Survey Results: Glbal Ketamine Availability, Use, and Regulatry Oversight Nvember 2, 2015 T gauge the clinical use f ketamine and issues related t its availability and regulatry cntrl, a questinnaire was develped and distributed t natinal veterinary assciatins, natinal and internatinal anesthesia/analgesia specialty discipline grups, and individual veterinarians with internatinal experience/ netwrk fr infrmatin cntributin. Specifically, the fllwing grups played an instrumental rle: Wrld Small Animal Veterinary Assciatin (WSAVA) cmprised f 95 natinal member assciatins and internatinal discipline grups fcused n small animal veterinary medicine frm arund the wrld WSAVA Fundatin currently fcused n building a small animal veterinary netwrk in sub- Saharan Africa Plly M Taylr MA VetMB PhD DVA DipECVAA MRCA MRCVS RCVS & Eurpean Veterinary Specialist in anaesthesia The survey questins were based n an earlier survey (WSAVA Glbal Pain Survey undertaken by the WSAVA Glbal Pain Cuncil; http://www.wsava.rg/wsava-glbal-pain-survey ) with revisins t expand the ketamine-specific infrmatin gathering fllwing the input f Plly M Taylr MA VetMB PhD DVA DipECVAA MRCA MRCVS RCVS & Eurpean Veterinary Specialist in anaesthesia and Jasn Nickersn, RRT, FCSRT, PhD, and Walt Ingwersen DVM, DVSc, DACVIM (WSAVA President Elect). The survey was distributed electrnically in English and Spanish beginning September 29, 2015 and the results reprted in this summary dcument include respnses received up t and including Octber 30, 2015. A cpy f the full survey, including intrductin is attached as Sectin I The cllated survey results are attached as Sectin II The fllwing is a summary f the key survey results: Ø Ketamine is a universally used agent spanning develping t develped cuntries and ften the nly available prduct fr veterinary anesthesia and analgesia. Ø Virtually all respnses indicated access t veterinary licensed ketamine, a significant finding cnsidering there are limited veterinary licensed prducts fr use in veterinary analgesia/anesthesia. Having a veterinary licensed prduct supprts safe and effective prduct use. Ø All respndents indicated that the lss f ketamine access/use wuld have a significant detrimental effect n veterinary practice and the patients being treated, preventing the
prfessin frm being able t prvide safe, cst-effective anesthesia and analgesia and in sme regins f the wrld, effectively pre-empt the ability t prvide surgical services bth elective and nn-elective.. Ø Of interest in this reprt is the significant impact that re-scheduling ketamine wuld have n extic, labratry animal, and wildlife veterinary practices. Ø As ketamine is critical t feral dg/cat spay-neuter prgrams especially in develping regins f the wrld - prviding a cst-effective and filed cnditin safe anesthetic/analgesic. The lss f ketamine use wuld limit if nt utright eliminate these prgrams frm ccurring resulting in a One Health impact with significant human health implicatins with regards t dg/cat bites and the spread f zntic disease especially Rabies. Ø Aside frm a select few cuntries, there exists a regulatry framewrk gverning access, strage, and recrding f ketamine use Summary: All respndents site that the internatinal re-scheduling and subsequent lss f ketamine as translating int a majr and glbal animal welfare issue f immense significance spanning all species including peple as this wuld significantly undermine the prvisin f feral dg/cat ppulatin cntrl. Based n the wide-spread natinal implementatin f ketamine/cntrlled drug access, strage, and recding regulatins, this wuld seem the prudent fundatin/platfrm fr the management f cncerns regarding prduct redirectin and/r recreatinal use. Plly M Taylr MA VetMB PhD DVA DipECVAA MRCA MRCVS RCVS & Eurpean Veterinary Specialist in anaesthesia Walt Ingwersen DVM, DVSc, DACVIM (WSAVA President Elect).
Sectin I: Survey including intrductin Dear WSAVA Member representative, member f the Small Animal Veterinary Cmmunity, We are asking yu t answer the fllwing survey questins n ketamine use, which shuld take apprximately 10 minutes f yur time and will be invaluable in ur lbbying effrts t keep ketamine available fr bth veterinary and human clinical use glbally. In brief: there is a lbbying effrt frm a number f cuntries t have the Cmmissin n Narctic Drugs (CND) re-schedule ketamine as a cntrlled substance, thereby limiting its use. This wuld effectively severely restrict r prhibit its use in bth veterinary and human medicine glbally. The Wrld Health Organizatin (WHO) is petitining against this prpsal as it will significantly undermine the ability t prvide cst effective anesthesia and analgesia in varius parts f the wrld. Mre infrmatin can be fund n the Glbal Pain Cuncil ages at www.wsava.rg What des this mean t yu: if this prpsal is passed by the CND, it is likely t take away yur ability t use ketamine in yur veterinary practice. WSAVA is wrking tgether with a number f ther internatinal veterinary and human medicine/anesthesia assciatins t lbby against ketamine re-scheduling. Lbbying against this prpsed re-scheduling wuld help t ensure cntinued access and wuld nt change in any specific natinal ketamine regulatins if they exist, they wuld remain in frce in yur cuntry. We urgently need input as t the current ketamine use practices in yur cuntry and the ptential impact f lsing access and/r use f ketamine nyur ability t care fr the animals yu treat. Please answer the fllwing and reply t walt.ingwersen@gmail.cm r Fax# +1-905-627-8425 at yur earliest pprtunity, and n later than Octber 26, 2015. Thank yu fr yur help in addressing this glbal animal and human welfare issue! Walt Ingwersen DVM, DVSc, DACVIM WSAVA President Elect Ketamine Use Questinnaire: Respndent infrmatin: 1. Name and degrees 2. Address and affiliatin (e.g., cuntry, assciatin, etc)
3. Cntact infrmatin 3.1. Phne 3.2. Fax 3.3. E-mail 4. Can we cntact yu if further infrmatin is required? Yes/N 4.1. Alternate cntact: General drug availability: 1. Are there regulatins in yur cuntry restricting the availability and use f medicines [e.g. access, strage, and use f cntrlled substances, such as piids and ketamine]? Yes/N 5.1. If s, briefly describe (pen bx fr respnse) Ketamine specific questins: 1. Is ketamine available fr use in yur cuntry: 1.1. As a veterinary licensed prduct Yes/N 1.2. As a human licensed prduct Yes/N 2. Check all the species that yu are aware f benefiting frm prduct use Dgs & cats Bvine Equine Other Nt applicable as nt available 3. If ketamine is available fr use, fr which purpse are they cmmnly used (please select all that apply)? Peri-perative analgesia Sedatin Acute traumatic pain Chrnic pain (e.g., stearthritis) Cancer pain Medical pain 4. D any f these factrs affect veterinary use f ketamine fr veterinary medicine in yur cuntry (please select all that apply)? Cncerns ver safety Cncerns ver efficacy Knwledge f use prtcls Cst Regulatry requirements (e.g., strage, recrd keeping, etc) Other (pen bx fr respnse)
5. Hw ften d yu use Ketamine in yur practice? times per (select ne) day/week/mnth/year 6. D yu currently stre Ketamine in a lcked cabinet? Yes/N 7. D yu currently use Ketamine utside the practice premises? Yes/N 8. Are yu aware f any cases where Ketamine has been lst r stlen frm the practice premise? Yes/N 9. D yu currently recrd Ketamine usage? Yes/N 10. If yu were t lse the ability t access and/r use ketamine, hw wuld this impact n yur ability t prvide prper care fr the animals yu treat? 11. Any ther cmments Thank yu fr yur assistance in this matter!
Sectin II: Cllated survey respnse infrmatin Number f survey Repnses received: 152 Nte: there were mre than ne respnse frm a number f cuntries including (in rder f greatest t least ) Suth Africa, Namibia, UK, India, and Sri Lanka. This prvided an pprtunity t assess the cnsistency f the infrmatin being prvided and hence its veracity. Respndent infrmatin: Prfessinal backgrund : all respndents were veterinarians Prfessinal affiliatin: There were 2 respnses frm veterinarians in academia, 1 frm a veterinarian in labratry animal practice, 1 frm a veterinarian in z animal medicine, and 1 frm the Suth African Rural Veterinarians assciatin. All else were frm veterinarians in small animal r mixed clinical practice Respnses were received frm 33 cuntries that included : Btswana Brazil Bulgaria Canada Clmbia Ecuadr France Germany Greece India Lithuania Luxemburg Malawi Mntenegr Mrcc Namibia Nepal Netherlands New Zealand Nigeria Pland Prtugal Singapre Slvenia Suth Africa Spain Sri Lanka Sweden Tanzania Thailand Uganda United Kingdm USA General drug availability: Only Sri Lanka, Nepal, and Malawi had n frmal gvernmental regulatins gverning ketamine access, strage, and recrding. All ther respnding cuntries had regulatins gverning ketamine access, restricting it t authrized veterinarians. While nt all reprting cuntries had cmprehensive regulatins that gvern strage and use recrding, the majrity did; exceptins were India, Slvenia, and Mrcc. Ketamine specific questins: 1. Is ketamine available fr use in yur cuntry: All cuntries except fr Uganda reprted access t/ability t use a veterinary-licensed ketamine prduct. Unfrtunately, many did nt knw the situatin in human medicine s this was incmplete data.
2. Check all the species that yu are aware f benefiting frm prduct use Dg and cat were the predminant respnse chice fr species use hwever likely reflective f survey distributin bias. This was fllwed by equine, wildlife, and extic animals with the ccasinal selectin f bvine and prcine. 3. If ketamine is available fr use, fr which purpse are they cmmnly used (please select all that apply)? Peri-perative anesthesia/analgesia and sedatin were the predminant respnses as they were selected by all survey respndents. This was fllwed by acute traumatic pain, medical pain, and cancer pain. Chrnic pain was nly selected by 3 respndents. 4. D any f these factrs affect veterinary use f ketamine fr veterinary medicine in yur cuntry (please select all that apply)? Knwledge f use prtcls and regulatry requirements were the predminant selectins, fllwed by cncerns ver safety. Cst was rarely selected. Under ther Btswana indicated a prblem with imprting ketamine int the cuntry. 5. Hw ften d yu use Ketamine in yur practice? times per (select ne) day/week/mnth/year All respndents indicated having ketamine in their practice and using it at least nce/week. Use estimates varied frm 1/week t 20/day with the mst cmmn answers being 1-2/day and 2/week. 6. D yu currently stre Ketamine in a lcked cabinet? All answered yes except fr Sri Lanka, Nepal, India, Prtugal, and Slvenia. 7. D yu currently use Ketamine utside the practice premises? Use utside f the practice was rare and limited t wildlife, spay/neuter prgrams, equine, and fd animal practices. 8. Are yu aware f any cases where Ketamine has been lst r stlen frm the practice premise? Nne f the respndents had experienced this persnally with the majrity respnding n ; exceptins were Canada, USA, Uganda, Slvenia, Suth Africa, Brazil, and France were single respndents indicated having heard f this ccurring. 9. D yu currently recrd Ketamine usage? Aside frm India, Malawi, Sri Lanka, Prtugal, and Mrcc, all respnded yes. 10. If yu were t lse the ability t access and/r use ketamine, hw wuld this impact n yur ability t prvide prper care fr the animals yu treat? The unanimus sentiment was that lsing ketamine use in practice wuld have a marked and negative impact n the prvisin f veterinary care encmpassing all species and all regins f the wrld.
The fllwing are select cmments transferred directly frm submitted surveys: Very significant. N surgery f dgs and cats can be perfrmed. Tanzania Withut ketamine, anaesthetic and analgesic facilities will be severely cmprmised. Prper treatment f many medical cnditins, periperative care, as well as humane treatment f wildlife will be negatively affected. Greece It wuld severely impact in particular n sterilisatin f all cats, all minr surgical prcedures n cats and small dgs, and in ur cntrl f peri-and pst-perative pain in particular. The drug is cheap and safe t use under African Field cnditins I fully understand the safety cncerns fr humans but feel that this shuld nt deprive us vets f such an imprtant medicine prvided we fllw current prcedures and cntrls Rescheduling f ketamine wuld nly cmplicate veterinarian s life: harder availability f the drug and mre paperwrk which wuld result in prer quality f anaesthesia and analgesia in small as well as large animal practice. I use Ketamine in my wildlife practice in almst every species I deal with, it is a vital drug. It wuld make practice impssible. It will definitely impact the care f ur patients as this drug is generally really safe t use in a wide spectrum f patients. It wuld als greatly increase the csts f safe, reliable anaesthesia in small animals and wildlife, making prcedures that require anaesthesia mre expensive fr the clients, thus ultimately making their decisin f hw they wuld like t cntinue treatment f their animals mre difficult. Ketamine is widely used in practice, wildlife wrk and research. Taking away the ptin f using ketamine wuld negatively affect the industry and animal care as a whle. I can t even describe hw devastating that wuld be t us. There is n alternatives available in Malawi, s withut the use f Ketamine ur vets wuldn t be able t perate at all. Because f its lw cst, it means we can affrd t sterilize many mre dgs than if we were using a mre expensive ptin. Ketamine is a huge part f ur wrk, and it wuld severely impact ur ability t help animals if we aren t able t buy it.
We have standardized and even published diazepam ketamine prtcls by perating clse t 15000 dgs fr animal birth cntrl and cntinuus anesthetic mnitring des make it safe as well as effective in lw resurce setting and its very ecnmic t.recrd keeping and strage practices can be implemented as per the law t t prevent misuse.india I am a veterinary surgen wrking t eradicate rabies frm Sri Lanka which invlves dg ppulatin management thrugh surgical sterilizatin. We use Ketamine fr the inductin and maintenance f anaesthesia as it is lw cst and safe fr animals. If we were t lse Ketamine in Sri Lanka we will nt be able t d surgeries n a daily basis and this will very badly affect n the ability t cntrl rabies which kills many animals annually.