Self-reported changes and experiences with substance use among real-world patients treated with medical ketamine.

In a survey of 201 patients receiving medical ketamine for psychiatric or pain conditions, most reported either a positive change (54.7%) or no change (44.3%) in their use of other substances. Those with a past history of problematic substance use showed significantly greater reductions than those with present or no such history. Patients described reduced craving, less need to self-medicate, and increased motivation to quit substances. Ketamine did not appear to induce or increase drug use among those with minimal or no prior use, though some reported risky behaviors such as using other psychedelics or substituting alcohol with recreational ketamine. Further research is needed to identify and protect at-risk patients.

Study at a glance

Abstract

Ketamine is increasingly used in community clinics as a long-term treatment for different psychiatric and pain conditions, including substance use disorders. Data are lacking, however, regarding the potential influence of ketamine on other substance use. In this secondary analysis, we aimed to explore the relationship between medical ketamine and other substance use among real-world patients by combining quantitative and qualitative data. In an online anonymous pilot survey (N = 201), patients rated change in other substance use since medical ketamine initiation and elaborated on their subjective experiences. Most patients self-reported positive/desirable change (54.7%) or no change in substance use (44.3%). Participants reporting past problematic substance use had significantly greater positive change compared with the groups of participants reporting present or no history of problematic substance use (ps < .020). Participants reported positive outcomes such as reduced substance use due to reduced need to self-medicate for coping, reduced craving, or enhanced motivation to quit use. Among participants with minimal or no substance use, ketamine did not appear to induce or increase drug-using behaviors. However, there were some reports of risky behaviors such as openness to using other psychedelics or ketamine used recreationally as a substitute for alcohol. Several implications for providers are discussed. More targeted quantitative and qualitative research is needed to fully characterize all patients but especially those at risk for potentially harmful nonmedical substance use. Such research could inform regulation efforts on safety, screening, monitoring, and patient and provider education, to maximize benefits and minimize risks related to medical ketamine. (PsycInfo Database Record (c) 2025 APA, all rights reserved).