Have you ever had surgery? How about surgery without anaesthesia? Now imagine you had to, not just for a filling or some small, relatively painless procedure, but for a potentially serious and threatening condition. Unpleasant doesn’t begin to describe the experience. Many people would call it torture. Luckily, most people don’t ever have to think about this, let alone experience it.
This week in Vienna, the UN is set to decide whether to make this medieval version of surgery a cruel reality for nearly 2 billion of the world’s poorest and most marginalised people. On Monday, the international body that supervises the application of the international drug control treaties, the Commission on Narcotic Drugs (CND), began its annual meeting, where it will consider whether ketamine should be reclassified as a prohibited or restricted substance.
This might sound to some like an uncontroversial decision. Ketamine is after all best known in the UK and much of the industrialised world as a party drug. But the reality is that for the world’s poorest and most marginalised people, it is the only anaesthetic available. In fact, it’s so important that the World Health Organization has classified it as an essential medicine.
What makes ketamine so useful in resource-poor settings is that, unlike other anaesthetics, it is easily administrable without specialised machinery and in the absence of reliable power or oxygen supplies. Given resource constraints in much of the developing world, this means that ketamine is often the only anaesthetic available for any kind of surgery, particularly emergency obstetric procedures, and is also the drug of choice for emergency responders in humanitarian crises. And if those things don’t sufficiently demonstrate ketamine’s utility, it’s also the world’s leading veterinary and wildlife anaesthetic.
Access to ketamine is therefore critical for all of the communities in which Save the Children and many other organisations provide support and assistance. This is why we have joined with nearly 80 other organisations, including dozens of professional medical associations, from around the world to stand against the reclassification of ketamine by the CND. Such a reclassification would effectively prohibit access to ketamine in nearly all of the developing world – an unmitigated disaster.
And while ketamine is only now coming under threat, access to many other medicines considered essential by WHO – equally important painkillers and drug dependence therapies – has already been highly restricted by classification under the drug conventions.
It is understandable that the first impulse of countries and communities affected by the drug trade and substance abuse would be to prohibit ketamine and other drugs with the potential for abuse. Concerns over the criminal drug trade and drug dependence are legitimate and people want to see these problems addressed. But as the last 50 years have demonstrated, the existing approach to address these problems has proven almost entirely unsuccessful on its own terms.
Prohibition has not stopped people from using or selling drugs, something which is, frankly, not possible. Instead, it has driven the drug trade underground, allowing a violent, unregulated criminal market to flourish in the absence of a well-regulated one. At the same time, it has left people who may have become dependent on drugs and those who need to make use of restricted medicines without anywhere to turn, resulting in increased harm to themselves and their communities. There’s a growing body of evidence cataloguing the “war on drugs’” devastating impact on development, particularly for the world’s poorest people, and the countless human rights violations that have resulted from it. Many – including the former presidents of Brazil, Colombia and Mexico – have called for a major shift in approach.
What the potential reclassification of ketamine demonstrates perfectly is the Alice-in-Wonderland nature of this existing approach, where the lives of millions of people, including those that may misuse or become dependent on the drug, are unnecessarily put at risk in the name of safety and public health. It makes clear the existing drug control regime’s callousness and indifference to the suffering of millions and makes transparent the prioritisation of the interests of the powerful and wealthy over the dignity and rights of most vulnerable and marginalised.
So as CND members, such as the UK, consider potentially rescheduling ketamine, we need to urge these governments to ensure that ketamine must not be scheduled at all. We need to make sure that we don’t add to our list of exports another example of the failure of the international drug control regime.