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| Not just a party drug: no ketamine means no surgery in some developing countries | Not just a party drug: no ketamine means no surgery in some developing countries |
| (about 2 hours later) | |
| My supply of ketamine is under threat and you should be worried. | My supply of ketamine is under threat and you should be worried. |
| I’m not a recreational drug taker. I’m an anaesthetist, and for me ketamine is medicine. | I’m not a recreational drug taker. I’m an anaesthetist, and for me ketamine is medicine. |
| In rural hospitals in Nigeria, injecting the drug is essential for pregnant women to have safe ceasareans, and for us to be able to insert IVs for fluids and attach the required monitors to children prior to an operation without a struggle. It can be used for preventing pain during or after surgery. Some of my colleagues even advocate the use of oral ketamine in soda for procedures in the accident and emergency department. | In rural hospitals in Nigeria, injecting the drug is essential for pregnant women to have safe ceasareans, and for us to be able to insert IVs for fluids and attach the required monitors to children prior to an operation without a struggle. It can be used for preventing pain during or after surgery. Some of my colleagues even advocate the use of oral ketamine in soda for procedures in the accident and emergency department. |
| Because it is very cheap compared to other anaesthetic drugs and can be administered in many different ways, ketamine has become the preferred anaesthetic agent in low and middle income countries (LMICs). It is on the essential drug list of the World Health Organisation with a potential to offer safe and affordable surgical and anaesthesia care for the 5 billion people, who would otherwise lack access to basic surgical care. It is the one anaesthesia drug that non-trained anaesthesists such as nurses and health assistants can be taught how to use safely to supplement the surgical workforce shortages in many developing countries. It is also the only anaesthetic that does not require piped oxygen, electricity or anaesthetic equipment. | |
| So, why on earth would you want to make it difficult to get a drug that can offset the gross inequity in access to surgical care? | So, why on earth would you want to make it difficult to get a drug that can offset the gross inequity in access to surgical care? |
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| The problem is the abuse and increased illicit use of ketamine as a party drug in Asia. China is one of the world’s largest producers of the drug but the smuggling and trafficking of illicitly produced ketamine across Asia has pushed the Chinese government to call for greater restrictions on ketamine. | The problem is the abuse and increased illicit use of ketamine as a party drug in Asia. China is one of the world’s largest producers of the drug but the smuggling and trafficking of illicitly produced ketamine across Asia has pushed the Chinese government to call for greater restrictions on ketamine. |
| I sympathise with their situation but their most recent proposal to the United Nations was to place ketamine under an international control known as scheduling. This would mean that countries that want to buy the drug and use it would have to state how much they intended to import each year and would not be able to buy any more. But in practice, like we saw with the scheduling of morphine, the supply chain would be severely affected and ketamine would become unavailable in more remote areas. Luckily, proposals made in March 2014 and March 2015 have both failed. That doesn’t mean though that China won’t make another attempt to have the drug scheduled in 2016. | I sympathise with their situation but their most recent proposal to the United Nations was to place ketamine under an international control known as scheduling. This would mean that countries that want to buy the drug and use it would have to state how much they intended to import each year and would not be able to buy any more. But in practice, like we saw with the scheduling of morphine, the supply chain would be severely affected and ketamine would become unavailable in more remote areas. Luckily, proposals made in March 2014 and March 2015 have both failed. That doesn’t mean though that China won’t make another attempt to have the drug scheduled in 2016. |
| Recognising that this drug is vital for safe surgery in many developing countries, the WHO’s expert committee on drug dependence recommended in 2006, 2012, 2014 and 2015 that ketamine abuse does not pose a significant global public-health risk to warrant scheduling. China should therefore maintain domestic control measures instead of seeking for international regulations. | Recognising that this drug is vital for safe surgery in many developing countries, the WHO’s expert committee on drug dependence recommended in 2006, 2012, 2014 and 2015 that ketamine abuse does not pose a significant global public-health risk to warrant scheduling. China should therefore maintain domestic control measures instead of seeking for international regulations. |
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| The World Federation of Societies of Anaesthesiologists (WFSA) also began an awareness campaign in December 2015 as we fear international scheduling will interfere with its supply chain and the manufacture and distribution of essential ketamine will likely dry up. We must learn a lesson from the scheduling of morphine, the use of which dropped in India and sub-saharan Africa because it was no longer available. Although morphine can be replaced by other painkilling drugs, anaesthesia providers in many African countries have no other options to ketamine. | The World Federation of Societies of Anaesthesiologists (WFSA) also began an awareness campaign in December 2015 as we fear international scheduling will interfere with its supply chain and the manufacture and distribution of essential ketamine will likely dry up. We must learn a lesson from the scheduling of morphine, the use of which dropped in India and sub-saharan Africa because it was no longer available. Although morphine can be replaced by other painkilling drugs, anaesthesia providers in many African countries have no other options to ketamine. |
| One recent example of the power of ketamine was when on a rainy saturday, a 25-year-old woman was brought into our hospital in Nigeria with severe electrical burns after electrical poles fell and killed a number of people during a storm earlier that day. She needed both her legs amputated and ketamine anaesthesia gave her a deep intense sleep, made her pain-free and helped her maintain a stable blood pressure, heart rate and good blood flow to all her organs. Because ketamine increases blood pressure, it is particularly useful for treating patients in shock like this woman. She recovered. But on the way out of the theatre, we were told more emergency operations had been booked, and it’s at moments like that I begin to imagine – what if our hospital couldn’t easily replenish it’s supply of ketamine? | One recent example of the power of ketamine was when on a rainy saturday, a 25-year-old woman was brought into our hospital in Nigeria with severe electrical burns after electrical poles fell and killed a number of people during a storm earlier that day. She needed both her legs amputated and ketamine anaesthesia gave her a deep intense sleep, made her pain-free and helped her maintain a stable blood pressure, heart rate and good blood flow to all her organs. Because ketamine increases blood pressure, it is particularly useful for treating patients in shock like this woman. She recovered. But on the way out of the theatre, we were told more emergency operations had been booked, and it’s at moments like that I begin to imagine – what if our hospital couldn’t easily replenish it’s supply of ketamine? |
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| No access to ketamine will make surgery a nightmare in countries like Nigeria. If scheduling does go ahead, whether this year or in the future, I fear illegal trips may become the order of the day. A whole new category of health immigrants could emerge: boatloads of patients and families desperate to cross over to Europe for surgery. I also worry about brain drain because the anaesthesia workforce will possibly become frustrated as a result of lack of ketamine. Less than 15% of anaestheologists work in LMICs already. Do we then leave our countries for greener (anaesthesia) pastures? The international community needs to remember ketamine is medicine in developing countries. | No access to ketamine will make surgery a nightmare in countries like Nigeria. If scheduling does go ahead, whether this year or in the future, I fear illegal trips may become the order of the day. A whole new category of health immigrants could emerge: boatloads of patients and families desperate to cross over to Europe for surgery. I also worry about brain drain because the anaesthesia workforce will possibly become frustrated as a result of lack of ketamine. Less than 15% of anaestheologists work in LMICs already. Do we then leave our countries for greener (anaesthesia) pastures? The international community needs to remember ketamine is medicine in developing countries. |
| Bisola Onajin-Obembe is an anaesthesiologist based in Nigeria and chair of the Africa regional section at the World Federation Of Societies of Anaesthesiologists. | Bisola Onajin-Obembe is an anaesthesiologist based in Nigeria and chair of the Africa regional section at the World Federation Of Societies of Anaesthesiologists. |
| Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter. | Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter. |