Tuesday, May 7, 2024
5/7/2024
Use of ketamine, a dissociative anesthetic, is currently on the rise both as a party drug and via off-label prescription. We have estimated recent increases in several domains including recreational use, poisonings, and seizures, which coincide with recent media coverage of results from trials about ketamine’s efficacy in treating depression, along with an increase in advertising of ketamine treatments for many other indications. Nonmedical use is commonly associated with adverse effects, and people who use illegally in particular are at risk for poisoning as illegal ketamine is no longer pharmaceutical grade and can be adulterated, placing people at risk for exposure to drugs such as fentanyl. We predict that a wave of nonmedical ketamine use is beginning and will be fueled by increasing acceptance and curiosity resulting from media, advertising, and popular culture exposure, and diversion of prescribed ketamine. To investigate the rapidly advancing ketamine landscape, this study will integrate data on 1) prescribing, medical use, and misuse, 2) recreational use, and 3) population-level data on availability and adverse events including poisonings and death. Informed by a robust conceptual framework, our multidisciplinary team will conduct this study in the New York City tristate area. Our aims are to: 1) monitor ketamine prescribing practices and availability via legal channels and determine their effect on shifts in medical use and misuse, recreational use, associated adverse effects, and drug diversion; 2) estimate trends, patterns, and correlates of recreational ketamine use and use severity among high-risk populations (nightclub/dance festival attendees and college students), and among people who use ketamine in these samples—deduce risky exposure to adulterants such as fentanyl; and 3) estimate and compare trends in ketamine use and use severity, availability, and related morbidity and mortality in the tri-state area and determine whether trends in use and adverse events are predicted by increasing prescribing and availability of both legal and illegal ketamine. We will address Aim 1 by quantifying and characterizing mental health clinics providing ketamine via surveys with clinicians who prescribe ketamine (n=320) and patients of mental health clinics who are prescribed ketamine (n=400). We will address Aim 2 through 6,400 screener surveys with an estimated 928 participants taking the expanded rapid survey focusing on ketamine use. Screeners will help us estimate prevalence of use while the full survey will focus on characteristics of use among people who use. We will also saliva-test those reporting past-48-hour use to test for exposure to >1,000 adulterant drugs including >100 fentanyl analogs. Aim 3 will be addressed by triangulating data from Aims 1 and 2 and contrasting it with ketamine-related secondary data on seizures (indicating availability), morbidity (poisonings), and mortality. This will be the first largescale epidemiology study to examine multiple aspects of increasing prescribing, medical use, misuse, recreational use, and associated adverse and iatrogenic effects of ketamine use. Results will inform policy to curb availability, as well as prevention, treatment, and harm reduction efforts.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
