Ketamine use is underreported -- likely due to unknown exposure -- among EDM partygoers

January 30, 2020

Nearly 37 percent of electronic dance music (EDM) party attendees test positive for ketamine use when samples of their hair are tested--despite only 14.6 percent disclosing that they have used the drug in the past year.

The study--published in the Journal of General Internal Medicine--suggests that ketamine use is extensively underreported and EDM party attendees may be unintentionally exposed to the drug.

Individuals who frequent EDM parties report higher levels of recreational drug use compared to the general population. They are also at high risk for unknown exposure to drugs, which occurs when drugs such as ecstasy (also known as MDMA and Molly) are adulterated with other substances. However, little is known about how ketamine is intentionally or unintentionally used in this population.

Ketamine is a dissociative anesthetic that has long been used in operating rooms and was approved by the FDA in 2019 as a fast-acting treatment for depression delivered as a nasal spray. It also has a long history as a club drug (known as Special K), recreationally used for producing feelings of detachment and hallucinations.

To better understand ketamine use in this high-risk scene, in 2019, the researchers surveyed hundreds of adults entering EDM parties in New York City about their past-year drug use. In addition, 216 participants provided hair samples, which were analyzed to detect drug use in the past 12 months using ultra-high performance liquid chromatography-tandem mass spectrometry.

While 14.6 percent of EDM party attendees reported using ketamine in the past year, hair analyses revealed that 36.7 percent tested positive for any level of ketamine. This suggests that, when taking into consideration both self-reported use and hair testing, the prevalence of ketamine use is closer to 40.6 percent among EDM party attendees--2.8 times higher than self-reported use.

"Intentional underreporting of drug use is common, but the underreporting we found here is higher than expected, considering that many party attendees reported use of other synthetic drugs," said Joseph Palamar, PhD, MPH, an associate professor of population health at NYU Grossman School of Medicine, an affiliated researcher with the Center for Drug Use and HIV/HCV Research at NYU School of Global Public Health, and the study's lead author. "Since it is unlikely that someone would disclose the use of drugs such as ecstasy and intentionally not report using ketamine, we believe many cases of positive detection may be due to unknown exposure through the use of adulterated drugs."

In further analyses, testing positive for ketamine after not reporting using the drug was associated with biologically confirmed exposure to MDMA. "Ecstasy has a long history of being adulterated with other drugs--including ketamine--but people who use ecstasy or other synthetic drugs may now be at an even higher likelihood of being exposed to ketamine without realizing it," said Palamar. "While ketamine is by no means the most dangerous drug, accidentally being exposed to the drug can lead to a pretty unpleasant dissociative experience."

The authors note that more research on both intentional and unintentional ketamine use is warranted.

"In addition, we feel it is important to determine whether extensive media coverage about ketamine's ability to treat depression influences recreational use," said Palamar.
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In addition to Palamar, study authors include Alberto Salomone of Università di Torino and Centro Regionale Antidoping e di Tossicologia in Italy as well as Caroline Rutherford and Katherine M. Keyes of Columbia University Mailman School of Public Health. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (R01DA044207 and K01DA038800).

About CDUHR

The mission of the Center for Drug Use and HIV/HCV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the NYU School of Global Public Health. For more information, visit http://www.cduhr.org.

About NYU Langone Health

NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. Included in the 200+ locations throughout the New York area are five inpatient locations: Tisch Hospital, its flagship acute-care facility; Rusk Rehabilitation, ranked as one of the top 10 rehabilitation programs in the country; NYU Langone Orthopedic Hospital, a dedicated inpatient orthopedic hospital with all musculoskeletal specialties ranked top 10 in the country; Hassenfeld Children's Hospital at NYU Langone, a comprehensive pediatric hospital supporting a full array of children's health services; and NYU Langone Hospital--Brooklyn, a full-service teaching hospital and level 1 trauma center located in Sunset Park, Brooklyn. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute-designated cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. For more information, go to nyulangone.org, and interact with us on Facebook, Twitter, YouTube, and Instagram.

About NYU School of Global Public Health

At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/

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