Legitimate Medication Use May Be Fueling the Black Market. Can You Recognize the Consequences?

Fact: Ketamine (Ketalar) is a legal, approved medication available in the United States as an anesthetic agent indicated for diagnostic and surgical procedures that do not require skeletal muscle relaxation; for induction of anesthesia preceding general anesthesia; and to supplement low-potency agents such as nitrous oxide. It’s also used as an anesthetic agent for animals. More ominous fact: Seizures of illicit ketamine rose 1,100% from 2017 to 2022. Maybe worst of all, a newsletter article published by Bloomberg suggests that those two sets of facts may be linked to an unfortunate degree, with the legal use of ketamine and certain other drugs actually driving illicit use. Beyond black market sales, though, there’s a “gray” market in which healthcare companies have established specialty clinics for the expressed purpose of administering IV treatment with ketamine for maladies ranging from anxiety and OCD to PTSD and alcohol addiction. The way this could all feed illegal use, according to the article, is by essentially normalizing use of ketamine (similar to the concept, also suggested in the article, that legalization of and easier access to marijuana has made it seem less risky and therefore “safer” to try for the first time). Another wrinkle is that, given the propensity for new businesses to fail within their first years of existence, when ketamine clinics go out of business their patrons may become desperate to source the drug outright illegally. The lessons for urgent care provider are 1) to be aware that patients may present in the hope of getting ketamine therapy from you, and 2) recognize that ketamine obtained and used outside of a doctor’s care may lend itself to overdosage; symptoms of ketamine toxicity to be vigilant for include sedation, decreased levels of consciousness, respiratory depression, apnea, hypotension, bradycardia, stupor, seizure, and coma.