Characteristics of poisonings involving ketamine in the United States, 2019-2021.
Joseph J Palamar, Nicole D. Fitzgerald, David J Grundy, Joshua C. Black, Jennifer S. Jewell, Linda B. Cottler
Journal of Psychopharmacology August 2023 DOI: 10.1177/02698811221140006 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study of poison control surveillance data Peer reviewed |
|---|---|
| Sample size | 758 |
| Population | People aged 13 and older in the US with reported ketamine exposures to poison control centers, 2019-2021 |
| Duration | 2019-2021 (3-year period) |
| Topics | Ketamine Esketamine |
| Keywords | Poisonings Polydrug use |
| Key findings | Reported ketamine exposures increased 81.1% between early 2019 and late 2021, and 19.6% of cases involved a major adverse effect or death. Co-use of GHB (aPR 3.43) or opioids (aPR 2.44) and injection-only administration (aPR 2.68) were associated with higher risk of serious outcomes, suggesting polydrug use is a particular risk factor. |
Abstract
The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression. We examined recent trends in adverse effects related to ketamine use. US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (n = 758). We examined quarterly trends in exposure and delineated correlates of patients experiencing a major adverse effect or death. The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (p = 0.018). The majority of patients were male (57.1%), and the plurality of cases involved intentional misuse or "abuse" (39.5%), followed by suspected suicide attempt (19.7%) and unintentional exposure (18.9%). A fifth (19.6%) experienced a major adverse effect or death. A third (33.4%) co-used other drugs; the drugs most commonly co-used were benzodiazepines (14.6%), alcohol (10.3%), and opioids (8.7%). Co-use of gamma-hydroxybutyrate (GHB; adjusted prevalence ratio (aPR) = 3.43, 95% confidence interval (CI): 1.57-7.46) and opioids (aPR = 2.44, 95% CI: 1.46-4.08) was associated with increased risk for a major adverse effect or death, as was injection-only administration (aPR = 2.68, 95% CI: 1.21-5.92). Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use-particularly with opioids or GHB-appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed.
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 18
- Redefining Ketamine Pharmacology for Antidepressant Action: Synergistic NMDA and Opioid Receptor Interactions? American Journal of Psychiatry March 1, 2025
- The Rapidly Shifting Ketamine Landscape in the US JAMA Psychiatry January 3, 2024
- Trends in drug use among nightclub and festival attendees in New York City, 2017-2022. International Journal of Drug Policy May 1, 2023
- Real-World Safety of Esketamine Nasal Spray: A Comprehensive Analysis Almost 5 Years After First Approval. American Journal of Psychiatry September 10, 2025
- Trends and characteristics in ketamine use among US adults with and without depression, 2015-2022. Journal of Affective Disorders March 15, 2025
and 13 more in the library
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- Harm related to recreational ketamine use and its relevance for the clinical use of ketamine. A systematic review and comparison study Expert Opinion on Drug Safety June 26, 2021
and 2 more in the library