Ketamine is a dissociative anesthetic used in veterinary and human medicine since the 1970s. Its clinical use has expanded to control of seizures, by 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 by EMS. 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 and 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/3,4-methylenedioxymethamphetamine (15%). In 2019, 2-fluoro-deschloroketamine 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.

中文翻译：

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纽约市司机中氯胺酮的流行率增加，包括 2-氟代去氯氯胺酮的鉴定

自 1970 年代以来，氯胺酮是一种用于兽医和人类医学的解离性麻醉剂。它的临床应用已扩展到通过院前紧急医疗服务 (EMS) 控制癫痫发作，并正在寻找作为镇痛替代品和抗抑郁药的新用途。氯胺酮为在没有阿片类药物和减少自杀念头的情况下有效管理慢性疼痛带来了希望；然而，由于其致幻特性，它作为一种娱乐性药物的持久性仍然存在。随着医药用途的扩大，人们探索了纽约市人口的多样性，以更好地了解其滥用情况。这项回顾性研究调查了 18 年（2003-2020 年）期间氯胺酮在驾驶员死亡中的流行情况，以及 6 年（2015-2020 年）期间涉及在药物影响下疑似驾驶 (DUID) 的案件。在 6 起司机死亡事故和 47 起 DUID 案例中发现了氯胺酮。由于在医院或 EMS 的管理，没有一名司机死亡被怀疑与氯胺酮滥用有关。在 DUID 病例中，在 6 年的研究期间观察到了增加的趋势，其中 100% (n = 47) 的病例被确认为非医院/非 EMS 施用的氯胺酮。在 DUID 病例中，94% 为男性，大多数年龄在 21 至 39 岁之间（85%），主要是西班牙裔（36%）和亚洲人（34%）。氯胺酮的血液浓度范围为 27 至＞2000 ng/mL，多药使用普遍。除氯胺酮外，检测到的最常见药物类别是大麻素（38%）、乙醇（32%）、苯二氮卓类药物（26%）、可卡因（19%）和苯丙胺/3,4-亚甲二氧基甲基苯丙胺（15%）。2019年，首次在两例病例中鉴定出2-氟去氯氯胺酮。尽管氯胺酮对精神疾病的接受度越来越高，但氯胺酮作为一种娱乐性药物的持久性和滥用仍然存在，并且应继续受到相关毒理学、临床和执法界以及新兴的非法氯胺酮类似物的监测。