Ketamine-Related Deaths Registered in Scotland 2013–2024

Background: Ketamine, a dissociative anaesthetic and non-competitive NMDA receptor antagonist, has legitimate medical applications. However, rising illicit use across the United Kingdom (UK) has been accompanied by growing reports of toxicity, dependence, and deaths. These have led to renewed policy discussions. Rationale and Aim: Previous national studies have reported ketamine-related deaths elsewhere in the UK, but not in Scotland. This study examined all Scottish deaths (2013–2024) where ketamine was implicated, to provide a comprehensive evidence base for UK-wide policy discussions. Methods: Data were derived from anonymised National Records of Scotland records. All cases where ketamine was implicated in death were identified. Descriptive and comparative analyses were undertaken by year, sex, age, manner, and substances co-implicated. Results: Eighty-eight deaths were identified (≈0.5% of cases), with a steady increase over time. Most decedents were male (81.8%); mean age was 35 years. Most (84%) were accidental and involved polysubstance use—typically opioids (58%), stimulants (55%), benzodiazepines (48%), gabapentinoids (25%), and alcohol (22%). Acute drug use was the principal cause of death in 85% of cases. Discussion: The marked upward trend parallels that observed elsewhere in the UK. Polysubstance involvement, especially combinations of ketamine with opioids or benzodiazepines, substantially increases fatal risk through additive central nervous system depression. These findings reinforce the need for clearer public health messaging, targeted harm-reduction interventions, and careful monitoring of misuse, prescribing and diversion trends. Conclusions: Scottish ketamine-related deaths increased twentyfold in a decade. Most are preventable, highlighting the need for continued targeted education, intervention, and epidemiological monitoring.