In brief
- On July 8, 2026, the French National Agency for the Safety of Medicines (ANSM) published two guides on long-term ketamine treatment: one for healthcare professionals and another for patients and caregivers.
- New analgesic indications authorized in France since 2024—for intractable chronic pain and palliative care—allow for repeated or extended dosing, which significantly increases the risk of severe liver and urological damage.
- Monitoring is now mandatory: periodic liver and kidney function tests are required, and treatment should only continue if pain or quality of life improves by at least 30% after one month.
The French National Agency for the Safety of Medicines and Health Products (ANSM) published two practical guides on July 8, 2026—one for physicians and another for patients and their families—on how to initiate and monitor prolonged or repeated ketamine treatment. The measure is part of a formal risk management plan (known as MARR, or additional risk minimization measures) supervised by the agency, and arrives three years after the same body warned of a spike in serious drug-related injuries.
What exactly is changing
The guides detail, indication by indication, the suggested ketamine dosages for analgesia: from 0.1–0.3 mg/kg via infusion for acute pain in emergency settings to regimens of 0.15 to 1.5 mg/kg per day for chronic neuropathic pain or intractable pain in palliative care, where it may be used as an adjuvant to opioids. Before starting treatment, the medical team must screen for and document any history of substance dependence. If use is prolonged or repeated, monitoring becomes systematic: a full liver panel (transaminases, GGT, alkaline phosphatase, and bilirubin) and checks on renal function and urine cytology, with blood in the urine serving as a red flag. If liver function is altered, the protocol dictates that treatment must be interrupted. The patient guide translates this into simple language: which symptoms to watch for (jaundice, pain during urination, urgent and frequent need to urinate, unusual fatigue), avoiding driving for 24 hours after each administration, and never adjusting the dose on one’s own.
The origin of the alert
The alert stems from an ANSM safety communication from August 2023, based on data from regional pharmacovigilance centers and drug dependence assessment centers. Those records showed an increase in ketamine use and a rise in hepatobiliary damage (cholestasis, cholangitis) and urological issues (non-infectious cystitis, interstitial cystitis, acute kidney failure, hydronephrosis) following prolonged or repeated use, as well as frequent off-label use, particularly for chronic pain like fibromyalgia. Since 2024, several ketamine formulations in France have received new authorized indications for analgesia that include long-term protocols, which is why it has taken the agency until now to establish a detailed follow-up protocol. Furthermore, in March 2026, the same authority approved a separate, strictly hospital-based framework for prescribing intravenous racemic ketamine for adults with severe suicidal ideation—another area where the drug is gaining ground in Europe alongside the already authorized esketamine.
What this implies
This is not an alert against ketamine, nor a call to restrict access, but rather an effort to provide a clear protocol for medical use that is becoming more long-term. More patients are receiving the drug repeatedly for pain that does not respond to other treatments, and this requires monitoring the liver and urinary system with the same seriousness as analgesic efficacy. The ANSM itself notes that hepatobiliary and urological damage also occurs in non-medical and prolonged use—including in party or chemsex contexts—so these warning signs (blood in the urine, jaundice, persistent pelvic pain) are equally relevant inside and outside of a hospital: knowing them is, in itself, harm reduction. You can find more context on the drug on our page dedicated to ketamine.
Related previous coverage: Intravenous ketamine versus esketamine: differences in a major study.
Source
- ANSM. Instauration et suivi d’un traitement prolongé ou répété par kétamine — Guide à destination des professionnels de santé. Agence nationale de sécurité du médicament et des produits de santé, July 8, 2026.
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
