Why is pharmaceutical ketamine disappearing?

Pharmaceutical-grade ketamine is increasingly being lost in transit between the manufacturers and the doctors who rely on it as both an anesthetic and a mental health drug. An analysis of 1,355 cases between 2017 to 2023 involving significant, though unspecified, quantities of ketamine liquid and lozenges reveals a slight overall rise in reports of the drug disappearing. 

In 2023, the most recent year for which there is data, there were 230 reported cases of “undistributed pharmaceutical ketamine” in the US, with 104 batches getting lost in transit and another 83 ketamine deliveries stolen somewhere along the supply chain after arrival at a hospital or clinic. “Diversions from hospitals and practitioners declined, but reverse distributor-related incidents surged, emphasizing vulnerabilities in the supply chain,” the authors wrote.

The middle-man banditry may reflect the increased demand for ketamine for personal use, says psychiatrist Joao Costa Ribeiro PhD, the founder of Liminal Minds, a ketamine clinic in Portugal. The use of ketamine, often referred to as “K,” is believed to be at an all-time high in the US, UK, Australia, and other countries. The UK is even considering moving ketamine to the strictest drug classification soon. As off-label prescribing becomes more widespread amid a global proliferation of clinics offering ketamine treatments, ketamine is steadily cementing its status as the world’s party drug of choice.

“Ketamine’s popularity as a safe and effective treatment in clinical settings may enhance people’s motivation to experiment with it,” says Ribeiro. “However, ketamine is not as safe as classic psychedelics for personal use because there is a higher risk of dependence and of severe consequences from heavy use, most notably bladder problems.”

The study, published as a research letter in the Journal of the American Medical Association (JAMA), is based on data obtained through a Freedom of Information Act request to the Drug Enforcement Administration (DEA). The research was led by Joseph Palamar, PhD, from New York University Grossman School of Medicine’s Department of Public Health. 

“The number of undistributed pharmaceutical ketamine diversions increased between 2017 and 2023,” the authors wrote. “While employee and customer theft as a proportion of reported diversions increased, ketamine lost in transit became the most common reported diversion type in 2023. Although diversion from practitioners and hospitals remained most common, such diversions decreased, and diversion among reverse distributors increased.” In a previous report, Palmer called for greater surveillance of pharmaceutical-grade ketamine. 

“With the rise of ketamine abuse, it is unsurprising to see increases in ketamine seizures and theft,” says Rebecca Harding, a neuroscientist and PhD candidate at University College London. “The growing supply appears to be meeting the surging demand for its recreational use. There is an urgent need for more research to better understand the negative consequences of ketamine misuse and to address these rising trends.”

In 1999, the DEA classified ketamine as a Schedule III drug, responding to rising personal use and reports of thefts from veterinary clinics that soon became part of psychedelic lore. In some parts of the world, it remains easily accessible in veterinary formulations, which can be adapted into powder for human consumption. 

The study authors, however, said that the data did not specify whether any of the diverted ketamine went missing from animal or human clinics. The data did not include diversions that may have occurred after distribution, such as those involving forged prescriptions. 

“Although these data cannot be used to infer misuse, individuals handling this drug at the predistribution level should be encouraged to use safeguards to prevent theft and other types of loss,” the paper concluded. Authors noted that pandemic-related measures could explain the relative fall in diversions in 2020 before numbers rose again to levels just above that of 2017, when there were 195 diversions.

“I would say that employee theft would typically be for personal use — not for selling — and in much smaller amounts than what is ‘lost in transit,’” adds Costa. “At our clinic, ketamine is locked in a safe, but in other medical settings, where it is used as anesthesia or as emergency pain relief, I think it might be more exposed to theft.”

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