Against WHO Advice, China Pushing for Ketamine Scheduling

A controversial proposal to restrict the availability of ketamine internationally has surfaced in the preliminary meetings ahead of the upcoming Commission on Narcotic Drugs (CND) meeting in March.

The latest push has come from China who want the drug placed in Schedule I of the 1971 UN Convention on Psychotropic Substances. This is the most restrictive category for substances under which they are deemed to have no medical use.

In a statement at the CND Intersessional on January 29, China argued that, "According to the [International Narcotics Control Board] INCB report in 2013, ketamine is the most widely abused non-controlled substance in Asia ... Illicit ketamine production and use in China has created major political and health problems."

As can be seen from the transcript of this meeting, China's calls were far from embraced, with Peru stating, "The scheduling of ketamine restricts access to essential, emergency surgery options and would create serious public health dilemmas in countries which do not have alternatives and will increase costs."

The World Health Organization (WHO) has consistently stated that ketamine should not be controlled and lists it as an essential medicine. Reviews of the drug by the WHO have taken place in 2006, 2012 and 2014, all of which highlight the importance it plays in the field of anesthesia, particularly in developing countries.

The 2014 review fears that should ketamine be scheduled, there is the potential for a public health crisis owing to the fact that it “would limit access to essential and emergency surgery … in countries where no affordable alternative anesthetic is available.”

Thanks to the international drug control system, the developing world already suffers tremendously from a shortage of vital opioid-based medicines such as morphine, with 83 percent of the world's population having little or no access to them as a result of their scheduling, according to the WHO. 

In response to China’s request, a fact sheet defending ketamine's status as an unscheduled substance has been published with the endorsement of several international NGOs and medical associations. Any move to control the drug, the document states, could be detrimental to the health of more than 2 billion lives in the developing world.

Furthermore, the fact sheet highlights that since China is the source of much of the world's illicitly consumed ketamine the country should “take the necessary steps to prevent the diversion, illicit manufacture and export of ketamine beyond its national frontiers, rather than to promote international scheduling.”

Thankfully, it is extremely unlikely that ketamine will be scheduled, due to the 1971 Convention outlining that a substance can only be controlled by the CND if it has been recommended by the WHO.

The 58th Session of the CND is due to be held from March 13-17.