Ketamine has long been recognised as a vital medicine, listed on the World Health Organization’s (WHO) essential medicines list and widely used in anaesthesia, emergency care and veterinary practice. But a landmark report published in March 2026 by the European Union Drugs Agency (EUDA) paints a more troubling picture of how this substance is increasingly being misused across the continent.

The EMPACT situation report, compiled with contributions from 32 countries, reveals that ketamine use in Europe is expanding in ways that cannot be explained by legitimate medical demand alone. The findings warrant serious attention from anyone concerned about the wellbeing of young people and communities.

The Gap Between Medical Need and Rising Imports

One of the report’s most striking revelations is the disconnect between stable medical demand and sharply rising imports. According to data gathered by the European Medicines Agency (EMA) across six major healthcare systems between 2014 and 2023, legitimate hospital prescribing of ketamine has remained consistently low, with no major fluctuations over the decade.

Yet ketamine seizures across EU Member States have surged dramatically, reaching at least 3.5 tonnes in 2024 alone, up from under 200 kg in 2016. The number of individual seizures rose to more than 8,000 in 2024, a figure that was practically negligible just a few years before.

Put simply: the supply arriving in Europe far exceeds what medicine and veterinary practice require.

Who Is Using Ketamine, and Where?

Non-medical ketamine use in Europe remains relatively low across the general population, but the picture within specific groups is more concerning. The report consistently finds use concentrated among young adults, particularly those involved in nightlife and recreational settings, where it is often taken alongside alcohol or other substances.

In the Netherlands, last-year use among young adults reached slightly over 3%, while in the United Kingdom, ketamine use among young adults more than tripled between 2006 and 2023. Wastewater analysis across 82 European cities confirmed that ketamine residues peak at weekends, reflecting its predominant role in recreational environments.

Perhaps most worrying is the trend emerging in the United Kingdom, where use is increasingly visible among school-aged children as young as 11. Some young people perceive ketamine as a cheaper and apparently safer alternative to other substances, a misconception that carries real and lasting consequences.

The Health Risks of Non-Medical Ketamine Use

The health consequences of non-medical ketamine use are serious and, in some cases, irreversible. Ketamine is associated with a range of acute harms including disorientation, impaired motor control, and acute psychological distress. When used alongside alcohol, cocaine, MDMA or opioids, the risks increase significantly.

Chronic use carries particularly damaging effects on the urinary system. Long-term exposure can cause severe bladder damage, including ketamine-induced cystitis, kidney injury and conditions requiring repeated surgical intervention. These complications can lead to lifelong disability. A troubling feature of these harms is that the drug’s anaesthetic properties can mask symptoms, meaning users may seek treatment only when damage is already severe.

Treatment demand tells its own story. Across Belgium, Germany, Italy, the Netherlands, Spain and France, the number of people entering specialist drug treatment for ketamine-related problems rose from 289 in 2018 to an estimated 1,329 in 2023. In the United Kingdom, demand for such treatment more than doubled in just two years, from 512 in 2021 to 1,201 in 2023.

Some countries have now established specialist clinics specifically to manage urological complications linked to ketamine use.

How Illicit Ketamine Reaches European Markets

Understanding where illicit ketamine comes from matters, because it shapes how the problem can be addressed. The EUDA report is clear: clandestine production within Europe is minimal. Unlike parts of South-East Asia, where large-scale illegal ketamine laboratories have been identified, illicit production sites found in Europe are almost entirely limited to crystallisation operations, where imported powder is converted into saleable forms.

The primary source of illicit ketamine circulating in Europe is diversion from legitimate supply chains. India is identified as the main production origin, with one manufacturer, Supriya Lifescience Ltd, producing an estimated 150 to 200 tonnes of racemic ketamine annually. Germany is the principal declared point of entry for ketamine into the EU, and the Netherlands has emerged as a key redistribution hub, with wholesale prices there dropping significantly from EUR 5,325 per kilogram in 2020 to EUR 1,605 by 2024, a clear indicator of increased availability.

A 2022 to 2023 Dutch law enforcement case illustrates the scale of the problem. A transnational criminal network transported 2,372 kg of ketamine from German pharmaceutical suppliers into the Netherlands across five shipments in just three months, using escort vehicles, encrypted communications, and concealment tactics to avoid detection.

A Patchwork of Laws Creating Gaps

Ketamine is not subject to international drug control, and within Europe, national approaches vary considerably. Some countries schedule it as a narcotic under drug law; others treat it under new psychoactive substance legislation or medicines law. A minority have minimal controls at all.

This fragmentation creates real problems. Traffickers can exploit inconsistencies between neighbouring countries, and cases have sometimes had to be pursued under medicines or economic crime legislation rather than drug law, resulting in lighter penalties. The report notes that ketamine trafficking networks are increasingly integrated with broader multi-drug criminal operations involving cocaine, MDMA and amphetamines.

Why Prevention Must Be a Priority

The report’s conclusions are clear: without coordinated action, the situation is likely to worsen. The harms being seen today are partly the result of supply-side changes from earlier years, and the trajectory points upward.

Targeted prevention efforts are urgently needed, particularly for young people, students and those in nightlife environments where ketamine use is becoming more established. Raising awareness of the genuine health risks associated with non-medical ketamine use, including the very real and often irreversible urological damage, is essential.

Clinical services also need greater awareness. Many cases of ketamine-related bladder damage go undiagnosed for extended periods because neither patients nor healthcare providers connect the symptoms with drug use. Earlier identification and intervention can meaningfully reduce long-term harm.

Ketamine use in Europe is no longer a niche concern. The evidence from this report shows a substance becoming more available, more frequently misused, and more damaging to those caught up in patterns of regular use. Addressing it requires honesty about what the data shows, and commitment to reaching those most at risk before the harm becomes irreversible.

Source: dbrecoveryresources