Deaths due to illicit ketamine use have increased twenty-fold since 2015 – but these deaths are increasingly occurring in complex polydrug settings, raising doubts over whether single-substance drug policies can reduce harms.
Analysis by King's College London, with the University of Hertfordshire and Manchester Metropolitan University, of coroner's reports in England, Wales and Northern Ireland between 1999 and 2024 found there were 696 deaths with detections of illicit ketamine between 1999 and 2024. It represents the most detailed assessment to date of ketamine-related deaths in England, Wales, and Northern Ireland.
Ketamine is a Class B anaesthetic drug that has hallucinogenic effects. It's cheap cost – around £15-30 for a gram compared to £80 for cocaine – could be driving increased consumption say researchers.
The number of people using ketamine in England and Wales has continued to rise with an estimated 299,000 people aged 16-59 reporting illicit ketamine use in 2024. The drug has been implicated in the deaths of celebrities, including Friends actor Matthew Perry, and Elon Musk is reported to use ketamine for his moods.
Whilst annual deaths with post-mortem detections of illicit ketamine have risen over the past decade, the proportion of deaths where ketamine was the sole or primary cause has fallen, reflecting a shift towards increasingly risky patterns of polydrug use. Opioids, cocaine, benzodiazepines, and gabapentinoids were frequently co-implicated in deaths, with the average number of substances involved in each case also rising.
The study also identified a demographic shift. While harms of ketamine use among young people – such as bladder injury and dependence – remain a serious concern, deaths are increasingly occurring among older, socioeconomically disadvantaged, and dependent drug users, rather than being confined to younger recreational populations.
Dr Caroline Copeland, lead author of the study from King's College London and the Director of the National Programme on Substance Use Mortality said: "We are seeing more ketamine-related deaths, but these deaths rarely involve ketamine alone. 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."
The study published today in Journal of Psychopharmacology also shows 85% of the deaths between 2020 and 2024 were men. Employment status was reported for 77% of the deaths between 2020 and 2024, with 42% employed, 42% unemployed and 11% students. The demographic profile of deaths shifted towards greater deprivation from 2020 to 2024. Death was deemed accidental in 88.9% of cases with 5.9% determined as suicidal.
The authors call for a more comprehensive response to address ketamine-related harms, including: expanded drug checking services and overdose prevention schemes, better integration of ketamine users into treatment pathways, and targeted education on the risks of polydrug use.
Ketamine can be prescribed medically as a sedative and is commonly used on animals. But when ketamine is misused, it can cause serious and sometimes irrevocable damage to the bladder. Mixing ketamine – a dissociative – with depressant drugs like opioids and benzodiazepines makes it harder to judge the effect each drug is having, which can result in people taking more of each drug than intended.
Dr Caroline Copeland added: "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' is published in the Journal of Psychopharmacology.
