The International Doctors for Healthier Drug Policies (IDHDP) is deeply concerned about the proposed scheduling of ketamine. This would cause considerable harm by greatly restricting its availability, especially in the developing world.
Ketamine is a uniquely useful anaesthetic, particularly in settings where even the most basic western medical facilities are unavailable as in much of the developing world. This notwithstanding, China has proposed scheduling ketamine under the UN drug treaties which would restrict its availability. Despite the World Health Organisation’s (WHO) advice against this scheduling, countries coming together for the UN Commission of Narcotic Drugs’ (CND) meeting in Vienna (9-17 March) will decide on 13 March whether or not to schedule ketamine. Scarcity or unavailability of ketamine risks a global crisis in essential surgery
As the Swiss delegation in Vienna pointed out last Monday “millions of surgical interventions are done with ketamine every year. Obstructed liver, birth defects, cancer, acute abdominal conditions, burns, industrial injuries and traffic accidents are among some of the emergencies where ketamine is used.”
Ketamine is the only anaesthetic, which can be used in regions where the power supply is often interrupted. When this happens, oxygen and ventilation equipment do not work. Ketamine is administered intravenously or intramuscularly in places where these full facilities are not available or in emergencies case if the patient is not prepared for anaesthesia with inhalants. Ketamine provides very good analgesia and can also be used as a sedative for physically painful procedures in emergency departments and emergency surgery in field conditions (such as in war zones).
Medical doctors agree that ketamine is a very safe anesthetic. Dr Chris Kinchin (England) recalls that he used ketamine regularly while working as an anaesthetist in the UK during the late 1970s. He always found it to be very effective as it did not tend to compromise the airway in the same way as conventional anaesthetics. “Restriction of its use could well mean that more dangerous forms of anaesthesia might have to be used in developing countries”
Dr Dinesh Ch Goswami, Secretary cum CEO, Guwahati Pain and Palliative Care Society (India) reminds us that ketamine is used in North East India for anaesthetic purposes and also for control of neuropathic pain. He urges member states to not schedule ketamine.
Ketamine is also a key medicine to treat patients who have a history or risk of opioid-dependence. Dr. Alex Wodak AM, Emeritus Consultant, Alcohol and Drug Service, St Vincent's Hospital (Australia), states that by using ketamine (as a coanalgesic) in surgical cases, say involving multiple fractures, or in painful conditions such as osteomyelitis, it allowed Australian doctors to improve pain relief with lower doses of opioids. This reduces the risk of opioid side effects including drowsiness, constipation and dependence. This was useful in all patients but particularly patients with a long history of injecting heroin (or other opioids) and severe dependence. Patients with say, septic arthritis as a complication of injecting, are similar.
Ketamine is also the main stay in veterinary anaesthesia and wild-life conservation. Veterinarians apply it like human physicians, but also (using a dart gun) to immobilize dangerous animals like a rabid dog. In the same way it is used in wild-life conservation for hanging a collar band with a transmitter on elephants and other animals.
Many rural areas of developing countries have already suffered from the restrictive availability of morphine leading to millions of people dying in agony from chronic illnesses. As Willem Scholten PharmD MPA, IDHDP board member, points out “Scheduling ketamine will leave them with no alternative anaesthesia for essential surgery, and will further deepen the already acute global crisis of surgery.”
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