Illicit ketamine on the rise in the US, research suggests

By Deidre McPhillips, CNN

(CNN) — A growing supply of illicit ketamine is making its way to the United States, new research suggests, fueling concerns about an increase in nonmedical use.

According to the new research published Tuesday in JAMA Psychiatry, law enforcement agencies seized more than 1,500 pounds of ketamine in 2022 – about 12 times more than in 2017.

Medical-grade ketamine is typically in a liquid form and is often administered through an IV. But most of the illegally obtained ketamine was in a powder form, said Joseph Palamar, an associate professor and researcher at the New York University and co-author of the new research.

That puts the illicit supply of ketamine at an increased risk of contamination with other drugs such as fentanyl, the highly potent synthetic opioid that is involved in most overdose deaths, experts say.

“Anywhere along the route, at any point, someone could adulterate the powder – whether it’s the person who was about to sell it in the club or at the party, or the manufacturer,” Palamar said. “We know this has been happening with heroin for years, but when it’s popping up in stimulants, that’s a different story. That could lead easily lead to an overdose.”

Ketamine is considered a dissociative anesthetic, which can create a feeling of calm and have some hallucinogenic effects. It is approved for sedation in medical settings, but has become more commonly prescribed off-label for treatment of chronic pain and depression. In 2019, the US Food and Drug Administration approved a nasal spray that uses a closely related version of the drug for treatment-resistant depression.

As additional medical uses for the drug are explored, some experts have raised concerns about potential abuse or dependence that can come with misuse. It has also long been used as a recreational party drug, and other research has found that this has increased in recent years, too.

In addition to the risk of contamination with other potent drugs, using ketamine without medical supervision could lead to adverse outcomes, experts say.

“Ketamine is possibly the major advance in the area of psychiatry in the past fifty years, but it’s not without risk,” said Dr. Gerard Sanacora, a psychiatry professor at the Yale School of Medicine. “It’s always been a balance. The reality is it is an amazing treatment for many people, but we also know that it is a drug that people misuse and will abuse. And if there isn’t tight control on it, you can guarantee that it will find its way into illicit drug use.”

The rise in off-label use of ketamine – through unregulated clinics and easier telemedicine prescribing practices during the Covid-19 pandemic – and the link to an increased demand for an illicit supply of ketamine isn’t exactly clear just yet, experts say. But it’s an important area to investigate.

“Ketamine is a very important treatment for people suffering with major depressive disorder and treatment-resistant depression, but when the FDA granted this approval, they did it with very strict guidance about how this was to be used,” Sanacora said.

“It’s gaining more attention and people are hearing about it being a positive treatment, but it seems like a lot of this illicit ketamine is not coming through those standard pharmaceutical delivery system routes, and that raises concerns.”

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