While debates are taking place on the medical use of cannabis, debates about ketamine have heated the global medical community in recent months.
Many of us might be aware of China’s long push to make this substance a List IV substance through the United Nations Commission on Narcotic Drugs (UNCND). This, after failing to place it as a List I (even more restrictive) under the 1971 Convention on Psychotropic Substances. Such a move would leave it with very limited access, especially in developing countries with vulnerable access to anaesthetics.
The country made the request in the context of the drug being used as a recreational drug in China and more widely across the East Asian region, where trafficking and misuse is increasing exponentially. However Ketamine is currently the most common and essential anesthetic substance in low-income countries. Since morphine and morphine related anaesthetics are more regulated, morphine use is often impossible in those countries with limited financial, legal, bureaucratic and logistical resources.
Now, with a toughened regulation of ketamine, the implications are:
- Annual estimates of scientific and medical needs must be submitted to the INCB (International Narcotics Control Board) for their validation.
- Limitation on estimates for production, exports and imports.
- Securitization of the supply chain through a system of authorized handling personnel.
- Medical prescription for its issuance for scientific/medical use.
- Report to the INCB all quantities imported, exported, produced and consumed.
- Build, maintain and monitor an inspection system for stocks and supply chains.
- Strategic planning, application and monitoring for tackling misuse.
However, in countries where electricity access remains difficult, stocks can not be regulated down to the nearest milligram, which would create a access barrier of the substance. In situations in which because of the already limited resource, ketamine is the most common (if not the only) method of anesthesia, the establishment of these regulations and maintenance of such control systems are massively disrupting. Furthermore, without Ketamine, surgeries in such low-income settings may stop being performed, or if so, it will push doctors in their health systems to perform risky and painful surgeries necessary.
Although the WHO has rejected this restriction requests through vetos, and the work done within WHO and UNDC by doctors to prevent any damaging ruling continues (in particular I can refer to the work of international researchers, especially J. Nickerson of the Bruyère Research Institute in Ottawa) China withdrew its proposals for further analysis, but this attempts are far from settled. The debate is still active, and any attempts that are not met by a mobilized medical community could jeopardize access to anesthesia to 5.5 billion people… Can any of you share (especially those in anesthesiology) how you´re keeping connected and active to deter this process in your local/national/international networks? Thanks to all.