Schedules of Controlled Substances: Proposed Placement of Ketamine Into Schedule III

DEPARTMENT OF JUSTICE

Drug Enforcement Administration

[DEA-183P]

21 CFR Part 1308

Schedules of Controlled Substances: Proposed Placement of

Ketamine Into Schedule III

AGENCY: Drug Enforcement Administration, Justice.

ACTION: Notice of proposed rulemaking.

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SUMMARY: This proposed rule is issued by the Deputy Administrator of

the Drug Enforcement Administration (DEA). It proposes the placement of

the substance ketamine, including its salts, isomers, and salts of

isomers, into Schedule III of the Controlled Substances Act (CSA). This

proposed action is based on an evaluation of the relevant data by the

DEA and a recommendation from the Assistant Secretary for Health and

Surgeon General of the Department of Health and Human Services (DHHS)

that ketamine and products containing it be placed into Schedule III of

the CSA. The effect of this proposed action will be to discourage the

diversion and abuse of ketamine, and subject ketamine to the

regulatory, civil and criminal controls of a Schedule III controlled

substance.

DATES: Comments and objections must be received on or before June 8,

1999.

ADDRESSES: Comments and objections should be submitted in quintuplicate

to the Deputy Administrator, Drug Enforcement Administration,

Washington, D.C. 20537; Attention: DEA Federal Register Representative/

CCR.

FOR FURTHER INFORMATION CONTACT: Frank Sapienza, Chief, Drug and

Chemical Evaluation Section, Drug Enforcement Administration,

Washington, D.C. 20537; Telephone: 202-307-7183; FAX: 202-307-8570.

SUPPLEMENTARY INFORMATION: Ketamine hydrochloride has been marketed in

the United States since 1971 as a rapid-acting general anesthetic. It

is used in both human and veterinary practice. Chemically, ketamine is

related to PCP, a Schedule II controlled substance. The effects

produced with use of ketamine are similar, although less intense and

shorter in duration, to those produced by PCP.

The DHHS, by letter of March 18, 1981, recommended to the DEA that

ketamine and products containing it be place into Schedule III of the

CSA. The DEA published a notice of proposed rulemaking (NPRM) (46 FR

29484, June 2, 1981) which proposed the placement of the substance

ketamine and salts thereof, into Schedule III of the CSA. In response

to the NPRM, the DEA received seven letters. Comments in support of the

proposed action were received from the American Veterinary Medical

Association and a professor at the Texas A & M University, College of

Veterinary Medicine. Comments in opposition were received from the

Warner-Lambert Company, the Humane Society of the United States, the

Division of Comparative Medicine at the Johns Hopkins University School

of Medicine, the Department of Laboratory Animal Medicine at the

Southwest Foundation for Research and Education, and the Director of

Scientific Support Services, Primate Research Institute at the New

Mexico State University. On review of the comments and the yearly

average of four documented instances of diversion or abuse between 1975

and 1981, the DEA determined that the incidence of actual abuse was not

sufficient to sustain the scheduling action. The DEA continued to

monitor the situation.

The DEA summarized the relatively little actual abuse information

available to it, and by letter of August 14, 1984, asked the DHHS if

its previous recommendation for control of ketamine as a Schedule III

controlled substance should stand. The DHHS, by letter of November 29,

1984, requested the information of abuse to which the DEA had referred.

The DEA furnished the information to the DHHS by letter of February 18,

1985. By letter of September 8, 1986, the DHHS reaffirmed the

recommendation to place ketamine into Schedule III of the CSA. On this

occasion, as earlier, the DEA determined that the incidence of actual

abuse, roughly five documented cases of diversion or abuse per year for

the 1980-1986 period, was not sufficient to sustain the scheduling

action and continued to monitor the situation.

Since 1992, 775 reports of ketamine diversion or abuse have been

received by the DEA. The incidence of law enforcement encounters of

individuals selling the drug, under its influence, or who had it in

their possession, along with the wide geographic distribution of the

encounters, the involvement of teenagers and young adults, the

occurrence of veterinary clinic

[[Page 17300]]

burglaries directed at ketamine, the spreading notoriety of ketamine as

a party drug, ``Special K'' or ``K'', and the number of ketamine abuse

related hospital emergency department visits have caused the DEA to

reconsider the noncontrolled status of the drug.

In 1998, the DEA submitted the DHHS information relevant to each of

the eight factors which are determinative of control under the CSA. By

letter of December 17, 1998, the Assistant Secretary for Health and

Surgeon General responded recommending that ketamine be added to

Schedule III. Enclosed with the letter was a document which summarized

the findings related to the factors which the CSA requires the

Secretary to consider [21 U.S.C. 811(c)].

The factors considered by the Assistant Secretary for Health and

Surgeon General and the DEA with respect to ketamine were:

(1) Its actual or relative potential for abuse;

(2) Scientific evidence of its pharmacologocial effect;

(3) The state of current scientific knowledge regarding the drug or

other substance;

(4) Its history and current pattern of abuse;

(5) The scope, duration, and significance of abuse;

(6) What, if any, risk there is to the public health;

(7) Its psychic or physiological dependence liability; and

(8) Whether the substance is an immediate precursor of a substance

already controlled under the CSA.

Ketamine is used in human and veterinary medicine to produce a

unique anesthetic state characterized by sedation, immobility, marked

analgesia, and amnesia. Since 1992, the DEA has documented more than

568 incidents of the sale and/or use of the drug in schools by minors,

on college campuses, at night clubs and rave dances, incidents of

public intoxication and improper operation of a motor vehicle while

under the influence of ketamine, burglaries of veterinary clinics in

which ketamine was the sole item targeted, and the sale of ketamine as

a drug of abuse to undercover police. During the same period of time,

207 ketamine abuse related visits to hospital emergency departments

were recorded by the Drug Abuse Warning Network.

The pharmacological and behavioral effects of ketamine are similar,

but somewhat less intense and shorter in duration, to those of PCP. Low

dose intoxication with ketamine results in impaired attention,

learning, and memory functions. Higher doses may result in ataxia,

dizziness, elevated blood pressure, mental confusion,

hyperexcitability, catalepsy (the inability to move), convulsions, a

delusional dream-like, hallucinations, and psychosis. Long-term use of

ketamine is associated with hallucinatory flashbacks and as inability

to concentrate. Several case reports suggest that psychological

dependence and tolerance develop in humans after long-term use of

ketamine. Behavioral and physical dependence have been demonstrated in

animals.

Diversion of ketamine pharmaceutical products from practitioners

has been the most frequently documented source of the drug, with the

primary sources being veterinary clinics. The liquid pharmaceutical

product is injected or, more commonly, evaporated and the resultant

powder inhaled (snorted). Clandestine manufacture of ketamine has not

been encountered. In contrast to that of PCP, the synthesis of ketamine

is difficult.

Ketamine is presently regulated as a controlled substance in 18

states; 15 states have placed it into Schedule III, two states have

placed it into Schedule IV, and Massachusetts has designated it as a

Class A substance. By letter of July 10, 1996, the President of Fort

Dodge Animal Health asked the DEA to place ketamine into Schedule III

of the CSA. That position reflected the belief ``that moving the

product to a Schedule III classification is in the best interest of the

veterinary industry and the public.'' In letters to the DEA earlier

that same year, the New Jersey Veterinary Medical Association and 43

veterinarians licensed by that State urged the DEA to place ketamine

into Schedule III, as a means to limit the abuse of the drug while

ensuring its continued availability for appropriate veterinary use.

Relying on the scientific and medical evaluation and the

recommendation of the Assistant Secretary for Health in accordance with

section 201(b) of the CSA [21 U.S.C. 811(b)], and the independent

review of the DEA, the Deputy Administrator of the DEA, pursuant to

sections 201(a) and 201(b) of the CSA [21 U.S.C. 811(a) and 811(b)],

finds that:

(1) Based on information now available, ketamine has a potential

for abuse less than the drugs or other substances in Schedules I and

II.

(2) Ketamine hydrochloride has a currently accepted medical use in

treatment in the United States; and

(3) Abuse of ketamine may lead to moderate or low physical

dependence or high psychological dependence.

Based on these findings, the Deputy Administrators of the DEA

concludes that ketamine, its isomers, salts, and salts of isomers,

should be placed into Schedule III of the CSA.

Interested persons are invited to submit their comments,

objections, or requests for a hearing, in writing, with regard to this

proposal. Requests for a hearing should state, with particularity, the

issues concerning which the person desires to be heard. All

correspondence regarding this matter should be submitted to the Deputy

Administrator, Drug Enforcement Administration, Washington, D.C. 20537.

Attention: DEA Federal Register Representative/CCR. In the event that

comments, objections, or requests for a hearing raise one or more

issues which the Deputy Administrator finds warrant a hearing, the

Deputy Administration shall order a public hearing by notice in the

Federal Register, summarizing the issues to be heard and setting the

time for the hearing.

In accordance with the provisions of the CSA [21 U.S.C. 811(a)],

this action is a formal rulemaking ``on the record after opportunity

for a hearing.'' Such proceedings are conducted pursuant to the

provisions of 5 U.S.C. 556 and 557 and, as such, are exempt from review

by the Office of Management and Budget pursuant to Executive Order

(E.O.) 12866, section 3(d)(1). The Deputy Administrator, in accordance

with the Regulatory Flexibility Act [5 U.S.C. 605(b)], has reviewed

this proposed rule and by approving it, certifies that it will not have

a significant economic impact on a substantial number of small

entities. Ketamine products are prescription drugs used as anesthetics

in hospitals and clinics. Handlers of ketamine are likely to handle

other controlled substances which are already subject to the regulatory

requirements of the CSA.

This rule will not result in the expenditure by State, local and

tribal governments, in the aggregate, or by the private sector, of

$100,000,000 or more in any one year, and it will not significantly or

uniquely affect small governments. Therefore, no actions were deemed

necessary under provisions of the Unfunded Mandates Reform Act of 1995.

This rule is not a major rule, as defined by section 804 of the

Small Business Regulatory Enforcement Fairness Act of 1996. This rule

will not result in an annual effect on the economy of $100,000,000 or

more; a major increase in costs or prices; or significant adverse

effects on competition, employment, investment, productivity,

innovation, or on the ability of United States based companies to

compete with foreign based

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companies in domestic and export markets.

This rule will not have substantial direct effects on the United

States, on the relationship between the national government and the

United States, or on the distribution of power and responsibilities

among the various levels of government. Therefore, in accordance with

E.O. 12612, it is determined that this rule, if finalized, will not

have sufficient federalism implications to warrant the preparation of a

Federalism Assessment.

List of Subjects in 21 CFR Part 1308

Administrative practice and procedure, Drug traffic control,

Narcotics, Prescription drugs.

Under the authority vested in the Attorney General by section

201(a) of the CSA [21 U.S.C. 811(a)], and delegated to the

Administrator of the DEA by the Department of Justice regulations (28

CFR 0.100) and redelegated to the Deputy Administrator pursuant to 28

CFR 0.104, the Deputy Administrator hereby proposes that 21 CFR part

1308 be amended as follows:

PART 1308--[AMENDED]

1. The authority citation for 21 CFR 1308 continues to read as

follows:

Authority: 21 U.S.C. 811, 812, 871(b), unless otherwise noted.

2. Section 1308.13 is proposed to be amended by redesignating the

existing paragraphs (c)(5) through (c)(11) as (c)(6) through (c)(12).

3. Section 1308.13 is proposed to be amended by adding a new

paragraph (c)(5) to read as follows:

Sec. 1308.13 Schedule III.

* * * * *

(c) Depressants.

* * * * *

(5) Ketamine, its salts, isomers, and salts of isomers . . 7285

[Some other names for ketamine: ()-2-(2-chlorophenyl)-2-

(methylamino)-cyclohexanone.

* * * * *

Dated: April 2, 1999.

Donnie R. Marshall,

Deputy Administrator.

[FR Doc. 99-8815 Filed 4-8-99; 8:45 am]

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