Abstract
Introduction
Recent decades have witnessed an extraordinary global crisis of drug misuse. Although opioid analgesics receive the most attention, numerous other drugs have increased rates of misuse.
Ketamine and esketamine
Ketamine and esketamine offer a unique natural experiment to explore two medications that are similar pharmacologically but differ in their availability to users and in their regulation by government agencies.
Misuse and abuse of ketamine and esketamine
Multisystem “mosaic” surveillance of many drugs using real-world data has emerged in recent years. Ketamine and esketamine have been monitored concurrently. Ketamine is much more widely available than esketamine and shows clear signs of increasing misuse and abuse. In contrast, esketamine is difficult to detect in postmarket surveillance even though availability is increasing.
Discussion
Ketamine and esketamine offer insights regarding the safety of prescription medications with the potential for misuse. Since the pharmacology of ketamine and esketamine are similar, the regulatory apparatus may be the primary difference that limits misuse. Ketamine has few restrictions and can be prescribed or administered by many healthcare providers, and is available as an illicit drug. In contrast, the product labeling for esketamine has rigorous restrictions on its use. Many important issues remain to be addressed. We need a more rigorous evaluation of the natural experiment of ketamine and esketamine. How does this experience relate to the introduction of new psychedelics?
Conclusions
Ketamine misuse use and misuse are increasing while esketamine use in increasing, but misuse is not increasing. It is reasonable to reevaluate the regulatory controls on ketamine to reduce its misuse and abuse.
Acknowledgements
The author acknowledges the remarkable efforts of our research team on postmarket surveillance of medications: Andrew Monte, MD, PhD; Joshua Black, PhD; Kari Rockhill, PhD; Jennifer Jewel, PhD; Kate Reynolds, MPH; Nancy Botiller, MS.
Disclosure statement
Richard C. Dart is Executive Director of the RADARS(R) System, which receives financial support from Janssen Pharmaceuticals.