Ketamine’s switch from club to ‘chill out’ drug is a sign of a troubling cultural change

It was once seen as a fringe club drug, whose use as a horse tranquilizer gave it a ‘dirty’ reputation. But with the illegal use of ketamine reaching record levels, the Home Office announced last week that it is considering reclassifying it as a Class A drug, in response to the dramatic increase in use among young people.

An estimated 299,000 people aged 16 to 59 reported using ketamine in England and Wales in the year ending March 2023, the highest number ever recorded, according to Home Office data. Behind the headlines is also evidence of a disturbing cultural change, with an increasing number of people using the drug, which has dissociative, narcotic and psychedelic effects, at home rather than occasionally at a party. This increases the risk of dependency, experts say, which can lead to devastating health consequences.

“Ketamine has evolved from a ‘club drug’ to a substance used for a wider range of motivations,” says Robert Ralphs, professor of criminology and social policy at Manchester Metropolitan University.

Ralphs recent research in Greater Manchester found that some young people were using the drug, usually purchased as a crystalline powder, to “relax” after a day of work or study. Others reported using ketamine daily and in large amounts to self-treat mental health issues.

“It’s literally an escape from reality, which can be appealing to people struggling with anxiety and trauma,” says Harry Shapiro, director of the charity DrugWise. “If you’re going to solve things, you have to look at mental health care. That’s where you start to address some of these issues.”

The increase in ketamine use is associated with a increase in the proportion of adults who will enter treatment with ketamine problems in 2023-2024, from 1.6% in 2022-23 to 2.3% last year. The total number of adults starting treatment was eight times as many as in 2014, the year ketamine was reclassified from a Class C to a Class B drug.

Some say this undermines the case for changing the drug’s classification to Class A, which carries a maximum prison sentence of seven years for possession and life for supply.

“It’s complete nonsense,” says Ravi Das, professor of psychopharmacology at University College London, who has researched possible medical applications of ketamine. “It was made a Class C drug (in 2006) and then upgraded to Class B and in both cases its use has continued to increase. If the goal is to discourage use, it just doesn’t work.”

Ralph agreed. He said: “I use ketamine in my teaching of my criminology students as an example of the ineffectiveness of the UK drug classification system. It is as if the government is doing something, but without addressing the underlying problems.”

But others say a message needs to be sent that ketamine is not safe, a narrative fueled by evidence that ketamine can be effective in treating depression in a clinical setting. Elon Musk is among those who have described the use of low doses of ketamine under medical supervision to control the “chemical tides” that cause depression.

Dr. Emmert Roberts, senior clinical lecturer at King’s College London and consultant addiction psychiatrist, welcomed the review but said there also needs to be investment in research into the addition of ketamine. “There is very little evidence about what works to treat ketamine use,” he said. He added that in addition to those using ketamine illegally, he saw an increase in the number of patients who were prescribed ketamine but then became addicted.

According to the Office for National Statistics, the number of deaths from ketamine in England and Wales remains quite low compared to other illicit substances, although it is steadily increasing. Between 2018 and 2022, it went from a low of 21 in 2019 to an all-time high of 37 in 2022. The Friends actor Matthew Perry died after suffering a fatal ketamine overdose in October 2023.

However, the potential harm goes beyond the acute effects of the drug. Doctors are reporting an alarming increase in the number of young patients with incontinence and other bladder and kidney problems caused by chronic ketamine use. Some users become trapped in a cycle of self-medication, and in the worst cases, major abdominal surgery, bladder removal or kidney transplants may be required.

“The more ketamine they take, the worse their (bladder) pain becomes, and they take more and more ketamine to control these symptoms,” says Dr. number of patients with ketamine-related complications in recent years.

“I think it’s incredibly important that a message is sent because the effects are so unknown and leave catastrophic side effects for otherwise healthy people,” he said.