Mis-anaesthetized society: expectancies and recreational use of ketamine in Taiwan

Abstract

Background The popularity of ketamine for recreational use has been increasing in Asia, including Taiwan. Still, little known about the pattern of ketamine expectancies and whether such patterns are related to ketamine use. This study aimed to examine whether the positive and negative ketamine expectancies are differentially associated with ketamine-using behavior, and whether such relationship may differ by early-onset use of tobacco or alcohol. Methods Participants were recruited using respondent-driven sampling (RDS) among regular tobacco and alcohol users, aged 18 to 50, residing in Taipei from 2007 to 2010. Totally 1115 participants (with an age distribution skewed to the right, median = 26; interquartile range: 22–32) had information on substance use and completed a 12-item ketamine expectancies questionnaire (with 6 positive and 6 negative statements). Using two axes of High and Low expectancies, the four combinations of binary positive and binary negative ketamine expectancies were created. Each participant’s drug-using experience was categorized into illicit drug naïve, exclusive ketamine use, polydrug ketamine use, or other illicit drug use. Using the weights in the network output by RDS Analysis Tool, multivariable logistic regression analysis was then conducted. Results The weighted prevalence was 2.4% for exclusive ketamine use, 9.0% for polydrug ketamine use, and 9.1% for the other illicit drug use. Ketamine users (11.4%) had greater positive expectancies and lower negative expectancies, particularly the combination of High Positive with Low Negative, as compared to the illicit drug-naïve or other illicit drug users. After adjustment for early-onset tobacco (or alcohol) use and sociodemographic characteristics, High Positive, Low Negative, and their combination of High Positive-Low Negative expectancies remained strongly associated with ketamine uses, without evidence of moderation from early-onset use of tobacco or alcohol. Conclusions Positive and negative ketamine expectancies were associated in opposite directions with ketamine use, independent of early-onset use of tobacco or alcohol. Our results indicate ketamine expectancies as possible targets for future intervention and prevention of ketamine use, with a less confrontational feedback on decreasing an individual’s positive expectancies is essential in preventing young people from the initiation of ketamine use.

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“…This discrepancy might be partly accounted for by the observed increased risk of unnatural causes of death such as suicide, traffic accidents and overdose, particularly for females. Our findings may thus be incorporated into relevant educational material that can help to decrease drug users' positive expectancies and enhance their negative expectancies, as indicated in a recent study [36].…”

“…Taiwan has witnessed a rapid increase in recreational ketamine use since the early 2000s, as revealed by adolescents surveyed in 2002 via street outreach (4.6 and 7.3% among adolescents with truancy aged 12-15 and 16-18 years, respectively) [33], school-attending adolescents in national surveys from 2004 to 2006 (the second most commonly used illicit drug, with a life-time prevalence of 1.13% in 2004, 0.61% in 2005 and 0.44% in 2006 among high school students) [34] and alcohol-and tobacco-using young adults recruited via social networks from 2007 to 2010 (the most commonly used illicit drug, with a life-time prevalence of 11.74%) [35,36]. Meanwhile, the life-time prevalence of ketamine use among people aged 12-64 in the national survey increased from 0.24% in 2005 [37] to 0.47% in 2009 [38], and then decreased to 0.39% in 2014 [39].…”

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“…Lately, ketamine has also been used as an anti-depressant and for the treatment of refractory status epilepticus [ 4 , 6 ]. Recently, ketamine has been used as a recreational and dissociative drug in places including the USA, Europe, and Asia [ 4 , 7 ]. Ketamine abuse can induce ulcerative cystitis without bacterial infection.…”

“…Toxics 2021, 9, 154 2 of 10 as a recreational and dissociative drug in places including the USA, Europe, and Asia [4,7]. Ketamine abuse can induce ulcerative cystitis without bacterial infection.…”

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“…In Taiwan, the pattern of illicit drug use underwent drastic changes in 1990s, starting with methamphetamine’s surge during this period to the upgrading of ecstasy to Schedule II controlled drugs in 1999 [ 28 ]. An increasing popularity of ketamine, ecstasy, and marijuana has been consistently found among school-attending adolescents in national surveys from 2004 to 2006 [ 29 ], as well as among alcohol- and tobacco-using young adults recruited via social network from 2007 to 2010 [ 30 , 31 ]. The most recent 2014 national survey in Taiwan found that the prevalence estimates of club (or party) drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin), and that club drug users were different from hard drug users in socio-behavioral correlates and psychosocial distress [ 32 ].…”