The Geopolitics of Ketamine (Part 2)
Ketamine cash fuels Myanmar's deadly military junta
Clockwise from top left: the flag of the World Health Organization; a bag of presumed ketamine; the military junta in Myanmar stands down its own citizens; Aung San Suu Kyi and Min Aung Hlain. See photo credits below.
The following is an excerpt from p. 206-212 of Chapter 4, “Mystical Medicine, Wicked Weapon: A Both/And Approach to Ketamine” from my new book, Drugism (2022):
[This week’s excerpt is continued from last week’s—read Part 1 here.]
Unbeknownst to many here in the US, China is and always has been a primary factor in our drug policy and consumption. Ketamine is no exception.
Indeed, China has played a central role in ketamine’s growing popularity despite the efforts of their own government to stop it. In fact, as we will see, the Chinese government’s efforts to suppress ketamine have instead directly contributed to its popularization (as is typically the case when any government tries to suppress drug use).
Another nation whose laws have directly affected the global ketamine market is India. China and India, who at one point produced nearly all of the ketamine on the world market, both cracked down on the drug in the early 2010s, causing production to shift to their regional neighbors, such as Myanmar, Pakistan, and Vietnam.
After China tried to ban ketamine globally multiple times, the US responded by fast-tracking the drug’s approval as an antidepressant by the FDA and taking a hands-off approach to the proliferation of ketamine clinics which offer the drug for multitude off-label uses. Now, ketamine is pouring out of Myanmar and Pakistan, two nations that have been subjected to decades of manipulation by US military and intelligence forces.
China has always been a primary factor in our drug policy and consumption. Ketamine is no exception.
We learned in Part 1 that ketamine became a controlled substance in the US in 1999. A few years later, in 2006, Chinese officials called for global restrictions on ketamine sales. Most of the illicit ketamine in the world came from within their borders and the Chinese government felt compelled to change that. However, what for China was an international embarrassment was for other nations a crucially important and affordable anesthetic. Their 2006 proposal was rejected by the World Health Organization (WHO). But it was just the beginning of an extended effort by China to rid the world of ketamine.
Six years later, in 2012, China again proposed that ketamine be restricted at the global level. And again, the WHO disagreed. Perhaps at this point China realized that if they wanted ketamine controlled, they would have to be the ones to do it, since huge volumes of the drug came from China. It was at this point that they started to raid, arrest, and execute suspects of ketamine production and trafficking.
In mid-2013, a man in Haikou, China was found distributing nearly eight kilograms of ketamine. He was executed shortly thereafter. As the execution took place, Chinese authorities were in the final stages of planning a raid in Boshe, a village on the eastern coast of China facing the South China Sea.
The raid was the result of a six-year operation which targeted drug production in Boshe. The village had been a source of illicit ketamine a methamphetamine for years. The drugs were produced by a cartel in Boshe. The alleged mastermind of the Boshe cartel was Cai Dongjia. Cai was also a member of the CCP who sat on the Municipal People’s Congress for his surrounding area.[i]
December, 2013 was a fateful month for ketamine.
One estimate suggested that 20% of the families in Boshe were involved in drug production. Another estimate put the figure at one third.[ii] Occasionally, the village’s residents took up arms, including AK-47s and grenades, against police. For years, Boshe had a reputation as an impermeable haven of drug production and was known as “the Fortress.” Pollution from the village’s drug production ruined their land and sickened their cattle.[iii]
The raid of Boshe took place in December, 2013. Police uncovered nearly half a ton of ketamine and almost 3 tons of methamphetamine. Police also located Cai Dongjia. He was just one of nearly two hundred people captured in the raid.
That same month, December 2013, the Directorate of Revenue Intelligence in India seized 1.2 tons of ketamine in an elaborate operation that uncovered an extensive network of ketamine production.[iv] At the center of the network was a man named Vikas Puri.
Puri was a pharmaceutical professional who had been educated at one of the top chemistry schools in India, the Institute of Chemical Tehnology.[v] Puri, upon receiving orders for ketamine, worked with various other chemical businesses to make it. Precursors were obtained from Freshia Chemicals. Rukhma Industries, another chemical manufacturer, produced the final product. The ketamine was then stored on the property of Biosynthetics, another chemical producer in India, and possibly elsewhere. It was then exported to US, UK, and Australia.
The same month that Puri’s properties were raided, Indian authorities added ketamine to Schedule X of their Drug and Cosmetics Act, which regulates the sale of drugs.[vi] Special licenses are required to sell Schedule X drugs. As a result, when ketamine was added to Schedule X this greatly affected the ketamine market, restricting its flow both within and beyond India.
In addition to India, the UK also changed ketamine’s legal status in December 2013, changing it from a Class C to a Class B drug.[vii] This placed more restrictions on its use and meant harsher penalties for those caught possessing it illegally.
US legislators and bureaucrats took a decidedly pro-ketamine stance.
Between the raids in China and India, and the policy changes in India and the UK, December 2013 proved to be a fateful month for ketamine. Shortly thereafter, in February 2014, UK police found 225 kilos of the drug in a Volkswagen van, a massive seizure considering the volumes typically found in the UK.
Starting in this time period, early 2014, drug users around the world saw a serious drop in ketamine availability which lasted through the following year.[viii] This drought drove prices up and purity down. This was bad for users, but for distributors, it ultimately resulted in benefit: when ketamine became plentiful again, purity standards had gone down and prices had gone up, which meant dealers could cut their product, charge more, and get more money per dose. And ketamine did, indeed, become plentiful again.
In 2014, China once again proposed that the UN place restrictions on ketamine. The proposal was not accepted. China refused to recognize defeat however and, in 2015 again, for a fourth time, asked the UN to restrict ketamine. Numerous other nations pointed out that they had already devised restrictive legislation for ketamine to curb its diversion to illegal markets.[ix] China, it seemed, was the only nation without functional controls on the drug. Their proposal was rejected for a fourth time.[x]
After China’s fourth and (so far) final attempt, two patterns emerged in the global ketamine market. One was the political and commercial embrace of ketamine in western nations such as the US and Canada. The other was the spread of ketamine production into Southeast Asia.
Here in the US, legislators and bureaucrats took a decidedly pro-ketamine stance. The following year, in 2016, the FDA granted breakthrough therapy status to a form of ketamine then being developed by Johnson & Johnson.[xi] This status allowed Johnson & Johnson to rush through trials (which themselves generated questionable results) to get the drug to market in 2019.[xii] The following year, it was approved for sale in Canada by their health department. The drug, which is produced by the Johnson & Johnson subsidiary Janssen Pharmaceuticals under the name Spravato, consists of (S)-ketamine in a nasal spray.[1]
In 2016, the same year the FDA granted ketamine breakthrough therapy status, ketamine seizures skyrocketed in Myanmar.
Authorities in the US have also chosen not to interfere with the proliferation of ketamine clinics across the nation. In these clinics, ketamine is administered for a variety of off-label uses, typically for exorbitant fees. The result, economically speaking, is that pharmaceutical companies and healthcare professionals are able to squeeze extra cash from the drug. For these clinics’ patients, the results vary, and are discussed more in the next section.
It is difficult to imagine such clinics being met with anything other than DEA raids just a few years ago, before ketamine’s status was threatened by China. Law enforcement has, rather than eradicate ketamine, adopted it as part of their repertoire of weaponry to deploy on civilians. In this same period the drug became increasingly used by teams of paramedics and police in arrest scenarios—another issue which we will cover shortly.
The US response to China’s political attack on ketamine demonstrates our government’s enthusiasm for new drug markets. China’s government, however, has no use whatsoever for new drug markets. It detests them. As we have seen, China’s government would rid the world of ketamine if they could. However, there is both a supply and a demand for ketamine inside China, however much its government wishes this were not the case.
China’s attempts to thwart the issue at the global level via the UN proved futile four times. So, they resorted to more traditional tactics: raids, arrests, imprisonment, executions. While this has not completely eradicated the illicit ketamine industry from China, it has encouraged multinational drug trafficking organizations to establish ketamine production elsewhere, outside of China or India.
This—the movement of ketamine production beyond China and India—is the second, significant pattern that has emerged in the wake of the China’s international campaign against the drug. The atmosphere created by the raids, executions, and policy changes in both China and India dealt a blow to illicit ketamine production in those countries and drove it into neighboring nations. Unsurprisingly, ketamine’s popularity in Southeast Asia has risen sharply in recent years, largely as a result of this shift in production. In this way, China’s attempts to eradicate ketamine have instead inspired its proliferation, both here in the US and throughout Asia.
Myanmar’s military junta protects and profits from the nation’s illegal drug trade.
In 2016, the same year the FDA granted ketamine breakthrough status, ketamine seizures skyrocketed in Myanmar.[xiii] That country, already steeped in drug trafficking, rapidly became the locus of ketamine production in the eastern hemisphere. The year concluded with a massive bust when the Myanmar navy found nearly a ton of ketamine disguised as tea.[xiv]
Concurrently, ketamine seizures in China dropped drastically.[xv] The growing demand for ketamine was now being met primarily by laboratories in Myanmar rather than China. Just weeks before the WHO rejected China’s final request to schedule ketamine, Myanmar had held its first democratic elections in twenty-five years. Opposition leader Aung San Suu Kyi won in a landslide, but was unable to become president due to a constitutional technicality. Instead, her close aide Win Myint became president and Suu Kyi took the office of state counsellor.[xvi]
Although on the surface, this may seem entirely irrelevant to ketamine, Suu Kyi’s rise to power soon inspired violent political backlash that brought with it a steep surge in Myanmar’s already-booming ketamine output. Her election meant the end of an extended period in which Myanmar’s military ruled the country. The military had for years depended on illegal drugs as a source of revenue.[xvii] Not only Myanmar’s military, but also many members of its government were deeply enmeshed in the drug trade. Suu Kyi’s administration, however, hoped to completely change the country’s approach to drugs, and in so doing effectively threatened not only the military but also the plethora of officials who had been bribed with drug money.
A few months into Suu Kyi’s first term, a consortium of rural opium farmers from various parts of Myanmar issued a statement in which they explained that the country’s army protects and profits from the drug trade. They asked the new government to revise Myanmar’s drug laws, decriminalize personal use, stop bribery, and provide opium farmers with access to basic services such as education, healthcare, and infrastructure.[xviii]
Aung San Suu Kyi’s election inspired violent political backlash that led to a steep surge in Myanmar’s already-booming ketamine output.
The new administration, it seems, was listening. A few months later, Suu Kyi’s administration began to work with the UN to devise a new drug policy for Myanmar. It took more than a year to complete, and was introduced in February of 2018 as the National Drug Control Policy (NDCP). Stunningly, the NDCP repeated, almost verbatim, nearly all of the requests the rural opium farmers had made in 2016. It recommended the decriminalization of drug use, the end of drug bribery and corruption within the government, and the provision of rural opium farmers with basic services such as education, healthcare, and infrastructure. It even recommended that farmers caught growing opium be guaranteed the rights to their land.[xix]
But all of these were merely recommendations. Unfortunately, the NDCP lacked the authority to actually implement any of its own suggestions. Suu Kyi’s administration was consequently unable to fulfill its goals to mitigate illegal drug production and the rampant corruption within Myanmar’s military and government. Its efforts were met not with success but with violent backlash from the military, and a further increase in ketamine production.
In 2020, Myanmar held another election and Suu Kyi’s administration won the vote again. However, on the day Myanmar’s parliament was to officially approve the second term, the country’s military arrested Suu Kyi and seized power. It was the start of a bloody coup in which the military mercilessly slaughtered more than 1,500 people and arrested well over 11,000 more.[xx]
Unsurprisingly, with the country back under the control of the military, drug trafficking has boomed even beyond its pre-coup level, itself already exorbitant.[xxi] Ketamine is just one of several drugs produced in Myanmar. It is joined by heroin (which, along with opium, are longtime staples of the country’s economy), methamphetamine, and, in recent years, fentanyl. The money made from these drugs helps prop up Myanmar’s military junta, just as it has for decades.
Ketamine made in Myanmar and sold in the US provides revenue for the military junta and its bloody occupation.
At least some of the ketamine produced in Myanmar makes its way into the US. Authorities have intercepted multi-kilogram shipments of the drug en route from Myanmar to California and New York.[xxii] Given the relationship between Myanmar’s drug trafficking organizations and its military junta, we can be certain that most or all of the ketamine that makes its way from Myanmar to the US provides revenue for the junta and its bloody occupation. This should give pause to those who use ketamine and are concerned for human rights.
In addition to Myanmar, another conflict-ridden country which has seen a massive spike in ketamine production in recent years is Pakistan. Similarly, the ketamine made in Pakistan is consumed throughout the world. In 2019, at least two large shipments of ketamine from Pakistan were intercepted in Malaysia, consisting of several hundred kilos of the drug each.[xxiii] In early 2020, nearly 600 kilos of ketamine thought to have originated somewhere along “the Iran-Pakistan coast” were seized by the Sri Lanka Navy; the load had been smuggled by several people from Pakistan.[xxiv] Later that year, authorities in Hong Kong intercepted a shipment of almost 200 kilos from Pakistan disguised as salt[xxv]. In the same period, several hundred kilograms of ketamine were seized domestically in Pakistan as well.[xxvi]
Although the bulk of the ketamine production in Asia has shifted from China and India to Myanmar and Pakistan, it has not disappeared altogether in the former two. In 2018, Chinese authorities seized 5.7 tons of ketamine being shipped to Thailand disguised as tea.[xxvii] In 2019, Indian authorities busted an illegal ketamine lab suspected of exporting the drug to Malaysia.[xxviii] In 2020, a Canadian citizen was sentenced to death in China as punishment for ketamine production.[xxix]
We can see quite plainly that the ketamine market is deeply impacted by geopolitical forces. In this section we learned about China’s attempts to have ketamine restricted at the international level. As it became clear that this tactic would not work, both China and India—then the leading global producers of the drug—cracked down on ketamine and increased the punishments for its illicit production and distribution.
In the wake of all this, two patterns emerged. The first was an almost knee-jerk reaction from the US government and private sector to embrace ketamine. The second, a massive shift in illicit ketamine production out of China and India and into neighboring nations such as Myanmar and Pakistan. As you read this, ketamine manufactured illegally in the Golden Triangle makes its way across the globe and in the process creates revenue for the murderous military junta which now controls Myanmar.
But that is not the only issue with ketamine. There are just a few more.
As you read this, ketamine made illegally in the Golden Triangle makes its way across the globe, funding Myanmar’s military junta.
Footnote
[1] Ironically, Spravato, which is marketed for treatment resistant depression, consists of (S)-ketamine rather than (R)-ketamine, the latter of which is thought to be a better antidepressant and also the gentler of the two.
Endnotes
[i] King.
[ii] 20% figure from Hatton, “The Ketamine Connection”; one-third figure from King.
[iii] Hatton.
[iv] “Chargesheet filed in...”
[v] “ICT gold medalist...”
[vi] Liao, Tang, and Hao, “Ketamine and international…,” 4.
[vii] Perraudin, “Fears grow that…”
[viii] Daly, “How Ketamine Made…”
[ix] United Nations Economic and Social Council, “Changes in the…”
[x] “UN rejects bid...”
[xi] “Esketamine Receives Breakthrough...”
[xii] On rushed trials, see Beres, “New analysis claims…”; on approval in Canada, see Delisle, “A New Antidepressant…”
[xiii] United Nations Office on Drugs and Crime, Annual Drug Seizures.
[xiv] Goldberg, “Record-breaking Ketamine…”
[xv] United Nations Office on Drugs and Crime, Synthetic Drugs in..., 27.
[xvi] “Aung San Suu Kyi.”
[xvii] See McCoy, throughout, and Scott, Drugs, Oil, and…, throughout, for more on the extensive history of the Burma/Myanmar military’s involvement with drug trafficking.
[xviii] “Statement of the...”, 1 and 2.
[xix] The Republic of the Union of Myanmar, “National Drug Control…,” 15, 16, and 18.
[xx] “Myanmar coup: Aung...”; “Myanmar death toll…”
[xxi] Reed, “How Myanmar coup…”
[xxii] United Nations Office on Drugs and Crime, Transnational Organized Crime…, 29.
[xxiii] United Nations Office on Drugs and Crime, Synthetic Drugs in…, 28; “Drugs worth $161 million...”
[xxiv] “Nine Pakistanis arrested…”
[xxv] “Ketamine smuggled from...”
[xxvi] Figure 13 from United Nations Office on Drugs and Crime, World Drug Report, 35.
[xxvii] “Thailand Described as...”
[xxviii] United Nations Office on Drugs and Crime, Synthetic Drugs in…, 28.
[xxix] “China sentences Canadian...”
Sources
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United Nations Office on Drugs and Crime. World Drug Report: Booklet 5: COVID-19 and Drugs: Impact and Outlook. Jun 2021. https://www.unodc.org/res/wdr2021/field/WDR21_Booklet_5.pdf
Photo credits
WHO flag from Security Today: https://securitytoday.com/articles/2020/03/26/world-health-organization-facing-cyber-attacks-during-coronavirus-response.aspx
Drug bag from The Recovery Village: https://www.floridarehab.com/drugs/ketamine/addiction/
Myanmar’s military junta in the streets from The Conversation: https://theconversation.com/myanmar-coup-one-year-on-military-junta-threatens-first-executions-in-decades-176043
Aung San Suu Kyi and Min Aung Hlain from Hindustan Times: https://www.hindustantimes.com/world-news/situation-critical-in-myanmar-with-mounting-resistance-to-military-junta-101655516365145.html
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