The Public Health (Single-Use Vapes) Bill 2025 completed Ireland’s parliamentary process at the Oireachtas on July 7. It currently awaits the signature of President Catherine Connolly, which is expected to be a mere formality. Retailers will be given a six-month period to shift existing products, with the new law taking full effect in January 2027. 

“By banning single-use vapes, we are helping to prevent nicotine addiction before it starts and creating a cleaner environment for everyone,” said Health Minister Carroll MacNeil, echoing talking points that have driven disposable vape bans in countries such as the United Kingdom.

The new ban is only part of Ireland’s wider crackdown on nicotine vapes. In 2025, for instance, the country imposed the European Union’s highest tax rate on e-liquids. 

Meanwhile, the Public Health (Tobacco Products and Nicotine Inhaling Products) (Amendment) Bill 2026, introduced earlier in the year, seeks to further restrict safer nicotine products that have helped millions quit smoking. Ireland’s smoking rate of about 18 percent remains vastly higher than the government’s target of below 5 percent—which it was supposed to reach by 2025.

“This now looks certain to go through, with little pushback from the opposition.”

That bill would limit vape flavors to tobacco or unflavored e-liquids only. It would additionally restrict colors and imagery on devices and packaging, and ban retail outlets from advertising nicotine products, among other measures. It would give ministers the power to regulate flavor descriptors and to amend the law to cover any future nicotine products.

Having recently passed the lower house, the bill is due to be debated in the upper house, the Seanad, later in July. An EU notification process would need to be completed before it can be enacted, but the government plans for it to take effect before the end of 2026.

“This now looks certain to go through, with little pushback from the opposition apart from [political party] Sinn Fein,” Tom Gleeson, a trustee of the New Nicotine Alliance Ireland charity, told Filter. 

“This move by the health minister will result in the first minister for health to leave office with a higher rate of smoking than when they took office,”said Gleeson, who credits vapes with helping him quit smoking. “Given the clear evidence that restrictions on reduced-harm products benefit smoking, it’s puzzling that they are willing to take that risk.”

“The lack of support for vaping from our health bodies has already reduced the impact of safer products on smoking rates,” he continued, “with Ireland lagging behind places like our close neighbors in the United Kingdom.”

In the UK, most people who quit smoking do so with the help of vapes. Though politicians there have also turned against tobacco harm reduction in recent years, the country has a prior track record of embracing it. The UK now has a significantly lower smoking rate than Ireland, and Brits are more likely to vape than to smoke.

Dr. Garrett McGovern, an Irish addiction medicine specialist and tobacco harm reduction advocate, told Filter that “flavors are an essential component of helping smokers quit”—an assertion that’s supported by substantial evidence. 

“They have not considered the unintended consequences: increased smoking rates across the age spectrum and a burgeoning illicit market.”

McGovern described the current bill as a “missed opportunity.” It makes the assumption, he continued, that a “so-called youth epidemic” of vaping entails harms that are somehow comparable to those caused by cigarettes. This is not true. 

In reality, McGovern said, “youth e-cigarette use is experimental, transient and in the vast majority of cases unproblematic, and not a gateway to cigarette smoking. Despite this, policymakers have decided that vaping is the enemy and needs to be eradicated.” 

The Healthy Ireland Survey 2025 found that 50 percent of Irish people who vape formerly smoked and have now quit combustible tobacco entirely. Another 33 percent vape and smoke—so-called “dual use,” which typically involves reducing the number of cigarettes smoked, and is often part of a journey to complete smoking cessation. 

Just 17 percent of people who vape in Ireland have never smoked—and even with them, there’s the question of what they would be doing if vapes weren’t available, given evidence of “common liability” to both vaping and smoking. 

When the most effective smoking-cessation aids are made not only more expensive but less visible and less enjoyable, advocates say that damaging outcomes are inevitable.

“They have not considered the unintended consequences: increased smoking rates across the age spectrum and a burgeoning illicit market to fill the void left by the unregulated one,” McGovern said.

Photograph (cropped) by Ecig Click via Flickr/Creative Commons 2.0

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On June 10, the Republic of Palau, an island nation in the Western Pacific with a population of 18,000, formally applied for a World Health Organization review of nicotine, under Article 2 of the 1971 UN Convention on Psychotropic Substances. This would have the potential to place nicotine under similar international drug restrictions to GHB, say, or methamphetamine—making the sale of non-medical nicotine products illegal.

The government of Palau, which banned vapes in 2023, argues that current efforts to protect people from combustible tobacco need to be sweepingly updated to include newer, safer products such as nicotine pouches and vapes.

“We may be a small nation, but the scale of a problem has never determined who acts on it,” said President Surangel S. Whipps, Jr. He urged governments around the world to follow suit in asking the United Nations “to finally treat nicotine like the toxic and addictive drug that it is.”

“Think of the consequences of prohibiting nicotine in international conventions just like cannabis, cocaine, heroin and so many other drugs.”

Ethan Nadelmann, founder and former director of the Drug Policy Alliance in the United States, said the initiative “may well be one of the most foolish in modern or even ancient history.”

“Think of the consequences of prohibiting nicotine in international conventions just like cannabis, cocaine, heroin and so many other drugs,” he told Filter. “All those drugs became far more popular after their criminalization than before, and far more dangerous.”

Prohibition generates vast illicit markets, corruption, violence and human-rights violations, he continued, “filling prisons with non-violent human beings whose only offense was to grow, possess, buy or sell a psychoactive substance that had long been legal.”

With nicotine, there’s additionally the critical harm reduction role of safer alternatives to smoking.

Smoking rates may be declining worldwide, but 1.3 billion people still use tobacco in risky forms, causing over 7 million deaths each year. Key to reducing this toll is the speed at which people who are unable or unwilling to quit nicotine transition to the safer products that over 100 million already use.

Nadelmann pointed to Sweden and New Zealand as countries that have “dramatically reduced cigarette smoking in recent decades without resorting to criminalization.”

“They claim it is an ‘initiative of the Republic of Palau,’ but it looks more like Palau is the willing puppet for a new billionaire-funded crusade.”

As part of its initiative, Palau’s government presented a scientific dossier and a website making the case against public access to nicotine. One of tobacco harm reduction’s most prominent voices labels this a “false operation.”

“They claim it is an ‘initiative of the Republic of Palau,’ but it looks more like Palau is the willing puppet for a new billionaire-funded crusade,” advocate Clive Bates, of Counterfactual Consulting, told Filter.

“The website is too slick, the lengthy science briefing was prepared in Europe, and an American activist group is involved,” he continued. “There is no disclosure about who is funding and organizing the campaign, but we can be pretty sure it isn’t the taxpayers of Palau with a population of 18k.”

It’s been reported that Palau’s application was put together by individuals who have been heavily involved in lobbying against safer nicotine products in Europe.

“What’s upsetting is that the anti-nicotine agenda being pushed on/by Palau … will do nothing to assist the people who are using deadly oral products.”

Just under 43 percent of Palau’s adult population legally and regularly consume gutka, a chewing tobacco mixed with betel (areca) nut, as David Zaruk described in Firebreak. The highly carcinogenic product is banned in many countries. Curiously, the dossier fails to mention the use of gutka, which is far more prevalent in Palau than smoking.

“What’s upsetting is that the anti-nicotine agenda being pushed on/by Palau … will do nothing to assist the people who are using deadly oral products,” Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), told Filter. 

Loucas added that denying people access to much less harmful products is contrary to basic human rights and the World Health Organization’s own harm reduction mandate. When Palau banned vaping, an option that has helped millions migrate from deadly forms of tobacco, it did so through according to the WHO’s MPOWER strategy. US billionaire Michael Bloomberg, a dedicated opponent of access to safer nicotine products, is a major funder of the WHO.

“Whether for money, for fame or other favors, there are countries willing to pawn their sovereignty and offer their place at the intergovernmental table to aggressive philanthro-colonialists, frustrated that billionaire money alone does not give them the standing and access of a nation state,” Bates commented.

Whether nicotine gets put on the UN’s scheduled list would depend upon a medical and scientific assessment by the WHO Expert Committee on Drug Dependence. That process would conclude in March 2028, subject to the votes of 53 member states.

“If the government of Palau’s proposal ultimately leads to a global prohibition of nicotine, and drug wars resembling those that have caused such devastation around much of the world in recent decades,” Nadelmann said, “then it will go down as a perpetrator of one of the most deadly war crimes in history.”

Photograph (cropped) of Koror, Palau, by Mandrusian via Wikimedia Commons/Creative Commons 4.0  

Update, June 25: This article has been edited to credit David Zaruk’s article for information concerning gutka use and policy in Palau.

The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.

The post Tiny Pacific Nation Applies for Global Nicotine Ban. Who’s Behind It? appeared first on Filter.

The effects are already being felt—including by prospective international visitors for the summer World Cup, who are being warned that trying to bring vapes into the country for their personal use could result in “confiscation, detention, and fines reaching up to $12,500.”

The impacts on Mexicans’ health and safety will be further-reaching.

Though vapes have been restricted for several years in Mexico, it’s been something of a gray area amid legal back-and-forth over politicians’ ban attempts, with some shops obtaining the right to sell the products through court orders. This latest move ends the uncertainty. People who break the law could face not only large fines but a prison sentence of up to eight years.

“Many of the vendors who operated in the gray market have closed, making it very difficult for people to get their products.”

An estimated 13.7 million people smoke tobacco in Mexico; around 40,000 die of smoking-related causes each year. Miguel Garcia, a tobacco harm reduction advocate based in Mexico City, fears for fellow Mexicans who use safer nicotine products to avoid smoking, as their access is squeezed. 

“Many of the vendors who operated in the gray market or sold through websites have closed their shops, making it very difficult for people to get their products,” he told Filter. “It’s a given that an ordinary citizen who was involved in the informal trade will stop doing so for fear of losing their freedom with up to eight years in prison.”

It isn’t only traders who could face enforcement threats, however.

Renata Demichelis Ávila is the director of human rights advocacy group Elementa DDHH in Mexico. Though the General Health Law ostensibly permits personal possession and use, she explained, it fails to define it. Article 479 of the law establishes specific personal-use quantities for other substances but not for nicotine vapes, creating what she termed a “legal vacuum.”

“The legal vacuum places users at serious risk. It is likely that people who use vapes will be stopped, detained or extorted.”

“Without a definition of personal use, enforcement is left to discretion, which significantly increases the risk of arbitrary actions by authorities,” Demichelis Ávila told Filter. “Personal use may be technically legal, but the lack of legal clarity leaves users vulnerable to abuses.”

“It is important to note, by excluding consumption and possession from the ban, the government’s narrative focuses on production and commercialization rather than explicitly criminalizing users—although in practice, the legal vacuum places users at serious risk,” she elaborated. “It is likely that people who use vapes will still be stopped, detained or extorted under [this] pretext.”

In other words, people who rely on vapes face a bitter choice: Run the risk of being targeted by law enforcement, or run the risk of returning to cigarettes.

The prohibition “reproduces and deepens well-documented patterns seen in Mexico’s drug policy; arbitrary detentions, extortions, police harassment,” Demichelis Ávila said. “That said, the greater risk lies not in mass criminalization of users, but in the structure of the market itself.”

Sanho Tree, a fellow at the Institute for Policy Studies, called Mexico’s vape ban “a gift to illegal non-state groups.”

Even before the ban was formalized, a significant slice of Mexico’s vape market was controlled by the powerful drug-trafficking networks known as “cartels,” which employ threats, violence and abductions to protect their revenue. Prohibition tightens this grip.

Sanho Tree, a fellow at the Institute for Policy Studies in Washington, DC, and director of its Drug Policy Project, called Mexico’s vape ban “a gift to illegal non-state groups.”

Banning vape sales simply hands them the whole market. “If the demand remains, illicit sellers will seek to maximize profit,” he told Filter.

That profit is lucrative, when around 2 million people in Mexico vape and the 2022 market was estimated at $1.5 billion—money that will only increase the networks’ power.

“Vapes are legal across the border in the United States and they’re not a major target of [US] law enforcement,” Tree noted.

That reduces the transnational networks’ risk, and gives rise to a situation that flips the drugs-arriving-from-Mexico narrative beloved of US politicians: vapes crossing the border into Mexico.

“It shifts the issue from a public-health approach to a punitive, criminal framework—one that Mexico already knows is ineffective and dangerous.”

The takeover of Mexico’s vape market by illicit actors means, among other things, that unregulated products will be sold without consumer protections, and that people might have to put themselves in unsafe situations to buy vapes.

Age checks are unlikely to be a priority for vendors operating outside the law—which is ironic, when Mexico became the eighth Latin American country to ban vapes in the name of protecting youth.

In that context, Garcia has further worries. “We fear, probably in the near future, people who lack ethics and values will not only offer vaping products, but will offer their menu of all the illicit products they already sell,” he said.

Mexico has endured a devastating drug war for decades, and its leaders should need no reminder of the downstream consequences of prohibition.

“It shifts the issue from a public-health approach to a punitive, criminal framework—one that Mexico already knows is ineffective and dangerous,” Demichelis Ávila said. “We’ve seen prohibition’s real effects; it doesn’t eliminate the market.”

Instead, it merely “reshapes it,” paving the way for more exploitation and violence.

Photograph by Paul Sableman via Flickr/Creative Commons 2.0

The post Mexico’s Vape Prohibition Is Already Biting appeared first on Filter.

On February 3, the International Drug Policy Consortium (IDPC), a global network of almost 200 NGOs, published a report—The UNGASS Decade in Review: Gaps, Achievements and Paths for Reform—documenting how any promise of UNGASS remains largely unfulfilled. The global response to drugs remains rooted in repression and prohibition. And where real reform has been accomplished and advances observed, that’s been “despite the drug control system, not because of it,” writes former Colombian President Juan Manuel Santos in the foreword to the report.

Despite the health and human rights framing of UNGASS, global drug control has inflicted catastrophic harms on individuals and communities in the decade since. During that period, the report notes, more than 2.6 million people have lost their lives to causes related to unregulated drugs, and mass incarceration has increased. Marginalized communities are disproportionately impacted and targeted. Unrealistic UNGASS aspirations to reduce drug use have been met by an estimated 28-percent increase in the worldwide number of people using unregulated drugs.

IDPC’s report calls for a drastic overhaul of global drug policies, which, it says, must be genuinely “oriented towards human rights, health and development.” Yet the community groups capable of leading such change “continue to be sidelined, underfunded, and increasingly exposed to threats and attacks.”

The report is published at a moment when the world and the UN system itself are at a critical juncture.

As IDPC Executive Director Ann Fordham put it in a press release, “punitive approaches are costing lives, undermining human rights and wasting public resources, while silencing the very communities that hold the solutions … [G]overnments must move beyond rhetoric and commit to real structural reform.” 

The report is published at a moment when the world and the UN system itself are at a critical juncture. In 2025, an independent panel was tasked by the UN Commission on Narcotic Drugs (CND) to review, by 2027, the international drug control machinery, providing a historic opportunity to rethink the global drug war.

At the same time, drug-war narratives have been building momentum in different parts of the world. The United States—with its strikes on civilian boats in the Caribbean and Pacific and recent abduction of Venezuelan President Nicolas Maduro under the guise of combating “narco-terrorism”—is the most visible example. But in many places, the rise of extremism and shrinking civil-society spaces threaten any scarce gains, compounding the vulnerabilities of people who use drugs.

The report provides detailed evidence of the devastating consequences of repressive drug policies in 10 areas of focus. Among them are human security; development; climate and environment; and civil society engagement, including the rights of Indigenous peoples. 

The most damning part of the report focuses on massive human rights violations in the name of drug control.

Drawing on existing evidence, the report also gives examples of how law enforcement strategies aimed at disrupting the illicit market lead to more violent competition among drug-trafficking organizations. The failure of these strategies in turn leads to further repression and militarization. By rejecting evidence-based reforms, the system effectively perpetuates itself and strengthens existing power structures.

The most damning part of the report focuses on massive human rights violations in the name of drug control: from killing campaigns led by former President Rodrigo Duterte in the Philippines, to militarization of drug enforcement in Ecuador, to mass incarceration in El Salvador, to the preventable deaths of millions of people as a result of the toxic drug supply created by toxic drug policies in North America. 

The report further denounces the problematic role of the world’s “drug-control bureaucracy”—including the United Nations Office on Drugs and Crime (UNODC) and the CND Secretariat—in sidelining or ignoring human rights and health. It meanwhile attributes any progress made in recent normative guidance on human rights in drug policy to the Office of the UN High Commissioner for Human Rights and other UN special mandate holders.

Unsurprisingly, the role of the US is evident throughout the report, where it is referenced more than 50 times. The country’s influence is most clearly exercised through dollars, and recent US decisions to suspend funding through mechanisms such as USAID, PEPFAR and the Global Fund have had disastrous consequences for worldwide harm reduction services, which have long been underfunded, and the people who need them.

Without far-reaching changes to the UN system, it seems likely that the current CND review process will see a repeat of the failures of the 2026 UNGASS.

These funding choices are accompanied by an increasingly militarized international posture. Framed as necessary to stem the flow of drugs into the US, such actions revive drug-war norms of force and exception. 

US actions epitomize a rapidly changing world where the influence and role of the UN are increasingly in doubt. In this light, the IDPC report calls for “urgent modernization” of UN drug control treaties, “in order to respond to new realities and remain fit for purpose.” While regular drug-policy discussion at the UN is “essential,” it continues, “the agenda and working methods of the CND must change to enable meaningful progress.”

Without far-reaching changes to the UN system, it seems likely that the current CND review process will see a repeat of the failures of the 2026 UNGASS—merely repackaging reform narratives while allowing criminalization, exclusion and repression to persist.

Image via Needpix

The post Ten Years After UNGASS, a Resurgent Global Drug War appeared first on Filter.

Critics frame this mechanism as “prohibition by default,” and the 2-FDCK move has drawn sharp rebukes from experts and advocates. They say that by criminalizing a compound with virtually no footprint in the illicit market, the DEA will stymie research that could yield the next generation of mental health treatments.

The DEA’s justification for the “emergency” nature of the ban has come in for particular criticism. According to the agency’s own data, 2-FDCK has been encountered by US law enforcement a grand total of 52 times since 2018.  

“Only 52 reports over eight years. In a country of 330 million, that’s a reach that borders on the absurd.”

“The problem is that the DEA defines what ‘imminent hazard’ exactly means,” Robert Rush, a Denver-based attorney and founder of the Rights and Reason Project, told Filter. “For 2-FDCK, the attorney general stated the drug is ‘widespread in the United States,’ based on only 52 reports over eight years. In a country of 330 million, that’s a reach that borders on the absurd.”

Rush, who has been prominent in challenging the DEA’s attempts to schedule other research chemicals, said the agency is using the emergency provision to bypass the rigor of the standard scheduling process. “They are creating a crisis where none exists to justify a policy that avoids the sunlight of a public hearing.”  

Kat Murti, executive director of Students for Sensible Drug Policy (SSDP), the nation’s largest youth-led drug policy reform organization, shares these concerns.  

“The DEA’s move to emergency-schedule 2-FDCK as a Schedule I substance is drug policy by panic, not evidence, and we will pay for it in blood,” she told Filter. “Emergency scheduling sidesteps scientific review and public-health input, replacing them with blunt enforcement tools that have repeatedly proven deadly.”

“We’ve seen this pattern over and over again: Rushed bans create chaos, not safety,” Murti continued. “Placing ketamine analogs into Schedule I will not eliminate use or make communities safer. It will push people toward increasingly unregulated and unpredictable markets, increase the risk of adulteration and overdose, and expose people—especially young people—to arrest, incarceration, and lifelong consequences.”

“After 30 days, it just becomes illegal. If you were a scientist developing an isomer or derivative compound from it, that’s too bad. Your work stops.”

Unlike the standard scheduling process, which allows for public commentary, scientific hearings and judicial review, emergency scheduling by the DEA essentially bypasses oversight for up to three years.

“The crazy thing about temporary emergency scheduling is that the ability to question its necessity is removed during the temporary period,” Rush noted. “There’s no opportunity to go to court or to have a hearing. After 30 days, it just becomes illegal. If you were a scientist developing an isomer or derivative compound from it, that’s too bad. Your work stops, and your liability begins.”

Of particular concern to the scientific community is that by placing 2-FDCK in Schedule I—the most restrictive class, reserved for drugs with “no currently accepted medical use”—the DEA will also restrict all of its salts, isomers and salts of isomers. This “blanket” approach is liable to freeze research into dozens of potentially beneficial medical compounds, some of which may not even have been fully identified.

The current fight over 2-FDCK is playing out against the backdrop of a recent, high-profile loss for researchers and advocates. In 2024, the DEA moved to ban DOI and DOC, two psychedelic research chemicals, which had between them been cited in over 1,200 National Institutes of Health-funded papers. Though the ban now looks set to go ahead, Robert Rush, working with SSDP, successfully demanded the first psychedelic scheduling hearing at the DEA since the famed MDMA case of 1985.

“The DEA, for too long, has had a rubber stamp in their decision-making processes,” Rush said of the DOI case at the time. “They have not had to defend their actions. I am looking forward to having the DEA defend its decision to criminalize an important research tool that it admits is not being diverted for illicit use. It is time they answered to the American public.”

Murti and SSDP have been vocal about the damage to critical research caused by the DEA’s moves. That’s particularly relevant with the 2-FDCK plan, given that its relative, ketamine, represents one of the few breakthroughs in depression treatment in recent decades.   

“At a time when we face an unprecedented mental health crisis, it is unconscionable for the DEA to claim that harm to research is irrelevant,” Rush said.

“Prohibition enforced through emergency orders is not public health—it’s a policy choice that puts lives at risk.”

Murti and Rush agree that the federal government must pivot away from what they call “reckless prohibition” toward policies that reflect today’s public health needs.

“If policymakers are serious about saving lives from overdose, the federal government must stop expanding emergency prohibition and instead invest in harm reduction, drug checking, evidence-based education and research,” Murti said. “Prohibition enforced through emergency orders is not public health—it’s a policy choice that puts lives at risk.”

Rush also frames the issue as a fundamental question of cognitive liberty—the right of individuals to maintain autonomy over their own mental states. “Restricting 2-FDCK without clear evidence of unique and substantial harm improperly infringes cognitive liberty by criminalizing mental states,” he argued. “Any regulation must be evidence-based, narrowly tailored, and focused on specific harms rather than speculative harms.”

As the DEA moves to finalize the temporary order, the Rights and Reason Project, SSDP and others are aiming, through legal challenges and advocacy, to end the days of “stealth” scheduling.

“They locked LSD, MDMA and psilocybin away, and decades later, we are still fighting to research these drugs with significant therapeutic potential,” Rush said. “Someone needs to fight this reckless prohibition, or we will repeat the mistakes of the past indefinitely.”

Image (adapted) via Wikimedia Commons/Public Domain

The post 2-FDCK: DEA Move to Emergency-Schedule Ketamine Analog Draws Fire appeared first on Filter.

It’s impossible for me to tell this story without context. Supply-side enforcement under the United States’ drug war, as the Iron Law of Prohibition describes, has caused catastrophic effects reminiscent of “bathtub gin” in the 1920s. In recent years this has been seen with the influx of veterinary sedatives like xylazine, and now its more potent big brother, medetomidine.

In 2020, having recovered from heroin addiction years previously, I was working at an outpatient buprenorphine clinic in Kensington, Philadelphia. This was an extremely difficult time: We were learning how to survive during a global pandemic while under occupation by the National Guard. 

As resources dwindled and dried up, many of the folks on my caseload began to disappear or die. At the height of the pandemic, it was impossible to walk two feet without finding a body in Kensington requiring resuscitation. Many of those people were close friends of mine. In that traumatic time, it seemed inevitable that I would start using again.

Over the three-year period that followed, I white-kuckled my way through more than 30 buprenorphine inductions and dozens of precipitated withdrawal events. I eventually found stability with methadone.

The nurse at the clinic refused to dispense my methadone. This, she told me, would “teach me to be on time.”

The sigh of relief from a full agonist was a heavenly turning point in my life. I had finally found recovery again. In the three years it had taken, I’d gone through an epidural abscess and subsequent spinal cord injury requiring multiple surgeries, three months of inpatient rehab for physical therapy and antibiotics; two rounds of sepsis; severe lower-extremity wounds related to xylazine contamination where I faced amputation; and the erosion of most of my teeth from sublingual buprenorphine.

One Saturday morning, six months into my recovery, I had a family issue which caused me to arrive at the methadone clinic seven minutes late. The nurse at the clinic refused to dispense my methadone dose for the day as well as the “gifted” take-home dose for Sunday.

This, she told me, would “teach me to be on time.”

As a rapid metabolizer at a clinic that uses the Methadose formulation, I was already experiencing the onset of withdrawal. I begged her to allow me to dose or perhaps travel to another clinic in the system.

She refused, and before closing the door reminded me to show up on Monday, or else I would be discharged for missing three consecutive doses.

I did my best to tough it out. But about 36 hours into withdrawal, I went to the only source that I knew could give me relief: the street.

This was in May 2024, just about the time that medetomidine was first detected in the Philadelphia drug supply. None of us knew about it. But I knew something was different, because the drugs gave me immediate, severe hallucinations—auditory, visual, and tactile. I also noticed long periods of unusual sedation and memory loss.

I was brought back to the ED critically ill. This was before medetomidine was known to be in the supply.

After three weeks of trying to stabilize on methadone once again, I found that every attempt to feel normal was insufficient. I was profoundly weak, incessantly vomiting and had uncontrolled diarrhea.

I went to the emergency department at a large hospital with a reputation for excellent addiction care. I sat in the waiting room for nine hours. Once withdrawal set in, however, I left.

Two days later, I was brought back to the ED critically ill. This was before medetomidine was known to be in the supply; xylazine was still the hot topic. Xylazine withdrawal was relatively straightforward and could be managed with minimal pharmacological assistance. I was left lying in a pile of my own feces and vomit, too weak to stand or communicate effectively, but aware of what was happening and being said around me.

As the nurses performed tasks, they talked over me as if I didn’t exist, joking about me and other patients and discussing weekend plans. Several of these nurses were former colleagues who knew me personally. The shame I felt while being ridiculed, unable to defend myself, was overwhelming. While my wife was in the room they were professional and provided care. But when they were unsupervised, I was clearly viewed as a nuisance.

The doctor sat down and began discussing end-of-life care and decisions. I spent the next few hours preparing videos for each of my children.

Once blood work started coming back they began to realize how critically ill I was, and I was admitted. I required multiple blood transfusions and long-term antibiotics.

On day three the doctor caring for me sat down and began discussing end-of-life care and decisions. He looked frightened, and explained to me that if my labs did not improve by the next morning, the likelihood of death would increase to 90 percent.

I will never forget that feeling. I spent the next few hours preparing videos for each of my children, telling my story and doing my best to make the case that I was a good father who loved them dearly. I wrote a letter to my wife, declaring my deep love for her and apologizing for not being a stronger and better man. It was a truly heartbreaking and helpless experience.

Miraculously, I turned the corner and everything began to improve. But I kept wondering what was so dramatically different about that experience.

It wasn’t until six months later that I spoke with journalist and harm reductionist Chris Moraff, who told me about his work with PA Groundhogs and the presence of medetomidine in Philadelphia. When I. described the exact block where I purchased the dope and the identifying stamp, he knew without question that I had experienced medetomidine withdrawal, essentially cold turkey—a condition now understood to be so severe that one hospital in Philadelphia has a designated ICU for these cases. Another hospital has a dedicated ambulance to transport medetomidine patients from other hospitals to more specialized care. Most rehabs in the area will now not accept opioid-withdrawal patients before medical clearance.

Prohibition made xylazine less available, at least short-term, but in typical fashion it ushered in a more potent substitute.

Two years ago, xylazine (“tranq”) was the focal point of most medical care, which primarily zeroed in on chronic wound management, limb salvage and infections. At one point xylazine was found in 99 percent of all street samples in Philadelphia. After xylazine was scheduled as a controlled substance in Pennsylvania—temporarily in 2023, then permanently the following year—this dropped to 40 percent, and continues to fall.

Prohibition made xylazine less available, at least short-term, but in typical fashion it ushered in a more potent substitute—the dramatic impacts of which were recently covered by the New York Times.

In fall 2025, I underwent skin graft surgery to finally close my old xylazine wounds. While I was recovering in the burn ICU, I spent a considerable amount of time talking with the physicians and nurses. They were all visibly concerned about medetomidine. Several of the nurses caring for me picked up shifts in the medetomidine-dedicated ICU. They told me they’d never seen so many resource-intensive cases in their entire careers. They appeared beat down and heartbroken, unsure if their work really mattered in the face of such a massive problem.

This story highlights several things. First, there continues to be large-scale ignorance of the detrimental effects of the punitive withholding of methadone in the carceral clinic system. People who take methadone are inherently at risk, and after years of prohibition, the street supply has become so dangerous that a single missed dose can prove fatal. Despite SAMHSA’s recommendations on take-home doses being relaxed in 2024, many (most) clinics have largely ignored these changes and still require daily in-person, observed dosing.

Second, stigma against people who use drugs in health care settings continues, and when it dissuades people from seeking care, it can be deadly.

I will never be the same man as I was prior to 2020. I want those we care for to live long, happy and healthy lives. Our systems stack the odds against them.

Third, my experience shows not only the importance of drug checking, but how it’s critical that changes detected in the drug supply are rapidly communicated to health providers, so they know what they could be dealing with.

And fourth, authorities should have learned long ago that banning drugs and enforcing drug laws may disrupt the supply, but never, in the long-term, for the better. The effects of the Iron Law of Prohibition have accelerated during the current overdose crisis, and our drug supply has long since reached a critical point of danger.

In the past we had the luxury of a supply not without risk, but reliable enough for harm reduction workers to have a sense of predictability and provide a safety net for those in our care. Those days are gone. Today I believe loving harm reduction means not only continuing to provide lifesaving supplies, but also doing everything we can to point people using dope adulterated with xylazine or medetomidine toward a safer supply.

I originally used heroin as a way to manage the ongoing effects of post-traumatic stress, and it did so with precision. I never suffered from abscesses, infections, hospital admissions or long-term complications. However, after using tranq dope for a short period I suffered catastrophic long-term health complications. And then I nearly died after unknowingly using medetomidine.

I will never be the same man as I was prior to 2020. Philly’s current dope is akin to being stood up on prom night by your dream date: empty, cold, lonely and forever painful. Every single time I move my body I am reminded how horrifically tranq is affecting our friends, and of those who have lost their lives after using medetomidine. I want those we care for to live long, happy and healthy lives. Our systems stack the odds against them.

Photograph by Olga Kononenko on Unsplash

The post The Lessons of My Near-Death Experience With Medetomidine appeared first on Filter.

Combustible cigarettes remain the most dangerous way to consume nicotine, killing up to two-thirds of long-term users. Nicotine is what makes people want to smoke, but it’s the toxic chemicals produced by combustion—not nicotine itself—that cause an array of deadly diseases. 

Many people who smoke are unable or unwilling to quit nicotine. For them, the good news is that smoke-free nicotine options such as vaping products and heated tobacco carry vastly lower risk than cigarettes, especially when properly regulated.

Where these products are available and affordable to adults, smoking falls and lives are saved; where they are banned or priced out of reach, the cigarette market is effectively protected.

In 2025, more Asian governments chose the latter path. Vietnam implemented and then tightened a total ban on safer nicotine options. It was joined, right at the end of the year, by Bangladesh.

For people who smoke in Dhaka, Hanoi or Bangkok, the choice is often between a deadly product and an illicit market fraught with risk amid law enforcement raids.

Full bans on safer nicotine products already existed in markets such as Thailand and India, where they have obstructed smoking cessation while fueling illicit trade. Extreme tax proposals and product restrictions in countries like Malaysia and the Philippines meanwhile risk making safer options more expensive or harder to obtain than cigarettes.

For people who smoke in Dhaka, Hanoi or Bangkok, the choice is often between a deadly product and an illicit market fraught with risk amid law enforcement raids. Yet their governments claim to have made progress.

When governments prioritize public health over ideology—or at least, allow consumers to make their own choices—very different outcomes are possible.  

New Zealand’s pragmatic vaping regulations have helped drive adult smoking to some of the lowest levels in the world. Sweden can boast similar success, thanks to widespread availability of snus and nicotine pouches.  The United Kingdom has seen millions of people switch from smoking to vapes. And Japan—a welcome Asia-Pacific outlier—has recorded a globally unprecedented decline in cigarette sales, linked to uptake of heated tobacco products.

These are not theoretical models; they are real-world public health gains.

But Asia-Pacific governments are under intense pressure not to replicate these wins, from a network of anti-nicotine NGOs funded by United States billionaire Michael Bloomberg and from the World Health Organization itself.

Asia-Pacific simply cannot afford strategies that preserve the status quo.  

The WHO’s tobacco treaty was created to reduce harm, yet its current guidance often encourages prohibitionist policies that shut out consumers and sideline evidence that safer nicotine products are critically important smoking-cessation tools.

This is the very opposite of harm reduction (which the WHO actually supports when it comes to other forms of drug use). With nicotine, instead of meeting people where they are and reducing risk, policymakers are narrowing options and increasing risk.

Around eight million lives are lost to smoking-related disease every year—the majority of them in the Asia-Pacific region. Widespread use of risky forms of oral tobacco only adds to a devastating public health burden that is borne overwhelmingly by low- and middle-income countries. 

Asia-Pacific simply cannot afford strategies that preserve the status quo.   

The real choice facing regulators is no longer whether they “like” safer nicotine products. It is whether they want fewer people to die, or not.

Image (adapted) via Picryl/Public Domain

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The move makes the country’s total ban on these harm reduction alternatives to smoking—implemented at the beginning of 2025, and including personal possession and use—even more absolute.

The World Health Organization—which broadly opposes and demonizes tobacco harm reduction—had previously urged Vietnam to add the safer nicotine products to its list of prohibited businesses, as a means to “ensure this ban can be effectively enforced.” There must be no exceptions even for exporters, the WHO insisted, as that could “undermine public health objectives, as well as create significant enforcement challenges.”

The WHO duly applauded the Vietnamese National Assembly’s compliance.

The WHO has also been praising Vietnam’s original prohibition of the world’s most successful smoking cessation aids, with a November 29 post marking the first anniversary of the legislature’s decision. The country’s smoking rate is just over 20 percent; among Vietnamese men, it’s over 40 percent.

The WHO elaborated on what it portrayed as the benefits of the ban: “Fewer young people using these products; Fewer cases of hospital admissions; A major drop in online promotion, in partcular [sic] that targets vulnerable young people.”

“Southeast Asia is one of the world’s highest-density regions, with highly uneven economic development. This makes harm reduction vulnerable to policy volatility.”

Experts are skeptical. Clive Bates, of Counterfactual Consulting, was among those to point out on social media that no data had been made available to validate the WHO claims. He added that one year was little time to get a clear picture of all the ramifications of the prohibition, given factors like stocks running out, potential behavioral changes and how the illicit market would respond.

“I am pretty sure the cigarette business and organized crime will be high-fiving the ban,” Bates wrote in a followup post, demanding evidence from the WHO’s Vietnam office.

Experts with a focus on Asia are similarly troubled. Alan Zhao is the CEO of a vape-oriented publication called 2Firsts, and has reported on Vietnam.

“Southeast Asia is one of the world’s highest-density regions, with some of the highest smoking rates and highly uneven economic development,” he told Filter. “This makes tobacco control and harm reduction particularly vulnerable to policy volatility.”

“When we look beyond the surface,” Zhao continued, “whether a country allows, bans or wavers, my personal observation is that the biggest risk is this: Policymaking seems driven more by interest-group dynamics than by evidence-based, scientific reasoning.”

The majority of people who smoke live in Asia. Yet though the continent includes tobacco harm reduction success stories like Japan, bans and restrictions on safer substitutes for cigarettes are widespread.

Vietnam’s state-owned tobacco company has about 60 percent of the cigarette market share.

Conflicts of interest can be observed in some of these policies—as in India, where the government holds a significant stake in the country’s dominant tobacco company, while banning the vapes that might outcompete it.

“Vietnam is really not so different than Thailand, India and China with regard to government tobacco interests,” Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), told Filter regarding Vinataba—Vietnam’s state-owned tobacco company, with about 60 percent of the cigarette market share.

“All those countries mentioned get accolades for banning safer products whilst manufacturing and selling deadly products,” Loucas said of reactions from the WHO and the network of anti-vape nonprofits funded by billionaire Michael Bloomberg.

Combustible tobacco use is a huge driver of death and disease in Vietnam. In 2021, over 14 percent of all the country’s deaths were linked to smoking.

The government seems determined to make sure that the most dangerous nicotine products are the only ones available. However, an illicit vape market is sure to give at least some consumers another option, as Loucas noted, albeit with more risks than if the products were regulated.

“Illicit products flow across borders easily between Vietnam, Laos and Thailand,” she said.

Loucas described developments in Vietnam as part of a pattern in Asia, with predatory external NGOs pushing bans that hamper smoking cessation while fueling illicit markets. “The issue of sovereignty doesn’t even rate,” she said, “because the countries with tobacco interests are still profiting from selling death.”

Photograph (cropped) of Ho Chi Minh City by calflier001 via Wikimedia Commons/Creative Commons 2.0

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“From Forest to Dust: Socioeconomic and environmental impacts of the prohibition of the coca and cocaine production chain in the Amazon basin and Brazil” was produced by a coalition called Intersection – Land Use, Drug Policy and Climate Justice, involving numerous NGOs.

Its 100-plus pages cover vast historical and geographical expanses, from the Spanish colonial era to today, and from the jungles of Brazil to the ports of West Africa. It calls for a system of legal regulation for coca, but one that doesn’t simply replace the control and violence of trafficking networks with that of multinational corporations. Instead, the authors argue, Indigenous communities and family farms should be centered, to ensure that the coca and cocaine trade won’t harm people and their lands.

“When armed conflict or the military arrive, it pushes the frontier of coca production into forest-covered areas.”

“In some regions, coca acts as a direct driver of deforestation,” Rebeca Lerer told Filter. A Brazilian journalist and human rights activist, Lerer was the editor and coordinator of the report, and founded the Intersection coalition.

“When armed conflict or the military arrive, it moves coca to more remote areas,” she explained. “It pushes the frontier of production into forest-covered areas—then authorities [seek to] eradicate coca, then usually mining or cattle ranching projects come.”

The cocaine trade is tied to environmentally destructive industries, details the report, as it provides financing and the infrastructure needed to move people, goods and services engaged in the illegal wildlife, fishing and logging trades—to name a few.

“The cocaine trade in the Amazon works as an investment bank for other environmental crime,” said Lerer, who also serves as the Latin American secretariat of the International Coalition for Drug Policy Reform and Environmental Justice, one of the groups that collaborated on the report.

“When the [authorities] repress one [cocaine trafficking] route, they shift to another forest area,” she continued. Trafficking groups “then involve traditional communities and local Indigenous lands in these routes. Repression moves this around without reducing the trade or consumption, and while increasing violence.”

The first section of the report was written by David Restrepo, research lead at the Center for Studies on Drugs and Security at the Universidad de los Andes. He gives a brief history of the coca leaf—from its ancient use as a spiritual, medicinal and communal substance in the Andes highlands; to the chemical extraction of the cocaine alkaloid and its launch as a global commodity; and finally, to the onset of prohibition and the rise of wealthy, militarized “cartels.”

“Among the millions of people across South America who continue to chew, cultivate, and revere coca, the leaf is not considered an intoxicant but a vital substance for social cohesion.”

It’s a story that’s taken another twist even since the publication of “From Forest to Dust.” On December 2, the World Health Organization opted not to recommend easing the blanket global prohibition of coca—going against the findings of the agency’s own expert report.

“Among the millions of people across South America who continue to chew, cultivate, and revere coca today, the leaf is not considered an intoxicant but a vital substance for social cohesion and balance with the natural world,” Restrepo writes.

Traditional use spans peoples like the Nasa in Colombia, mambe circles in the northwest Amazon, and Quechua-speaking highland Peru and Bolivia. But the plant’s importance to diverse cultures is overshadowed by its potent white derivative—and authorities’ disastrous attempts to suppress it.

The report covers harmful domestic and international crackdowns, the export of the United States drug war through initiatives like “Plan Colombia,”  and how enforcement moves the trade around, per the “balloon effect.”

“Prohibition, even in its infancy, generated adaptive supply,” Restrepo writes. “When one route closed, another emerged.” He criticizes US and Colombia-led anti-trafficking actions, and notes how Colombia’s 2016 peace deal with the leftwing militia group FARC fragmented the cocaine trade in the country, with “dissident factions, paramilitary successors, and criminal entrepreneurs filling the authority gap.”

In Peru and Bolivia, meanwhile, Restropo explains how coca cultivation has continued to increase. Prohibition “reshuffles and disperses [the trade], often into ecologically fragile regions where state presence is weak.” He cites UNODC data showing that potential leaf yields more than doubled, from 4.1 tons per hectare in 2013 to 8.5 tons by 2023. That single hectare could produce up to 19 kilograms of cocaine per year.

Coca-related forest loss has doubled over the past decade—exceeding 20,000 hectares in some years. The refinement process also produces significant pollutants.

But changing fortunes in the global cocaine trade have made Brazil an emerging player, with groups like the Red Command and the Capital’s First Command taking key roles in manufacturing, the domestic supply and global export.

Amid these changes, coca-related forest loss has doubled over the past decade—exceeding 20,000 hectares in some years. The refinement process also produces significant pollutants from gasoline, sulfuric acid, ammonia and acetone. Field studies show elevated heavy metal and acid residues in nearby soils and waterways, and coca processing areas are associated with more fish and amphibians dying.

But efforts to eradicate coca are also environmentally destructive. Notoriously, aerial crop fumigation operations have poisoned forests, waterways, farms and human beings with the herbicide glyphosate. 

The report’s second section, jointly written by University of São Paulo urban geography researcher Thiago Godoi Calil and members of the Mãe Crioula Institute, continues to document the destruction.

It describes the rise of “narco-deforestation” and “narco-mining”, where the illicit drug trade is tied to illegal extractive industries like logging, wildlife and plant smuggling, and to land-grabs and sex trafficking. The authors note that from 2017-2021, 16 major seizures in the Brazilian Amazon found cocaine shipments in illicit lumber on its way to Europe.

“Because it’s criminalized, there is no control over the waste process. It contaminates water, soil and animals … There are health hazards for lab workers.”

In the following section, members of the Instituto Fogo Cruzado cite UNODC estimates showing that global cocaine production of 3,708 tons in 2023 produced an estimated 2.19 billion tons of carbon dioxide. Every aspect of the production and supply chain—from cutting and burning forests to grow coca, to the refinement process, disposal of waste and transportation—contributes to this. And prohibition means the absence of mitigating regulations.

“The production itself generates impacts,” Lerer told Filter. “So many chemical products are used. Because it’s criminalized, there is no control over the waste process. It contaminates water, soil and animals in the surroundings. There are health hazards for lab workers, and adulterants used by people with poor expertise.”

These environmental harms go far beyond the interior regions of the Brazilian Amazon—including out to the oceans, with chemical traces found in mussels, sharks and other fish.

The multi-billion dollar cocaine industry additionally serves as an “investment bank” for extractive underground industries in Brazil, the authors write: “The main ‘indirect’ effects of the prohibition associated with this refining structure are related to the financing of other illegal activities and the use of political influence and the armed branches of the drug trade to corrupt public agents and avoid oversight. For communities and environmental defenders, this translates into an increase in deaths and threats.”

To put the scale in perspective, the authors estimate that the cocaine refinement industry alone could generate up to $6 billion a year in Brazil—a sum nearly six times larger than the total target for the Amazon Fund ($1.05 billion), a government-managed philanthropic organization combating deforestation.

In another section of the report, Mary Ryder and Steve Rolles of Transform Drug Policy Foundation briefly mention some local efforts—particularly in Europe—to consider legal regulation of cocaine and other stimulants.

Hower, they write, “More realistic in the short term, perhaps, is the possibility for coca based products, such as coca tea, coca leaf or mambe (that only contain a small amount of the active cocaine alkaloid) to be imported and sold in European markets—particularly if coca’s legal status under the UN conventions is revisited.”

“Despite these impacts, drug policy reform is almost entirely absent from the climate policy agenda.” 

Jenna Rose Astwood and Clemmie James, of the International Coalition on Drug Policy Reform and Environmental Justice, conclude the report by describing an approach they call “ecological harm reduction.”

“The question is no longer why the drug war has failed—but why it persists,” they write. “The answer: it enables illegal, unregulated extraction in biodiversity-rich forests vital to our climate future.”

“Despite these impacts, drug policy reform is almost entirely absent from the climate policy agenda,” they continue. “This omission is dangerous. It is not possible to protect the Amazon, or meet climate goals, while ignoring one of the biggest forces driving its destruction.”

Astwood and James call for environmental justice and an end to the drug war, pointing to what they describe as Indigenous peoples’ “approach rooted in ecological interdependence.” But they don’t completely endorse the legal regulation of drugs unless it’s combined with efforts to protect the environment, workers and people who depend on vulnerable lands.

“A legal market, if poorly implemented, can reproduce the harms of prohibition through unsustainable agricultural practices, corporate capture, land grabbing, and further marginalization of those already embedded in the drug economy,” they write. “A just transition to a regulated drug market must reduce the influence of extractive and criminal economies by establishing safeguards to prevent exploitative actors from entering the legal space.”

“We need to start by freeing the coca leaf—from there we should design what this trade should look like from an ecological harm reduction lens.”

Their recommended components of this vision include sustainable environmental practices such as permaculture and companion planting; responsible land, water and energy use; ensuring food security for rural communities; and diversifying agricultural systems. Processing and refining of controlled substances, they argue, should be relocated to urban and suburban areas where waste can be better controlled.

They also endorse various protections for workers including the rights to organize, collective bargaining, safe working conditions, fair wages, and an end to forced and child labor. And land reforms should protect peoples with traditional ties to ecosystems. Stolen lands should be returned with just compensation, and resources should be provided for restitution and community-led redevelopment.

“Prohibition started with the plants, and we think we need to go back to the plants,” Lerer said. “We need to start by freeing the coca leaf—from there we should design what this trade should look like from an ecological harm reduction lens and avoid corporate capture. Illegal cocaine promotes environmental destruction, but ‘Big Pharma’ cocaine is also not going to deliver climate justice.”

Photograph of deforestation in northern Brazil by Felipe Werneck via Wikimedia Commons/Creative Commons 2.0

The post “From Forest to Dust” Shows How Drug Prohibition Drives Climate Crisis appeared first on Filter.

The WHO’s own expert review had detailed in September how millions of people across the Andes consume the coca leaf daily as part of a longstanding cultural practice without any significant negative effects—and that, conversely, coca control strategies are associated with substantial public health harms.

And yet on December 2, the WHO’s Expert Committee on Drug Dependence (ECDD) recommended that the plant be kept in Schedule I of United Nations drug treaties—the most restrictive category of control—because coca leaves can relatively easily be converted into cocaine.

“The simplicity of extracting cocaine from coca leaf and its high yield and profitability are well known,” the ECDD wrote. “The Committee also reviewed evidence of a marked increase in coca leaf cultivation and in the production of cocaine-related substances, in the context of significant, increasing public health concern about cocaine use. In that context, the Committee considered that reducing or removing existing international controls on coca leaf could pose an especially serious risk to public health.”

“It’s unacceptable for humanity to demonize a sacred medicinal plant. It was more of a political decision than a scientific one.”

The committee noted that a 34 percent year-on-year increase in cocaine production was reported in 2023, with some countries reporting historically high levels. But reform advocates emphasize that coca is not cocaine. They insist that the WHO’s review acknowledged both the plant’s medical potential and the lack of evidence of problematic coca leaf use anywhere in the world—two key criteria a drug must satisfy to be placed in a less restrictive schedule.

“It’s unacceptable for humanity to demonize a sacred medicinal plant,” Jaison Perez Villafaña, a wisdom keeper or mamo from Colombia’s Arhuaco community, told Filter. “It was more of a political decision than a scientific one. The coca leaf (el ayu) is not itself to blame for being converted into cocaine by humans with economic interests.”

The ECDD said it recognized that “coca leaf has an important cultural and therapeutic significance for Indigenous peoples and other communities and that there are exemptions for traditional use of coca leaf in certain national frameworks.” A coalition of Indigenous coca leaf producers and consumers wrote to the WHO in October urging the UN body to “clearly differentiate” between traditional coca use and issues associated with cocaine.

Steve Rolles, senior policy analyst at Transform Drug Policy Foundation, called the WHO’s suggestion that keeping coca in Schedule 1 would restrict cocaine production “ridiculous,” saying the decision exposed “the moral and scientific bankruptcy pervading the entire system” of global drug control.

“Whilst we may expect decisions like this to emerge from political bodies subsumed within entrenched ‘war on drugs’ narratives, there was a hope that the more objective, scientific, and nominally independent corners of the UN would maintain a degree of pragmatism and principle—even if their recommendations were later rejected by UN political entities,” he wrote on LinkedIn.

“The risks of cocaine powder or smoked crack cocaine, creations of the global North, which is also by far the biggest market for both, are demonstrably of a different order to traditional coca use, chewed or in tea, which occurs exclusively in the global South,” Rolles added. “It is the global South where the burden of both the failed war on cocaine, and the criminalization of entire cultures is most acutely felt.”

The WHO review had affirmed that traditional coca chewing has caused no documented fatalities, is not associated with significant dependence potential and has possible therapeutic applications.

In 2020, following a WHO recommendation, the UN’s Commission on Narcotic Drugs voted narrowly to relax international controls on cannabis, acknowledging its medical value after decades of “reefer madness.” For reform advocates, that decision appeared to signal a slow and overdue shift toward evidence-based scheduling. Therefore there were hopes that the UN system could also distinguish between the coca leaf—containing less than 1 percent cocaine alkaloid—and the refined powder that fuels global demand.

Yet coca will continue to be treated as though it has the same risk profile as cocaine—even after the WHO review affirmed that traditional coca chewing has caused no documented fatalities, is not associated with significant dependence or “abuse” potential, and has possible therapeutic applications ranging from anti-inflammatory effects to modest improvements in post-meal glucose.

“The WHO’s decision is deeply disappointing and profoundly troubling,” Ann Fordham, executive director of the International Drug Policy Council, said in a press release. “This was not a routine review—it was a critical test of the UN drug control system. The Committee has shown it cannot objectively assess evidence or consider the human rights consequences of prohibition. Instead, it has chosen to reinforce the racist and colonial foundations of international drug control. This decision makes clear that the system is broken and resistant to meaningful reform.”

Experts have long argued that the logic behind the coca ban is selective and ignores existing treaty precedents. Plants such as ephedra, which is used to manufacture methamphetamine, psilocybin-containing mushrooms and mescaline-producing cacti all remain unscheduled at the plant level, despite being used to produce controlled substances.

Villafaña and other Indigenous leaders have warned that these pressures amount to a form of cultural violence.

While open persecution of coca-chewers in the Andes has waned, prohibition still shapes daily life in parts of the region—from farmers who lose crops to stop-start aerial fumigation campaigns, to communities caught between eradication forces and the networks that dominate the illegal cocaine trade. In the September review, the independent group of experts contracted by the WHO noted research that showed exposure to harmful glyphosate-based pesticides like Roundup, found to be a probable carcinogen, from authorities’ aerial spraying of coca crops “increased the number of miscarriages and the number of medical consultations related to dermatological and respiratory illnesses in targeted communities.”

The review added that another study showed that forced coca eradication incentivized coca farmers to intensify production through increased use of toxic agro-chemicals “in remaining or subsequent coca plots, increasing their exposure to those chemicals.”

Villafaña and other Indigenous leaders have warned that these pressures amount to a form of cultural violence. Coca is central to Andean communities’ spiritual practice, conflict resolution, work, ceremony and community health—yet its use outside narrow “traditional” exemptions places people at risk of criminal sanctions.

“It would be a relief for us as a culture,” Villafaña said, “if the world recognized it as a sacred plant and didn’t demonize it.” But, he added, the decision would not otherwise affect his community, whose members will continue chewing coca as they always have done.

Photograph by Crista Castellanos via Wikimedia Commons/Creative Commons 4.0

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