In medical settings, ketamine has traditionally been used for anesthesia and treatment of severe pain.1 In 2019, an intranasal version was approved by the Food and Drug Administration (FDA) for treatment-resistant depression.2 Since then, ketamine clinics have become increasingly popular for the prescription and administration of the medication.3 Recreational use of ketamine has been reported to be increasing, but it comes with risks such as breathing difficulties, seizures, amnesia, and overdose.4,5 Because of the risks associated with misuse, the FDA issued a warning in 2022 to advise that ketamine be dispensed and administered only under a safety program called a Risk Evaluation and Mitigation Strategy (REMS).6
To evaluate trends in ketamine use, we reviewed 125,919,204 patients and found 3,714 of them who were prescribed ketamine between 2017 and 2022. The number of patients with a ketamine prescription in 2022 was 5.47 times the 2017 rate, as seen in Figure 1.
Pain diagnoses have been the most common diagnoses for encounters where ketamine is prescribed, but major depression and anxiety diagnoses have been on the rise, as seen in Figure 2.
We also looked at the incidence of ketamine overdoses to determine if the increase in prescriptions has led to an increase in ketamine overdoses. As seen in Figure 3, we found that the rate of ketamine overdoses did rise after the FDA approval for depression in 2019 but decreased for the first time in 2022, which may be the result of the REMS program.2
