Ketamine use is increasing — and so is complexity

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269,000–299,000 people in the UK reported ketamine use in the last year.

Treatment demand has risen from around 400 to over 5,000 per year, alongside growing pressure on emergency and urology services.

 

While ketamine still represents a smaller proportion of overall substance use demand, the rate of growth and complexity of presentation are significant.

A System Under Strain

 

Substance use treatment systems are largely structured around the identification of dependence and associated social breakdown.

 

This model works well for many substances, where escalating use is typically accompanied by clear indicators such as loss of control, withdrawal, and deterioration in day-to-day functioning.

 

Ketamine does not reliably follow this pattern.

 

Significant harm may develop without clear dependence.
Use may be intermittent or contained (for example, weekend use), without obvious disruption to social roles or responsibilities.

 

As a result, individuals may not meet expected thresholds for intervention, despite increasing and clinically meaningful risk.

 

A Distinct Clinical Profile

 

Ketamine-related harm presents differently.

 

• Use may be intermittent

• Escalation can be rapid

• Severe harm may emerge without established dependence

 

Presentations often involve a combination of:

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• Cognitive change

• Behavioural disturbance

• Emerging physical symptoms

 

These patterns do not align well with treatment models designed around stable use and conventional markers of dependence.

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A Mismatch in Response

 

76% of ketamine users report dissatisfaction with the treatment they receive from services.

 

This reflects a gap between:

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• how ketamine-related harm presents

• how services are structured to respond

 

Interventions may be applied:

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• too broadly

• too late

• without alignment to the processes driving the presentation

 

What Is Missing

 

The issue is not access to services.

It is the absence of a structured way to:

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• recognise how ketamine-related harm develops

• organise clinical understanding

• guide proportionate and timely intervention

 

A different approach is required — one that can respond to progression, variation, and complexity, rather than relying on fixed thresholds of dependence.