Deaths following illicit ketamine use have accelerated in recent years, increasingly involving complex polydrug use and socio-economic vulnerability. Policy responses should extend beyond single-substance legislative controls to include harm reduction, treatment integration, and social support strategies.
Two deaths in the UK following DMT use occurred in the context of polydrug use, with both cases involving additional compounds that can increase serotonergic drive, potentially causing serotonin syndrome. DMT was detected in femoral blood at 0.23 mg/l and 0.24 mg/l. One case involved cocaine and amphetamine; the other involved venlafaxine and mirtazapine. A literature search found three previous fatalities after DMT use, all accidental, two during ayahuasca ceremonies. Polydrug use is increasingly common, and users of unregulated drugs should exercise caution when combining them with other unregulated drugs or prescribed medications.