April 28, 2016

Veterinarians Can Exhale About Ketamine—For Now

One of the most widely used veterinary anesthetics remains accessible, for now.
 
By Amy Karon, DVM, MPH
One of the most widely used veterinary anesthetics remains accessible, for now.
 
In March 2016, for the second year in a row, the United Nations (UN) Commission on Narcotic Drugs postponed its decision about whether to internationally regulate ketamine by scheduling it according to the 1971 Psychotropics Convention.
 
In doing so, UN officials bowed to international pressure from the American Veterinary Medical Association (AVMA), the World Veterinary Association (WVA), and the World Health Organization (WHO), all of which emphasized ketamine’s crucial role in veterinary medicine, especially in lower-income countries and crisis zones which often lack access to anesthetic gases and only have access to injectable ketamine for treating post-surgical pain.
 
This is the fourth time in a decade that WHO has opposed scheduling ketamine. “We have found that placing substances under international control can often limit access to them for medical purposes,” Kees De Joncheere, WHO director of the Essential Medicines and Health Products Department, said in December 2015. “Morphine is a case in point – even though it is inexpensive and one of the best substances available for pain management, in most countries, availability and use are limited due to excessive regulation.”
 
“The medical benefits of ketamine far outweigh potential harm from recreational use,” added Marie-Paule Kieny, WHO assistant-director general for Health Systems and Innovation. “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.”
 
Supporters of scheduling ketamine cite its popularity as a “club drug.” Illicit use has especially surged in China, where it is manufactured illegally on a massive scale. In some cases, ketamine abuse has caused death or permanent disability.
 
In 2014, China asked the UN to add ketamine to Schedule I, the strictest level of control that is reserved for LSD, ecstasy, and other drugs that “constitute an especially serious risk to public health and which have very limited, if any, therapeutic usefulness,” according to a WHO technical report.
 
China revised its request in March 2015 after global pushback, instead asking the UN to make ketamine Schedule IV, which applies to therapeutically valuable drugs with some potential for abuse.
 
“In theory, it is a level of control flexible enough to suppress illicit use, while allowing the drug’s extensive medical purposes to be met,” Christopher Hallam, a research and analysis officer with the International Drug Policy Consortium, told WHO during an open session.
 
But in practice, Schedule IV is equivalent to prohibition in poor rural areas of Africa and Asia, Hallam added. He cited phenobarbital, a first-line epilepsy treatment whose Schedule IV status makes it unavailable to about 80% of affected patients in low-income countries, he said.
 
Ketamine is already regulated in the United States as a schedule III narcotic, a fact that the AVMA has repeatedly emphasized. The organization continues to oppose “any change in scheduling, either nationally or internationally, that could make this drug less accessible for veterinary use.”
 
Despite the UN’s inaction, AVMA and other organizations “need to remain vigilant in monitoring the situation, because there are UN members who would like to see ketamine scheduled internationally,” AVMA officials added in the statement.
 
Dr. Amy Karon earned her doctorate in veterinary medicine and master’s degrees in public health and journalism from the University of Wisconsin-Madison. She was an infectious disease epidemiologist and “disease detective” (EIS officer) with the Centers for Disease Control and Prevention before becoming a full-time medical writer. She lives in the San Francisco Bay area, where she volunteers for the local Humane Society.
 

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