Ketamine-related deaths registered in Scotland 2013-2024

Ketamine, a dissociative anaesthetic and non-competitive NMDA receptor antagonist, has legitimate medical applications. However, rising illicit use across the United Kingdom (UK) has been accompanied by growing reports of toxicity, dependence, and deaths. These have led to renewed policy discussions. Previous national studies have reported ketamine-related deaths elsewhere in the UK, but not in Scotland. This study examined all Scottish deaths (2013-2024) where ketamine was implicated, to provide a comprehensive evidence base for UK-wide policy discussions. Data were derived from anonymised National Records of Scotland records. All cases where ketamine was implicated in death were identified. Descriptive and comparative analyses were undertaken by year, sex, age, manner, and substances co-implicated. Less than one hundred deaths were registered during this period, and represented a very small proportion of all drug-poising deaths. There was a steady increase over time. Most decedents were male; the average age was the mid-30s. Most deaths were accidental and involved polysubstance use - typically opioids, stimulants, benzodiazepines, gabapentinoids, and alcohol. In most cases, acute drug use was the principal cause of death. The marked upward trend parallels that observed elsewhere in the UK. Polysubstance involvement, especially combinations of ketamine with opioids or benzodiazepines, substantially increases fatal risk through additive central nervous system depression. These findings reinforce the need for clearer public health messaging, targeted harm-reduction interventions, and careful monitoring of misuse, prescribing and diversion trends. Scottish ketamine-related deaths increased twentyfold in a decade. Most are preventable, highlighting the need for continued targeted education, intervention, and epidemiological monitoring.