Ketamine should remain a class B substance, the ACMD has advised the government. However, police and health professionals need better support to ‘identify, prevent and respond’ to ketamine-related harms, it stresses.
The government asked the ACMD to review the prevalence and harms of ketamine misuse and for its advice on reclassifying the drug to class A last year – the Home Office has a statutory duty to consult the ACMD under the Misuse of Drugs Act before it can make any changes to legislation. ‘After examining the latest evidence, engaging with people with lived or living experience with the substance, consulting stakeholders, and reviewing academic research, the ACMD concluded ketamine should not be reclassified and should remain in class B,’ the council stated.
Ketamine’s acute harms align with its status as class B, the ACMD said, although it expressed concern about the growing use of high-dose ketamine. People with experience of ketamine use and harms who contributed to the review said that upgrading the drug to class A would be unlikely to lower rates of use, while health and social care professionals were also largely opposed to reclassification. The report highlighted that many acute harms experienced by ketamine users ‘are likely to be significantly influenced by using other drugs at the same time, and that reclassifying ketamine in isolation would unlikely reduce prevalence or misuse’.
Ketamine was controlled as a class C substance in 2006, then reclassified as class B in 2014 after advice from ACMD related to the increasing evidence of bladder damage caused by frequent use.
A report last year from King’s College London, the University of Hertfordshire and Manchester Metropolitan University found that deaths involving ketamine had increased twenty-fold in a decade. However, the fact that the deaths were ‘increasingly occurring in complex polydrug settings’ raised doubts over the extent to which single-substance drug policies could reduce harms, it said.
Among the ACMD’s recommendations are for a national patient safety alert on ketamine to be cascaded to all NHS health organisations, and that drug services, education and social care providers, mental health services, primary care and hospitals should ‘work collaboratively to deliver holistic support’ – including drug treatment alongside specialist urology, pain management, hepatology and gastroenterology services. ‘The ACMD report highlights the need for a “whole system approach” through its recommendations to tackle issues related to ketamine use, as no single recommendation is sufficient to do this alone,’ said ACMD chair Professor David Wood.
‘As a charity that provides treatment for people struggling with drugs, including ketamine, we think the decision not to reclassify ketamine as class A is the right one,’ said WithYou’s director of pharmacy Abigail Wilson. ‘We already know reclassification won’t reduce the growing harms we’re seeing. Since the previous reclassification of ketamine from class C to class B in 2014, ketamine use has doubled. We absolutely recognise the serious health risks at play. The rise in bladder damage from ketamine use, and other long-term complications are alarming and we’ve responded by working with partners to improve treatment pathways and focusing on increasing awareness and education. Rather than the threat of punishment which deters people from seeking help, we must prioritise prevention, early intervention, and easy to access support for those experiencing ketamine-related harm.’
‘Ketamine use and harm is rising sharply, particularly among young people, and it is essential that more is done to support the individuals, families and communities affected,’ added Turning Point’s national head of service for substance use Nat Travis. ‘We support the ACMD’s recommendation that ketamine remains classified as a class B substance. Increasing criminal penalties for ketamine use risks deterring people from seeking help and may make them more vulnerable to drug-related harm. We need better education on the risks associated with drug use, dedicated information and support services for people using ketamine, with more coordination across treatment services, GPs, pharmacists and hospitals ensuring truly accessible support for those who need it. These are the measures that will meaningfully reduce ketamine-related harm.’
Ketamine: an updated review of use and harms available here