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Medical use of ketamine is surging. So are illicit forms of the drug.

U.S. seizures of illegal ketamine have dramatically risen, new research shows, as the drug has become a popular mental health treatment

Ketamine seizures by federal, state and local law enforcement are on the rise in the United States. (Getty Images/iStockphoto)
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U.S. authorities have seized increasing quantities of illegal ketamine, according to new research, a trend that coincides with the psychedelic drug’s rising popularity as a treatment for mental health ailments.

The number of ketamine seizures by federal, state and local law enforcement in the United States increased from 55 in 2017 to 247 in 2022, while the total weight increased by more than 1,000 percent over that time, according to a letter published Wednesday in JAMA Psychiatry. Most of the ketamine was in powder form, which could raise the risk of being adulterated with deadly drugs such as fentanyl.

Joseph Palamar, an associate professor at NYU Langone and the letter’s lead author, sees the trend of seizures as evidence of greater recreational demand for ketamine. He said ketamine enjoys a much larger public profile now than when it was mostly limited to electronic dance music clubs in the 1990s.

Now ketamine shows up in popular television shows such as HBO’s “The White Lotus” and is openly mentioned by celebrities as a breakthrough mental health medication. Clinics have sprung up across the country offering infusions of ketamine, while some doctors and telehealth start-ups have prescribed it in lozenge form for use at home. Other studies have indicated that recreational use and poisonings have increased.

“I don’t think it’s coincidental that all those things are increasing at the same time,” Palamar said. “When things start becoming popular, the thought of ketamine is introduced to people who never would have used the drug.”

This doctor prescribes ketamine to thousands online. It’s all legal.

Ketamine has long been used as an anesthetic in hospitals and abused recreationally for its mind-altering properties. But it has emerged in recent years as a powerful, quick-acting antidote to depression, anxiety and post-traumatic stress. A variant of ketamine called Spravato was approved by the Food and Drug Administration in 2019 to treat severe depression, but that came with a strict risk protocol to ensure patient safety.

Many patients have been put off by hurdles to accessing Spravato, and physicians who see generic ketamine as safe and effective routinely prescribe it off-label. Some see Spravato as an example of a pharmaceutical company seeking financial gains by patenting a derivative of a compound known to be safe, and some who favor off-label ketamine are distrustful of Big Pharma.

One author of the letter in JAMA Psychiatry disclosed receiving consulting fees from Janssen, the company that developed Spravato.

Palamar, who reported no fees from the pharmaceutical industry, said he doesn’t want to be overly alarmist but worries about the purity of ketamine that people are getting illicitly. In the club scene in the early 1990s, he said, all ketamine came in vials stolen from veterinary offices. Now that it is coming in powder form, “it means you never truly known what’s in it,” he said. “My biggest concern is someone is going to think it’s a smart idea to mix fentanyl in it.”

The research in the JAMA letter draws only tentative conclusions, nodding to limitations on drug testing and purity and possible shifts in policing and trafficking methods that could affect the data. “Prevention and harm reduction efforts are needed to protect the public as nonmedical use many continue to increase in tandem with media coverage and therapeutic use,” the letter concludes.