The Board has continued to show a narrow conception of its duties. The completion of incomplete and problematic statistics will never solve the problem.
A. E. Blanco, in an Anti-Opium Information Bureau communiqué (1930)

Describing the activities of the INCB is, on the one hand, a relatively easy task and, on the other, one beset by difficulties. The ease is due to the fact that the Board has clear-cut duties and that much of its output is in the form of publications; by studying these one can learn a great deal about the nature of its work. The difficulties arise from the Board's use of secrecy. The need for secrecy is stipulated by the international legislation under which the Board operates and is understandable in view of the necessity to treat as confidential the information supplied to it by individual governments. But "official secrecy," as it operates in bureaucracies (see Gerth and Mills, 1948) has a way of expanding the area it covers. Thus the minutes and agendas of INCB meetings and its communications with governments have all become classified material. A written request we made to the INCB for access to the minutes of the PCB and DSB, from their inception up to 1942, was turned down. An idea of how "closed" the area of participation in information-sharing is can be gathered from the following incidents.

During the plenipotentiary conference to consider amendments to the Single Convention, the chief British delegate, Peter Beedle, observed that, although the reports of the Board were becoming increasingly important because of the information they gave on the illicit traffic, "the source of information remained a mystery," and this he considered "unsatisfactory and anomalous in a world where co-ordination and dialogue were the order of the day" (E/CONF.63/C.1/SR.4, 1972). As this delegate was also for some time a representative to and chairman of the Commission on Narcotic Drugs, his statement implies an information gap between the two bodies.

Earlier too, the Board had not shared its information with the Advisory Opium Committee, as is evidenced by the following letter from its first president, Leonard Lyall, to the chairman of the Committee:

The Board was further informed that the Advisory Committee would probably ask the Board to communicate to it the annual estimates for the year 1930 that it will receive from the various, governments . . The Board, anxious as it is to oblige the Advisory Committee in every way, considered this question carefully, but came to the conclusion that these forms are confidential, and that the Board would therefore scarcely be justified in communicating them even to the Advisory Committee, without the consent of the Governments concerned (Letter from L. A. Lyall to C. Fotitch: OC 1093 1 XI, 1929).

This predilection for confidentiality imposes a limitation on any attempt to assess the work of the Board. The limitation is probably not so very serious when it is only a question of describing the statistical work of the Board, but, as one of its own vice-presidents pointed out, the Board is not merely a body "for the mechanical recording of statistics; a computer could fulfil that role" (CND: 24th, 1971: 170). It makes decisions with regard to these statistics, and, if there are treaty violations, it can recommend sanctions against the government concerned (see Appendix B). We see only one aspect of how the Board exercises control, but we can only conjecture with regard to the other—that which is generally referred to as its semijudicial function. It is thus difficult to determine to what extent the Board has fully used or underused its powers, or to what extent it has kept strictly to the performance of its obligations under the treaties. The Board has interpreted the scope of its functions as widely as it could, and it has appeared more willing of late to take stands on matters of policy. Its 1972 report is a good example of the recent readiness to venture opinions on the circumstances and social consequences of drug use. In doing so, it runs the risk of laying itself open to criticism and pressure—criticism from those better versed in such matters, and pressure from those countries wishing to convert others to their point of view.

The Board is in session twice a year and its annual meeting-time amounts to about a month. Previously, it had met more frequently, and the pattern of meetings was such that not only did the PCB and DSB hold joint meetings (in addition to separate ones) but even their own individual meetings overlapped in time. Indeed there was increasing personal union, in that several people were simultaneously DSB and PCB members. Although arguments have been advanced in favor of having separate bodies (Eisenlohr, 1934), few would deny today that merging the two was an improvement on the old system. There has also been some disagreement over the frequency with which the Board should meet. The Board is in favor of more frequent meetings; when the secretary-general's Committee on the Reorganization of the Secretariat recommended that the Board should only meet once a year, the Board pointed out that not only was it necessary to meet twice a year but that a third meeting might well be called for from time to time'(INCB, 1969). A factor which may have contributed to a diminished need for so many meetings is the accumulating experience of the Secretariat. The Board's sessions are an opportunity for more intense contact between its members and the Secretariat staff; probably because of the smallness of the two bodies, the relationship seems to be closer here than for corresponding groups in other parts of the drug control apparatus.
One of the main tasks at these meetings is the inspection of advance estimates furnished by governments of their drug requirements for the following year. For this purpose the Board has a subcommittee which meets before the full Board meets. This subcommittee in fact performs to a large extent the job of the earlier Supervisory Body. In its plenary sessions the Board discusses what eventually becomes the contents of its publications.

The main output of the Board consists of four documents: a basic annual report and three separate publications containing mostly quantitative data.

Of these three publications, the first we will consider is the annual statement of the Estimate of World Requirements of Narcotic Drugs and Estimates of World Production of Opium.

The main purpose of the estimates is to limit the manufacture of and trade in drugs to legitimate requirements. The estimates are based on governmental estimates given in advance and are tabulated by country, by drug, and by type of use. The categories of use are: domestic consumption for medical and scientific purposes; utilization for the manufacture of other substances; maintenance of reserve stocks.

Governments are required to state the method used for determining their figures, especially if they are found to be significantly higher than those of previous years. Some countries fail to provide the Board with their estimates of requirements, and in these cases the Board determines them itself. The Board may have reason, sometimes, to challenge the validity of the governmental estimates, and this can give rise to extensive correspondence with the governments concerned. The provision for governments to submit supplementary estimates adds flexibility to the system but creates considerable additional work for the secretariat. The supplementary estimates are published four times a year as addenda to the original statement of estimates. The outcome of the Board's correspondence with governments is difficult to assess without a systematic study of its contents, which, for reasons already mentioned, we did not find possible.

The crucial question underlying the application of the estimates system is, by what criteria are medical requirements determined? The Board is faced with this question when it is not able to relate the figures it receives to the method claimed to have been used to arrive at them. For the consumption estimate the Board offers a formula to be followed by governments; for the other categories no method can be uniformly used in all countries, since conditions vary widely. The search for criteria of medical need goes back to the time of the League of Nations, when a subcommittee of the Advisory Committee and Health Committee grappled for a time with this question. Initially, it was suggested that calculations of requirements should be based on a rate of 600 milligrams of raw opium per inhabitant per year. Subsequently, the subcommittee adopted a norm of 450 milligrams; consumption above this level was to be considered not only unnecessary but also harmful, and consumption below it was to be an indication that part of the population was being deprived (CH 264, 1924). There seemed to have been some recognition of the relativity of this norm, for it was conceded that it applied only to European countries. It was estimated that, at 450 milligrams of opium per capita, the world's legitimate requirements would amount to 720 tons annually. Interestingly enough, the U.S. Congress had, in a resolution of 1923, declared that 100 tons would satisfy the annual medical and scientific needs of the world (Buell, 1925).

Uncertain and arbitrary as the criteria must be, the system was not unworkable, and the Drug Supervisory Body was able to tell which governments had overestimated their needs. In the Commission also, a resolution had been passed to discourage overestimation, the extent of which was reckoned at 25 percent for morphine and 54 percent for cocaine (CND: 9th, 1954). Moreover, the Drug Supervisory Body was able to observe that estimates were often merely a reflection of sales projections. In its 1960 report it expressed surprise that "the criteria on which some governments base their estimates should have been dictated solely by prospects of sales" (DSB, 1960: 9).

Further criteria were elaborated, based on such measurements as the number of hospital beds, the number of doctors, dentists, and veterinarians in each country. WHO was approached for its advice. The Drug Dependence Unit to which this question was referred presented its conclusions in a paper entitled "Variations in Legal Narcotics Consumption as between Countries and Underlying Factors" (WHO/APD/INT/22, 1961). According to this paper the criteria used did not yield figures that reflected actual needs.

In fact, it is evident that the key factor in determining medical requirements is actual use. The Board, too, has observed that the majority of countries claimed to base their estimates on consumption in previous years, even though the estimates and the use figures did not always tally (INCB/Estimates, 1970: vii). Deciding which comes first is very much in the nature of deciding between "the chicken and the egg," although one might also see the usefulness of the estimates system as an "educational device" (Halbach, interview) that impels countries to follow more critically the level of their drug consumption. On the other hand, it is also likely that, instead of doing that, some countries merely fall back on consumption levels of previous years and produce an estimate based on those without further enquiry.

Although a full evaluation of the estimates system is not possible without considering the other statistical work of the Board and the interventions it has made, it does seem as if the Board has had to adjust to changes in medical practice without being able to question them. A case in point is the therapeutic use of cannabis in several European countries during the 1960s. Another illustration is provided by trends in the level of demand for medical purposes for certain drugs, as shown in table 6.1. We see from this table that the estimated requirements for pethidine and codeine have all risen over time while those for heroin have fallen. The increase in morphine is accounted for by the increased demand for codeine, for whose manufacture most of the morphine produced is used. Methadone requirements show a different trend. It will be recalled that when heroin was first developed it was greeted as a welcome substitute and cure for morphine addiction. Now methadone is used in treating opiate dependence, and since 1969 an increase of nearly 100 percent in its rate of production has been reported by the Board: of the total increase, the share ofthe U.S. rose from 41 percent in 1967 to 84 percent in 1970 (INCB/Statistics, 1970). The acceptance of methadone maintenance represents such a deviation from earlier policies which favored abstinence—the conference which adopted the Single Convention, for instance, urged the setting up of facilities for treatment "in a hospital institution having a drug-free atmosphere" (Resolution II)—that one wonders what the international reaction might have been if methadone had been introduced on a large scale by any country other than the U.S.

These changes make it difficult to determine what in fact constitutes medical need, nonmedical need, and quasi-medical need. What conclusion is one to draw from the fact that India, with a population of 550 million, anticipated using eight times as much opium for medical purposes during 1971 as the United States, which had a population that year of 205 million, whereas total requirements of U.S. citizens for codeine and pethidine for that same year were, respectively, twice and fifteen times those of India's? Is the acceptance (implied by approved estimates) of the increase in the use of codeine justified, when the WHO Expert Committee had pronounced it an addiction-producing drug (WHO/EC DD, 1958) and cases of its use intravenously and in high oral doses had been reported (CND: 24th, 1971)?

The second part of the statement of estimates relates to estimates of opium production, which are tabulated by country, and within each country by region and area. Estimated amounts of opium to be harvested and area of cultivation are given, as is the average moisture content of the opium to be harvested. The same difficulties must attend the assessment of these estimates as of those already discussed, but because the number of countries is limited to those complying with the 1953 Opium Protocol, this exercise is more manageable. Opium producers often protest that these estimates are at best a rough guess since variations in weather and other physical conditions can greatly affect the size of the crop.

The Board also publishes an annual report entitled Statistics on Narcotic Drugs. This contains nine statistical tables and, in recent years, some comment and analysis of the data presented. These tables provide a picture of the consecutive stages of the legal trade in drugs—from agricultural production to manufacture to export/import, consumption, and stocks. Data relating to these stages are taken from returns from governments, and control is exercised through checking whether the returns from an exporting country correspond, for example, to those of the importing country. In addition, the publication contains information on seizures.

The third addendum to the Board's annual report is the Comparative Statement of Estimates and Statistics which is a balance sheet showing whether the amounts available have been accounted for and whether each country has stayed within the limits set by its estimates. This way, the Board exerts "control" by showing that the supply of drugs in a country does not exceed its estimated requirements. If this limit has been exceeded, the Board can intervene by asking the country concerned to take steps to remedy the situation. The effectiveness of this kind of control depends on a number of factors: one is the quality of the returns received by the Board and another is the way the estimates have been made up. If the estimates were merely figures adjusted to former levels of production or importation and consumption, then comparing them with the contemporary statistics would seem to be a superfluous exercise. All that the Board is doing then is simply repeating what the governments themselves have already done, if, in fact, governments draw up their estimates on the basis of prior consumption. Often the estimates are not even adaptations; they are repetitions of the previous year's data without account being taken of any changes which may have occurred (INCB, 1968). But if the estimates are not just the statistics in another guise, then the situation is, of course, different; control will have been exercised not only over whether consignments of drugs keep within the estimates of their intended destinations but also indirectly over drug consumption in the general population, overprescribing of drugs by physicians, and so on. If the Board does question the estimates submitted to it and if the governments concerned do then modify them accordingly, with consequent changes in production or import, then this form of indirect control will to some extent have been applied. It is clear, nevertheless, that the basis of the Board's supervision is in seeing that, in any given country, the legal supply of drugs is not so abundant that it can spill over into the illicit market. How large or small the supply should be depends on how much medicine the country's government decides is needed by its citizens, and often this depends on how much medicine is being taken to begin with.* In some countries addicts or drug-dependent persons are included in the category of medicine-takers while in others they are not.

In summary, the Board's statistical output consists of estimates of requirements, data on the licit movement of drugs, and comparisons between estimates and utilization—all of which are based on government reports. The history of the Board is in a sense & history of constant struggle for better cooperation from national authorities and for a higher quality in their returns. Sometimes the level of precision expected from governments is extremely high, as when, for example, the Yugoslavian government was asked by the Board in 1972 to explain a failure to report five milligrams of LSD (E/CN,7/SR.688). In its annual reports the Board often refers to the need for an improvement in governmental reporting. In its 1947 report, the Board defined three criteria for measuring the adequacy of the statistical reporting system:

—the number of countries collaborating;
—the number of returns (each country has to complete ten per year);
—the quality of the statistics.

* The term "medicine" is used here with the same limited application as the term "drugs" (see Introduction).

The Board's reports regularly give the yearly percentages of total returns received compared to the number expected. Some of these are given below:

The figure for 1971 represents 867 returns out of a total of 948 due. Despite the high rate of returns, the limitations of the three measures are evident, given the lack of criteria for estimating production, trade, or medical need.

Many countries do not submit their estimates of requirements, and in these cases the Board establishes them. In 1935 the Board established estimates for 48 countries and received estimates from 123. In 1972 the corresponding numbers were 14 and 174. It is noteworthy that estimates of drug needs for all China had been provided by the Nationalist government in Taiwan.

The last publication to be considered is the Board's main annual report on its work, to which the reports already discussed are supplements. The report contains comments on the working of the system of statistical returns, but there seems to be a tendency in recent years for these to become a less important feature of the report. More attention is being paid to the kind of issues that are discussed by the World Health Organization and the Commission.

The report is one of the media used by the Board to exert moral pressure, and it therefore contains many appeals, declarations, and expressions of approval and disapproval, as the case may be. Because it provides valuable insight into the values and beliefs which underlie the Board's approach to the problem with which it deals, and so as to convey the "feel" of the report's phraseology and style, we will briefly review one issue—that for 1971, the last available at the time of writing this chapter.*

* The 1972 report, which has appeared since this section was written, will be referred to in subsequent chapters.

The report begins with a listing of the eleven Board members (see Appendix B), accompanied by details of their academic and professional qualifications. The personal data are considerably fuller than those given for the individuals serving the WHO expert committees and the Commission on Narcotic Drugs in their respective publications, and the rationale for this must lie in the need to stress the independence and high caliber of the INCB members. The report proceeds to a survey of the general world drug situation, and the tone here is alarmist: a "virtual epidemic" of "drug abuse" (p. 8) is said to have occurred. The report then goes on to review the current state of international control, and "problem countries" in the Middle East, South East Asia, and the Andean region are specially mentioned. This is followed by another review of the general situation, this time by class of drug—the opiates, cannabis, the coca leaf, and cocaine. In an earlier chapter the report states that "so long as demand persists (and there is reason to fear that it will in fact expand), production will inevitably rise, in one place or another, to meet it" (p. 20). A subsequent chapter states what the Board thinks should be done to curtail demand; from this one learns that the Board's concept of "demand" is, in fact, no less narrow than the earlier notion that it is a question of curing addicts and deterring would-be users. The measures proposed entail the identification and treatment of "individual cases of addiction which may be redeemable"; checking "the epidemic spread" by "protecting" the "individuals or groups particularly at risk"; and the limitation of "deterioration in severe and relapsing cases" (p. 28-29). The report concludes that

humanity is facing a world crisis: a crisis which is portrayed in the spectacular growth of drug abuse; in the revival of the evil in countries where firm action seemed to have succeeded in checking it; in the emergence of new channels of illicit traffic; in the appearance in law-respecting countries of group defiance of the law . . . (p. 34).

There is no lack of drama in these polemics. They also show a certain insularity; a failure to see things in their proper proportions. One's own area of concern is seen as the all-important one, claiming more attention than can reasonably be assigned. Its seriousness is played up in terms which go beyond the immediate circumstances in a way which is likely to distort judgment.

Finally, some observations on the members of the Board. The conditions of appointment laid down by the Single Convention are "competence, impartiality and disinterestedness." However, it is doubtful whether actual practice adheres to these strict standards. The Board is not a "pure" apolitical body because governments will not allow it to be. An illustration of this is provided by the German declaration at a League Council meeting in 1927 that German ratification of the 1925 convention would be contingent on a German expert becoming a PCB member (Council, 6 December 1927). Although a requirement of appointment has been that a person in government service should relinquish his position on appointment to the Board, one of the members, Marcel Granier-Doyeux, is, in fact, simultaneously an ambassador and an INCB vice-president. One would also have thought that Harry Greenfield's close connections with the British-American Tobacco Company were not altogether compatible with his position as president of the Board, given the Board's goal of combating drug dependence, and the dependence factor in, and health damages of, cigarette smoking.

We have discussed the Board at some length without 'considering the secretariat. This is not to imply the latter's insignificance. On the contrary, most of the work which goes into the preparation of the published reports is carried out by the staff members, but as this forms the bulk of the secretariat's work program, (E/4463), it is not necessary to explore its activities in greater detail.