Ketamine use on the rise – Can we prevent a new wave of harm?

Developed in the 1960s as a dissociative anesthetic, ketamine remains essential in surgery, trauma care, and treatment‑resistant depression. It provides pain relief but also produces strong alterations in perception and consciousness, creating rapid shifts from controlled to unpredictable states.

Outside medical settings, ketamine most commonly appears as crystals or powder and is typically taken intranasally, although oral and injectable use have also been reported by some people who use drugs. Its effects begin quickly, producing sensory distortion, dreamlike detachment, and intense dissociation that may leave longer‑lasting cognitive or psychological impacts. These effects can vary substantially depending on dose and context of use, as well as the use of other substances.

A widening footprint in the Nordics

Ketamine use is rising across the Nordic region. According to the latest EUDA wastewater analysis, ketamine residues increased by around 41 per cent across Europe, with none of the Nordic country showing any decline. Sweden shows the sharpest rise, while Finland follows the broader continental trend, supported by indicators such as seizures increasing from 150 grams in 2020 to nearly 18 kilograms in 2023.

Denmark and Norway show stable or slightly upward patterns, and Iceland shows no signs of decline. Taken together, these findings depict consistent regional growth, with Sweden accelerating most rapidly.

Available evidence also suggest that ketamine use is not limited to recreational nightlife settings but increasingly overlaps with broader drug markets and people who use drugs more regularly.

Health consequences that cannot be ignored

Despite its reputation in some circles as a “safer” drug, ketamine can cause serious and sometimes irreversible harm. The most severe is ketamine bladder syndrome, which involves chronic inflammation, scarring, reduced bladder capacity, and potentially the need for surgical intervention.

Ketamine can also raise blood pressure and heart rate, impair coordination, and increase risk of accidents. Psychologically, repeated dissociative exposure has been associated with increased anxiety, depersonalization, and impairments in memory and attention, particularly among individuals with frequent or sustained ketamine use. A minority of users develop frequent, high‑dose use associated with tolerance, dependence and withdrawal symptoms when use stops. Some harms may persist even after cessation, and relapses into use is commonly reported in treatment settings.

Why the moment to act is now

The Nordic countries are at a critical point: early enough to influence outcomes, yet late enough that clear warning signs are already visible. Many young adults experimenting with ketamine lack knowledge about dose variability, spacing use, hydration, and recognizing early bladder symptoms – factors that increase risk within social groups.

At the same time, people who regularly actively use other drugs may adopt ketamine for different purposes, such as managing comedowns, self-medicating psychological distress, enhancing intoxication, or coping with withdrawal symptoms. This introduces distinct risk profiles and service needs.

Health systems may be unprepared. Experience from the UK shows that clinicians initially struggled to recognize ketamine‑related bladder damage and to manage dependence in patients with chronic pain. Meanwhile, market shifts from liquids to powders and occasionally adulterated or synthetic variants create new uncertainties in potency and risk.

A narrow but actionable window remains. Rising ketamine use does not have to become a public health crisis if the Nordic countries respond proactively. Strengthened harm‑reduction messaging, updated clinical guidance, improved monitoring, and earlier detection could all help to  significantly reduce future harms.

Supervised Drug Consumption Rooms (DCRs) could further support prevention by offering controlled environments that reduce acute risks, enable early health assessment, and connect high‑risk and polysubstance users to relevant services. Integrating ketamine‑related risk awareness into DCR models could strengthen early intervention and limit long‑term consequences. Experiences from Europe and the UK show that delayed action carries real costs, but the Nordic region can still choose a more prepared, evidence‑driven path.

The article is written by

Kim Kannussaari, Senior Specialist, EHYT Finnish Association for Substance Abuse Prevention

on the request of PopNAD