Findings

1925: Cannabis in the International Convention relating to Dangerous Drugs

“Starting with the International Opium Commission (Shanghai, 1909), Governments over time established an international consensus on the need for the regulation of psychoactive substances. Moreover, a set of normative instruments and multilateral bodies and systems were developed to help States implement and adjudicate such regulation” (Pietschmann, 2009, p. 1).
Cannabis was for the first time placed under international control on 19 February 1925 with the “International Convention relating to Dangerous Drugs” (C25) adopted at the end of the Second Opium Conference, 1924–1925 (Kendall, 2003; Kozma, 2011b; League of Nations, 1925; Mills, 2003; The cannabis problem…, 1962) and entered into force in 1928 (LoN, 1928). Contrary to what is sometimes believed, this was more the result of “a triangulation between various State interests and blocs” (Collins, 2020, p. 280) than an initiative of the United States (Scheerer, 1997): “Indian hemp” was indeed added to the C25 “at the behest of Egypt, and previous encouragement from South Africa, Italy, and others” (Collins, 2020 p. 281; UNODC, 2008; Waetjen, 2018) and in particular, similarly conservative governments in African and Latin American countries (Campos, 2012; Collins, 2021; Duvall, 2019; Gootenberg and Campos, 2015; Kozma, 2011a; 2011b).
During the 1924–1925 Conference, proposals to extend international controls to Cannabis were soon tabled by the government of King Fuad I from the recently-independent Egypt, a country that “prides itself on being the first country to ban cannabis cultivation, as early as the late 1870s” (Kozma, 2011a, p. 444). During the Conference, the country’s Ambassador, which considered “the illicit use of hashish [being] the principal cause of most of the cases of insanity occurring in Egypt,” (UNODC, 2008, p. 54), called on to other delegates:
“even at the risk of seeming importunate, I insist, and shall continue to insist on the importance of this question […] I am certain that you, gentlemen, who work under the aegis of the League of Nations, will help us in the struggle we have undertaken against this scourge, which reduces man to the level of the brute and deprives him of health and reason, self-control and honour” (UNODC, 2008, p. 55)
Such efforts to place hashish’s Cannabis under international control, just like with opium’s Papaver and coca’s Erythroxylum , went knowingly “against a 2,000 year long history of drug cultivation, production, trading and use” (Buxton, 2008, p. 3). They can be seen as surprising given the fact that, at that time,Cannabis -based medicines were well-accepted globally (Buxton, 2008, p. 3; Collins, 2020, p. 280; Duvall, 2019; Frankhauser, 2002; Hamilton, 1912; Krawitz, 2006; Mathre and Krawitz, 2002; Mikuriya, 1969; Pisanti and Bifulco, 2017; Zuardi, 2006). If Cannabis -based medicines enjoyed a number of standardised pharmacopeial monographs under the 1925 Brussels Agreement on the Unification of Pharmacopoeial Formulas for Potent Drugs (Riboulet-Zemouli, 2020 pp. 13–14, 16), the plant was mainly present in traditional medicine, but also as a commonly used ingredient in locally-compounded medicines, often containing a variety of actives principles varying importantly between pharmacies and villages.11Until the mid-20th Century, most popular practices of day-to-day healthcare maintenance and treatment of minor ailments fundamentally relied on self-medication, eventually under the advice of pharmacists or other traditional healers –and not necessarily on consultations of a clinical practitioner, better documented in the medical literature.
The Egyptian Ambassador did not pretend to ignore it (UNODC, 2008, p. 55), yet, the confluence of several moral impetus for prohibition, as far as Egyptian authorities and elites were concerned, was also solid:
“it was a public health concern, it was a religious concern, it was also Egypt’s image abroad that was on the line here. All were backed by a strong centralizing state (since the 1870s), a nationalist agenda and a civilizing process” (Kozma, 2011a, p. 455).
After centuries of irrelevance in the public debate, Cannabis progressively became a symbol of what certain elites saw as “the nation’s weakness” and its moral decline, as well as a filter through which Egyptian elites looked down at popular classes, where the use ofCannabis products was normalised. As Liat Kozma (2011, p. 454) puts it:
“The 1924[-1925 Opium] conference was the first in which an Egyptian delegation was represented. Putting cannabis on the table, alongside opium and coca-based manufactured drugs, had both practical and symbolic dimensions. A mere five years after the British had prevented the participation of an Egyptian delegation in the post-First World War Versailles conference to present its demand for independence, a purely Egyptian delegation of diplomats and medical doctors presented an Egyptian agenda in an international forum.”
In spite of Egypt wrestling the mention of “Indian hemp” in the C25 from the international community, the “control of cannabis was far less comprehensive than control of opium/morphine/heroin or coca/cocaine” (UNODC, 2008, p. 55), and this was particularly explicit by the fact that
“the 1925 Geneva Convention only placed under control galenical preparations of Indian hemp, that is the extract and the tincture, but it did not mention pharmaceutical preparations containing the extract or tincture of Indian hemp.” (OIHP, 1935, p. 161, author’s translation).
These “galenical preparations (extract and tincture) of cannabis” were
“subject to all the provisions of the 1925 Convention relating to such manufactured drugs as morphine, except that parties need not furnish statistics on manufacture and that manufacture need not be confined to establishments licensed for the purpose” (The cannabis problem…, 1962)
Only “pure” resin obtained from Cannabis was under the international controls established by the C25: theoretically 100-percent pure “extracts” without any added substance. Since the molecular composition of these was not known by the time (Mechoulam and Hanuš, 2000) it was considered that “the resin […] is the active principle of Indian hemp” (LoN, 1939d, p. 29). Consequently, anything other than pure, uncut raw Cannabis extract was outside of the treaty’s controls and legal realm, and this was the case
“even [for] those containing 99 parts or more of Indian hemp extract or Indian hemp tincture to one part or less of any indifferent substance, [which] are not considered as possible agents of drug addiction” (Wesserberg, 1935).
A situation evidently unsatisfactory for Egyptian diplomacy at the time.

The structure of drug control under the League of Nations

Under the C25, Article 8 (exempting preparations of drugs from international control) and Article 10 (adding new preparations to international control) vested two international bodies with a joint mandate of selecting the preparations that should start or cease to be internationally controlled: the Health Committee of the LoN and the OIHP. Today, Articles 8 and 10 of the C25 find echo in Article 3 of the 1961 Single Convention on narcotic drugs and Article 2 of the 1971 Convention on psychotropic substances, which both externalise the appraisal of any change in the scope of control over substances to the WHO –which took over the mandates of both LoN’s Health Committee and the OIHP (Howard-Jones, 1950; 1979; Renborg, 1957, p. 101).

A multifaceted global health leadership

The OIHP was created in Rome on 9 December 1907 in the wake of the series of International Sanitary Conferences held in the second half of the 19th century (Howard-Jones, 1950; OIHP, 1938). The Office became fully operative in 1909 (incidentally also considered the year of inception of the international drug control system with the Shanghai Commission). OIHP’s core objectives were to
“centralize all information concerning epidemic diseases, in a context of European imperialist expansion and fear of the return on the Old Continent of large cholera epidemics” (Frioux, 2009 p. 168,translated by the author).
It rapidly ended up summing plague, tuberculosis, yellow fever and influenza to cholera, as progresses in medicine and epidemiology boomed. Essentially focused around the “quarantine concept” for its first 10 years, the OIHP started to diversify its activities by the turn of the first world war (Howard-Jones, 1979, p. 13; OIHP, 1933). This came not only in reaction to the health-related consequences of the armed conflict, but also to maintain the leadership of the Office in a nascent international health landscape where glimpses of competition had arisen with competing organisations, including from the private sector like the Red Cross (informal, yet mentioned in humanitarian treaties; Durand, 1978; Howard-Jones, 1979) or the Rockefeller foundation (Lin and Birn, 2021; Paillette, 2012). More threatening even for the OIHP was the adoption in 1919 of the Treaty of Versailles, founding the LoN and giving it a mandate on “the prevention and control of disease” and task to “[place] under the direction of the League all international bureaux already established by general treaties” (LoN, 1935b, pp. 14–15).
The LoN quickly wished to centralise public health concerns under a single international “Health Organisation” to be based in Geneva, and “of which the [OIHP] shall be the foundation” (Howard-Jones, 1979 p. 22). The Office would progressively have been incorporated within the LoN system (Ghebali, 1972; Howard-Jones, 1979; LoN, 1945a, pp. 5–9; LoN, 1945b, pp. 62–64).
But the OIHP resisted, and consistently managed to maintain its independence from the League, basked in its self-proclaimed status of first-ever international public health body,[5] a relative success on the control of pandemics, “firmly rooted in 19th-century conceptions of international health work” (Howard-Jones, 1979 p. 25), and thanks to the fervent support of the governments of Italy and France which jointly handled the Secretariat of the Office (Howard-Jones, 1979; Paillette, 2021). Its independence is evidenced by the fact that, after WWII, it survived six years after the dissolution of the LoN (WHO, 1947b; 1952a).
Consequently, in the 1925–1945 period, various international health organisations coexisted, in a context of tensions and drama (Howard-Jones, 1979 pp. 27, 61; Le Monde, 1946). The situation was maintained thanks to a status quo with the LoN that was negotiated by OIHP’s founder, French diplomat Camille Barrère, in which:
“the functions of general consultative council on health [are] entrusted to the [OIHP], which remains autonomous and maintains its headquarters in Paris, without modification of its composition or its attributions” (LoN, 1945a, pp. 6–7; see also OIHP, 1925).
In the 1930 Yearbook of the LoN , this “consultative council” is described as follows:
Composition: composed by permanent representatives of about forty States, it remains autonomous and maintains its headquarters in Paris, without alteration of its composition or attributions. […]
Attributions: It has the power to discuss and propose international conventions. It examines the works of the Health Committee, exposed in its resolutions, and discusses all questions submitted to it by that Committee, so as to provide consultative advise. […]
Procedure: It meets twice a year. Its sessions follow those of the Health Committee by a few days. It receives the text of the Committee’s resolutions in the form of a report.” (Ottlik, 1930, p. 144, author’s translation).
Not only “the organizational structure upon which international health work was based during the twenty inter-war years was the result of a deadlock” (WHO, 1958, p. 27), but the OIHP was a
“club of senior public health administrators, mostly European, whose main preoccupation was to protect their countries from the importation of exotic diseases without imposing too drastic restrictions on international commerce” (Howard-Jones, 1979, p. 17)
Far from secondary, the role of individuals is enlightening, if not critical, in understanding the shaping of early international politics (Rodogno et al, 2013, pp. 96–97). This is particularly true in the field of global drug control, where a “more personal, idiosyncratic cast” persisted until the 1950s (Fig. 1; McAllister, 2000, p. 210).
Camille Barrère illustrates this. French Ambassador in Rome (1897–1924) and “great protector” of the OIHP (Howard-Jones, 1979, pp. 31–33; Paillette, 2021), he had chaired the 1907 funding conference of the Office. Barrère, who had an opinion on all issues, assiduously attended OIHP meetings until his death, in 1940. In addition to unconditional support from France, his views of “the nascent fascist movement [in Italy] with almost unalloyed favour and enthusiasm” (Shorrock, 1975, p. 595),33Renzi (1971, pp. 193-194) even presents evidence that Barrère provided personal financial support to Benito Mussolini. and his inclination to balancing public health concerns with trade requirements –and particularly, commerce in and between European countries and their foreign colonies (Howard-Jones, 1979)–, Camille Barrère knew how to play “the hostility of the United States and USSR, membersof the Office, but from which [the LoN] had not obtained adherence” (Le Monde, 1946) in order to sustain the OIHP and its independence. Howard-Jones (1979, p. 32) explains:
“In fact, that Barrere should have had any influence at all in planning international health work was grossly anomalous. He was neither a health expert nor a health administrator, but a fulltime professional diplomat.”