Reported ketamine poisonings in the US rose from 205 in 2019 to 414 in 2023, the highest in reporting history. Most cases involved ingestion (57.2%) and misuse or abuse (36.2%). The proportion of cases involving suspected suicide attempts doubled from 12.7% to 25.9%, and ingestion increased from 46.0% to 65.2%. Cases with major effects or death decreased from 23.4% to 15.6%. Overall, 18.6% of cases experienced a major event or death, but prevalence was lower for those who inhaled ketamine compared to those who did not. Both medical and recreational use and related adverse events need monitoring, especially as off-label prescribing of take-home oral formulations appears to be increasing.
About one-third of US adults who used psychedelics in the past year traveled out of state to do so, primarily to Colorado and Oregon, which have decriminalized natural psychedelics. Travelers were more likely than nontravelers to report anxiety or depression symptoms and to have visited an emergency department or urgent care for a psychedelic-related issue. They were also more likely to use psychedelics for medical symptoms, at healing centers, or at ceremonial sites. Emergency physicians in both legalized and nonlegal states should be aware that travel for psychedelic use is common and may carry risks of adverse outcomes.