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18 Mar 2015

Millions of patients in developing countries have had their access to a lifesaving drug preserved after the Chinese Government abandoned a controversial bid to have the widely-used anaesthetic ketamine scheduled as a narcotic drug by the United Nations.

In a decision greeted with relief by public health experts around the world, China last week deferred for a year a proposal for the United Nations Commission on Narcotic Drugs to classify ketamine as a controlled drug amid concern about growing abuse of the medicine for recreational purposes.

Chinese authorities have become increasingly alarmed about the illicit use of ketamine, where it often goes by the street names ket, Vitamin K or Special K, and had proposed that it be put in the same schedule 1 category as psychedelics such as LSD, making its supply and use subject to heavy restrictions.

It would have meant that any countries wanting to purchase the drug faced an annual limit on how much they could import, and severe restrictions on who could administer it.

Medical experts including the World Health Organisation and the World Medical Association warned the change would have been a disaster for billions of patients in developing countries, where ketamine is the only viable form of short-term pain relief.

Ketamine is one of the most commonly used anaesthetics in the developing world because it is cheap and easy to use. It is injectable, which means it can be administered by doctors and nurses in even basic settings and, because it does not interfere with coughing and gag reflexes, patients do not have to be intubated. It is also valued in cases of traumatic injury and shock because it raises blood pressure.

The WHO had strongly advised the Commission to reject the proposal on public health grounds, arguing that to schedule the drug would have the practical effect of denying its use to millions who undergo lifesaving surgery in developing countries every year, such as caesarean sections.

World Medical Association President Dr Xavier Deau said that although the desire to tackle the recreational abuse of the drug was understandable, scheduling it would make it unavailable and increase the suffering of people “in the most difficult of clinical circumstances”.

“We know from experience with other anaesthetics, especially pain medication, that the scheduling of drugs effectively prevents their use, and that patients in poor areas and in rural settings are then unable to receive treatment with those drugs,” Dr Deau said.

Instead of scheduling ketamine, the WMA said it would be better to tackle the problem of illicit use by tightening controls on the drug’s supply through prescriptions and by the pharmaceutical industry.

Adrian Rollins

 


Published: 18 Mar 2015