A new proposal to limit access to ketamine around the world would have a devastating effect on the health of millions of women in poorer countries, say campaigners. Although in developed nations ketamine is known primarily as a party drug, in lower income countries it's one of the most widely used anesthetics available, and is particularly notable for its use during caesarean sections.

Because ketamine is injectable, it's far easier to administer and transport than gas anesthetics, making it indispensable for doctors carrying out life-threatening surgeries in rural areas. It's also safer than other anesthetics as it induces a dissociative state but allows patients to retain their gag and cough reflexes. This is essential for saving lives during caesarean sections, as women who lose these reflexes due to heavy sedation can die when acid accumulating in their stomach floods their lungs.

The proposal to limit access to ketamine has been submitted by China and will be discussed by the UN’s Commission on Narcotic Drugs (CND) next month. China is suggesting that ketamine become a Schedule I drug — the same category as psychedelics such as LSD and more commonly abused substances like cocaine. This means that it would be prohibited from use except for "very limited medical purposes" and could only be administered by "persons directly under the control of the government." Countries would also have to submit import quotas for the drug each year in advance.

Campaigners arguing against the proposal say the effect of these restrictions would be devastating for lower income countries. Richard Laing, a professor of international health at Boston University’s school of public health, told The Guardian that the proposal was a "David and Goliath struggle between people interested in access to an essential medicine for women and victims of trauma in poor countries and the drug control establishment in rich countries."

China is submitting the proposal because it is worried about abuse of the drug by its citizens. A UN report from May last year noted that ketamine is "more widely misused in East and South-East Asia than in the Americas and Europe," with ketamine-induced seizures in China and Hong Kong making up 60 percent of the reported global share. China is also major exporter of ketamine and its proposal has the backing of a number of countries including Russia.

For some health experts, attempts to restrict access to ketamine are simply another example of how the international system of drug control has fueled global health inequality, specifically the access to effective and affordable pain relief. Studies show that even on a per capita basis, poorer countries have far less access to pain relief, and restricting ketamine would only exacerbate this problem. Even worse, it would disproportionately affect women and unborn children in poorer countries.