Patient register would help reduce harm from ketamine use, says advisory council

A registry of all patients who are regularly prescribed ‘off-label’ ketamine or esketamine would help to reduce harms from the drug, the Advisory Council on the Misuse of Drugs (ACMD) has said.

The ACMD’s recommendation came in a report — ’Ketamine: an updated review of use and harms’, published on 28 January 2026 — which has been developed to provide advice on the ways to reduce the prevalence and harms of ketamine use and misuse in the UK.

It has advised that the drug should remain a class B substance, owing to the acute harms associated with its misuse.

The report highlighted that acute harms of ketamine use include agitation, hallucinations, abnormal muscle movements and a reduced level of consciousness, whereas in severe cases, users experience psychosis and convulsions.

Chronic use can also lead to damage to the urinary system and chronic abdominal pain, it added.

The patient register is among several recommendations made in the report, which intend to reduce harms. Esketamine is licensed for anaesthetic use in humans, while a preparation of esketamine is also licensed for treatment-resistant depression.

The report also noted that the Royal College of Psychiatrists recommended ketamine in 2025 for the psychiatrist-led management of treatment-resistant depression in specialist settings, adding that “consequently, therapeutic use of ketamine for this indication is likely to increase”.

A registry of legitimate, off-label use would “facilitate patient safety monitoring and reporting of outcomes” and “would provide invaluable information about long-term safety of ketamine or esketamine use under these circumstances”, the report said.

The ACMD also recommended that a national patient safety alert — cascaded to all NHS healthcare associations — would be a good way to inform healthcare staff of the “public health threat caused by increasing ketamine use and summarise its associated health harms”.

Healthcare professionals, including community pharmacists, should “be able to identify signs of ketamine use (such as bladder-related issues, unexplained abdominal pain), and offer non-judgemental, evidence-based advice tailored to the individual’s needs”, the report said.

In addition, it urged that the undergraduate curriculum for pharmacy, as well as for nursing and medicine, should cover the long-term harms associated with ketamine use, as well as the importance of early recognition of these harms.

David Wood, chair of the ACMD, said: “[The report] highlights the need for a ‘whole system approach’ through its recommendations to tackle issues related to ketamine use, as no single recommendation is sufficient to do this alone.”

Commenting on the report, Claire Anderson, president of the Royal Pharmaceutical Society, said: “Ketamine has important clinical uses, but rising harms linked to non-medical use are a serious concern and we welcome the ACMD’s focus on harm reduction and improved awareness of the risks.

“Pharmacy teams are highly accessible and well placed to recognise possible signs of ketamine misuse, such as bladder or unexplained abdominal problems, and to offer non-judgemental, person-centred advice and signpost to support.

“We support measures to strengthen national monitoring of ketamine use and clear guidance for healthcare professionals, including pharmacists, alongside education for pharmacy students on long-term harms to help earlier identification and better outcomes for patients.”