How valid is the united nations world drug report?

The World Drug Report is an annual publication of the United Nations Office on Drugs and Crime that analyzes the global drug market and its societal impact (1). The third booklet of the 2022 report, titled “Drug Market Trends of Cannabis and Opioids,” is the only section that addresses medical cannabis (2).

The booklet begins with the phrase “Drugs can kill,” which could be seen as a bit of a bias. Such a generalizing statement could be replaced with similarly worded ones, such as “horse riding can kill” (in fact, a renowned neuroscientist was ostracized by his colleagues for publishing a paper that the annual death rate from horse riding was higher than that caused by MDMA) (3). However, one certainly has to take a more nuanced view of this report. Especially if one takes a look at the USA, where there is a considerable dependence problem for opioids, after US-American physicians prescribed the substance oxycodone for a long time, in considerable quantities and then still very uncritically. This unspeakable prescribing behavior (which would never have been possible in Germany) has led in the USA to patients being almost deliberately made dependent. When no more prescriptions followed, they switched to other highly potent narcotics such as cocaine and heroin to satisfy their addiction and dependence. The drug, iatrogenically induced, tragically became the gateway drug to illicit drug use.

Among the examples of bias in the UN report is a study cited in Figures 15 and 16 of the 3rd Booklet. In this study, the authors analyzed cannabis-related hospitalizations in Germany. However, the study has several shortcomings. First, only the absolute and not the relative number of cannabis-related hospitalizations was counted. This does not take into account changes in the population as well as changes in the prevalence of cannabis use. It should also be noted that these figures represent hospitalizations only according to the data source used here (DESTATIS, German Federal Statistical Office), each new admission is a new case. However, the same patient may have been admitted more than once within a year, which makes the case number appear increased, even though it is ultimately the same case with a readmission. The authors also point to changes in German insurance law in psychiatry that provide incentives to shorten the length of stay in hospitals and thus unintentionally lead to more hospitalizations. Namely, patients may subsequently be readmitted, which then presents as a perceived increase in hospitalizations, although the reason was ultimately a too-rapid discharge with a flare-up of symptomatology. In addition, the study found that the number of hospitalizations for all conditions increased during the observation period, which was not accounted for in the analyses in the study. The study authors conclude that the increase in hospitalizations may be due to the legalization of medical cannabis, without substantiating this (4). However, this is a mere assumption, which was then also adopted by the authors of the UN report (2).

After spending a full page explaining the caveats in assessing the impact of cannabis legalization, the authors of the UN report continue with statements that may seem factually correct, but for which the evidence is sometimes very weak or inconclusive. The UN report does not emphasize the need for a neutral point of view and instead uses weak evidence to make all-encompassing statements. This is evident in the table on pages 31 to 33, which summarizes the impacts of cannabis legalization. (2)

The World Drug Report has often been criticized. First, the World Drug Report relies primarily on data submitted by member states through questionnaires to analyze the illicit drug market. In a book on the politics of crime statistics, Peter Andreas and Kelly M. Greenhill note that there are incentives for UN member states to inflate their drug crime figures, for example, to show that their drug control policies are effective.(5) The UN report has also been criticized by Amnesty International for failing to mention the devastating impact of drug policies on human rights, as well as police brutality, mass incarceration, and the death penalty. (6, 7)

All in all, the World Drug Report should be viewed as a report on the global illicit drug market that may contain unreliable data and presents the data in a way that serves a particular point of view, but not as a scientific report on cannabis and its pharmacology. Therefore, this UN report should also not be used by the media to criticize or downplay the immense benefits of legalizing medical cannabis in Germany.

1. United Nations Office on Drugs and Crime. World Drug Report 2022: Booklet 1 [Internet]. 2022. Available from: https://www.unodc.org/unodc/en/data-and-analysis/wdr-2022_booklet-1.html
2. United Nations Office on Drugs and Crime. World Drug Report 2022: Booklet 3 [Internet]. 2022. Available from: https://www.unodc.org/unodc/en/data-and-analysis/wdr-2022_booklet-3.html
3. Perkins A. Ecstasy v “equasy.” The Guardian [Internet]. 2009 Feb 11 [cited 2022 Aug 8]; Available from: https://www.theguardian.com/commentisfree/2009/feb/11/drugs-alcohol-drugs-policy
4. Gahr M, Ziller J, Keller F, Muche R, Preuss UW, Schönfeldt-Lecuona C. Incidence of inpatient cases with mental disorders due to use of cannabinoids in Germany: a nationwide evaluation. Eur J Public Health. 2022 Apr 1;32(2):239-45.
5. Andreas P, Greenhill KM, editors. Sex, Drugs, and Body Counts: The Politics of Numbers in Global Crime and Conflict. Illustrated edition. Ithaca, N.Y: Cornell University Press; 2010. 304 p.
6. UN World Drug Report: four key takeaways [Internet]. Transform. [cited 2022 Jul 6]. Available from: https://transformdrugs.org/blog/un-world-drug-report-four-key-takeaways
7. Iran: Addicted to death: Executions for drugs offences in Iran [Internet]. Amnesty International. [cited 2022 Jul 6]. Available from: https://www.amnesty.org/en/documents/mde13/090/2011/en/

Based on materials provided by krautinvest.de