On March 13, the Commission on Narcotic Drugs will convene in Vienna, Austria, for an annual meeting on drug control. On the Commission's agenda is a proposal1 to place ketamine—the leading anaesthetic used in developing countries—under Schedule I of the 1971 Convention on Psychotropic Substances, the same sort of international control reserved for the most highly illicit psychotropic drugs, such as mescaline and LSD. If the proposal passes, it will be a catastrophe for access to ketamine and safe surgery in developing countries. The 1971 treaty contains a legal requirement that WHO must consent before the Commission can add any drug to Schedule I. In particular, the treaty gives WHO sole authority to decide whether “there is sufficient evidence […] warranting the placing of [a] substance under international control”, and stipulates that, in this medical and scientific context, WHO's “assessments shall be determinative”.2 Thus, while the Commission has normative responsibility and the United Nations Office on Drug Control (UNODC) has operational responsibility for the treaty, WHO can, by law, veto them taking steps to put a drug in Schedule I. WHO's Expert Committee on Drug Dependence reviewed the evidence for the use and abuse of ketamine after a submission from the Government of China in June 2014,3and has previously reviewed submissions in 2006 and 2012. WHO has consistently recommended against placing ketamine under international control (scheduling) because of insufficient evidence for widespread public health consequences resulting from its abuse and fear that scheduling would reduce medical access. The Expert Committee reviewed 32 submissions from anaesthesiology organisations, including several from low-income and middle-income countries, and advised against the scheduling of ketamine for the same reason.4 Despite WHO's veto, UNODC has now committed the Commission to voting on whether to place ketamine under Schedule I. Not only is this unprecedented, but the UN's own commentary on the 1971 treaty states that “The Commission could […] not place in Schedule I […] a substance which the World Health Organization has found to have more than a ‘very limited’ therapeutic usefulness” and warns that if the Commission tried to do so it “would act ultra vires” (ie, beyond its legal powers).5 This attempt to restrict ketamine is a simultaneous affront to global public health, human rights, and the rule of law. Access to controlled drugs in low-income countries is deplorably poor; the Commission should not repeat its mistakes by restricting access to yet another essential medicine. AA has previously worked as a consultant for the UNODC. JWN declares no competing interests.

The bureaucrats hate those with depression. They literally want us dead instead of cured.