The illicit ketamine market has expanded beyond Asia, with rising use and emerging harms in new regions.

• Once concentrated in East and South-East Asia, several countries with time-series data (for example, the United Kingdom, Australia or the United States) have recorded an increase in the use of the substance at the level of the general population over the past decade.
• The highest levels of ketamine residues in wastewater have been detected in North America and several countries of Western and Central Europe. Data from 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, including more people entering treatment with ketamine as their primary drug, although overall treatment numbers remain relatively low compared with other substances.