The old kid in the block: Unpacking signals of increased availability and use of ketamine

Ketamine (‘K’, ‘ket’, ‘keta’, ‘special K’) is an established medicine, and, since at least the early 90’s, it has also been present in the illicit drug market. Until 2015, the limited data available suggested that the availability and use of ketamine in Europe was somewhat modest when compared with other regions of the world, particularly in Asia. By then, people who used ketamine in Europe appeared to obtain it mainly through the diversion of pharmaceutical products. However, the situation appears to have changed over the last decade. The available supply indicators suggest an increase in the availability of ketamine in Europe, with at least 2.8 tonnes of ketamine powder seized in the EU in 2022, in contrast to just 45 kg in 2012. The drug mainly arrives in Europe in bulk powder shipments, with rare instances of illicit local production so far. The increase in availability is accompanied by increasing signs that non-medical use may be expanding, and that ketamine has become an established drug among some groups. This is of concern, as regular ketamine use has been linked to various acute and chronic harms, including serious urological complications. In some cases, users might be unaware they are using ketamine, as it can be found in mixtures with stimulant drugs and sold as ‘pink cocaine’ or ‘tucibi’.

Given its status as a non-scheduled substance, ketamine may sometimes fall into a monitoring blind spot when compared to illicit drugs, for which seizure and toxicology data tend to be routinely reported and analysed. As the availability of ketamine increases and non-medical use expands, so should monitoring, preparedness, and responses. The oral presentation will focus on the latest European data, focusing mostly on supply indicators (seizures, trafficking, production, and price), placing them in the wider context of the prevalence of use and potential risks to public health.