International Health Policy

The 1925 Brussels Pharmacopoeia Agreement and Geneva Opium Convention were foundational in shaping international pharmaceutical regulation. The former sought to standardise potent medicines, while the latter established controls over psychoactive substances. Despite differing objectives, both treaties influenced global pharmaceutical governance, contributing to modern regulatory frameworks and standards such as those of WHO or the European Pharmacopoeia. A century later, the year 2025 is witness to turbulent shifts in geopolitics and global health governance, but also revived contemporary debates on drug policy and traditional medicines. This letter revisits the seldom-documented history and impact of international pharmacy law, highlighting the relevance of these two pioneering treaties to evolving pharmaceutical governance and international health law.

Background – ‘‘Cannabis’’ and ‘‘cannabis resin’’ are derived from the Cannabis plant, used as herbal medications, in traditional medicine and as active pharmaceutical ingredients. Since 1961, they have been listed in Schedule IV, the most restrictive category of the single convention on narcotic drugs. The process to scientifically review and reschedule them was launched by the World Health Organisation (WHO) on 2 December 2016; it survived a number of hindrances until finally being submitted to a delayed and sui generis vote by the UN Commission on Narcotic Drugs on 2 December 2020, withdrawing ‘‘cannabis’’ and ‘‘cannabis resin’’ from Schedule IV.

Design/methodology/approach – To evaluate WHO’s scheduling recommendations, the process leading to the Commission vote and subsequent implications at global, national and patient/clinician levels. Narrative account of the four-year proceedings; review of the practical implications of both rejected and accepted recommendations.

Findings – The process was historically unprecedented, of political relevance to both medical Cannabis and evidence-based scheduling generally. Procedural barriers hampered the appropriate involvement of civil society stakeholders. The landscape resulting from accepted and rejected recommendations allow countries to continue creating decentralised, non-uniform systems for access to and availability of ‘‘cannabis’’ and ‘‘cannabis resin’’ for medical purposes.

Originality/value – Perspective of accredited observers; highlight of institutional issues and the lay of the land; contrast of stakeholders’ interpretations and engagement.