Ketamine remains an important emerging topic in the evolving drug landscape. This week's NDEWS Special Report and Web Monitoring Report independently identify upward trends in ketamine-related indicators, demonstrating strong harmonization across our surveillance system.

Together, these findings highlight the importance of multidisciplinary surveillance approaches for identifying and contextualizing emerging drug trends before they are reflected in traditional public health data sources.

As always, we welcome your input.

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Why are we reporting on this? Ketamine continues to be widely discussed across Reddit in both recreational and therapeutic contexts. Recent discussions highlight growing interest in ketamine's perceived mental health benefits, its use in combination with other psychoactive substances, concerns regarding long term health effects, increased tolerance and availability. Commenters also discuss the increasing normalization of ketamine in some social settings alongside ongoing questions about routes of administration, contamination, and product quality.

What is Ketamine? Ketamine is a dissociative anesthetic. It is available in pharmaceutical formulations for clinical use and is also increasingly encountered in illicit markets in powder, crystal, and liquid forms.

Public Health Impacts: Reddit discussants report adverse effects associated with repeated ketamine use, including increased tolerance, bladder discomfort, headaches, and nasal irritation. Commenters also express concerns about product purity and the potential for adulterants. Multiple discussants seek information about the safety of combining ketamine with other substances, and ketamine's potential therapeutic effect for depression, post-traumatic stress disorder, chronic pain, and substance use disorders.

How is it Being Discussed? Reddit commenters frequently discuss ketamine as both a recreational and therapeutic substance, describing its dissociative effects that alter perception, and facilitate introspection and emotional processing. There is extensive discussion regarding combining ketamine with LSD, psilocybin, MDMA, opioids, benzodiazepines, cannabis, stimulants, salvia, and other dissociative compounds, with many conversations focused on timing, expected effects, and safety considerations. Discussants also compare ketamine with other psychoactive substances, debate its social acceptance relative to cocaine and psychedelics, and discuss alternatives with similar subjective effects. Additional conversations focus on ketamine treatment in a clinical setting for depression, PTSD, and pain management, oral and intranasal administration, pricing and availability, storage practices, reagent testing, and strategies to reduce health risks from chronic use.

Click here to read more about NDEWS Online Monitoring.

A recently published narrative review in Substance Use & Misuse co-authored by NDEWS SAG Member Mark Gold examined the increasing use of ketamine outside medical settings alongside its growing role in treating treatment-resistant depression. The study also highlighted rising reports of non-prescribed use, self-medication, and misuse, along with adverse outcomes including urinary tract damage, cognitive impairment, psychiatric symptoms, and substance use disorder risk. The authors call for further research and stronger clinical oversight to balance therapeutic benefits with public health concerns.

Read the full narrative review here.

A recently published study in the Journal of Forensic Sciences led by NDEWS Co-Director Joseph Palamar and co-authored by NDEWS SAG Member Alex Krotulski compared oral fluid ketamine test results with self-reported recent use to assess whether detected ketamine reflected intentional use or possible unintentional exposure from adulterated drugs. The results of the study determined that among those testing positive for ketamine, only 41.5% reported past 24-hour use. The authors concluded that norketamine detection was the strongest predictor of self-reported use, but relying solely on norketamine detection or higher ketamine concentration cutoffs may miss some cases of use or exposure.

Read the full study here.

A recently published study in Fundamental & Clinical Pharmacology co-authored by NDEWS Co-Director Joseph Palamar sought to identify and characterize clinics advertising ketamine for psychiatric conditions online in the New York metropolitan area, with attention to advertising suggesting ketamine is prescribed for at-home use. In the multivariable model, advertising ketamine for at-home use was more common among clinics advertising oral ketamine and less common among clinics listing a medical doctor as being on their team. The study concluded that out of 233 clinics identified, over a third of the clinics advertised ketamine for at-home use and highlighted the need for monitoring and clearer guidance to mitigate potential safety risks.

Read the full study here.

A recently published study in The International Journal of Drug Policy by Mezaache et al. set out to characterize patterns of ketamine analogue use, user profiles, and associated health outcomes in France. A retrospective analysis of cases was conducted involving 2-fluorodeschloroketamine, deschloroketamine, N-ethyldeschloroketamine, fluorexetamine, and hydroxetamine. Fifty-six cases were identified from 2017 to 2024 and 61% of those cases were deemed serious with 11% being recorded as deaths by the DRAMES registry. 

Read the full study here.

A recently published study in the Journal of Substance Use and Addiction Treatment by Mosca et al. examined publications focused on clinical interventions for ketamine misuse from three literature databases. From 3183 records screened, 73 studies met the inclusion criteria, including 5 controlled clinical studies, 15 observational studies, 15 case series, and 38 case reports. The results determined that management of ketamine misuse is heterogeneous and often based on evidence taken from either case reports or small series. The authors noted that more evidence and standardized treatment approaches are needed. 

Read the full study here.

As gabapentin prescribing has doubled over the past decade, its nonmedical use has risen in parallel, primarily in people with opioid use disorder. Yet the assumptions driving both clinical practice and scheduling policy have largely outpaced the evidence. This webinar presents data from multiple studies spanning national surveillance surveys, Medicaid claims, urine drug testing data, and clinical interviews that together reframe the gabapentin problem and moves us forward toward understanding the role of gabapentin as friend or foe in the ongoing opioid crisis.

📅 Date: Thursday, July 30, 2026

🕑 Time: 1:00 pm - 2:00 pm ET

📍 Location: Virtual via Zoom

Register here.

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

What We Offer:
- Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
- Mentorship from leading UF faculty in epidemiology, public health, psychology, medicine, and more
- Hands-on research with landmark and important NIH-funded projects and access to rich data
- Career development support, including grant writing, publishing, and professional networking
- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
- Interested in a PhD in Epidemiology, or early-stage postdoctoral fellows
- Demonstrated interest in substance use, addiction, or public health research

Location: Gainesville, Florida — a dynamic hub for scientific innovation with high quality of life and low cost of living.

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.