Non-prescribed ketamine use rises sharply across the UK

The rise in non-prescribed ketamine use across the UK in recent years is a 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 among young people, and the number of people starting treatment for ketamine addiction in 2023-2024 reached 3609, 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 treatment, and help evaluate emerging therapies.

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

But ketamine is also increasingly used recreationally at doses much higher than those prescribed for depression, which can cause serious health problems, such as irreversible damage to the bladder and kidneys and psychiatric conditions, they warn.

And as ketamine use increases, more individuals are seeking treatment for addiction. The number of people starting treatment for ketamine addiction in 2023-24 was 3609, more than eight times higher than the 426 reported in 2014-15.

However, the authors point out that ketamine use disorders remain inadequately defined in psychiatric guidelines, and there is a lack of evidence around potential drugs for treatment and prevention.

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

Balancing ketamine's medical value with rising non-prescribed use presents a complex challenge, write the authors.

"The Home Office is considering reclassifying ketamine as class A, but opinions remain divided. A proportionate response should go beyond legislation to include clear governance of therapeutic use, investment in treatment and prevention, and balanced public messaging."