WHO Opposes Global Control of Ketamine: The Horse 1/5/16

By: Pat Raia

The World Health Organization (WHO) has opposed a Chinese United Nations (U.N.) delegation request of the U.N. Commission on Narcotic Drugs to place a commonly used anesthetic and analgesic, ketamine, under international control. The Chinese delegation made its request—which would restrict veterinarians’ ability to access it—in March 2015 on grounds that ketamine poses a public health risk when abused by people in recreational and other situations. Veterinarians worldwide, however, rely on ketamine to treat animals in their care.

Faced with the possibility of losing ketamine access, U.S. veterinary professional organizations advised their memberships to submit comments about the Chinese request to the Food and Drug Administration (FDA). Ketamine is probably the most widely used veterinary anesthetic in the world, primarily because of its safety, says René Carlson, DVM, president of the World Veterinary Association and 2015 president of the American Veterinary Medical Association (AVMA). Ketamine is also the only induction anesthetic agent used for horses in many countries.

“Since the majority of equine anesthesia is conducted in the field, ketamine is the ideal drug for intravenous anesthesia because of its high reliability and unique pharmacokinetic properties,” Carlson said.

Also, because there’s little accumulation of ketamine in the body when administered for prolonged periods, the drug provides a rapid recovery time, Carlson said.

Internationally, WHO includes ketamine in its Essential Drug List as a minimum medical need for a basic health-care system. In the United States, ketamine is classified as a Schedule III drug under the Controlled Substances Act. The U.S. classification system ranges from Schedule I (substances defined as drugs but have no medical use, such as heroin) to Schedule V (drugs with lower potential for abuse, such as the low doses of codeine in certain cough suppressants). U.S. veterinarians used the drug in more than 30,000 equine surgeries last year alone, said G. Kent Carter, DVM, former president of the American Association of Equine Practitioners (AAEP). If ketamine would be put under international control, it would be elevated to a Class I substance.

In October Carter submitted a letter on the AAEP’s behalf calling for ketamine to remain at the Schedule III level. The AVMA also submitted statements, said Sharon Curtis Granskog, AVMA assistant director for media relations.

During the weekend of Dec. 12, the WHO recommended that ketamine not be placed under international control after review of the latest evidence by the WHO Expert Committee on Drug Dependence.

“The Committee concluded that ketamine abuse does not pose a global public health threat, while controlling it could limit access to the only anesthetic and pain killer available in large areas of the developing world,” the WHO reported in its statement. “The medical benefits of ketamine far outweigh potential harm from recreational use.”

Kathleen Anderson, DVM, 2016 AAEP president praised the WHO decision.

“The AAEP commends the World Health Organization (WHO) for its recent recommendation,” she said. “Elevating ketamine to a Schedule I drug is not needed and would result in unacceptable negative impacts on horse health and welfare by removing a key component of essential anesthesia. Without ketamine, field procedures and acute pain management could not take place nationally or internationally. This is particularly critical in developing countries with limited veterinary hospital resources.”

It’s now up to the U.N. to take action on the WHO recommendation when the agency’s Commission on Narcotic Drugs next meets in 2016, Granskog said. Meanwhile, the U.N. Commission’s decision remains pending.