Illegal use patterns, side effects, and analytical methods of ketamine

doi:10.1016/j.forsciint.2016.09.001

Forensic Science International

Volume 268, November 2016, Pages 25-34

https://doi.org/10.1016/j.forsciint.2016.09.001 Get rights and content

Highlights

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Ketamine (KT) is one of the most illegally used drugs in China and Taiwan.
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KT abuse leads to mental/physical side effects and abnormal functions in organs.
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Administration method of KT is snorting followed by injection and oral ingestion.
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Careful assessment, early identification or surveillance of KT users is required.

Abstract

In Asian countries, such as China, Taiwan, and Hong Kong, ketamine (KT) is one of the most prevalent illicit use drugs. KT is regulated by various drug-related laws in many countries, such as Korea, Taiwan, China, U.S.A, Netherlands, UK, Australia, Mexico, and Canada. This review research explored pharmacology and side effects of KT, the illicit use patterns of KT, the analytical methods of KT in biological samples, and the concentrations of KT from abusers and non-abusers. Many side effects of KT have been reported mental and physical problems. Although many studies conducted various analytical methods for KT, this research focused on the urine and hair analysis and compared some parameters of samples, instruments, columns, extraction methods, internal standards, LOD/LOQ levels, metabolites, NK/K ratio, cut off values, and m/z values. Our research also compared the concentrations of KT in biological samples from abusers and non-abusers. Many rapid and precise analytical methods for illegal KT use are needed to be developed and applied to real samples. To minimize and prevent harm from KT, the authorities and appropriate agencies require a careful assessment, evaluation, early identification, and surveillance of KT users in both clinical and social settings. In addition, there is a need to construct a stricter legislative management and provide preventive education to younger individuals because illegal KT use is relatively common among the young populations.

Graphical abstract

Introduction

Ketamine (KT) is a general anesthetic agent for human and animals in clinical practice and is pharmaceutically manufactured as a 1:1 racemic mixture of enantiomers (S-(+)-KT and R-(−)-KT). The metabolite of KT, norketamine (NK) shows pharmacological action, including an anesthetic potency about one-third of KT [1]. The most commonly used illicit drugs in Asian countries are opioids, amphetamine-type stimulants (ATS), cannabis, and KT [2]. KT has become one of the most commonly illegally used drugs around the world [1], [3], [4], [5], [6] and it is the third most used illicit drug in Taiwan and China in particular [2].

KT has mental side effects including psychedelic, psychotic features, and depressive symptoms, physical side effects including blurred vision, out-of-body experiences, and numbness [1], [7], [8], [9], [10], [11], and effects on organs including brain, kidney, and lung [7], [8], [12], [13], [14]. Also, KT has been reported to have genotoxicity [15], [16].

KT is a popular drug in clubs and pubs, and major users of KT are young people [3], [9], [17], [18], [19], [20], [21], [22]. Although it varies by country, common routes of administration are snorting followed by injection and oral ingestion [3], [5], [16], [17], [20], [21], [23], [24], [25]. To prevent people from abusing drugs and causing social problems, there are laws regulating the drug abuse including KT in many countries. For example, Korea regulates persons who use, possess, smuggle, and manufacture KT illegally [26], [27], [28] and U.S.A also regulates persons who have KT without permission [8].

In urine and hair analysis of KT, there are some pros and cons when GC/MS and LC/MS are used. Sample washing, instruments, columns, extraction methods, internal standards, the limits of detection (LOD) and quantification (LOQ) levels, metabolites, NK/K ratio, cut off values, and m/z values were compared through an in-depth literature reviews. Moreover, the concentrations of KT in the biological samples from both regular and non-regular abusers were described.

This review describes pharmacology and side effects of KT, the illegal use patterns of KT and regulated laws in some countries, the analytical methods from biological samples, and the concentrations of KT from regular and non-regular abusers.

Section snippets

Methods

Comprehensive literature search was conducted to determine the characteristics of KT including pharmacology of KT, differences in administration methods, use in combination with other drugs, side effects from KT abuse, toxicity, use pattern, common place of abuse, common ages of abuse, major administration method of KT abuse, related laws in many countries, analytical methods, range of LOD/LOQ for KT and NK, cut-off values for KT, and concentrations in biological samples from regular and

Why has KT become a recreational drug?

KT has an original purpose as an anesthetic but illegal KT users use KT because of its dissociative and hallucinogenic effects [6]. Although there are many drugs abused in Asia, KT abuse and related problems has been increased recently. Therefore, we focused on KT and tried to figure out the characteristics of KT in this review.

Recently, KT superseded originally used drugs in Asia countries such as China, Taiwan, and Vietnam. This seems to be related to the penalty. In particular, KT is

Conclusions

KT has become one of the most commonly used drugs around the world, particularly in China and Taiwan, where KT is the third most illegally used drug. The adverse effects of KT include mental and physical effects, as well as negative effects on some organs. KT is a popular drug in clubs and pubs, and the major users of KT are young people. Although there is a difference by country, the major administration method of KT is snorting. In many countries, there are laws that regulate its abuse.

Acknowledgments

This work was supported under the international cooperation program managed by the National Research Foundation of Korea (2014K2A1B8048584) and Priority Research Centers Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A6A1A03007648).

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Review ArticleIllegal use patterns, side effects, and analytical methods of ketamine

Highlights

Abstract

Graphical abstract

Introduction

Section snippets

Methods

Why has KT become a recreational drug?

Conclusions

Acknowledgments

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Anaesth. Crit. Care Pain Med.

Int. J. Drug Policy

Psychiatry Res.

Toxicol. Lett.

Biol. Psychiatry

Urol. Sci.

Urol. Sci.

J. Food Drug Anal.

Int. J. Drug Policy

Forensic Sci. Int.

Forensic Sci. Int.

Eur. Psychiatry

Drug Alcohol Depend.

Medicine

Neurosci. Lett.

Semin. Perinatol.

Drug Alcohol Depend.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

J. Chromatogr. A

J. Chromatogr. B

J. Chromatogr. B

J. Chromatogr. B

Forensic Sci. Int.

J. Chromatogr. A

Talanta

J. Forensic Leg. Med.

Forensic Sci. Int.

Br. J. Anaesth.

Review Article
Illegal use patterns, side effects, and analytical methods of ketamine