Ketamine produced legitimately outside the EU to make medicines is increasingly finding its way onto Europe’s illicit drug market, according to a new report published today by the EU Drugs Agency (EUDA). The study, Ketamine in Europe, provides the first comprehensive multi-country intelligence picture of how organised criminal networks are exploiting legitimate pharmaceutical supply chains in Europe and the implications this may have for public health and law enforcement. The report was produced within the framework of the European Multidisciplinary Platform Against Criminal Threats (EMPACT), following concerns raised by EU Member States.
Ketamine is an essential medicine, listed by the World Health Organization (WHO) as indispensable for anaesthesia and pain relief, as well as a psychoactive substance increasingly present on European illicit drug markets. As the drug is not subject to international control, systematic reporting on health and supply indicators is not required in most jurisdictions, creating monitoring blind spots.
Led by Belgium and supported by Germany and the EUDA, the analysis brought together intelligence and data from 32 countries. These contributions were complemented by information from the European Medicines Agency (EMA) and the EUDA’s health and supply monitoring systems, creating a consolidated evidence base to support situational awareness and clarify the current policy challenges.
The findings suggest that increases in imports and seizures of ketamine in Europe are unlikely to be associated with medical and veterinary use, which has been relatively stable in Europe for at least a decade. Ketamine availability on the illicit market appears to be driven by the criminal exploitation of structural vulnerabilities in a fragmented regulatory landscape, which appears to be driving supply. This results in significant profits for organised crime networks, as well as growing public health harms, particularly in those who consume frequently or in high quantities.
Stable legitimate medical demand but a growing illicit market
In 2024, authorities across Europe intercepted at least 3.5 tonnes of ketamine, a large increase from the quantity reported in 2016 (200 kg). Over the same period, a targeted study by the EMA found no major fluctuations in hospital prescribing or primary care use of ketamine across six major European healthcare systems. This suggests that the growing availability of ketamine on the illicit market in Europe is unlikely to be explained by the diversion of finished medical or veterinary products. Instead, it appears to stem largely from legitimate large-scale pharmaceutical production, primarily in India, which is diverted into illicit channels after legitimate importation in Europe.
Companies in Germany appear to play an important role as a major legitimate importer of ketamine into the EU, while criminal groups in the Netherlands have emerged as key distributors in the illicit market. This is reflected in the large quantities seized and from the analysis of illicit wholesale prices, which indicate increased availability. No evidence of significant clandestine production in Europe was found, beyond a few ketamine crystallisation sites.
The imported diverted ketamine supplies illicit markets within Europe, but a significant share is also subsequently redistributed to destinations outside the region (e.g. Australia, Canada, New Zealand, the United States and some countries in Asia). Trafficking operations are international, adaptive and typically embedded within broader multi-drug networks. Ketamine is regularly transported and stored alongside other drugs (e.g. cocaine or synthetic drugs), sharing infrastructure and sometimes overlapping consumer markets. Digital marketplaces, encrypted communication platforms and cryptocurrencies also appear to be facilitating distribution.
Rising harms in specific settings
Non-medical ketamine use remains relatively low in the general population in most European countries, compared with other illicit drugs, but harms associated with the substance are increasingly seen within certain sub-populations. Evidence from nightlife environments and youth settings indicates that ketamine has become more established among some groups, often in combination with other substances. In some countries, particularly the United Kingdom, there are signs that use among younger age groups, including school-aged children, may be emerging as a significant health concern.
The report notes that treatment demand linked to ketamine use is rising in several countries, with chronic urological and psychological harms increasingly reported among heavy users. As a result, some countries have established specialised clinics to treat urologic complications associated with long-term use, including severe ulcerative cystitis and lasting bladder dysfunction.
The way forward
Despite these strong signals, significant gaps in evidence remain. Regulatory fragmentation creates data gaps which limit a full understanding of the situation, as well as enforcement and judicial gaps that trafficking networks are well positioned to exploit.
The report calls for stronger cooperation between medicines regulators, public health authorities and law enforcement agencies at national and European level to better identify vulnerabilities in supply chains and to respond more quickly when risks emerge.
The analysis underlines the importance of combining supply-side measures with public health responses, including prevention efforts aimed at young people and improved monitoring of ketamine-related harms. It further recommends strengthening forensic and analytical capabilities, including advanced profiling techniques, that could help distinguish between diverted pharmaceutical products and illicitly produced substances.
Taken together, the report’s findings point to a complex challenge. Ketamine is an essential medicine with important clinical uses, yet weaknesses in regulatory and supply chain environments are creating opportunities for criminal exploitation in Europe, which are resulting in serious public health harms. Strengthening monitoring, improving cooperation and closing key information gaps will be important steps in ensuring that emerging risks linked to ketamine can be identified and addressed at an early stage, while safeguarding its legitimate medical use.
