“Kéta,” “K,” “Special K”: The Rising Misuse of Ketamine – Understanding the Risks and Monitoring Solutions

Ketamine is a general anesthetic drug for human and veterinary use, the first specialty of which was marketed in France in 1970.

More than 50 years later, this product is also more and more present in various facts in France or abroad for its diverted use. For example, it was discussed following the death of Matthew Perry, one of the protagonists of the famous series Friends. The magnitude that the diverted use of ketamine takes as hallucinogenic, far from its essential medical use is without equivalent. How and why did we get to such a situation?

In France, recreational uses explode with techno from the 90s

In the United States and then in Europe, the first cases of deviation of its medical use towards recreational use were described in particular in health professionals (anesthesists) having access to the products. At the end of the 90s, its use in France won the techno festive space, where it is offered under different names (Keta, K, Kate, Special K, the Golden, the veterinarian …) and consumed essentially nasal (60-100 mg) or oral, for its hallucinatory effects.

The diverted use of ketamine will also reach Asia. She will gain a considerable scale, especially in the night clubs of Taiwan and Hong Kong. In 2006 in Hong Kong, ketamine was the second most consumed psychoactive substance after heroin.

A substance under surveillance thanks to addictovigilance

In France, for many years, ketamine has been the subject of national addictovigilance expertise reports, thus making it possible to detect, identify and characterize new uses of use as well as their health consequences.

It must be said that France is the only country in Europe to have implemented a specific watch system since psychoactive substances and their consequences on health since 1990, thanks to the thirteen evaluation and information centers on pharmacodependence-adictovigilance (CEIP-A) which constitute the French addictavigilance network.

This analysis is based on the triangulation of several French data sources, including serious cases with ketamine (which are a legal obligation for health professionals) and data from a pharmacosurveillance system called Oppidum (observation of illicit psychotropic products or diverted from their drug use).

This device makes it possible to know the psychoactive substances consumed by the patients taken care of in France in the structures specialized in addictology, thanks to a collection carried out each year during the month of October. In October 2012, 35 patients (0.7 %) were consumers of ketamine. This figure continues to believe since until waiting for 107 consumers (2 %) during the collection in October 2023.

A constant progression of regular users

The proportion of regular ketamine users is also constantly increasing. This is also the case for those who increase the doses of ketamine and have disorders of use, that is to say an addiction with ketamine.

This problem of use disorders with ketamine is found in declarations of addictovigilance with users who find themselves in difficulty with their consumption. This manifests as increases in doses, craving Who describes the irrepressible need to consume, complications in the health field (urinary complications, complications on the liver, psychiatric complications, etc.), financial consequences … This leads users to consult or to be hospitalized.

Note in this context of use disorders with ketamine, clinical situations which bring in search of pharmaceutical ketamine, by passages via emergency services to obtain ketamine. This testifies to the bridges that can exist between so -called “illicit” ketamine and pharmaceutical ketamine.

As for the profile of users, it is diversifying. Some continue to use ketamine in a festive or recreational context, others for a “self-therapeutic” purpose (reduction in anxiety, well-being, painkiller, improvement in mood, alcoholic withdrawal, etc.) without the effectiveness of ketamine in these indications having been demonstrated and out of any medical support, which exposes them to possibly serious undesirable effects and finally sexual, especially in a context of chemsex.

Ketamine also experienced by a minority of young people

Interestingly, three recent studies carried out in France on the levels of experimentation of psychoactive substances have specifically included ketamine. Their figures testify in particular to the installation of the experiment of ketamine in the general population but also among young people.

We observe in France:

• In 2023, a prevalence of experimentation of ketamine in life of 2.6 % (3.3 % among 18-24 year olds, 4.8 % among 25-34 year olds, 3.2 % among 35-44 year olds; out of a representative sample of 14,984 people aged 18 to 64), according to the French observatory of drugs and addictive trends.
• A prevalence of use of ketamine of 0.9 % (ranging from 0.6 % to 4.7 % depending on the school situation) when questioning young people aged 17 during the defense and citizenship day (on a representative sample of 23,701 girls and boys aged 17.4 years), according to Escapad 2022 data.
• A prevalence of ététamine experimentation of 1.1 % (1.4 % boys, 0.9 % girls) in students from the sixth to the final year, according to data D2022 of the ENCLASS system. And it is not a French specificity. In the United Kingdom, for example, ketamine experimentation increased from 0.5 % in 2010 to 0.8 % in 2020. Among the 16-24 year olds, this use doubled during the same period, from 1.7 % to 3.2 %.
  
  

  Station to severe complications, especially urinary

  An abundant scientific literature characterizes complications related to ketamine consumption, in particular severe urinary complications (such as interstitial cystitis) in regular consumers of ketamine often nasal.

  Yet at the beginning, as often for any new event, the link with ketamine was debated and even criticized, with arguments evoking other hypotheses such as the existence of an adulterating product in ketamine, its preparation methods (heating of ketamine) or the synthesis of a toxic metabolite of ketamine by Asian users who often present genetic polymorphisms.

  It was in 2007 that the first two scientific articles on urinary complications will appear in regular ketamine users, in Hong Kong and Canada, breaking the hypothesis of the toxic metabolite linked to the Asian population.

  Interestingly, this Canadian publication will give rise to other publications by teams using medical Ketamine, repeatedly, to treat complex pain and also relating to this framework for urinary complications.

  Experimental studies in animals will take useful light to establish this link with in particular the development of an animal model of cystitis induced by the repeated administration of high doses of ketamine or the highlighting of symptomatic urinary abnormalities in rat after the administration of method -state, a powerful synthesis drug and a NMDA receptor antagonist.

  Difficulties in urinating, frequent urination …

  These cystitis are manifested by difficulty urinating (dysuria), the presence of blood in the urine (hematuria) and very frequent urination related to a reduced capacity of the bladder. They can cause repercussions on the upper urinary device so in the kidneys, leading to what are called hydronephrosis.

  Severe and disabling clinical tables may require surgical interventions. These complications are observed in the event of continuation of the consumption of ketamine. From the first urinary symptoms, stopping is the best treatment.

  In France, all these clinical complications related to psychoactive substances at risk of abuse (drugs or not) are closely followed by pharmacologists from the French addictovigilance network, piloted by the National Agency for the Safety of Medicines and Health Products (ANSM).

  Important seizures, a sign of product circulation

  

  

  Ketamine is a product that circulates more. In 2022, nearly 3,000 seizures were made in Europe, for a total of almost 2.79 tonnes of ketamine. They are part of an increasing dynamic.

  This use is facilitated by an accentuated dissemination of ketamine (as evidenced by the levels of increase in increase at European and global level) and facilitated accessibility (deal, dematerialization by the use of digital tools, etc.).

  This situation explains the exposure figures in the general population, or more specifically among schoolchildren and high school students, and also the increase in health complications linked to ketamine in France or elsewhere.