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It was once viewed as a fringe club drug whose use as a horse tranquilliser gave it a “dirty” reputation. But with illegal ketamine use reaching record levels, the Home Office announced last week that it was considering reclassifying it as a class A drug in response to a dramatic increase in use among young people.
An estimated 299,000 people aged 16 to 59 reported ketamine use in the year ending March 2023 in England and Wales, the largest number on record, according to Home Office data. Behind the headline figures, there is also evidence of a troubling culture shift, with an increasing number of people taking the drug, which has dissociative, anaesthetic and psychedelic effects, at home rather than in an occasional party setting. This heightens the risk of dependency, experts say, which can lead to devastating health consequences.
“Ketamine has moved beyond a ‘club drug’ to a substance that is used for a wider range of motivations,” said Robert Ralphs, a professor of criminology and social policy at Manchester Metropolitan University.
Ralph’s recent research in Greater Manchester found some young people took the drug, typically bought as a crystalline powder, to “chill out” after a day working or studying. Others reported taking ketamine daily and in high amounts to self-medicate mental health problems.
“It’s literally an escape from reality, which can be attractive to people battling anxiety and trauma,” said Harry Shapiro, the director of the charity DrugWise. “If you’re going to fix things you need to look at mental health services. That’s where you start addressing some of these issues.”
The increase in ketamine use has been matched by a rise in the proportion of adults entering treatment in 2023-24 with ketamine problems, from 1.6% in 2022-23 to 2.3% last year. The total number of adults starting treatment was eight times as many as in 2014, the year in which ketamine was reclassified from a class C to class B drug.
This, some say, undermines the case for changing the drug’s classification to class A, which carries a maximum jail sentence of seven years for possession and life in prison for supply.
“It’s complete nonsense,” said Ravi Das, a professor of psychopharmacology at University College London, who has researched potential medical applications of ketamine. “It was made a class C drug [in 2006] and then upgraded to class B and in both of those instances use has continued to increase. If the purpose is to deter use, it just doesn’t work.”
Ralph agreed. He said “I actually use ketamine in my teaching to my criminology undergraduates as an example of the ineffectiveness of the UK’s drug classification system. It’s the government looking like they’re doing something but without having to address the underlying issues.”
But others say a message needs to be sent out that ketamine is not safe, a narrative that has been fuelled by evidence that, in a clinical setting, ketamine can be effective at treating depression. Elon Musk is among those who have described using low doses of ketamine under medical supervision to manage the “chemical tides” that cause depression.
Dr Emmert Roberts, a senior clinical lecturer at King’s College London and a consultant addiction psychiatrist, welcomed the review but said investment was also needed in research on ketamine addition. “There is very little evidence on what works to treat ketamine use,” he said. He added that, in addition to those using ketamine illegally, he was seeing an increase in patients who were prescribed ketamine but subsequently became addicted.
The number of ketamine deaths in England and Wales remains fairly low compared with other illicit substances, according to the Office for National Statistics, although it is steadily increasing. Between 2018 and 2022, it went from a low of 21 in 2019 to an all-time high of 37 in 2022. The Friends actor Matthew Perry died after being injected with a fatal overdose of ketamine in October 2023.
However, the potential harms go beyond the drug’s acute effects, with doctors reporting alarming increases in young patients presenting with incontinence and other bladder and kidney problems caused by chronic ketamine use. Some users become trapped in a cycle of self-medication, and the worst cases can require major abdominal surgery, bladder removal or kidney transplants.
“The more ketamine they take, the worse their [bladder] pain gets and they take more and more ketamine to manage these symptoms,” said Dr Nicholas Raison, a consultant urological surgeon at King’s College hospital, who has recorded a severalfold increase in the number of patients presenting with ketamine-related complications in the last few years.
“I think it’s incredibly important that a message is sent because the effects are so unknown and are leaving otherwise healthy people with catastrophic side-effects,” he said.
