Characteristics and circumstances of death related to the self-administration of ketamine.

BACKGROUND AND AIMS Ketamine is used for anaesthesia, sedation and the treatment of mood disorders, but also widely used for non-medical purposes. This study aimed to: 1. determine the characteristics and circumstances of all recorded cases of self-administered ketamine-related death in Australia, 2000-2019 and 2. determine the toxicology and major organ pathology of cases. DESIGN Retrospective study of all Australian cases in which self-administered ketamine was a mechanism contributory to death, retrieved from the National Coronial Information System. SETTING Australia-wide CASES: 68 cases, with a mean age of 35.2 years (SD 11.5, range 16-63) and 76.5% male. MEASUREMENTS Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology. FINDINGS Death was attributed to toxicity in 82.3% of cases (accidental 58.8%, deliberate 23.5%), suicide by violent means (8.8%) and traumatic accident (8.8%). In six cases the decedent had been prescribed ketamine. In 32.4% the final route of ketamine administration was by injection. The fatal incident predominately occurred in a private environment (72.1%). Ketamine was present in the blood of 90.1%, being detected in other biomarkers in 9.9%. The median blood ketamine concentration was 0.2 mg/L (0.02-6.9mg/L). Other drugs were detected in 95.5% of cases: opioids (59.1%), hypnosedatives (57.6%), psychostimulants (50.0%), alcohol (27.3%), Δ-9-THC (18.2%), antidepressants (28.8%), antipsychotics (9.1%). Pulmonary oedema was present in 82.2% of cases that underwent autopsy and pneumonia in 26.7%. CONCLUSIONS The typical case of self-administered ketamine-related death in Australia, 2000-2019, was a male in his mid-thirties who had used multiple drugs, with the fatal incident most commonly occurring in a private setting. Death due to accidental drug toxicity was the most common manner of death, but suicide was highly prevalent.