liaison Coordinator
Mary of the Cross Centre--A service of Centacare Catholic Family Services
Melbourne, AUSTRALIA
Professor Nick Crofts, Director
Turning Point Alcohol and Drug Centre
Melbourne, AUSTRALIA
Damon Brogan, Manager
VIVAIDS Inc -- The Victorian Drug User Organisation
AUSTRALIA
EAST ASIA
Wan Yanhai
AIZHIXING Institute of Health Education
Bejing, CHINA
SOUTH ASIA
Dr. Suresh Kumar
Institute of Palliative Medicine
Calicut—Kerala, INDIA
R.K.Raju, General Secretary
North East India Harm Reduction Network
Manipur State, INDIA
Luke Samson, Executive Director
Sharan, Society for Serving the Urban Poor
New Delhi, INDIA
Dr. Dhruba Man Shrestha M.D., Chairman
Mental Hospital
Lagankhel Lalitpur, NEPAL
SOUTHEAST ASIA
Professor Adeeba Kamarulzaman, President
Malaysian AIDS Council
MALAYSIA
Paisan Suwannawong, Executive Director
Thai AIDS Treatment Action Group (TTAG)
THAILAND
Seree Jintakanon, Chairman
Thai Drug Users' Network (TDN)
THAILAND
LATIN AMERICA
Pablo Cymerman, Director of Advocacy Department
Intercambios Civil Association
Buenos Aires, ARGENTINA
Violeta Ross
Bolivian Network of HIV+
BOLIVIA
Anna Azevedo Simoes, M.D., PhD, Director
Center for Treatment and Rehabilitation of Addicts- CENTRA-RIO/SES
Health Department of the Government
Rio de Janeiro State, BRAZIL
Monica Gorgulho
Dínamo - Informação Responsável sobre Drogas e Afins
BRAZIL
Md. Guillermo A. Castaño P.
Fundacion Universitaria Luis Amigo
Medellín, COLOMBIA
Agustin Lapetina, Director
NGO "El Abrojo"
Montevideo, URUGUAY
NORTH AMERICA
Diane Riley, PhD
Canadian Foundation for Drug Policy
Ottowa, CANADA
Walter Cavalieri, Executive Director
Canadian Harm Reduction Network
Toronto, CANADA
Evan Collins
Hassle Free Clinic
Toronto, CANADA
Michael O'Connor, Executive Director
Interagency Coalition on AIDS and Development
Ottawa, CANADA
LaVerne Monette, Executive Director
Ontario Aboriginal HIV/AIDS Strategy
Toronto, CANADA
Sarah Lippek
AIDS Center of Queens County
Rego Park, NY USA
Jim Pickett, Director,Public Policy
AIDS Foundation of Chicago
Chicago, IL USA
Judith Auerbach, Ph.D., Vice President
Public Policy and Program Development
American Foundation for AIDS Research (amfAR)
Washington, DC USA
Paul Bowman CMA
Boston Addiction Action Center
Boston, MA USA
Robert Newman M.D., Director
Baron Edmond de Rothschild Chemical Dependency Institute
New York, NY USA
Dan Bigg, Director
Chicago Recovery Alliance
Chicago, IL USA
Daliah Heller, Executive Director
CitiWide Harm Reduction
Bronx, NY USA
Jay Dobkin, M.D., Director
Columbia University Medical Center AIDS Program
New York, NY USA
Julie Davids, Executive Director
Community HIV/AIDS Mobilization Project
New York, NY USA
Ethan Nadelmann, Executive Director
Drug Policy Alliance
New York, NY USA
George M. Carter, Director
Foundation for Integrative AIDS Research
Brooklyn, NY USA
Allan Clear, Executive Director
Harm Reduction Coalition
New York,NY USA
Luciano Colonna, Executive Director
Harm Reduction Project
Denver, CO USA
Mike Bunyard
HIV and Hepatitis C Prevention Programs, HIV Resource Center
Roseburg, OR USA
Steve Wakefield, Community Working Group
HIV Prevention Trials Network
Seattle, WA USA
Sharon Dembinski, MS, RNP, CMA, Program Coordinator
Kent Hospital Mothers On Methadone Program
Warwick, RI USA
Ernest Drucker, PhD, Professor of Epidemiology and Social Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx NY, USA
Julie Scofield, Executive Director
National Alliance of State and Territorial AIDS Directors
Washington, DC USA
Joycelyn Woods
National Alliance of Methadone Advocates (NAMA)
New York, NY USA
Stephanie Vazquez, Co-Director
NAMA New York Chapter
New York, NY USA
James M. Oleske, M.D., MPH
François-Xavier Bagnoud Professor of Pediatrics
Department of Pediatrics, New Jersey Medical School
Newark, NJ USA
Jennifer Flynn, Executive Director
New York City AIDS Housing Network
New York, NY USA
Ericka R Lear, Director
PANAMA
Hollidaysburg, PA USA
Paul Feldman, Director of Policy and Advocacy
National Association of People with AIDS Silver Spring, MD USA
Carmen Arlt
Porter- Starke Services, Inc.
Chemical Dependency and Addictions
Valparaiso, IN USA
Jason Farrell, Executive Director
Positive Health Project, Inc.
New York, NY USA
Paola Barahona, Executive Director
PreventionWorks
Washington, DC USA
Bill Wendt JD, CAC III, Chief Executive Officer
Signal Behavioral Health Network
Denver, CO USA
Renee Cox, Executive Director
Prevention Point Pittsburgh
Pittsburgh, PA USA
Barbara M. Finger, Director
Texas National Alliance of Methadone Advocates (TexNAMA)
San Antonio, TX USA
Josiah D. Rich, M.D., MPH, Director
Center for Prisoner Health and Human Rights
The Miriam Hospital
Providence, RI USA
Jeremiah A. Barondess, M.D., President
The New York Academy of Medicine
New York, NY USA
Tom Brewster, Executive Director
Addiction Research and Treatment Services
University of Colorado School of Medicine
Boulder, CO USA
Ricci Joy Levy, Executive Director
The Woodhull Freedom Foundation
Washington, DC USA
Frederick L. Altice, M.D.
Yale University School of Medicine
New Haven, CT USA
R. Douglas Bruce, M.D., MA
Yale University School of Medicine, Yale AIDS Program
New Haven, CT USA
Gerald Friedland, M.D.
Yale University School of Medicine
New Haven, CT, USA
