Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver, CO, USA.
Clin Toxicol (Phila). 2024 Aug;62(8):477-482. doi: 10.1080/15563650.2024.2380773. Epub 2024 Aug 2.
Recent decades have witnessed an extraordinary global crisis of drug misuse. Although opioid analgesics receive the most attention, numerous other drugs have increased rates of misuse.
Ketamine and esketamine offer a unique natural experiment to explore two medications that are similar pharmacologically but differ in their availability to users and in their regulation by government agencies.
Multisystem "mosaic" surveillance of many drugs using real-world data has emerged in recent years. Ketamine and esketamine have been monitored concurrently. Ketamine is much more widely available than esketamine and shows clear signs of increasing misuse and abuse. In contrast, esketamine is difficult to detect in postmarket surveillance even though availability is increasing.
Ketamine and esketamine offer insights regarding the safety of prescription medications with the potential for misuse. Since the pharmacology of ketamine and esketamine are similar, the regulatory apparatus may be the primary difference that limits misuse. Ketamine has few restrictions and can be prescribed or administered by many healthcare providers, and is available as an illicit drug. In contrast, the product labeling for esketamine has rigorous restrictions on its use. Many important issues remain to be addressed. We need a more rigorous evaluation of the natural experiment of ketamine and esketamine. How does this experience relate to the introduction of new psychedelics?
Ketamine misuse use and misuse are increasing while esketamine use in increasing, but misuse is not increasing. It is reasonable to reevaluate the regulatory controls on ketamine to reduce its misuse and abuse.
近几十年来，全球范围内药物滥用问题异常严峻。尽管阿片类镇痛药受到了最多的关注，但还有许多其他药物的滥用率也在上升。
氯胺酮和艾司氯胺酮为探索两种药理学上相似但在用户可及性和政府机构监管方面存在差异的药物提供了一个独特的自然实验。
近年来，利用真实世界数据对多种药物进行多系统“马赛克”监测的方法已经出现。氯胺酮和艾司氯胺酮同时得到了监测。氯胺酮的可及性远高于艾司氯胺酮，且明显有滥用和误用增加的迹象。相比之下，即使可用性在增加，艾司氯胺酮在上市后监测中也很难被发现。
氯胺酮和艾司氯胺酮为具有潜在滥用风险的处方药物的安全性提供了一些见解。由于氯胺酮和艾司氯胺酮的药理学相似，监管机制可能是限制滥用的主要区别。氯胺酮几乎没有限制，许多医疗保健提供者都可以开处方或给予氯胺酮，且氯胺酮也可作为非法药物使用。相比之下，艾司氯胺酮的产品标签对其使用有严格的限制。仍有许多重要问题有待解决。我们需要更严格地评估氯胺酮这一自然实验，了解其与新迷幻剂引入之间的关系。
氯胺酮的滥用和误用在增加，而艾司氯胺酮的使用量在增加，但误用没有增加。重新评估氯胺酮的监管控制以减少其滥用和误用是合理的。
