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[e-drug] Ketamine scheduling alert. Your action requested.

E-DRUG: Ketamine scheduling alert. Your action requested.
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   There is a scheduling proposal for ketamine for the 58th Commission on
   Narcotic  Drugs,  although  WHO  recommended not to schedule ketamine.
   Ketamine  is  an  essential  medicine  used  for  anaesthesia. 

   Several countries  protested  against  the  placing of the proposal on the 
CND
   agenda,  because  the  procedures as set out by the international drug
   control  conventions  are  violated by this proposal. However, the CND
   Secretariat  seems  to press through for having a vote on 10 March and
   most  countries seem to follow the Secretariat as sheep. 

   Scheduling of ketamine  will  affect the medicine's availability and 
therefore, will
   be  disastrous  for the ability to provide essential surgery to some 2
   billion  people  in rural area's of developing countries. It will also
   severely restrain veterinary practice and wild life conservation.

   A fact sheet is available at:
   [1]     http://idhdp.com/media/400229/ketamine-fact-sheet.pdf    
   This  fact  sheet  has  received  37  endorsements so far and more are still
   incoming.  

   NGOs  can  endorse  the  fact  sheet  by confirming this to
   [2]    wk.scholten@xs4all.nl     while attaching their logo.

   A  campaign  against  the  scheduling  is ongoing and is having some
   results  already,  but  more  needs  to  be  done.  Please  tell those
   governments  represented  in  the Commission on Narcotic Drugs to vote
   against  the  proposal, by sending letter and making appointments with
   the responsible officers. 

   The countries to focus on are:

     In  Europe:  Hungary,  Italy,  Spain and Denmark (plus the European
     Commission,  DG  Migration  and  Home  Affairs,  Unit D4 Anti-Drugs
     Policy: although not having a vote, it may influence EU countries)

     In Asia: India, Indonesia, Japan, Republic of Korea, Thailand;

     In  Africa:  Angola,  Benin,  Cameroon,  Democratic Republic of the
     Congo,   Namibia,  Nigeria,  Togo,  United  Republic  of  Tanzania,
     Zimbabwe; and

     In   Latin-America:   Bolivia  (Plurinational  State  of),  Brazil,
     Colombia,  Cuba,  Guatemala,  Mexico,  Peru,  St.  Vincent  and the
     Grenadines, Suriname, Uruguay.

   Important  is to realize that not any scheduling is acceptable, as, in
   some  countries,  even  the  lightest scheduling will be a barrier for
   accessing  ketamine. Furthermore, even if a country scheduled ketamine
   at  the  national level, it does not mean that such a country needs to
   support  the  international scheduling: WHO's Expert Committee on Drug
   Dependence  recommended  that  there  should  be not any international
   scheduling, and if there is a problem at the national level, countries
   can   control   it   at  their  national  level,  while  ensuring  its
   availability for medical and scientific purposes.

   Please  note  that  we  do not have much time left: the agenda item is
   expected  to  be discussed on 10 March, but many countries will decide
   which position they will take days even weeks in advance!
   The  main  issues are in the fact sheet mentioned above. Additionally,
   after we finalized the Fact Sheet and received the first endorsements,
   we  received a number of considerations that can be used as additional
   arguments when approaching governments requesting them to vote against
   scheduling:

    1. Essential  medicines, including ketamine, are covered by the Right
       to  Health, in particular as described in article 12 of the ICESCR
       and  the  General  Comment  14:  countries  are  obliged  to  make
       essential  medicines  available  to  their populations (and have a
       responsibility for the realization of the Right to Health in other
       countries).

    2. If  ketamine  is  not  scheduled  under national substance control
       legislation,  this  does not mean that it is completely free: most
       countries  have  pharmaceutical  legislation that makes ketamine a
       prescription  only  medicine, e.g. because it is an injectable. If
       countries  enforce  such  legislation,  it  will  be  hard  to get
       ketamine for other use than medical/veterinary use and this should
       therefore prevent non-medical use, including recreational use.

    3. A  few more reasons why ketamine is the only usable anaesthetic in
       developing  countries  is  that for administering anaesthesia with
       gases  an  uninterrupted  power supply and uninterrupted supply of
       oxygen are necessary.

    4. Ketamine  is  very important in veterinary medicine, partially for
       the  same  reasons  as in human medicine (but oxygen and power are
       also  in  industrialized  countries  not  always at hand at remote
       farms  or  in  the  meadow  etc!),  but also for the safety of the
       veterinarian,   who  can  administer  the  ketamine  with  a  dart
       injection   before  approaching  a  dangerous  animal.   (See  the
       attached one-pager written by Dr Kathy Clarke, recently retired as
       head of anaesthesia at the Royal Veterinary College).

    5. Ketamine  is  a  mainstay  of many wild life conservation, zoo and
       wildlife  medicine  initiatives and without access to the medicine
       we  would have huge difficulties in managing many field programmes
       in  conservation  medicine  e.g.  blood  sampling,  radio-tracking
       collar attachment, etc.

   Willem Scholten  PharmD   MPA
   Consultant - Medicines and Controlled Substances
   Wielsekade 64
   3411 AD  Lopik, the Netherlands
   T:  +31 348 769 029
   M: +31 6 4847 3368
   E: [3]
   wk.scholten@xs4all.nl
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