Unrecorded ketamine use is rising sharply across the UK

Unrecorded ketamine use is rising sharply across the UK

The rise in unprescribed ketamine use in the UK in recent years is cause for concern, say doctors in the BMJ today.

Irene Guerrini at South London & Maudsley NHS Foundation Trust and colleagues warn that its low cost has made it popular with young people, and the number of people starting treatment for ketamine addiction in 2023-2024 reached 3,609, more than eight times higher than in 2014-2015.

They say public awareness of the risks and long-term harms associated with ketamine remains insufficient, and they call for better diagnostic criteria, a national registry and screening tools to support earlier identification, guide and assess the evaluation of emerging therapies.

Ketamine is routinely used as a general anesthetic, and lower doses are prescribed for chronic pain, treatment-resistant depression and suicidal pursuit, they explain. Intranasal esketamine is also licensed for the treatment of depression.

But ketamine is also increasingly being used in doses much higher than those prescribed for depression, which can lead to serious health problems such as:

And as ketamine use increases, more people are seeking addiction treatment. The number of people starting treatment for ketamine addiction in 2023-24 was 3,609, more than eight times higher than the 426 reported in 2014-15.

However, the authors note that ketamine use disorders remain poorly defined in psychiatric guidelines, and there is no evidence of potential medications for treatment and prevention.

People who use ketamine also report that health services often lack an understanding of ketamine addiction and offer minimal treatment options for the drug, meaning treatment is often partially effective.

Balancing the medicinal value of ketamine with increasing non-prescribed use presents a complex challenge, the authors write.

"The Home Office is considering reclassifying ketamine as Class A, but views remain shared. An appropriate response should go beyond legislation to include clear governance of therapeutic use, investment in treatment and prevention and balanced public messaging."

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