Associations between substance use treatment and ketamine use: A hypothesis-generating analysis

Ketamine is increasingly used in clinical settings for mental health and pain management, yet its misuse poses public health risks. While prior studies have examined ketamine trends, few have explored its use among individuals receiving treatment for substance use disorders (SUD).

Using 2021-2023 data from the National Survey on Drug Use and Health (NSDUH), we analyzed the association between past-year ketamine use and receipt of SUD treatment among U.S. residents aged 12 and older. Stratified analyses by substance type and use category (use, misuse, and disorder) were conducted using adjusted logistic regression models.

Among 173,808 participants who reported substance use, 3.19 % received past-year treatment and 0.26 % reported past-year ketamine use. Ketamine use was more common among those in treatment (1.39 %) than not (0.22 %). Across SUD strata, treatment was associated with higher odds of ketamine use, including alcohol SUD (aOR = 2.73; 95 % CI: 1.58-4.71), marijuana SUD (2.32; 1.34-4.02), inhalant SUD (5.22; 1.96-13.94), methamphetamine SUD (5.10; 2.08-12.48), pain reliever SUD (2.62; 1.16-5.90), and opioid SUD (2.76; 1.23-6.18). Among misuse strata, associations included pain relievers (2.69; 1.40-5.16), opioids (3.13; 1.71-5.74), and psychotherapeutics (2.09; 1.21-3.62). Among use strata, treatment was associated with higher odds for cigarettes, alcohol, marijuana, heroin, PCP, DMT/AMT/FOXY, methamphetamine, pain relievers, tranquilizers, and stimulants.

Past-year treatment is a marker of elevated ketamine exposure across multiple substance domains. Findings are hypothesis-generating and underscore the need for clinical screening, patient education on unsupervised ketamine risks, and research clarifying timing, intent, and outcomes of ketamine use in SUD populations.