Yes, there is the possibility of dependence with the use of ketamine, especially if the person is using it regularly or using it in large doses without the guidance of a medical practitioner. The danger is associated with repeated use, the development of tolerance and alterations in mood and sensation in the absence of the drug. However, this is a different form of ketamine use than the one involving medical prescriptions. When used correctly with a health care professional, the amount and frequency of Ketamine administration is under control.
The Advisory Council on the Misuse of Drugs (ACMD) most recently reviewed the drug for the 2026 review, during which it was identified that people who use large amounts of ketamine regularly can become dependent on it and experience withdrawal symptoms. It also discovered its long-term use could impact the bladder, urinary passage, kidneys, liver and bile ducts.
Can ketamine cause dependence?
Ketamine may lead to dependence. This creates a sense of dependency that someone might begin to feel that they have to use the drug in order to be normal and that they may not be able to stop using the drug. The stronger association seems to be between dependence and the frequency and intensity of the use of the drug.
The ACMD states that for certain individuals, use of ketamine becomes problematic, characterised by tolerance, escalation in dosage, dependence, and withdrawal symptoms after stopping. It also claims that doses are relatively small and not likely to make one addicted after long-term use within recommended therapeutic limits.
It is not the case that all individuals who use ketamine will become dependent on it. People differ in risk, and risk is influenced by the amount and frequency of use of ketamine.
What tolerance means
Tolerance is when the same dose of a substance may be less effective over time. A person can then become tempted to use more to get those same effects.
Tolerance can be a factor with ketamine that can lead to further use and escalation of dose. An increase in tolerance is identified as a factor in problematic high dose use from the 2026 ACMD Review.
Even higher and more frequent exposures can lead to health problems and tolerance is important. Addiction isn’t the same as it is in itself. Tolerance may occur in someone who does not exhibit the full indicators of a substance disorder.
Signs use is becoming difficult to control
No definitive symptom of ketamine dependence is available. Some changes in behavior may indicate that use is becoming increasingly difficult to manage.
This can involve a tendency to use more than one wants or wants to, trouble stopping, thinking about ketamine regularly, and using it in spite of health, work, relationships or day-to-day issues. Cravings can also occur.
According to the NHS, addiction is when someone becomes unable to control their use of a substance or addictive behaviour to the extent that it is damaging. Assistance is not limited to those who are using drugs and have caused great harm to themselves.
Psychological vs physical dependence
There are psychological and physical dependencies associated with dependence, but this isn’t a shared experience for everyone.
Psychological dependence can involve cravings, strong urges to use ketamine or feeling that the drug is needed to cope with certain feelings or situations. Physical dependence is a change in the body that can result in symptoms when medication is discontinued.
These ideas are related; however, it does not necessarily mean the same thing as addiction. A person can have symptoms of withdrawal, but not all the symptoms of a substance use disorder.
This ketamine addiction evidence is still being built. The evidence available for management of ketamine dependence and withdrawal syndrome is still not adequately large and strong, the ACMD states.
What is known about withdrawal?
Addiction can happen when heavy use of ketamine ceases. The evidence review by the ACMD indicates symptoms could occur within approximately 24 hours for heavy users and usually last for a few days but some reported lasting longer. Symptoms may involve cravings, low mood, anxiety, restlessness, sweating, shaking, tiredness, loss of appetite and loss of sleep.
Other psychological effects can also occur, affecting some people with nightmares, paranoia and more. However, as with other drugs, there is no definitive treatment for withdrawal from any kind of use because the evidence related to the symptoms of a ketamine withdrawal is limited.
If someone is concerned about a change in their ketamine use, they can contact a GP for assistance or a drug treatment facility. Professional assistance can be helpful in determining both the physical and psychological health.
Health problems associated with frequent use
Regular ketamine use isn’t the only worry associated with using the drug. Serious urinary system problems have been linked to long-term use. Symptoms can include needing to urinate more often, urgency, pain when passing urine and blood in the urine. Patients can suffer significant damage to their bladder and urinary tract.
Ketamine is known to cause abdomen pain and liver/bile duct issues in chronic users as well. Some long-term effects may occur even after stopping using ketamine.
These risks are just one reason why it is important not to underestimate the possibility of developing dependency, even if the individual doesn’t feel that they have become dependent.
When to ask for help
Using ketamine may feel hard to resist, increasingly become a daily habit or create difficulties in daily life, and at that point, it is acceptable to seek assistance. Attention must also be given to any physical symptoms, particularly urination that is painful, persistent abdominal pain and blood in the urine.
A GP may be able to cover up the use of drugs without letting the rest of the healthcare team know and then arrange a referral to the right treatment. Individuals may also reach out to a drug treatment facility directly in England.
Being seeking help does not require someone to fit into a certain type of description. The goal is to understand what is going on, minimise harm and offer the appropriate care.
NHS drug treatment support
NHS drug treatment services can help someone who has the desire to decrease or stop taking drugs. In England, people can come forward or a GP can make a referral to a local drug treatment service.
Treatment will vary based on the individual and may involve talking therapies, support and help with any physical or mental health issues related to the treatment. There is also the possibility of a key worker who can help them throughout the treatment process.
Ketamine dependence is a health concern, not something for which to be embarrassed. Support at an early stage can help reduce additional health issues and facilitate a person’s ability to control their drug use.
References
https://pubmed.ncbi.nlm.nih.gov/40033594
https://www.nhs.uk/live-well/addiction-support/addiction-what-is-it
Evidence last checked: 23 September 2026
