Ketamine is an anesthetic that is used in human medical procedures but is most commonly used in veterinary treatment. When abused, Ketamine produces hallucinogenic effects as well as muscle relaxation and loss of coordination.
- Ketamine is sometimes used in medical settings, such as to sedate children who have had adverse reactions to other anesthetic medications, as well as in radiation and burn therapy.
- When taken in high doses, the dissociative anesthetic effect of ketamine causes sedation, which can lead to people experiencing out-of-body-like feelings and a detachment from reality.
- Ketamine powder is the most commonly abused form of the drug. It is a white crystalline substance that is crushed and snorted, normally through rolled-up notes or straws.
.jpg?v=1722502466)
Understanding Ketamine
Ketamine is a powerful dissociative anesthetic used in humans but most commonly used on animals, most notably on horses. Ketamine produces hallucinogenic effects in humans when abused, making it a popular drug in the club and rave scene. Common nicknames for Ketamine include special K, Kit Kat, and vitamin K.
Ketamine is sometimes used in medical settings, such as to sedate children who have had adverse reactions to other anesthetic medications, as well as in radiation and burn therapy. It is also used in situations where sedation is necessary, but stronger anesthetics may be too much for the individual to handle.
Ketamine origins
Ketamine is a derivative of phencyclidine (PCP) and was developed in the 1960s before being confirmed for public use as an anesthetic for humans and veterinary medicine by the FDA in 1970.[3]
Clinical uses of ketamine
Ketamine is FDA-approved as a form of general anesthesia. However, it is also used off-label as pain relief for physical trauma, treating forms of status epilepticus, and as an alternative for treatment-resistant depression and anxiety.
Genral anesthesia
Ketamine is used for general anesthesia, either alone or with other anesthetics like nitrous oxide. It is often used to treat fractures and other skeletal injuries due to its anti-hyperalgesic and anti-inflammatory effects. It is also used in pediatric settings as an opioid alternative for pain management.[4]
Pain relief
Small amounts of ketamine are used to reduce inflammation and pain without causing dissociation. Ketamine may be used for pain management in:[4]
- Fractures, dislocations, and other mild bone injuries.
- eclampsia/pre-eclampsia.
- Mild to moderate trauma injuries.
- Chronic lower back pain.
- Pain in the joints and extremities.
- Chronic abdominal pain.
Status epilepticus
Ketamine has proven to be an effective treatment for cases of refractory status epilepticus (RSE). Status epilepticus (SE) is a form of epilepsy where seizures can last for 5 minutes or more, or with multiple concurrent seizures without consciousness being regained in between.[5][6]
Refactory SE is when standard medications used to treat the conditions don't work. This can become super-refractory when subsequent alternatives don't work either. Studies have found that ketamine has proven to be 57% effective in treating SE in refractory cases.[5][6]
Treatment resistant mental health conditions
Research has shown that ketamine provides effective relief for refractory depression and anxiety disorders.[7][8]
While studies are still limited by access and legal limitations, they have shown that the correct type and dose of ketamine can alleviate symptoms. Studies into anxiety treatment showed that symptoms would often return within 2 weeks of administration, while higher doses of ketamine could relieve depression symptoms for a prolonged period.[7][8]
What ketamine looks like
When Ketamine is used in a medical setting, it is often injected as a liquid to induce relaxation and sleep. It is also available in other forms, which are more commonly found when the substance is being used illicitly.
Ketamine powder
Ketamine powder is the most commonly abused form of the drug. It is a white crystalline substance that is crushed and snorted, normally through rolled-up notes, straws, or off the tip of a key. The powdered form of the substance is sometimes wrapped in a cigarette paper and swallowed. This method of ingesting ketamine, called "bombing," can delay the onset of effects, leading inexperienced users to over-administer.
Ketamine liquid
Ketamine liquid is rarer than powdered ketamine as an abused substance, but some inject themselves with it to get a more powerful high.
Ketamine pills
Ketamine tablets are less common but can still be obtained and misused. Tablets take longer to have an effect but can be more intense. Ketamine pills are often manufactured illegally and will often resemble ecstasy pills.
Nasal spray
Ketamine powder is soluble and can be diluted in a ratio of water while still maintaining its effects. This diluted ketamine liquid is often administered via a nasal spray.
Effects of ketamine
Ketamine acts as a dissociative hallucinogenic tranquilizer that can cause relaxation throughout the body, mild to moderate hallucinations, cognitive impairment, and dissociation from reality.
The effects of ketamine will typically last around an hour and will begin to take effect 10-20 minutes after first taking the substance.
K-holes and other adverse effects
When taken in large amounts, the dissociative qualities of ketamine are heightened, with users reporting out-of-body experiences, lack of motor function, and loss of communication skills.
This state, commonly referred to as a "K-hole", can be harmful as the individual is often unable to control their body properly and will have impaired perception and motor functions, which may lead to accidents.
Adverse side effects of ketamine can also include:
- Increased heart rate.
- Elevated blood pressure.
- Muscle rigidity.
- Respiratory issues.
- Visual and auditory hallucinations.
- Disassociation.
- Paranoia.
- Depression.
- Physical and cognitive impairment.
What ketamine misuse feels like
When taken in high doses, the dissociative anesthetic effect of ketamine causes sedation, which can lead to people experiencing out-of-body-like feelings and a detachment from reality. Ketamine also sedates the body, making movement sluggish and adversely affecting balance and coordination.[2]
It also distorts perception and can cause hallucinations as well as distorted hearing and vision. The dissociative nature of the drug causes those who take it in high doses to become unable to speak or function, a condition commonly referred to as a ”K-hole”.
The risks of taking ketamine with other substances
The anesthetic effects of ketamine can have hazardous side effects when taken with other drugs, notably central nervous system (CNS) depressants such as opioids or alcohol. CNS depressants lower the respiratory rate, which can lead to breathing problems when mixed with tranquilizers like ketamine.
Partygoers also often mix ketamine with the stimulant cocaine, often referred to as “CK”, to balance the effects of both substances and produce a more potent and sustained high. CK can be dangerous as cocaine raises the heart rate while ketamine relaxes muscles and increases blood flow, which may lead to heart-related issues.
Ketamine overdose
Ketamine affects everyone differently, often based on physical attributes and substance use history. This makes it hard for the user to determine how much is enough and can lead to an overdose. Even experienced users can overdose, as they will often take more of the drug to reach the dissociative state of a K-hole. A ketamine overdose can result in a total loss of mobility, which can lead to respiratory failure and, in rare extreme cases, death.
Ketamine addiction
Ketamine addiction is rare but can happen. As the drug alters brain function, a person can become physically and psychologically dependent on ketamine. Once dependence on a substance has taken hold, it often causes negative consequences to an individual's life. How a substance use negatively impacts a person's life is how substance use disorders are evaluated and diagnosed according to the DSM-5.
Diagnosing ketamine use disorder
The DSM-5 uses 11 criteria to measure and diagnose substance use disorders, with the more concurrent negative consequences accumulated equating to a more severe ketamine use disorder.
Signs of ketamine addiction include:
- Increasing the amount (frequency and or quantity) of ketamine.
- Becoming obsessed with the next opportunity to use.
- Spending excessive amounts of money on the substance, even money you may not have.
- Failing to keep up with responsibilities such as school and work.
- Building up a tolerance and needing more and more to feel the high.
- Neglecting friends and family in order to use.
Once dependence on ketamine has formed and addiction is established, getting free of the drug can be extremely difficult. Attending a dedicated treatment center or residential rehab facility greatly increases the chances of recovering from ketamine addiction and can provide therapy and support for long-term sobriety.
Ketamine withdrawal
Ketamine alters dopamine regulation and disrupts N-methyl-d-aspartate (NMDA) receptor function, causing psychological and physical withdrawal after prolonged use stops.[9][10]
Studies into the effects of ketamine cessation after chronic use showed that users form a dependence on the substance's dissociative and euphoric effects, leading to cravings and physical withdrawal symptoms when use stops.[11]
Ketamine withdrawal symptoms may include:
- Anxiety.
- Depression.
- Cravings.
- Mood swings.
- Memory and concentration impairment.
- Fatigue.
- Irritability.
- Shakes.
Severe ketamine withdrawal symptoms
Ketamine detox
Ketamine detoxification can be managed without professional help, as common withdrawal symptoms are not considered life-threatening. However, therapeutic interventions and monitored detox are advised for the best chance of successful recovery and relapse prevention.
The most common form of ketamine detox involves utilizing talk therapies, such as CBT and motivational interviewing, to address the behavioral aspects of the addiction and introduce craving and relapse management tools.
Medical management for ketamine withdrawal symptoms may also be necessary in some cases, though there are no FDA-approved medication options for ketamine detox. Treatment specialists may use benzodiazepines such as lorazepam to manage physical withdrawal from ketamine, while psychological symptoms may be treated with SSRI antidepressants and antipsychotics.[14][15]
