Pubdate: Mon, 09 Mar 2015
Source: National Post (Canada)
Copyright: 2015 Canwest Publishing Inc.
Author: Tom Blackwell
Page: A3


Public Health Advocates Resist Proposed Ban on Anesthetic

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.

"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 Mr. 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 Prof. 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 ... taking into consideration 
the 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% of the world has no access to it or any other 
painkiller more powerful than Tylenol, said Mr. 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 that allows virtually no 
medical uses, then late on Friday proposed schedule 4 instead, said 
Mr. Nickerson.

But it makes little difference, he said. The onerous bureaucratic 
requirements to monitor and document the use even of schedule-four 
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, though, the drug has been appropriated by the club and 
rave scenes in some parts of the world, particularly China and 
Southeast Asia, its English 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 Prof. 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.
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MAP posted-by: Jay Bergstrom