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[e-drug] Ketamine secured for medical and veterinary use!

E-DRUG: Ketamine secured for medical and veterinary use!
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Dear all,

This morning, the Commission on Narcotic Drugs discussed the possible 
bringing of ketamine under international drug control. Initially, China 
proposed to add the substance under Schedule I of the UN Convention on 
Psychotropic Substances. Such a scheduling means that the substance can 
be used for medical purposes only under direct governmental supervision, 
and in very limited situations. The proposal was very inappropriate for 
an essential medicine. However, thanks to the efforts of many, China 
amended its proposal to the less strict Schedule IV of the same 
convention. Again we opposed this and thanks to our opposition, China 
withdrew this morning its entire proposal. The CND then decided 
to postpone its decision on scheduling ketamine to a future date to 
allow more information to be gathered. A transcript of the debate is 
available here: 
http://www.cndblog.org/2015/03/agenda-item-6b-change-in-scope-of.html#more

This is a very good result and I want to thank everyone who was involved 
in the lobbying to keep access to ketamine as a human and veterinary 
medicine for his or her efforts. In the end we had 87 endorsements on 
the fact sheet and several organizations came to Vienna to convince the 
delegates personally. Many went to their governments to convince the 
ministries of health and the drug controllers that any scheduling of 
ketamine was not a good idea.

Over the past few weeks it became more and more clear that we were 
successful, and many countries declared that they would oppose the 
scheduling. Initially, we were able to find over 19 CND members opposing 
schedule IV, and once we had these, we continued to convince more CND 
Member countries to oppose all scheduling. This became clear only 
gradually toward last weekend. In my messages you may have seen the 
countries I recommended to focus your lobby on. On purpose we decided 
not to be transparent on the countries we had convinced. I hope for your 
understanding, as such transparency would have made it easy for China to 
lobby these countries back into its camp.

During the week at the CND (which started last Monday), we discussed 
with country delegations the possible ways forward, being afraid of 
unwanted precedents in the procedure. But finally today, it happened as 
some had predicted: China withdraw its proposal while saving face by 
saying that this allows for more data collection. How serious this "more 
data collection" is, is in this stage not completely sure. It may be 
that we never hear back about ketamine scheduling, but _some vigilance 
is needed in the coming years.

What further to do? - There are over 50 countries who have scheduled 
ketamine in their national legislation (i.e. independent form the 
international drug control conventions). In several of these countries, 
veterinarians and physicians may have experienced reduced availability 
of ketamine already. They and their organizations may want to discuss 
the issue now with their governments in order to re-increase 
availability. Because of this CND and Chinas proposal, the climate may 
have changed now. After some of the preparatory meetings, someone 
mentioned that this was the first time ever that the countries at the 
CND discussed medicines availability for over three hours. Never before 
there was such a focus at the international level on the relation 
between drug control and medicines availability. Therefore, this is the 
moment that most drug controllers around the world are seeing that drug 
control has also the negative side for public health of medicines 
unavailability.

Medical and veterinary organizations may also want to use the 
opportunity for discussing the availability of medicines controlled as 
drugs more in a general way, e.g. the availability of opioid analgesics, 
long-acting opioids for the treatment of opioid dependence, 
phenobarbital and other controlled medicines.

For those who want to take action in this regard, I also refer to the 
WHO Guidelines on this issue, available in multiple languages, including 
English, French and Spanish: 

http://www.who.int/entity/medicines/areas/quality_safety/guide_nocp_sanend/en/index.html

I thank you once more, and I dare to do so also on behalf of the others 
who were involved in a core team of campaigners (which I am not going to 
list, because we were a fuzzy network which' composition changed every 
now and then).

Best regards,
Willem Scholten
-- 
Willem ScholtenPharmDMPA*
Consultant Medicines and Controlled Substances
Wielsekade 64
3411 ADLopik, the Netherlands
wk.scholten@xs4all.nl
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