The United Nations has rebuffed, for now, pressure from China to enact what could amount to a global ban on ketamine, as many in the medical profession — veterinarians and physicians alike — work to maintain access to the drug.
The Chinese government for years has sought to bring ketamine under stricter global control due to recreational abuse in the country. How such restrictions might impact U.S. ketamine supplies is unknown, though many suspect that any international regulatory action would limit its availability.
Ketamine currently isn’t regulated under the Convention of Psychotropic Substances, a treaty established in 1971 as an international control system for the manufacture, distribution, transfer and use of drugs. The World Health Organization considers ketamine to be an “essential medicine," a class of drugs that WHO officials deem to be relatively cheap, safe, effective and necessary to satisfy the health-care needs of large populations. The job of regulating ketamine is left to individual nations.
China wants to change that.
Ketamine has been used as an anesthetic in human and veterinary medicine for more than 50 years. For decades, it was manufactured by drug companies, but that’s changed with underground ketamine laboratories proliferating in China, feeding what many consider to be an epidemic. Ketamine reportedly has become the most abused drug in Asia, known for its powerful dissociative and hallucinogenic effects.
Physicians say that recreational abuse of ketamine doesn’t dilute the drug’s importance to health care. Medicinal ketamine is heavily relied upon in many lower- and middle-income countries because it does not depress a patient’s respiration or circulation during surgical procedures. That means it can be administered without oxygen, ventilators, an electricity supply and other support systems that are required when administering other anesthetics.
Veterinarians worldwide use ketamine as an anesthetic and adjunct to pain control, and it remains a important drug used to tranquilize horses.
In December, WHO officials rejected China’s fourth petition since 2006 to schedule ketamine under the Convention. “The medical benefits of ketamine far outweigh potential harm from recreational use,” said Marie-Paule Kieny, assistant-director General for Health Systems and Innovation at WHO. “Controlling ketamine internationally could limit access to essential and emergency surgery, which would constitute a public health crisis in countries where no affordable alternatives exist.”
WHO took its recommendation in March to the UN, which has the final word on Convention matters, where it met by yet another appeal from the Chinese government to impose ketamine restrictions.
The American Veterinary Medical Association was among many professional groups that lobbied against China's proposal for international scheduling.
“Ketamine is a key component of veterinary medical anesthetic and pain management protocols worldwide, and any regulatory action that limits its availability to the veterinary profession would gravely impact animal health and welfare,” AVMA CEO Dr. Ron Dehaven wrote in a March 10 letter to U.S. Embassy officials in Vienna, where the UN Commission on Narcotic Drugs was gathered.
The UN commission ultimately rejected China's petition based on the advice that it could deprive millions of a much needed anesthetic medication. WHO officials pointed out that ketamine already is regulated in most countries. In the United States, for example, its distribution is strictly controlled by the U.S. Drug Enforcement Agency.
The UN's decision doesn't mean China won't keep pushing. If it does, the World Small Animal Veterinary Association wants to be prepared. The organization has created a petition to ensure that ketamine remains viewed as an “essential medicine.”
More than 7,700 people have signed since the petition went live in March. WSAVA President-elect Dr. Walt Ingwersen hopes to collect 10,000 signatures.
“We’re hoping to keep it alive, active and dynamic,” he said. “Ultimately, this will come back … and when we’re asked about ketamine’s global veterinary relevance and importance, we’re able to say, 'Look, 10,000 people think this is an important drug. This is critical medicine.' ”