Essential medicines and health products

WHO Recommends against International Control of Ketamine

Seven ‘New Psychoactive Substances’ Considered to Pose Health Risks[ii].

December 2015 – For the fourth time since 2006, the World Health Organization (WHO) today recommended that ketamine should not be placed under international control after review of the latest evidence by the WHO Expert Committee on Drug Dependence. The Committee concluded that ketamine abuse does not pose a global public health threat, while controlling it could limit access to the only anaesthetic and pain killer available in large areas of the developing world.

“The medical benefits of ketamine far outweigh potential harm from recreational use.”

Marie-Paule Kieny, Assistant-Director General for Health Systems and Innovation at WHO.

“The medical benefits of ketamine far outweigh potential harm from recreational use,” said Marie-Paule Kieny, Assistant-Director General for Health Systems and Innovation at WHO. “Controlling ketamine internationally could limit access to essential and emergency surgery, which would constitute a public health crisis in countries where no affordable alternatives exist.”

Ketamine is an anaesthetic used in surgical and diagnostic procedures, it is often the only anaesthetic agent available in most developing countries and is also used for pain management. In 1985, ketamine was placed on the WHO Essential Medicines List and was recently described as ‘for sedation of both children and adults … perhaps the most widely used agent in the world’[i]. Ketamine has a good safety profile and is easy to use, especially in under-resourced health systems and emergency settings where clinical conditions and medical equipment are generally not available. In recent years ketamine has also been used recreationally, which has prompted moves to control the substance under international law. On each of these occasions - in 2006, 2012, 2014 and this year – the WHO Committee has recommended against scheduling. This and other recommendations of the Expert Committee will be conveyed to the Commission on Narcotic Drugs for its final decisions in March 2016.

“We have found that placing substances under international control can often limit access to them for medical purposes,” said Kees De Joncheere, WHO Director for Essential Medicines and Health Products. “Morphine is a case in point: even though it is inexpensive and one of the best substances available for pain management, in most countries availability and use are limited due to excessive regulation.”

Expert Committee reviews other psychoactive substances

The Committee also evaluated the dependence-producing properties of nine psychoactive substances and recommended scheduling of seven ‘new’ such substances - commonly known as ‘legal highs’ or designer drugs – for international control[ii] due to the health risks they pose. These drugs have recently appeared in the market as recreational drugs and are often not controlled under national laws or international conventions.

In response to requests from the Commission on Narcotic Drugs and the International Narcotics Control Board, the Committee also received an update on the pharmacology, toxicology and the claimed therapeutic applications of cannabis and cannabis resin. The Committee requested that WHO begin collecting data towards a pre-review of cannabis, cannabis resin, extracts and tinctures to identify any therapeutic advantages that they may have compared to other therapeutics.

About the WHO Expert Committee on Drug Dependence

WHO has a mandate, under the UN Single Convention on Narcotic Drugs (1961) and the UN Convention on Psychotropic Substances (1971), to conduct medical, scientific and public health evaluations of psychoactive substances. It does this via the Expert Committee on Drug Dependence, which is made up of independent experts from around the world. The Committee can recommend substances be scheduled for international control or not, after conducting a critical review of the scientific and public health evidence. Substances that have medical use are first subject to a pre-review, before going through the critical review process. According to the conventions, WHO’s assessments of substances shall be “determinative as to medical and scientific matters”.

[i] Letter from the World Society of Intravenous Anaesthesia to the ECDD, 8th May 2014. Available at ‘Letters of Support’
[ii] acetylfentanyl, MT-45, para-methoxymethylamphetamine (PMMA), α-pyrrolidinovalerophenone (α-PVP), para-methyl-4-methylaminorex (4,4’-DMAR), methoxetamine (MXE) and phenazepam