Ketamine is more than a recreational drug. The World Health Organization (WHO) lists ketamine as an essential medicine for its use as a cheap and efficient anesthetic. Its administration requires no electricity, oxygen, or even trained anesthetists, making it a particularly useful pharmaceutical in developing nations. In many countries, ketamine is one of the few modern surgical tools at hand.
This is why last week WHO announced that they wouldn't support increasing international restrictions on the drug. This is the fourth time since 2006 WHO has made this recommendation, and the fourth time in that period the Chinese government has called for ketamine to come under the same regulatory framework as Xanax or Valium.
It's currently up to individual countries to police the recreational use of the drug. But the Chinese government has long wanted ketamine listed under the Convention on Psychotropic Substances of 1971 treaty. Last week they took their case to the 58th UN Commission of Narcotic Drugs (CND) held in Vienna, but their submission fell on deaf ears. The representative for China later issued this somewhat eccentric response, acknowledging respect for WHO's stance on red meat, but not their regard for ketamine. "I am seriously considering whether I should eat more white meat or become vegetarian... but in regard to ketamine we believe WHO needs to be cautious."
The issue for China is that ketamine is the nation's recreational drug of choice. While western countries are battling methamphetamine, it's estimated 99 percent of all illicit ketamine seizures are made in China. There are a few reasons for this but the underlying impetus is price.
"Compared to methamphetamine and heroin, K is rather cheap," an anonymous member of the Public Security Bureau in Dongguan told Motherboard in 2013. Indeed, a cost comparison by CNN valued ketamine in China at around $13 a gram while coke was $103 a gram. This is a huge difference attributed to how easily local drug cooks can access ketamine precursors, whereas other drugs still require some level of importation. And then there's the fact that ketamine seems to enjoy less social stigma. "The general public is unaware of the dangers of K," claimed the public security member. "Many believe this drug isn't addictive, and have the misunderstanding that it's not harmful to your health."
Over the past decade China has become famous for manufacturing research chemicals sold as synthetic drugs overseas. The labs producing these drugs are legal under Chinese law, but unlicensed production of ketamine isn't. Accordingly Chinese police last year seized 7.85 tons of black market ketamine from over 500 laboratories. This was a 122 percent increase on seizures from 2013.
Despite this crackdown the spokeswoman for the World Federation of Societies of Anaesthesiologists (WFSA), Niki O'Brien told VICE that ketamine is a low priority for law enforcement internationally. "Ketamine is the most popular recreational drug in China and a small number of neighboring countries," she said, "but it does not cause significant social harm on a global scale."
This is the reason so many doctors are reluctant to see access to ketamine hampered. China has responded by softening their original push to list ketamine as a schedule I drug, down to a schedule IV listing. Other drugs that receive a similar scheduling include benzodiazepines and long-acting barbiturates.
According to Dr. Rob McDougall, member of the WSFA and Deputy Director of the Department of Pediatric Anaesthesia and Pain Management at the Royal Children's Hospital, any restriction on ketamine will prohibit use. "The evidence is that once you start controlling drugs at an international level it's difficult to maintain a legitimate supply and that's a real concern," he told VICE.
For China, the real problem seems to be that their legal system struggles to permit their enormous output of research chemicals, while restricting the manufacture of ketamine. This seems to be why the WHO has recommended China maintain domestic control measures instead of enacting international regulations; effectively saying it's not our problem.
As Dr. Rob McDougall told VICE "If you took ketamine away from [developing nations], in some places 70 percent of the patients that go through the operating theaters wouldn't receive any anesthesia agents at all. This is a global health problem."
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