Ketamine: The WHO Once Again Speaks Out Against Classifying This Drug as a Narcotic

For the fourth time since 2006, the World Health Organization (WHO) expert committee has recommended that injectable ketamine not be placed under international control. In support of this recommendation, the committee again points out that classifying this drug as a narcotic could limit access to it in both human medicine and veterinary medicine. It is, in fact, the only anaesthetic and analgesic available and widely used to treat both small and large animals worldwide. Placing it under international control would also jeopardize the ability of certain developing countries to access effective anesthesia and analgesia.   The 58th session of the United Nations Commission on Narcotic Drugs (CND) was scheduled to decide in March 2015 whether to schedule ketamine under Schedule I of the 1971 Convention on Psychotropic Substances. Ultimately, the decision to place this anaesthetic under international control—as China had requested—was postponed until March 2016 to allow the CND to gather more data and opinions on the matter. According to the WHO, the public health risk posed by the illicit and misuse of ketamine worldwide does not constitute a threat sufficient to justify its registration with the Veterinary Council, given its undeniable medical benefits. Thus, its benefits far outweigh the harm that may result from its recreational use. It remains to be seen whether the fourth position statement by its expert committee against classifying ketamine as a psychotropic substance will be heeded and whether the CND will not disregard its conclusions next spring. The WHO’s new recommendation aligns with the recommendations and position of numerous organizations* of veterinarians and physicians worldwide, who have rallied to defend the medical use of injectable ketamine. This medication, often the only anaesthetic available in most developing countries, is also used for pain management. Since 1985, ketamine has been included on the WHO’s List of Essential Medicines, and its use “for the sedation of children and adults” has recently been described. However, placing substances under international control often results in reduced availability for medical purposes. Morphine is a good example: even though this drug is inexpensive and one of the analgesics of choice for pain management, access to and use of it are limited in most countries due to excessive regulation. The WHO expert committee also assessed the addictive potential of nine psychoactive substances** and recommended placing seven of them under international control, due to the risks they pose to global public health. These substances have recently emerged on the market as recreational drugs, and their use is often not yet regulated by national laws or international conventions. The committee also received an update on the pharmacology, toxicology, and claimed therapeutic applications of cannabis and cannabis resin. Data collection will precede the WHO’s advisory opinion on these substances, in order to identify their benefits compared to other therapeutic agents.   * Notably the World Veterinary Association (WVA), the Federation of Veterinarians of Europe (FVE), the World Small Animal Veterinary Association (WSAVA), the American Veterinary Medical Association (AVMA), the World Medical Association (WMA), etc. ** Acetylfentanyl, MT-45, para-methoxymethylamphetamine (PMMA), α-pyrrolidinovalerophenone (α-PVP), para-methyl-4-methylaminorex (4,4’-DMAR), methoxetamine (MXE), and phenazepam.