The Journal of American Medical Association (JAMA) published a report this week noting the increase in diversions of the drug ketamine. The report was authored by Joseph J. Palamar, PhD, Caroline Rutherford, MS and Katherine M. Keyes, PhD. and they obtained data on undistributed pharmaceutical ketamine diversion from the DEA via a Freedom of Information Act request. Palamar has written a previous report calling for more surveillance of ketamine.

The report stated that recreational use of illicit ketamine, off-label ketamine prescribing, and for-profit clinics have become more common, with a lack of regulatory oversight and increased direct-to-consumer advertising. It said, that in 1999, the US Drug Enforcement Administration (DEA) classified ketamine as a Schedule III controlled substance in response to increasing recreational use and thefts from veterinary clinics. Law enforcement seizures of illegal ketamine have increased but the authors want to examine how pharmaceutical ketamine was being diverted.

Increased diversion

The study found that there were 1355 reports of pharmaceutical ketamine diversion between 2017 and 2023. There were 195 diversions in 2017, and the number increased from 166 in 2020 to 230 in 2023. Ketamine lost in transit increased overall from 5.1% in 2017 to 45.2% in 2023

The authors found the following:

While employee and customer theft as a proportion of reported diversions increased, ketamine lost in transit became the most common reported diversion type in 2023. Although diversion from practitioners and hospitals remained most common, such diversions decreased, and diversion among reverse distributors increased. Whether these trends reflect increased ketamine prescribing or demand cannot be assessed.

The researchers acknowledged some limitations to their work. Specifically, the data on ketamine form factors such as lozenges vs. liquid wasn’t available. In addition to that missing data, diversions weren’t characterized as to whether it came from veterinary clinics or clinics with human patients. The diversion that happens after distribution through avenues like forged prescriptions was also not included. On top of that, remote working during the pandemic may have affected reporting timeframes.

 



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