Ketamine use and stimulant prescribing: parallel responses to distress

I would like to thank the authors for their article ‘Ketamine: when the party’s over’, a timely and thoughtful piece on an issue that is becoming an increasingly significant concern for general practice and for society more broadly. ¹

Solutions to substance misuse are complex, yet the Government is likely to simply reclassify ketamine from Class B to Class A. There is little evidence that reclassification meaningfully alters consumption patterns. ² The idea that a 15-year-old might consult Hansard, Parliament’s biblical record, before deciding whether to take ketamine on their lunch break, is absurd.

Legislation is also unlikely to have much impact on the supply side. As the authors describe, young people increasingly purchase drugs online via social media platforms and encrypted messaging apps, with substances discreetly delivered by post. ³ Your local postman may unwittingly function as your neighbourhood’s most efficient drug courier.

Effective responses are therefore unlikely to be legislative and far more likely to involve honest, drug-specific education about cumulative harms — particularly irreversible bladder damage — alongside pragmatic harm-reduction measures and early, non-punitive routes to support. Without addressing the social and psychological drivers that make dissociation attractive in the first place, policy risks continuing to prioritise symbols over substance, while young people view ketamine use as a rational response to the society they inhabit. ⁴

It is also worth reflecting on whether medical practice itself may be contributing, unintentionally, to this landscape. Stimulant medications such as methylphenidate are increasingly prescribed to children, despite a recent BMJ umbrella review finding a dearth of evidence for effectiveness or safety beyond 52 weeks. ⁵ When clinicians respond to complex distress with mind-altering substances, it should not surprise us if some young people later adopt parallel strategies of self-medication.