Secondary Logo

Journal Logo

Ketamine Versus Special K

A Double-Edged Sword

Cottrell, James E. MD; Hartung, John PhD

doi: 10.1213/ANE.0000000000001151
Editorials: Editorial

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

Recreational 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 Onajin-Obembe1 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.

Back to Top | Article Outline


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.

Back to Top | Article Outline


a Available at: Accessed December 2, 2015.
Cited Here...

Back to Top | Article Outline


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;122:908–10
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
© 2016 International Anesthesia Research Society