Increasing Prevalence of Ketamine in Drivers in New York City Including the Identification of 2-Fluoro-Deschloroketamine

Abstract

Ketamine is a dissociative anesthetic used in veterinary and human medicine since the 1970s. Its clinical use has expanded to control of seizures, pre-hospital emergency medical services (EMS), and is finding new purpose as an analgesic alternative and antidepressant. Ketamine brings hope for effective management of chronic pain in the absence of opioids, and decreasing suicidal ideations, however, its persistence as a recreational drug for its hallucinogenic properties remains. In the wake of expanding medicinal purposes, the diversity of New York City’s population was explored to better understand its misuse. This retrospective study looks at the prevalence of ketamine in driver fatalities over a period of 18 years (2003–2020) and cases involving suspected driving under the influence of drugs (DUID) over a period of 6 years (2015–2020). Ketamine was identified in 6 driver fatalities and in 47 DUID cases. None of the driver fatalities were suspected of ketamine misuse, due to administration either in hospital or EMS administration. In the DUID cases, an increasing trend was observed over the 6-year study period with 100% (N = 47) of the cases confirmed as non-hospital/non-EMS administered ketamine. Of the DUID cases, 94% were male, with the majority between the age of 21–39 years (85%) and were predominantly Hispanic (36%) and Asian (34%). Blood concentrations of ketamine ranged from 27 to > 2000 ng/mL with polydrug use prevalent. The most common drug classes detected in addition to ketamine were cannabinoids (38%), ethanol (32%), benzodiazepines (26%), cocaine (19%), and amphetamines/MDMA (15%). In 2019, 2-fluoro-deschloroketamine (2F-DCK) was identified in two cases for the first time. Despite its increased acceptance for mental health disorders, ketamine’s persistence and misuse as a recreational drug remains and should continue to be monitored by relevant toxicological, clinical, and law enforcement communities along with emerging illicit ketamine analogs.

Metabolite elucidation of 2‐fluoro‐deschloroketamine (2F‐DCK) using molecular networking across three complementary in vitro and in vivo models

“…A ketamine analogue called ‘2‐fluoro‐deschloroketamine’, ‘2F‐DCK’, or ‘2FK’, was recently identified 2–7 . A large retrospective study in New York City between 2003 and 2020 showed an increase in traffic fatalities related to ketamine and derivative use, including 2F‐DCK 8 . 2F‐DCK emerged especially in Asian countries where a recent study showed the extent of ketamine and 2F‐DCK consumption through their quantification in wastewater from large Chinese cities 9 …”

Polydrug Definition and Assessment: The State of the Art

“…Finally, the interest in polydrug use has translated into the use of new forms of assessment beyond self-reports, blood analyses [ 50 ] and urine tests [ 51 ], such as analysing the content of used syringes [ 52 ], the toxicological analysis of post-mortem specimens [ 53 ], hair analysis [ 54 ], evaluation of latent fingerprints [ 55 ], oral fluid analysis [ 56 ], social media data analysis [ 57 ], the literal test analysis of polydrug overdose death (from death certificate data) [ 58 ] and trace residue sampling strategies (analysis of discarded drug packaging samples) [ 59 ].…”

Detection of fentanyl, synthetic opioids, and ketamine in hair specimens from purposive samples of American and Italian populations

“…It is noteworthy that the frequent use of amphetamine/methamphetamine/MDMA as a whole was observed in 26 segments (31.3%), of which 14 tested positive also to cocaine. City area [36,37]. Correlation matrices for the measured levels of common drugs in the Italian population of hair samples are presented in Figure 1.…”