Deaths involving ketamine have increased twenty-fold since 2014, according to research by King’s College London, the University of Hertfordshire and Manchester Metropolitan University. However, the fact that the deaths are ‘increasingly occurring in complex polydrug settings’ raises doubts over the extent to which single-substance drug policies can reduce harms, the researchers state.
The study – which is based on analysis of coroner’s reports in England, Wales and Northern Ireland and represents the most detailed assessment of ketamine-related deaths to date – found just under 700 fatalities with detections of illicit ketamine between 1999 and 2024, with annual deaths increasing from 15 in 2014 to almost 200 projected deaths last year.
However, while the number of deaths involving post-mortem detections of ketamine have been increasing over the last decade, the proportion where the drug was the ‘sole or primary cause’ has fallen, reflecting ‘a shift towards increasingly risky patterns of polydrug use’. Just under 300,000 adults in England and Wales reported using ketamine in 2022-23.
While the widely reported ketamine-related harms among young people – such as irreversible bladder damage – continue to be a concern, the analysis also detected a shift towards use by an older demographic, the researchers say. Deaths involving ketamine are increasingly occurring among ‘older and socioeconomically disadvantaged dependent drug users’ rather than being confined to a younger recreational population, with the drug’s low cost potentially driving rising rates of consumption. The demographic profile of deaths ‘shifted towards greater deprivation from 2020 to 2024’ the report says, with the deaths classed as accidental in almost 90 per cent of cases.
Mixing a dissociative drug like ketamine with depressants such as opioids and benzodiazepines can make it harder to judge the effect the drugs are having, the researchers warn, which can result in people taking more than intended. A more comprehensive response to ketamine-related harms is needed, the report states, including an expansion of drug checking services, better education on the risks of polydrug use, and improved integration of ketamine users into treatment pathways. A study by the University of Exeter and UCL published earlier this year found that almost half of people affected by ketamine use disorder were not seeking any support or treatment.
Ketamine was controlled as a class C drug almost 20 years ago then reclassified to class B in 2014, with the Home Office currently considering whether to reclassify it as a class A substance.
‘We are seeing more ketamine-related deaths, but these deaths rarely involve ketamine alone,’ said lead author of the King’s College study and director of the National Programme on Substance Use Mortality, Dr Caroline Copeland. ‘They are increasingly part of complex polydrug use patterns, often among people facing social disadvantage and entrenched drug dependence. This means single-drug policies, such as reclassification, are unlikely to tackle the real drivers of harm. Illicit ketamine use has moved beyond the recreational setting. To reduce deaths, we need harm reduction, treatment, and social support strategies that reflect the realities of polydrug use – not just legislative changes focused on one substance.’
Deaths following illicit ketamine use in England, Wales and Northern Ireland 1999–2024: An update report to inform the reclassification debate, published in Journal of Psychopharmacology available here