Pubdate: Mon, 09 Mar 2015
Source: Vancouver Sun (CN BC)
Copyright: 2015 Postmedia Network Inc.
Author: Tom Blackwell
Page: A9


The anesthetic, a popular club drug, is widely used in surgeries in
poor countries

In a dispute that pits the war on drugs against global health needs -
and one UN agency against another - a pair of Canadian researchers is
spearheading a last-ditch bid to keep a widely used anesthetic from
being declared an illicit narcotic.

The Chinese-led proposal to put ketamine on the international schedule
of "psychotropic" substances - alongside the likes of LSD and
mescaline - stems from its use as a club drug said to deliver
hallucinogenic "cheap thrills."

But "scheduling" the medicine would also likely deprive most of the
developing world of an inexpensive anesthetic employed in countless
surgeries, say opponents ranging from the Red Cross to Human Rights
Watch and the World Health Organization.

The expert committee that advises the WHO on drug dependency has said
scheduling and the restrictions that come with it would lead to
essential operations being cancelled and a "public-health crisis" in
many countries.

Early research also suggests ketamine - which is illegal for
recreational use in Canada - has promise as a breakthrough treatment
for patients with intractable depression, an application that could be
undermined by narcotics controls, critics say.

The WHO is supposed to have a veto over such proposals, but the United
Nations Office on Drugs and Crime UNODC has ignored its fellow UN
agency's objections - and international law - by pushing ahead with a
vote on China's proposal next week, charges a University of Ottawa
professor behind the opposition effort.

"If the resolution passes, it will be a catastrophe for access to
ketamine and safe surgery in developing countries," Amir Attaran and
former student Jason Nickerson write in the latest edition of the
journal Lancet. "This attempt to restrict ketamine is a simultaneous
affront to global public health, human rights and the rule of law."

It was Nickerson who stumbled on the drive to control ketamine last
year, and who has since been key in building an international
opposition of non-governmental organizations and experts, said Attaran.

The respiratory therapist, who just obtained a doctorate in population
health, flew to Vienna Friday to lobby the 53-member Commission on
Narcotic Drugs that is set to decide the issue this week.

Canada has a vote on the commission but has yet to reveal its
position, saying only that it is aware of concerns of both sides.

"Our department is examining the issue =C2=85 taking into consideration t=
implications for developing countries where ketamine is an essential
anesthetic," said Sean Upton, a Health Canada spokesman.

Critics point to the status of morphine as what they desperately want
to avoid with ketamine. UN and other controls on the inexpensive
narcotic mean 80 per cent of the world has no access to it or any
other painkiller more powerful than Tylenol, said Nickerson.

The 1971 Convention on Psychotropic Substances at the heart of the
controversy is a system designed to control drugs of abuse worldwide.
If the treaty does not list a substance, member countries can still
bring in their own local rules.

The Chinese initially proposed putting ketamine in Schedule 1 - the
convention's most restrictive category - which allows virtually no
medical uses, then late on Friday proposed Schedule 4 instead,
Nickerson said.

But it makes little difference, he said. The onerous bureaucratic
requirements to monitor and document the use even of Schedule 4 drugs
create an "absolute barrier" to access in most low income nations,
said the University of Ottawa researcher.

Ketamine is injected into patients, and in poorer countries often
employed instead of costlier anesthetic gases that require special
machinery and expertise to administer.

It is also employed widely by veterinarians.

Meanwhile, the drug has been appropriated by club scenes in some parts
of the world, particularly China and Southeast Asia, picking up
nicknames including "Special K" and "Cat Valium."

A 2008 report by the UNODC says it produces a euphoric, sometimes
psychedelic experience in low doses. Higher concentrations can plunge
users into an "an out-of-body or near-death experience known as the
K-hole," the report said. The agency lamented that ketamine is not
internationally controlled, making it difficult to get a clear picture
of its illicit use.

A spokesman for the UNODC said Friday the issue is being championed by
a member country and the agency itself "is not responsible for setting
drug policy."

But Attaran said the office has its fingerprints all over the
proposal, given that it pushed the matter ahead for a vote, when the
convention says the WHO must approve such initiatives first.