With the 59th meeting of the United Nations Commission on Narcotic Drugs (CND) currently underway in Vienna, experts in the fields of neuroscience, veterinary medicine, and law have called upon representatives not to introduce a worldwide ban on ketamine. The CND is due to vote on such a proposal at the meeting.
Publishing a statement in The Lancet, the authors claim that placing the drug under international control would leave low- and middle-income countries (LMICs) with a scarcity of affordable anaesthetics for use in essential surgical procedures.
First synthesized in 1962, ketamine blocks N-methyl-D-aspartate (NMDA) receptors, which are found on the membranes of nerve cells. In doing so, it inhibits the transmission of nociceptive input signals to the brain, meaning it prevents painful stimuli from being detected. This effect, combined with its extremely low cost, makes ketamine an excellent anaesthetic in regions where alternative medications are either too expensive or inaccessible due to a lack of infrastructure or expertise.
A recent study into the medical facilities in 22 LMICs revealed that only 53 percent had functioning anaesthesia machines, precluding the possibility of providing a range of life-saving surgeries to patients. In such countries, ketamine provides an essential alternative, as it can be administered with minimal equipment and in the absence of a fully qualified anaesthetist, while also boasting an excellent safety record. For instance, it does not interfere with respiratory reflexes or blood pressure, and because of this is regularly used during surgical operations in LMICs.
The drug’s beneficial potential was highlighted by a recent pilot program called Every Second Matters-Ketamine, which was implemented in Kenya between December 2013 and March 2015. During the study, five non-anaesthetists were given five days of training in the use of ketamine as a surgical anaesthetic, and went on to use the drug to safely and successfully support 193 surgeries, ranging from orthopedic procedures to caesarean sections, with no adverse effects.
Aside from its analgesic – or pain-killing – properties, ketamine is also currently attracting the attention of psychotherapists due its ability to relieve symptoms associated with depression, while it is also the most widely used form of veterinary anaesthetic.
However, while ketamine has been shown to be safe and effective when used in controlled medical settings, its unregulated use as a recreational drug has led to several countries banning it. When abused in such a way, ketamine can cause a range of potentially dangerous side effects such as hallucinations.
In spite of this, the World Health Organization’s Expert Committee on Drug Dependence recently advised the CND not to place ketamine under international control, citing the negative effect this would have on healthcare in LMICs while also claiming that the drug “does not pose a global public health threat.”