Ketamine and etomidate in vaping devices: a case series based on social media reports

Dear Sir, ‘Kpods’ and ‘space oil’ have caused growing concern due to their severe health risks and rising use among youths. While Kpods may appear similar to normal nicotine vapes, there are distinctions to be made. Kpods contain etomidate or ketamine (anaesthetic agents) in unknown concentrations, which can cause life-threatening respiratory depression and neuropsychiatric effects. Kpods are more expensive than nicotine vapes, typically costing SGD 50–100 instead of the usual SGD 10–70.[1] While nicotine vapes have been gaining worldwide traction and Western countries such as the United Kingdom are dealing with increased use of fentanyl and ‘spice’ (synthetic cannabinoid) vapes, Kpods have been trending particularly in Singapore and Hong Kong. While epidemiological studies on the effects of Kpods remain limited, social media platforms and news articles have become repositories for anecdotal accounts. We identified 22 cases of Kpods usage through a cross-sectional search across multiple social media platforms (Google, Instagram, TikTok, YouTube, Reddit, X) between 18 and 23 July 2025 [Table S1, Supplemental Digital Appendix at https://links.lww.com/SGMJ/A254]. Inclusion criteria were first- or second-hand accounts of Kpods usage. The popularity of Kpods is multifaceted. Buyers often lack awareness of the serious health risks posed by Kpods[2] and are attracted to the transient euphoria that Kpods provide, offering temporary respite from stressors.[3] This is exacerbated by its ease of access via unregulated Telegram groups[4] and the scheming tactics employed by sellers touting that etomidate and ketamine are undetectable in standard urine drug tests.[1] The side effects of Kpods can be both physical and psychological, with the most common being an unsteady ‘zombie-like’ gait and emotional dysregulation, respectively. Severe outcomes include suicide attempts and even death. It is worth noting that Kpods also affect other aspects of users’ life, including school, work and family. Several users described addiction developing within months, escalating from occasional use to daily dependence. Some experienced withdrawal symptoms such as intense body pain and psychological cravings when attempting to taper their usage, making it difficult to quit completely. Alarmingly, our results revealed that a significant proportion of Kpods users were youths (16 out of 22 cases [72.7%]; age 15–35 years), with students as young as 12 experimenting with Kpods,[1] highlighting the easy accessibility of Kpods. Parental vigilance, strong social media anti-vaping campaigns, comprehensive school-based education and increased enforcement are important. Plagued by the Kpods epidemic, Hong Kong has implemented strict measures, including a week-long ‘anti-space oil’ campaign in all schools, frequent patrols using rapid test kits for etomidate and intelligence-driven online crackdowns.[3] Given the disastrous effects that Kpods have on one’s life and their rising usage, especially among youths, timely intervention by policymakers is essential. Financial support and sponsorship Nil. Conflicts of interest See KC is a member of the SMJ Editorial Board and was thus not involved in the peer review or publication decisions of this article.