Special Section: Health, Rights, and the Future of Global Drug Control Martin Jelsma Introduction For thousands of years, coca has been a cornerstone of the cultural, spiritual, and medicinal traditions of Indigenous Peoples in the Andean-Amazonian region. Coca leaves typically contain between 0.2% and 0.8% cocaine alkaloid, giving chewing the leaves or drinking coca tea a mild stimulant effect comparable to that of coffee. Under the 1961 Single Convention on Narcotic Drugs, coca leaf and cocaine are both placed in Schedule I, strictly limited to licensed medical and scientific uses, which has resulted in the criminalization of coca cultivation and trade for other purposes and the erosion of Indigenous and cultural rights protecting traditional practices. In June 2023, Bolivia formally requested a critical review of the coca leaf’s status under the 1961 Single Convention, arguing that resolving the incoherence in the current classification would put an end to the violation of legitimate rights and would allow the international community to benefit from the coca leaf in its natural state.[1] A year later, Colombia formally endorsed the initiative, which also received broad support from civil society and the United Nations (UN) human rights system.[2] A decision to deschedule the coca leaf “would represent a significant step toward aligning the international drug control system with the dignity and rights of Indigenous Peoples,” according to the UN Special Rapporteur on the rights of Indigenous Peoples.[3] The World Health Organization (WHO) is responsible under the treaty for conducting scientific assessments of psychoactive substances and recommending the appropriate level of international control. Scheduling recommendations are made by the WHO Expert Committee on Drug Dependence (ECDD) based on the independent critical review report and comments received from member states and other stakeholders, including UN agencies and civil society. The committee can recommend to retain the current status, to transfer a substance to another schedule (reschedule), or to delete it from the schedules altogether (deschedule). Any recommendation to change a substance’s scheduling status must subsequently be approved by vote of the UN Commission on Narcotic Drugs (CND). To the disappointment of many, WHO concluded in December 2025 that it would not recommend any change to the coca leaf’s status. For Andean-Amazonian Indigenous Peoples and other coca-growing or coca-consuming populations who have struggled for decades to end the global ban, the WHO decision was hard to understand and felt like a betrayal.[4] Coca and the World Health Organization In the 1950s, WHO used biased data and racist arguments that led to the inclusion of coca in Schedule I of the 1961 Single Convention and to the obligation, under article 49, to abolish traditional coca-chewing practices because of their alleged dangerous and addictive properties.[5] “The primary institutional responsibility for this historical error therefore lies with the WHO itself,”Bolivia argued in the dossier supporting its 2023 request for a critical review.[6] By 1992, however, the WHO Expert Committee had begun to question the advisability of prohibiting psychoactive plants that are traditionally used by Indigenous Peoples, cautioning that “the social problems resulting from the prohibition of these products under international controls might outweigh any health benefits” and recommending that the social role and health consequences of coca chewing be studied.[7] This concern informed a three-year WHO research project, which determined in 1995 that the “traditional use of coca appears to have no negative health effects and that it serves positive therapeutic, sacred and social functions among indigenous groups in the Andean region.” US threats to cut funding to WHO, however, prevented publication of the study.[8] Its main findings have since been validated in the recent critical review report, which states that “the contemporary scientific literature on the public health impact of coca leaf remains consistent with the 1995 WHO Cocaine Report.”[9] The critical review initiated at Bolivia’s request therefore gave WHO another opportunity to look in the mirror of its problematic past and help repair the injustices that followed. As part of that review, external academic experts conducted a year-long literature review that “did not reveal evidence of clinically meaningful public health harms associated with coca leaf use,” concluding that it is “not associated with significant dependence or abuse potential” and that the therapeutic properties are potentially of “great interest for future developments to establish their efficacy and safety for use in human medicine.”[10] At its 48th meeting, held on October 20–22, 2025, the ECDD considered the draft critical review report and drew conclusions for WHO’s scheduling recommendation.[11] WHO selected 14 medical experts for the meeting. None came from the Andean region or had special expertise on coca leaf, Indigenous knowledge, or human rights. Advice on legal matters and treaty interpretation was provided by observers from WHO’s legal counsel, the International Narcotics Control Board (INCB), and the UN Office on Drugs and Crime (UNODC). Following its deliberations, the ECDD recognized the important cultural and therapeutic significance of coca leaf for Indigenous Peoples but concluded that it should remain in Schedule I because cocaine can be easily extracted from the leaf and because “reducing or removing existing international controls on coca leaf could pose an especially serious risk to public health.”[12] However, controls on coca cultivation and the use of coca leaf for illicit cocaine production are established separately in several articles of the 1961 Single Convention and were subsequently reinforced by the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. Those controls would remain in force even if coca leaf were removed entirely from the schedules and were no longer classified as a narcotic drug.[13] The ECDD failed to provide an explanation for its assumption that descheduling coca leaf would therefore reduce treaty controls on illicit cocaine production. Moreover, the global cocaine market has expanded despite coca leaf’s strict classification, raising a further question: Why would maintaining its Schedule I status have any effect on the cocaine market now?[14] Plants and precursors Under the international drug control treaty system—which consists of the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances—botanical raw materials are scheduled only when they are considered to produce harmful effects themselves, while measures against the illicit use of plants to extract scheduled alkaloids considered harmful in concentrated form are covered in specific treaty articles.[15] Responding to the ECDD’s conclusion that coca leaf should remain in Schedule I because cocaine can easily be extracted from it, Colombia argued that “the criteria of convertibility in the critical examination was decisive and, at the same time, the least developed from a technical point of view,” noting that the ECDD equated the concept of “extraction” with “convertibility.”[16] WHO’s guidance for the review process—a document adopted by WHO’s Executive Board that governs the evaluation procedure for scheduling recommendations—refers to “substances convertible to narcotic drugs” as the “control of precursors.”[17] Only a limited number of chemical compounds have been included in the 1961 schedules based on the convertibility principle; these include ecgonine (convertible to cocaine) and thebaine (convertible to morphine). No other psychoactive plant, such as opium poppy, cannabis, khat, kratom, ephedra, or peyote, has ever been recommended for scheduling by WHO on the grounds of its “convertibility” or “transformation” into the alkaloids it contains.[18] The coca review marks the first time the ECDD has claimed that a plant meets the definition of a “precursor” under the international drug control conventions. The scheduling system has been plagued by inconsistencies from the start. The original lists attached to the treaties were politically negotiated amid decolonization struggles and were strongly influenced by prevailing Western cultural supremacy and pharmaceutical concepts and interests.[19] Many of the drugs initially brought under international control, including coca, cannabis, opium, psylocibin, mescaline, DMT, and LSD, were never reviewed by WHO.[20] Since then, many more substances have been added to the schedules (now covering more than 300 across the three conventions), but none has ever been released from treaty control. Coca and Indigenous rights Respect for Indigenous rights has only recently entered global drug policy debates, and the coca review brought significant attention to the issue. The Single Convention’s requirement to restrict the use of coca leaf exclusively to medical, scientific, and narrowly defined “industrial” purposes and to ban the traditional practice of coca chewing arguably represents one of the most blatant legal conflicts between international drug control and human rights obligations. Concerns about violations of Indigenous rights led the Office of the United Nations High Commissioner for Human Rights (OHCHR) and UN Special Procedures to engage actively in the coca review process. In October 2025, the chief of OHCHR’s Indigenous Peoples and Minorities Section, Hernán Vales,told the ECDD that the prohibition of the coca leaf has undermined the right to cultural identity, traditional medicine, and self-determination and that the review offered an opportunity to address a long history of structural discrimination and historical injustice: “A human rights-based approach demands that we acknowledge this history and ensure that the recommendations arising from this process actively work to repair the harms that have been inflicted on Indigenous Peoples.”[21] The International Guidelines on Human Rights and Drug Policy, endorsed by several UN agencies, including WHO, similarly call on states to ensure that drug control efforts do not interfere with the right of Indigenous Peoples to maintain their cultural, spiritual, and traditional health practices involving psychoactive plants.[22] Prohibition and exemptions Bolivia, Colombia, and Peru by now all have provisions in their constitutions and legislation that recognize coca as part of their cultural heritage and exempt traditional uses from criminal prosecution under specific circumstances, and all three made coca-related reservations under the 1988 Convention, but only Bolivia has a reservation under the 1961 Single Convention.[23] Tensions with international treaty obligations have hampered national legislative attempts to establish clear distinctions between licit and illicit markets. Moreover, all existing legal exemptions and reservations are limited to the domestic domain, prohibiting imports and exports for any purpose beyond those allowed by the Single Convention. They do not satisfy the rights of Indigenous Peoples to use their resources for the development of their communities and to engage freely in all their traditional and other economic activities—rights that should also allow them to export coca if they so desire.[24] Exemptions are based on the defense of millennia-old traditional and Indigenous practices, leaving more contemporary coca uses subjected to the criminalization related to coca’s Schedule I status, even more so when involving international trade. For example, traders who bring coca from Bolivia—where it can be grown legally under the treaty reservation—to Argentina—where consumption is decriminalized—are prosecuted on a daily basis.[25] Andean migrants around the world also continue to face criminal charges for bringing coca products home for personal consumption.[26] Beyond reducing criminalization, enabling the legal export of coca products would offer promising livelihood opportunities for coca farmers and, in Colombia, could provide a more sustainable alternative to current crop substitution schemes while contributing to peacebuilding. Appreciating the result of the ECDD meeting, the United States claimed at the reconvened CND session on December 4, 2025, that “the practices identified as traditional are largely medical or industrial, and therefore legitimate within the context of the Single Convention,” adding that “the Schedule I status of the coca leaf should not prevent countries from enacting domestic regulatory systems that allow for these practices while maintaining needed control measures to prevent diversion.”[27] WHO echoed this reasoning in a press release the following week, deeming that coca’s existing status allows for traditional uses and Indigenous cultural practices, using it as an excuse to deny any historical or contemporary responsibility for rights violations and criminalization resulting from coca’s Schedule I classification.[28] US and European opposition Significant progress has been made over the past decade in bringing health, development, and human rights considerations into global drug policy debates, placing increasing pressure on the UN drug control system. In 2024, the long-standing “Vienna consensus” finally broke, primarily over the issue of harm reduction, fundamentally changing the political negotiating practices at the CND.[29] This shift also enabled the establishment, a year later and at Colombia’s initiative, of a UN panel to review the current drug control machinery. But recent years have also seen a trend toward securitization and a resurgence of “narco-terrorism” discourse, accompanied by intensified military “war on drugs” operations and extrajudicial killings. This is taking place within the broader geopolitical context of disregard for international law, a crisis of multilateralism, rising authoritarianism, wars and genocide, funding cuts, and shrinking civic space. These developments have also affected UN drug policy debates, sharpening North-South divides, shifting political alliances, and revealing Western hypocrisy. The European Union (EU), often seen as a human rights champion in UN drug policy debates, has lost its “moral high ground” due to its selective adherence to international law, including its weak responses to Israeli and US war crimes. The EU has also moved toward a more crime-focused approach to what it presents as the combined threats of drugs, organized crime, migration, and terrorism, a trend reflected in its new drug strategy.[30] Some European countries have also played an active role in opposing changes to the current status of the coca leaf. Following the position agreed among G8 countries, and after joining the US-convened “Group of Friends of the Convention,” Germany rallied other EU countries to object to Bolivia’s 2009 proposal to amend the 1961 Single Convention by removing the obligation to abolish coca chewing.[31] After the amendment was blocked, Bolivia withdrew from the convention, re-adhering in 2013 with a coca reservation and a decade later initiating the WHO coca review. During the recent review process, France was particularly vocal, expressing concern about the “health and security risk that rescheduling of the coca leaf might entail” because it would lead to “a likely significant increase in the availability of cocaine.”[32] The EU common position, agreed in February 2026, expresses support for WHO’s assessment that coca leaf should remain under its current classification based on the ease of extracting cocaine. While reaffirming its respect for Indigenous rights, the EU maintained that “traditional uses should take place in the framework of specific exceptions and reservations.”[33] The position paper did not mention that several EU countries (Germany, Finland, France, Ireland, Italy, Portugal, and Sweden, together with the other G8 members and Israel) registered objections against Bolivia’s 2013 treaty reservation that was meant precisely for that purpose.[34] Mexico and the Netherlands, to their credit, have since withdrawn their objections. On October 2, 2025, the United States stated that “removing the coca leaf from Schedule I would derail our joint efforts and only reward the narco-terrorists.”[35] The Trump administration had recently launched a campaign of military strikes against suspected drug-trafficking boats in the Caribbean and sanctioned the Colombian government under President Gustavo Petro in response to increased coca cultivation and what it described as efforts to seek “accommodations with narco-terrorist groups.”[36] These developments unfolded just weeks prior to the ECDD meeting in October 2025 and were hanging like a Sword of Damocles over the deliberations. A recommendation to deschedule coca, at a time when WHO was also facing dramatic funding cuts, was considered too risky and unlikely to win a CND majority vote. Against this backdrop, the questionable decision to basically reclassify coca leaf as a “convertible precursor” offered the only available procedural escape from more political controversy. Conclusion and recommendations The coca review was a failed litmus test of the UN regime’s ability to repair historical injustices and resolve growing tensions with scientific evidence and human rights. The outcome casts a shadow on the independence of the WHO review procedure and has revealed a disconnect within WHO between its drug control treaty mandate and the commitment of other departments to promote traditional medicine and Indigenous health. It has also laid bare inconsistencies in the treaty system and incoherence in the application of control measures to psychoactive plants, extracted alkaloids, and convertible precursors. With its conclusion, the ECDD effectively closed the door—at least for the coming years—on ending the 60-year-old UN coca ban, as the CND can change the 1961 schedules only in accordanc
