Ketamine is suddenly everywhere

Vox

14 hours ago

covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017.
Ketamine seems to be everywhere — from the nightclub to the psychiatric clinic. Among its growing number of users is Elon Musk, who says he takes ketamine every two weeks for depression as prescribed by a doctor. He's far from alone: More and more Americans are turning to ketamine for relief for their mental health struggles.
But the New York Times reported recently that Musk was taking so much ketamine during last year's presidential campaign, sometimes daily, that he reportedly told people it was causing him bladder problems, a known symptom of chronic ketamine use. Musk's reported experience with the drug — from medical to possibly abusive — provides a window into ketamine's growing popularity in the United States, and the paradox that popularity presents.
Ketamine, both an anesthetic and a hallucinogen, was first synthesized in the 1960s and has long been used for surgery and veterinary medicine. More recently, it has shown remarkable effectiveness in alleviating symptoms of depression, particularly in treatment-resistant populations. Clinics administering the drug — which legally must be licensed by the government to provide intravenous infusions — are becoming more popular. The Food and Drug Administration approved the first ketamine-derived nasal spray for depression in 2019.
On the other hand, as highlighted in the Times' report alleging that Musk was mixing ketamine with other drugs, more Americans appear to be using ketamine recreationally and outside of medical supervision. Chronic misuse can put people at risk of serious physical and mental health consequences, from kidney and liver damage to memory loss and paranoia.
'There is absolutely a role for ketamine to help people with depression and suicidal ideation,' said Dr. Kevin Yang, a resident physician in psychiatry at the University of California-San Diego. 'At the same time, that doesn't mean it's going to be safe and effective for everyone.'
According to a study co-authored by Yang and published earlier this year, the percentage of Americans who reported using ketamine within the past year grew by 82 percent from 2015 to 2019, took a brief dip in 2020 — possibly because of the pandemic complicating people's access to the drug — and then rose another 40 percent from 2021 to 2022. The increases were similar for both people with depression and people without, suggesting that the growth is being driven by both more people seeking ketamine for clinical purposes and more people using it recreationally. The overall number of people taking ketamine is still tiny: About 0.28 percent of the population as of 2022, though this might be an undercount, as people don't always tell the truth in surveys about drug use.
There is other evidence to suggest more people are taking ketamine recreationally. Yang's study found that ketamine use was rising most among white people and people with college degrees, and users reported taking it more often in combination with other recreational drugs such as ecstasy and cocaine.
Ketamine drug seizures nationwide increased from 55 in 2017 to 247 in 2022, according to a 2023 study led by Joseph Palamar at New York University. Experts think most recreational ketamine is produced illicitly, but the number of legitimate ketamine prescriptions that are being diverted — i.e., lost or stolen — has been going up, a 2024 analysis by Palamar and his colleagues found, which is another possible indicator of a blossoming black market. The buzz about ketamine's popularity in Silicon Valley and its persistence in certain club cultures that first emerged in the '80s confirms its place in the counterculture.
We can't know the reality behind Musk's public statements and the anonymous reporting about his ketamine use. The Times reports that people close to Musk worried that his therapeutic use of ketamine had become recreational; Musk quickly dismissed the Times's reporting. But the drug does coexist as a therapeutic and a narcotic, and the line between the two can be blurry.
People should not try to self-medicate with ketamine, Yang said. Its risks need to be taken seriously. Here's what you need to know.
How to think about ketamine as its popularity grows
Ketamine is edging into the mainstream after years at its fringes. It has been around for decades, enjoying a boom as a party drug in the '80s and '90s. For the most part, ketamine had been viewed warily by mainstream scientists. But in 2000, the first major research was published demonstrating its value in treating depression. And increasingly over the past decade, however, ketamine has started to gain more acceptance because of its consistently impressive study results. Studies have found that for some patients, ketamine can begin to relieve their depression symptoms in a matter of hours after therapy and other medications have failed. The testimonials of patients whose depression improved quickly, such as this one published in Vox, are convincing.
The benefits identified in clinical research have opened up a larger market for the substance. Johnson & Johnson developed its own ketamine-derived treatment for depression (esketamine, sold as a nasal spray called Spravato) that received FDA approval in 2019, the first of its kind. The number of monthly prescriptions for Spravato doubled from the beginning of 2023 to October 2024. People can also visit clinics to receive an IV of conventional ketamine for treatment, and that business is booming too: In 2015, there were about 60 clinics in the US dedicated to administering ketamine; today, there are between 1,200 and 1,500.
For the 21 million Americans who experience major depression, this widening access could help: ketamine and esketamine do appear to have strong anti-depressive effects — as long as it is used in consultation with a doctor and under their supervision. A 2023 meta-analysis of the relevant studies found that across many clinical trials, most patients reported significant improvements in their symptoms within 24 hours. It is recommended primarily for people whose depression has not gotten better after trying other treatments or for people with severe suicide ideation, who need a rapid improvement in their symptoms to avoid a life-threatening emergency.
But providers also screen potential patients for any current substance use problems for a very important reason: The risks for ketamine abuse are real.
When taken outside of a clinical setting, ketamine is often consumed as a pill or a powder, either snorted or mixed with a drink, and it's easy to take too much. One recent survey found that more than half of patients who attempted to take ketamine at home for depression either intentionally or accidentally took more than the prescribed amount. Users can also develop a tolerance over time, which raises the risk that people will take stronger and stronger doses to feel the same effects.
Packs of illegal ketamine are seen before a destruction ceremony to mark the 'International Day against Drug Abuse and Illicit Trafficking' in Yangon on June 26, 2023. Sai Aung Main/AFP via Getty Images
Scientists have found that people who use ketamine can develop a dependency on it, especially with frequent and high-dosage use. They become irritable or anxious without the drug and experience other withdrawal symptoms. Its addictive quality, while less potent than that of nicotine or opioids, is an important difference from some other hallucinogens, such as psilocybin, that are also being used in experimental settings for mental health needs and are less likely to be habit-forming.
Maintenance doses can also be necessary for ketamine therapy, and regulating any long-term use to prevent dependency is another reason medical supervision is so crucial. There is limited evidence that most people who use ketamine in a clinical setting do not end up abusing it, which is a promising sign that properly managing its use reduces the risk of therapeutic use turning into a disorder. But because ketamine's use for depression is still so new and still growing, it's an important risk to watch out for. Johnson & Johnson urges patients to be mindful of Spravato's potential for misuse.
The line between genuine therapeutic use and abuse becomes clearer when a biweekly treatment at a clinic turns into a regular at-home habit, especially if that involves obtaining the drug from illicit sources whose purity is not guaranteed. Street ketamine is typically just the drug itself, produced and sold illegally. But Dr. Nabarun Dasgupta, who oversees the University of North Carolina's Street Drug Analysis Lab, told me they've noticed a recent rise in samples where ketamine is combined with other substances.
On its own, ketamine overuse in the short term can cause nausea and high blood pressure, with all of the attendant risks, as well as hallucinations and 'bad trips.' Longer-term abuse can lead to problems with a person's bladder and urinary tract, which can create difficulty urinating — the kind of issues Musk described to people in private, according to the Times. People who chronically abuse ketamine can also experience paranoia, memory loss, and a shortened attention span.
The potential for ketamine in a clinical environment is exciting. But its use does come with risks, and not enough people are aware of them: A recent survey from the United Kingdom found that many people there who were taking ketamine did not know that it could be addictive.
It can be. Ketamine is not something to experiment with on your own. Clinics have all sorts of safety checks for their patients, Yang told me. Ketamine 'absolutely has been shown to be very effective,' he said, before adding the all-important qualifier: 'under the supervision of a clinical physician.'