Recreational ketamine use among U.S. adults surged by 40% between 2021 and 2022, according to a new study, prompting medical authorities to issue urgent guidance on the drug's proper use amid growing safety concerns.
The increase follows an already substantial 82% rise in ketamine use from 2015 to 2019, researchers report. This latest surge is particularly pronounced among young adults aged 26 to 34, who were 66% more likely to use ketamine compared to 18- to 25-year-olds. College-educated individuals were more than twice as likely to have used the drug compared to those with a high school education or less.
"These findings are consistent with other research indicating increased use among nightclub attendees in New York City along with increasing law enforcement seizures of illicit ketamine in the U.S.," noted Dr. Kevin Yang, a third-year resident physician in psychiatry at the University of California-San Diego School of Medicine, who led the research team.
Shifting Patterns of Use
The study, published in the Journal of Affective Disorders, revealed a notable shift in ketamine use patterns. While the 2015-2019 surge was largely associated with people suffering from depression—possibly self-medicating their condition—the more recent increase occurred primarily among individuals without depression.
"These findings suggest a potential shift in the relationship between ketamine use and depression, such that recreational use became less associated with depression over time," the researchers wrote.
The analysis also found ketamine use was "highly associated with the use of other 'club drugs,' such as ecstasy/MDMA, GHB, and cocaine," suggesting that ketamine consumption often occurs alongside other substances in recreational settings.
Medical Concerns and Safety Guidelines
In response to growing concerns, the American Society of Anesthesiologists (ASA) has issued new guidelines on ketamine's proper use. The guidance comes in the wake of high-profile incidents, including the 2023 death of "Friends" star Matthew Perry from a ketamine overdose.
"Ketamine was originally introduced and has its greatest use as an anesthetic," explained ASA president Dr. Donald Arnold. "People who have struggled with mental health issues and are understandably excited about a new treatment may not realize that they are risking their lives by receiving treatment without medical supervision in unaccredited clinics or offices without established safety standards."
The ASA emphasized that ketamine can cause potentially life-threatening effects if used improperly, including high blood pressure, slowed breathing, respiratory failure, cardiac issues, and seizures.
Therapeutic Use vs. Recreational Misuse
While ketamine has gained attention for its potential to rapidly alleviate depression symptoms, the U.S. Food and Drug Administration (FDA) has never approved it for any use other than anesthesia. In 2019, the FDA did approve a nasal spray ketamine derivative called esketamine (Spravato) specifically for treating depression in adults.
The drug—also known on the street as "Special K" or "Super K"—is primarily used as an anesthetic for humans and animals. At higher doses, it can cause significant perceptual changes, with users reporting feelings of detachment from their bodies or environment. The National Institute on Drug Abuse (NIDA) notes that "at higher doses, a person may experience extreme detachment from their body and reality, which is called being in a k-hole."
New Safety Recommendations
The ASA guidelines state that ketamine should only be administered in monitored settings under the care of licensed health professionals with appropriate rescue equipment immediately available. Other key recommendations include:
- Ketamine should be prescribed only for medical indications as part of a comprehensive treatment plan
- Treatment should be overseen by appropriately trained and licensed medical professionals
- Patients should receive periodic face-to-face monitoring
- Therapy should have a clear endpoint and defined course
- Doses should be kept to the minimum necessary for clinical effect
- Patients must be educated about potential hazards
"Anesthesiologists are working with psychiatrists via joint research, training programs, and other initiatives to advance mental health treatment using these drugs," Arnold noted. "People who believe ketamine might be helpful in addressing their mental health issues should talk with their primary care physician or mental health professional."
Public Health Response
The shifting demographics and patterns of ketamine use provide important insights for public health officials developing targeted responses.
"Prevention outreach should be expanded to settings like colleges where younger adults may be at heightened risk, providing education on the harms of polydrug use, particularly in combination with opioids," the researchers concluded.
Health authorities are particularly concerned about the rapid growth of unlicensed in-person clinics or online services that supply ketamine by mail, where patients might receive instructions on self-administration but little to no ongoing monitoring or guidance.
As ketamine use continues to rise, medical experts emphasize that the potential therapeutic benefits of the drug must be balanced against its significant risks, with proper medical supervision remaining essential for patient safety.
