Pubdate: Mon, 09 Mar 2015
Source: Windsor Star (CN ON)
Copyright: 2015 The Windsor Star
Author: Tom Blackwell
Page: A10


Canadians Say Drug Is Vital As an 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 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 wrote 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, Attaran said.

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 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 

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 UNODC spokesman 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.
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MAP posted-by: Jay Bergstrom