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E Editorial

Ketamine Versus Special K: A Double-Edged Sword

James E. Cottrell, MD, and John Hartung, PhD

ecreational ketamine, known as Special K among

American drug addicts, has become a significant
drug of abuse in China. Indeed, ketamine abuse
in China has become a big enough problem to motivate
its government to recommend that the United Nations
place ketamine under international control as a Schedule I
Psychotropic Substance in March 2014. As of March 2015, 7
other nations provided comments.a
Many governments weighed in against the recommendation. The government of Norway expressed concern
that in low- and middle-income countries ... ketamine
is often the only available anaesthetic, and placing ketamine under international control could block access
to that essential medicine. The Norwegian response
referred to the World Health Organization recommendation that ketamine should not be brought under international control owing to the humanitarian consequences
of such an action. The governments of Australia, Peru,
and the United States concurred. The Spanish summarized their concerns about making ketamine a Schedule
I drug: Placing ketamine under Schedule I of the 1971
Convention would imply prohibiting the use, production,
import, export, transit, trade, distribution and possession
of the substance ... it should not be included in Schedule
I of the 1971 Convention. Perhaps the most compelling
objection came from the United Kingdom. After acknowledging the risks posed to public health by illicit use of
ketamine, the United Kingdom delegation calculated that
5.5 billion people live with limited or non-existent access
to controlled medicines and that for them, ketamine is
often the only anaesthetic agent available.
In this issue of Anesthesia & Analgesia, Joshi and OnajinObembe1 provide all the ammunition that the world

anesthesiology community needs to remind China that it

was not so long ago that ketamine was as important to the
health of its population as it still is for 5.5 billion people
around the world today.
In addition to the importance of ketamine in developing nations, a recent review article presents evidence that
ketamine may be an appropriate workhorse IV anesthetic
agent worldwide and so deserves resurgent interest and
investigation in the developed nations.2 Being a developed
nation entails a responsibility to consider worldwide cost/
benefit ratios of United Nations actions whenever the issue
at hand is a double-edged sword. The problem of ketamine
use among drug addicts, serious as it is, remains smaller
than the benefits that ketamine bestows on millions of
patients who need surgery in locations where ketamine is
the only general anesthetic available.E

Name: James E. Cottrell, MD.

Contribution: This author helped write the manuscript.
Attestation: James E. Cottrell approved the final manuscript.
Name: John Hartung, PhD.
Contribution: This author helped write the manuscript.
Attestation: John Hartung approved the final manuscript.
This manuscript was handled by: Hugo Van Aken, PhD,
FRCA, FANZCA, and Steven L. Shafer, MD.
1. Joshi GP, Onajin-Obembe B. The role of ketamine in low- and
middle-income countries: what would happen if ketamine
becomes a scheduled drug? Anesth Analg 2016;122:90810
2. Zeiler FA, Sader N, Gillman LM, Teitelbaum J, West M, Kazina
CJ. The cerebrovascular response to ketamine: a systematic review of the animal and human literature. J Neurosurg
Anesthesiol 2015; epub ahead of print

From the SUNY Downstate Medical Center, Brooklyn, New York.

Accepted for publication December 2, 2015.
Funding: None.
The authors declare no conflicts of interest.
Reprints will not be available from the authors.
Address correspondence to John Hartung, PhD, SUNY Downstate Medical
Center, Box 6, 450 Clarkson Ave., Brooklyn, NY 11203. Address e-mail to john.
Copyright 2016 International Anesthesia Research Society
DOI: 10.1213/ANE.0000000000001151


CN.7/2015/7/Add.1. Accessed December 2, 2015.

March 2016 Volume 122 Number 3

Copyright 2016 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited.