In the last decade, the illicit market of ketamine has expanded outside of East and South-East Asia where it was previously concentrated.

• In mid to late 2010s, several countries with time-series data (for example, the United Kingdom, Australia, or the general population of the United States) have recorded an increase of prevalence of use of the substance at the level of the general population.
• Highest levels of ketamine residues in wastewater have been detected in North America and several countries of Western and Central Europe.
• Data on waste-water analysis in selected cities in Western and Central Europe suggest an increase in ketamine consumption, in particular between 2024 and 2025.
• At the same time, there is evidence of increasing ketamine harms in Western and Central Europe with growing requests for drug-related treatment due to ketamine as a primary drug of the persons who use drugs, though these remain relatively low in number compared to most controlled drugs.