Trends in poisonings involving ketamine in the United States, 2019-2023.
Joseph J Palamar, Jennifer S. Jewell, Omar El-Shahawy, Joshua C. Black
Drug and Alcohol Dependence March 1, 2025 DOI: 10.1016/j.drugalcdep.2025.112549 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 1,519 |
| Population | Ketamine-related poisonings reported to US Poison Centers |
| Duration | 2019-2023 |
| Topics | Ketamine Esketamine |
| Keywords | Poisonings Polydrug use Drug-safety Substance-abuse Ketamine-poisoning Mental-health-risks Medical-toxicology |
| Citations | 9 |
| Key findings | Reported ketamine poisonings in the US increased from 205 in 2019 to 414 in 2023, with a doubling of suspected suicide attempts and a decrease in cases involving major effects or death. |
Abstract
Off-label prescribing of ketamine to treat psychiatric disorders has been increasing, as has recreational use and availability of illicit ketamine. It is important to examine trends in ketamine-related poisonings to inform public health efforts. We examined data from poisonings (exposures) involving ketamine reported to Poison Centers in the US between 2019 and 2023 (n = 1519). Annual trends were examined for number of exposures and characteristics of exposures, and we delineated correlates of major (life-threatening) adverse effects and death compared to less severe outcomes. The number of reported ketamine exposures increased from 205 in 2019 to 414 in 2023. Most cases involved ketamine ingestion (57.2 %), and a plurality involved misuse or "abuse" (36.2 %) and moderate effects (44.8 %). The percentage of cases involving suspected suicide attempts doubled from 12.7 % in 2019 to 25.9 % (a 103.9 % increase; P < 0.001); ingestion use increased from 46.0 % to 65.2 % (a 41.7 % increase; P < 0.001), and cases involving ketamine in liquid form decreased from 65.1 % to 41.2 % (a 36.7 % decrease; P < 0.001). Cases with major effects or death decreased from 23.4 % in 2019 to 15.6 % in 2023 (a 33.2 % decrease; P = 0.039). A major event or death was experienced by 18.6 % of cases, but prevalence was lower for those who inhaled ketamine (aPR=0.49, 95 % CI:0.29-0.85) compared to those who did not inhale. Poisonings involving ketamine are at their highest in reporting history. Both medical and recreational ketamine use and related adverse events need to be monitored, especially as off-label prescribing of take-home oral formulations appears to be increasing.
Comparable studies
Other observational and cohort studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Taming the Ketamine Tiger Volunteers from a prison population | 2010 | Observational study | n = 20 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine | 2013 | Observational cohort | n = 30 |
| Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder | 2014 | Observational cohort | n = 108 |
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
Citations in the library
Cited by 6
- Trends in ketamine use among nightclub attendees in New York City, 2017-2024. International Journal of Drug Policy June 1, 2025
- Real-World Therapeutic Use of Ketamine in Clinical and Non-Clinical Settings: A Cross-Sectional Survey Journal of Psychoactive Drugs September 23, 2026
- Monitoring of Clinics That Use Direct-to-Consumer Advertising for Off-Label Ketamine in the New York Metropolitan Area: A Cross-Sectional Systematic Web Search. Fundamental and Clinical Pharmacology July 1, 2026
- Ketamine Use in Self-Described Therapeutic Contexts: A Thematic Analysis of Reddit Posts Behavioral Sciences March 24, 2026
- Ketamine as a Mental Health Treatment AJN, American Journal of Nursing February 19, 2026
and 1 more in the library
Cites 12
- Ketamine use: a review Addiction July 21, 2011
- A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders JAMA Psychiatry March 1, 2017
- A Review of the Nonmedical Use of Ketamine: Use, Users and Consequences Journal of Psychoactive Drugs December 1, 2000
- Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review BJPsych Open December 23, 2021
- Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial British medical journal February 2, 2022
and 7 more in the library