Medical examiners have seen an increase in ketamine-involved deaths in South Florida this year.
In the first half of 2025, ketamine was present in 33 deaths in Miami-Dade County, according to toxicology reports.
"We first started noticing that there's a lot of ketamine in our cases that also involve other drugs," said Diane Moore, director of toxicology at the Miami-Dade Medical Examiner Department.
"I'm like 'there's ketamine again, there's ketamine again,' and I'm reading the history and there's a pending toxicology case for a drug overdose. It kind of clues us in that it's something we should be paying attention to and tracking," she added.
This year's numbers follow a national increase of ketamine deaths over the past couple of years, Moore said. Up until 2017, ketamine was identified in fewer than 10 cases per year. In 2023, there were 68 cases.
Ketamine is a safe and effective anesthetic when used in a hospital or clinic setting, said Dr. Bruce Goldberger, a clinical professor at the University of Florida College of Medicine.
Under supervision, ketamine is given by intramuscular injection or intravenously. A ketamine nasal spray also has become a popular approved treatment for medication-resistant depression and post-traumatic stress disorder.
Moore said she's been told ketamine spray is sometimes passed around in the clubs in Miami-Dade. Illicit forms of ketamine, most often mixed with MDMA (known as ecstasy) also are popular.
"South Florida is part of the party scene, and ketamine and MDMA are an element of the party scene," Goldberger said.
Ketamine, originally developed in the 1960s, depresses the central nervous system, which can cause circulatory and respiratory distress if an overdose occurs. Ketamine overdoses cannot be reversed by naloxone, an opioid-overdose reversal drug.
"Ketamine is generally a very safe medication if its use is supervised by a physician, but it does have a high potential for misuse and can lead to death," Goldberger said.
Becca Smith, an outreach worker with the Florida Harm Reduction Collective in Polk County, said she's seen an increase in illicit and prescription use of ketamine.
For a long time, ketamine was considered an upper-class party drug, Smith said. But the overdose death of Matthew Perry and Elon Musk's openness about taking prescription ketamine for depression have thrust the drug into the spotlight.
"We are running into supplies with fentanyl and heroin that also have ketamine in them," Smith said. "Anything you can add to your supply that has a tranquilizing effect will make it stretch further."
She noticed ketamine use started to pick up in Polk County among the opioid drug users she helps within the last three to four months.
"We keep seeing tolerance build up, and the market keeps looking for more things to put in the dope to get the achieved effect," Smith said.
Smith couldn't say if ketamine was replacing the non-opioid sedative called xylazine, also known as tranq, in the supply.
Mostly seen on the East Coast in places like Philadelphia, xylazine was created to be used in veterinary offices as a sedative. In people, the drug can cause hours-long blackouts and necrosis of the skin, which can lead to amputation.
In Florida in 2023, xylazine was present in 550 overdose deaths, a 17% increase over the year before, and was the cause of 340 overdose deaths, a 27% increase over the previous year, state records show.
"Drug trends shift consistently; we can count on that. But we can't often predict what will happen in the near future," Goldberger said.
Smith said a growing number of people have started using their friend's ketamine's prescriptions or are buying prescription ketamine on the street. It's attracted a different group of people that don't have experience with any drugs.
"They have no idea what they're getting into," Smith said. "They don't know enough to know that what they're feeling is dangerous."
Ana Goñi-Lessan, state watchdog reporter for the USA TODAY Network - Florida, can be reached at [email protected].