The war on ketamine: Canadian researchers fight Chinese-led effort to declare anesthetic an illicit narcotic – National Post

In a dispute that pits the war on drugs against global health needs — and one UN agency against another — a pair of Canadian researchers is spearheading a last-ditch bid to keep a widely used anesthetic from being declared an illicit narcotic.

The Chinese-led proposal to put ketamine on the international schedule of “psychotropic” substances — alongside the likes of LSD and mescaline — stems from its use as a club drug said to deliver hallucinogenic “cheap thrills.”

But “scheduling” the medicine would also likely deprive most of the developing world of an inexpensive anesthetic employed in countless surgeries, say opponents ranging from the Red Cross to Human Rights Watch and the World Health Organization.

The expert committee that advises the WHO on drug dependency has said scheduling and the restrictions that come with it would lead to essential operations being canceled and a “public-health crisis” in many countries.

If the resolution passes, it will be a catastrophe for access to ketamine and safe surgery in developing countries

Early research also suggests ketamine — which is illegal for recreational use in Canada — has promise as a breakthrough treatment for patients with intractable depression, an application that could be undermined by narcotics controls, critics say.

The WHO is supposed to have a veto over such proposals, but the United Nations Office on Drugs and Crime [UNODC] has ignored its fellow UN agency’s objections — and international law — by pushing ahead with a vote on China’s proposal next week, charges a University of Ottawa professor behind the opposition.

“If the resolution passes, it will be a catastrophe for access to ketamine and safe surgery in developing countries,” Amir Attaran and former student Jason Nickerson write in the latest edition of the journal Lancet. “This attempt to restrict ketamine is a simultaneous affront to global public health, human rights and the rule of law.”

It was Mr. Nickerson who stumbled on the drive to control ketamine last year, and who has since been key in building an international opposition of non-governmental organizations and experts, said Prof. Attaran.

The respiratory therapist, who just obtained a doctorate in population health, flew to Vienna Friday to lobby the 53-member Commission on Narcotic Drugs that is set to decide the issue this week.

Canada has a vote on the commission but has yet to reveal its position, saying only that it is aware of concerns of both sides.

“Our department is examining the issue … taking into consideration the implications for developing countries where ketamine is an essential anesthetic,” said Sean Upton, a Health Canada spokesman.

Critics point to the status of morphine as what they desperately want to avoid with ketamine. UN and other controls on the inexpensive narcotic mean 80% of the world has no access to it or any other painkiller more powerful than Tylenol, said Mr. Nickerson.

The 1971 Convention on Psychotropic Substances at the heart of the controversy is a system designed to control drugs of abuse worldwide. If the treaty does not list a substance, member countries can still bring in their own local rules.

The Chinese initially proposed putting ketamine in schedule 1, the convention’s most restrictive category that allows virtually no medical uses, then late on Friday proposed schedule 4 instead, said Mr. Nickerson.

An out-of-body or near-death experience known as the K-hole

But it makes little difference, he said. The onerous bureaucratic requirements to monitor and document the use even of schedule-four drugs create an “absolute barrier” to access in most low-income nations, said the University of Ottawa researcher.

Ketamine is injected into patients, and in poorer countries often employed instead of costlier anesthetic gases that require special machinery and expertise to administer.

It is also employed widely by veterinarians.

Meanwhile, though, the drug has been appropriated by the club and rave scenes in some parts of the world, particularly China and southeast Asia, its English nicknames including Special K and “Cat valium.”

A 2008 report by the UNODC says it produces a euphoric, sometimes psychedelic experience in low doses. Higher concentrations can plunge users into an “an out-of-body or near-death experience known as the K-hole,” the report said. The agency lamented that ketamine is not internationally controlled, making it difficult to get a clear picture of its illicit use.

A spokesman for the UNODC said Friday the issue is being championed by a member country and the agency itself “is not responsible for setting drug policy.”

But Prof. Attaran said the office has its fingerprints all over the proposal, given that it pushed the matter ahead for a vote, when the convention says the WHO must approve such initiatives first.

National Post

tblackwell@nationalpost.com

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