“It is disturbing indeed that changes of such magnitude can be proposed by a Government in a far-away country and instigated by a global organisation we have never heard of on our behalf and without our consent…”
PART 1: The Abuse and the Politics
For most English-speaking people, the ‘CND’ is an acronym for another organisation that has been around for decades (we, or our parents may even have been part of it) the ‘Campaign for Nuclear Disarmament’. But it is also an acronym for something much more sinister. There is another CND that you will probably have never heard of – the Commission on Narcotic Drugs(CND) – and the activities of this CND has serious implications for animal and human welfare all over the world. This CND is a division of the United Nations Office on Drugs and Crime (UNODC), an organisation that is engaged in fighting the trafficking of, the dealing in and the illicit use of drugs, and their association with international crime (UNOCD, 2015a). CND’s job is to supervise the applications of the international drug control treaties, which determine the scheduling of drugs within the Single Convention’s Schedules of Drugs (UNOCD, 2015b). Scheduling is a system that restricts the legal availability of drugs on a sliding scale from the most restricted to the least, and its purpose it to control the misuse of some drugs for recreational, or other non-medical purposes. This inevitably has an impact on the availability and the legitimate use of some drugs.
- Schedule 1: e.g. 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy), lysergic acid diethylamide (LSD), cannabis. Have little or no value in medicine and are strictly controlled requiring a licence from the Home Office licence to acquire and use them.
- Schedule 2: e.g. amphetamines, heroin, morphine, methylphenidate (Ritalin). Have many applications in medicine, but because they are very addictive they are often abused. It is therefore required that they are securely stored and detailed records of their use must be kept.
- Schedule 3: e.g. barbiturates, buprenorphine, tramadol. Have many applications in medicine, but are still often abused, although they are less addictive. Storage and control is less rigorous than for Schedule 2 drugs.
- Schedule 4: e.g. anabolic steroids, diazepam, ketamine (ketamine will be moved to schedule 2 on 30th November 2015). Have many applications in medicine and are not subject to secure storage and record keeping.
- Schedule 5: e.g. cough mixtures, ibuprofen, paracetamol. These drugs are sold in pharmacies as low-dose, over-the-counter medicines and are not controlled.
In addition to scheduling, the UK Misuse of Drugs Act, 1971 (MDA) is specifically aimed at preventing the non-medical use of some drugs, in particular, those with the potential for recreational use. Its scope includes both medicines and other drugs which have no medical uses. Drugs covered within the MDA are licenced as Controlled Drugs (CD), and they are divided into 3 classes that determine the seriousness of misuse and the punishment imposed on those misusing them (GOV.UK, 2015).
- Class A: e.g. cocaine, heroin, MDMA, LSD, methadone, methamphetamine (crystal meth), any injectable form of a Class B drug. Possession – 7 years imprisonment and fine. Supply – life imprisonment and fine.
- Class B: e.g. amphetamine, barbiturates, cannabis, codeine, ketamine. Possession – 5 years imprisonment and fine. Supply – 14 years imprisonment and fine.
- Class C: e.g. anabolic steroids, diazepam, gamma-hydroxybutyric acid (GHB). Possession – 2 years imprisonment and fine. Supply – 14 years imprisonment and fine.
Controlled Drugs are classified in both systems, for example, Ecstasy is a class A, schedule 1, Heroin is a class A, schedule 2, Cannabis is a class B, schedule 1, Ketamine is a class B, schedule 4 and the Benzodiazepines are class C, with some being schedule 3 while others are schedule 4.
Once a year, the CND have a meeting that gives all 193 Member States of the United Nations a platform to raise and discuss any changes in the scope of the control of substances (the schedules) their respective countries Governments would like to see implemented.
At the meeting in March 2014, China proposed that ketamine should be reclassified as a schedule 1 drug. Algeria, Argentina, Columbia, the Czech Republic, Italy, Moldova and Russia all supported China’s proposal. Hungary and Ukraine also supported the proposal as long as the reclassification was to schedule 2, while Latvia and Spain would support it if the reclassification was to schedule 2, 3 or 4 (AAGBI. 2014).
With China’s massive growth over the last decade and the increase in the disposal income of the Chinese, the use of recreational drugs has also risen sharply. Although heroin remains the drug of choice, the Chinese Government is concerned about the rise in the popularity of ketamine use among its affluent citizens (Tremonti, 2015).
PART 2: The Animal Welfare
The problem with the Chinese proposal is that ketamine is arguably one of the most useful and versatile drugs for legitimate medicinal use on the planet and its reclassification to schedule 1 would effectively render it unavailable overnight. If implemented, this change would have unimaginably bad consequences.
For millions of people and other animals all over the world, it would lead to needless suffering, pain and death on a mass scale. This is a bold claim, but it is true (Boseley, 2015; WSAVA. 2015). Professor Richard Laing of the University of Boston, school of public health, describes China’s proposal for the re-scheduling of ketamine as a:-
“David and Goliath struggle between people interested in access to an essential medicine and victims of trauma in poor countries, and the drug control establishment in rich countries” (Boseley, 2015).
So, what is so special about ketamine?
Why ketamine is a ‘wonder-drug’
Ketamine is the creation of Calvin Stevens, a chemist at the pharmaceutical company, Pfizer in the United States in 1962. Stevens was looking for a replacement for the anaesthetic agent, 1-(1-phenylcyclohexyl)piperidine (PCP), more commonly known as phencyclidine, or as the recreational drug angel dust, where it is used as a powerful hallucinogenic. The problem with PCP for legitimate, medical use is that it causes seizures and is also toxic in some patients. Ketamine has a similar structure to PCP and shares its desirable anaesthetic properties, but without these side effects. As an anaesthetic, ketamine is unique in the way it works because of how it interacts with different neural pathways in the brain that control sensory perception. Ketamine inhibits specific groups of N-methyl-D-aspartate (NMDA) receptors in the brain that results in the inhibition of the sensory association areas of the cerebral cortex, the limbic system and the thalamus.
The role of the thalamus is to receive sensory input from the ears and eyes along with tactile and kinaesthetic (touch, balance, pain) sensory information ascending the spinal cord to the brain. The thalamus relays this information to the limbic system and the association cortices for processing. The formation of short- and long-term memories of emotional significance are also facilitated in the limbic system.
When all these systems are shut down by ketamine, the brain is no longer able to process or perceive any sensory input – including pain – yet the patient is suspended in a cataplectic-like state of apparent wakefulness, with eyes open, is able to breath without assistance, swallow and cough and there is no fall in blood pressure. In reality, the patient is completely cut off and unaware of what is going on in the outside world and, once awake again, has no recollection of what happened.
This state is called dissociative anaesthesia (Aroni et al., 2009). At lower doses, the effects of ketamine can create out-of-body experiences and hallucinations and it is these properties that attract some individuals to take the drug recreationally. In legitimate medical patients, these side effects are controlled by administering other drugs such as benzodiazepines or opiates along with the ketamine.
Ketamine is also a unique and powerful analgesic drug in its own right (Aroni et al., 2009). Its mode of action is through the NMDA receptors in the spinal cord and also via the inhibition of the synthesis of nitrous oxide (NO), popularly known as laughing gas. NO is a neurotransmitter distributed widely throughout the nervous system where it is responsible for the transmission of pain signals to the brain. Ketamine is a very effective analgesic in cases where other pain killers are ineffective, for example, neuropathic pain associated with chronic diseases such as cancer, spinal cord injuries, fibromyalgia and burns. These analgesic effects are present at low doses so the patient remains fully awake and aware of what is going on, but without pain.
For ambulance crews attending severely injured road traffic accident patients on the roadside, burns patients etc., intravenous ketamine is routinely given as soon as possible to alleviate suffering. Other analgesic drugs are often dangerous for patients with severe injuries and blood loss because of their negative effects on breathing and blood pressure. Ketamine can also be safely combined with most other conventional analgesic drugs, for example morphine, to treat complex pain syndromes.
For critically ill patients, conventional anaesthesia poses significant risks without the use of sophisticated anaesthetic equipment, assisted breathing, the ready supply of intravenous fluids and blood products and the presence of a team of medical experts to monitor the patient. Witness this in any accident and emergency department in the UK and other affluent countries. There are many places in the world where well-equipped hospitals are simply not available, and without ketamine, even routine procedures such as caesarean section would become extremely painful and potentially life-threatening (Boseley, 2015). The same is true for veterinary procedures, for example Trap-Neuter-Release programs for cats and dogs.
A quick search of the scientific literature for the uses of ketamine in veterinary medicine yields over 200 papers for just cats and dogs.
There are many more for other ‘small animal’ species such as rabbits, ferrets, guinea pigs, mice, rats, gerbils, hamsters, dagus, birds and reptiles.
Ketamine is widely used every day in veterinary practices all over the world for anaesthesia in routine procedures in small animals, for pain relief following elective surgery such as orthopaedic operations and in trauma patients.
If ketamine is reclassified as a schedule 1 drug, there is no other drug available that has all its benefits and animals and people will suffer as a consequence.
It has to be said that neither China, nor Russia are well known for their humanitarian approach and basic human rights are a pale shadow compared to ours in Western Europe. Concerns for animals are largely non-existent and animal welfare barely registers on their political radar.
There is some good news about ketamine, however. Since the Chinese proposal, there has been much lobbying by the World Health Organisation (AAGBI, 2014), the World Small Animal Association (WSAVA, 2015) and others. For example the WSAVA Global Pain Council (GPC) drafted the following statement for presentation to the CND:-
“Access to anesthetic and analgesic drugs is imperative for the mitigation of animal suffering and the WSAVA’s Global Pain Council was created to address inequalities in both education and access to analgesic/anesthetic modalities in differing regions of the world. In some regions, ketamine is the only analgesic/anesthetic agent available to the veterinary profession and is essential to enable veterinarians to perform their day-to-day activities in an ethical and humane manner. Restrictions on its use would have a significant and negative impact on animal welfare on a global scale.” (WSAVA, 2015).
At the CND meeting in March 2015, the Chinese withdrew their proposal ‘for further consideration’ (CND Blog, 2015; UNOCD, 2015c). However, the Chinese – along with the other countries that supported them in 2014 – are unlikely to let go of this and it will come back to haunt us in the years to come.
As responsible pet owners and guardians of animal rights and animal welfare, we have a duty of care to educate ourselves and everyone we know about the value of ketamine in veterinary medicine. We also have a duty to make sure that we keep ourselves up to date with how these proposed changes in the classification of ketamine are developing.
It is disturbing indeed that changes of such magnitude can be proposed by a Government in a far-away country and instigated by a global organisation we have never heard of on our behalf and without our consent.
So, spread the word and keep an ear to the ground on this one, people, and do help support the WSAVA in their campaign to keep ketamine available.
You can find more information on their website here –
© copyright Robert Falconer-Taylor, 2015
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AAGBI. 2014. Letter to Eng CMO re international regulation of ketamine. The Association of Anaesthetists of Great Britain and Ireland (AAGBI). http://www.aagbi.org/sites/default/files/Letter%20to%20Eng%20CMO%20re%20international%20regulation%20of%20ketamine.pdf. Accessed 13 June, 2015.
Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. 2009. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol. 2009 Aug;49(8):957-64.
Boseley S. 2015. Ketamine control plan condemned as potential disaster for world’s rural poor. The Guardian. Friday 27 February 2015. http://www.theguardian.com/world/2015/feb/27/raver-drug-ketamine-control-plan-at-un-condemned-as-potential-disaster. Accessed 14 June, 2015.
CND Blog. 2015. CND Day 1 – Agenda item 6(b): Change in the scope of control of substances. Commission on Narcotic Drugs (CND). Friday March 13, 2015. http://www.cndblog.org/2015/03/agenda-item-6b-change-in-scope-of.html. Accessed 14 June, 2015.
GOV.UK. 2015. Courts, sentencing and tribunals: Drugs penalties. UK Government. https://www.gov.uk/penalties-drug-possession-dealing. Accessed 14 June, 2015.
Tremonti AM. 2015. China calls for the UN to classify Ketamine as illicit narcotic. The Current / CBC Radio. Thursday March 12, 2015. http://www.cbc.ca/radio/thecurrent/the-current-for-march-12-2015-1.2991658/china-calls-for-the-un-to-classify-ketamine-as-illicit-narcotic-1.2991688. Accessed 14 June, 2015.
UNOCD. 2015a. About UNODC. United Nations Office on Drugs and Crime (UNODC). http://www.unodc.org/unodc/en/about-unodc. Accessed 13 June, 2015.
UNOCD. 2015b. The Commission on Narcotic Drugs (CND). United Nations Office on Drugs and Crime (UNODC). http://www.unodc.org/unodc/commissions/CND. Accessed 13 June, 2015.
UNOCD. 2015c. Commission on Narcotic Drugs Report on the fifty-eighth session. United Nations Office on Drugs and Crime (UNODC). http://daccess-dds-ny.un.org/doc/UNDOC/GEN/V15/021/78/PDF/V1502178.pdf. Accessed 13 June, 2015.
WSAVA. 2015. Ketamine – Please support the WSAVA on this important issue. World Small Animal Veterinary Association (WSAVA), Canada. April, 09 2015. http://www.wsava.org/article/ketamine-please-support-wsava-important-issue. Accessed 13 June, 2015.