Fact Sheet on the proposal to discuss international scheduling of ketamine at the 58th CND

The World Health Organization considers ketamine an “essential medicine” and does not recommend scheduling it under the international substance control conventions. Regarding essential surgery, a WHO document states that ketamine must be accessible in all facilities where anaesthesia is needed, in order to ensure safe and affordable surgical care. (…)

Further to the above, the ECDD considered evidence submitted from all over the world that ketamine is widely used as an anaesthetic in human and veterinary medicine, especially in low- and middle-income countries, as well as in emergency situations. Ketamine is easily administered by trained providers. Compared to anaesthetic gases, which require costly equipment and appropriately trained specialists, it is inexpensive and safe to administer. Since many countries have no appropriate or affordable alternatives, scheduling ketamine would force patients in those regions to forego lifesaving essential surgery, further compromising realization of the health-related Millennium Development Goals. (…)

Under the terms of the 1971 Convention, medicines in Schedule I have “very limited medical usefulness”. Parties to the Convention are obliged to prohibit any medical use of a Schedule I substance except by “persons directly under control of the government,” and even use for and by those persons is very restricted (Art. 7). Providers in nongovernment institutions and clinicians in remote areas, especially in resource poor settings, will be unable to use ketamine if it is placed in Schedule I.

The control stipulated for Schedule I substances would be very inappropriate for ketamine, given its critical use in developing countries and in zones of armed conflict where high-tech resources, labs, operating rooms etc. are unavailable.

People living in rural areas of low-resource countries will not have access to essential surgery if ketamine is less available, or completely unavailable. International restrictions could potentially affect the health of an estimated 2 billion or more people, living mainly in Africa, Asia and Latin-America. (…)

The WHO ECDD did not recommend placing ketamine in any schedule. Hypothetically, however, placing ketamine in any other schedule would also limit its availability and accessibility, both of which are mandatory criteria for essential medicines. The cumulative evidence from over fifty years of international drug control shows that restrictive regulatory requirements imposed by scheduling essential medicines create costly burdens for low resource countries. Strict scheduling requirements result in decreased clinical use or abandonment altogether.3 In the words of the Convention, “the use of psychotropic substances for medical and scientific purposes is indispensable and […] their availability for such purposes should not be unduly restricted”.

  • Access to controlled medicines

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