Keta, K, Special K… ketamine consumption is exploding in France (and it’s very worrying)

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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 increasingly present in news stories in France or abroad for its misused use. For example, it was discussed following the death of Matthew Perry, one of the protagonists of the famous series Friends. The scale of the misuse of ketamine as a hallucinogen, far from its essential medical use, is without equivalent. How and why did we arrive at such a situation?

In France, recreational uses explode with 90s techno

In the United States and then in Europe, the first cases of deviation from medical use to recreational use were described, particularly among health professionals (anesthetists) who had access to the products. At the end of the 90s, its use in France spread to the techno party space, where it was offered under different names (Kéta, K, Kate, Special K, Golden, Veterinarian, etc.) and consumed mainly nasally (60 -100 mg) or oral, for its hallucinatory effects.

The misuse of ketamine will also reach Asia. It will gain considerable momentum there, particularly in the nightclubs 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 expert reports, thus making it possible to detect, identify and characterize new use practices as well as their consequences on health.

It must be said that France is the only country in Europe to have put in place a specific monitoring system on psychoactive substances and their consequences on health since 1990, thanks to the thirteen Evaluation and Information Centers on Drug Dependence- Addictovigilance (CEIP-A) which constitute the French Addictovigilance Network.

This analysis is based on the triangulation of several French data sources, including reports of serious cases with ketamine (which are a legal obligation for health professionals) and data from a pharmacosurveillance system called OPPIDUM (Observation Illicit psychotropic products or diverted from their Medicinal Use).

This system makes it possible to know the psychoactive substances consumed by patients treated in France in structures specializing in addiction, thanks to a collection carried out each year during the month of October. In October 2012, 35 patients (0.7%) were ketamine users. This figure has continued to grow since then, expecting 107 consumers (2%) during the collection in October 2023.

A constant increase in 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 present use disorders, that is to say an addiction to ketamine.

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

Note in this context of ketamine use disorders, clinical situations which report behavior seeking pharmaceutical ketamine, by going through emergency services to obtain ketamine. This demonstrates the links that can exist between so-called “illicit” ketamine and pharmaceutical ketamine.

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

A ketamine also experimented by a minority of young people

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

We thus observe in France:

• in 2023, a lifetime prevalence of experimentation with ketamine of 2.6% (3.3% among 18-24 year olds, 4.8% among 25-34 year olds, 3.2% among 35-44 years old; on a representative sample of 14,984 people aged 18 to 64), according to the French Observatory of Drugs and Addictive Tendencies OFTH.
• a prevalence of ketamine use of 0.9% (ranging from 0.6% to 4.7% depending on the school situation) when we question young people aged 17 during 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 experimentation with ketamine of 1.1% (1.4% boys, 0.9% girls) among students from sixth to final year, according to d2022 data from the EnCLASS system.

And this is not a French specificity. In the United Kingdom, for example, experimentation with ketamine increased from 0.5% in 2010 to 0.8% in 2020. Among 16-24 year olds, this use doubled during the same period, from 1, 7% to 3.2%.

Beware of severe complications, particularly urinary ones

An abundant scientific literature characterizes complications linked to the consumption of ketamine, in particular severe urinary complications (like interstitial cystitis) in regular users of ketamine, often via the nasal route.

However at the beginning, as is often the case with any new event, the link with ketamine was debated and even criticized, with arguments evoking other hypotheses such as the existence of an adulterant in ketamine, its preparation methods (heating of ketamine) or the synthesis of a toxic metabolite of ketamine by Asian users which often presents genetic polymorphisms.

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

Interestingly, this Canadian publication will give rise to other publications by teams using ketamine for medical purposes, repeatedly, to treat complex pain and also reporting urinary complications in this context.

Experimental studies in animals will shed useful light on establishing this link, notably with the development of an animal model of cystitis induced by repeated administration of high doses of ketamine or the demonstration of symptomatic urinary abnormalities. in rats after the administration of methoxetamine, a powerful synthetic drug and NMDA receptor antagonist like… ketamine.

Difficulty urinating, frequent urination…

These cystitis are manifested by difficulty urinating (dysuria), the presence of blood in the urine (hematuria) and very frequent urination linked to reduced bladder capacity. They can cause an impact on the upper urinary tract and therefore on the kidneys, leading to what we call hydronephrosis.

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

In France, all these clinical complications linked to psychoactive substances at risk of abuse (medicated or not) are closely monitored by the pharmacologists of the French Addictovigilance Network, managed by the National Medicines and Product Safety Agency. health (ANSM).

Significant seizures, a sign of the circulation of the product

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

This use is facilitated by an increased distribution of ketamine (as evidenced by the increasing levels of seizures at European and global level) and easier accessibility (deal, dematerialization through the use of digital tools, etc.).

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

Joëlle Micallef, Department of clinical pharmacology and pharmacomonitoring, AP-HM Center for Evaluation and Information on Drug Dependence – Addictovigilance PACA-Corsica Institute of Systems Neuroscience (U1106), Aix-Marseille University (AMU) and Thomas Soeiro, Department of clinical pharmacology and pharmacomonitoring, AP-HM Center for Evaluation and Information on Drug Dependence – Addictovigilance PACA-Corse Institute of Systems Neuroscience (U1106), Aix-Marseille University (AMU)
This article is republished from The Conversation under a Creative Commons license. Read the original article.

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