Ketamine was developed in 1962 as a rapid-acting dissociative anesthetic that was used in surgery. It was approved for human use by the Food and Drug Administration (FDA) in 1970. Unfortunately, abuse began along the West Coast and spread across the country by the 1980s. The illicit market produced new forms of the drug, available as powder, capsules, crystal rocks, tablets, and injectable solutions. The drug is largely abused intranasally (via sniffing) or orally.
As a dissociative anesthetic, ketamine produces experiences like distorted vision and sounds, and feelings of detachment from the environment and from oneself. Those who take ketamine for recreational purposes will likely feel detached from themselves. The drug acts similarly to PCP or DXM. While ketamine has important medical uses, it is often diverted (stolen from hospitals or veterinary clinics). Although there are legitimate medical uses, and the drug is not considered addictive, it is abused in specific situations. Ketamine is still a Schedule III drug, according to the Drug Enforcement Administration (DEA). When it is abused, it is most often abused in social situations, like at nightclubs or raves. Sometimes, ketamine is sold instead of, or mixed with, MDMA, ecstasy, or Molly.
Ketamine: Medical Uses, Abuse Risks
The World Health Organization (WHO) lists ketamine as an essential medicine, especially as an anesthetic and analgesic. With medical supervision, ketamine is a better surgical anesthetic than many others, and it is safer for a wider range of patients. It is also the anesthetic of choice in veterinary surgery. However, abuse of ketamine does occur all over the world; WHO notes 58 countries have reported illicit sales and abuse of ketamine.
When ketamine is used for surgery, the rate of adverse psychiatric events, including psychosis, hallucinations, or panic, ranged from 10 percent to 20 percent, according to a survey of data from 89 studies on the drug. When doctors applied sedating agents to their patient to ease ketamine’s negative psychiatric symptoms, the risk of adverse outcomes dropped considerably. However, if a person abuses ketamine recreationally, they are not likely to have this kind of medication available or professionals watching them for adverse reactions; as a result, the risk of induced psychosis is high.
Ketamine may find a new prescription market soon. Medical professionals are searching for new, more effective methods of treating mood disorders, especially anxiety and depression, and tightly controlled doses of ketamine have been found to improve depression symptoms within minutes, inducing improvements in mood that last for a long time. However, wider prescription of ketamine could lead to a new and deadly form of prescription drug abuse.
Currently, however, legitimate medical use of ketamine is restricted to hospitals and veterinary clinics. While the drug may be diverted from these locations or other medical clinics, it is not prescribed to people as a treatment the way that opioid painkillers are prescribed. Instead, abuse of ketamine typically begins in social settings, like clubs, in order to induce a hallucinogenic or psychedelic euphoria. Ketamine is abused predominantly by young adults, between 18 and 25 years old, at a rate of about 0.2 percent. The average ketamine abuse rate among anyone age 12 and older is 0.1 percent. While it is not a widely abused drug, its intense and immediate effects can lead to lasting consequences.
The Dangers of Ketamine Abuse
When ketamine is given to a person as an anesthetic, it is injected; nonmedical abuse usually involves tablets or snorted powders. The drug’s effects set in rapidly, within 1-5 minutes when the drug is injected; when snorted, it takes 5-15 minutes for effects to set in. Taking the drug orally requires it to move through the digestive system, so it takes effect on the brain within 5-30 minutes, depending on the dose and if it is mixed with adulterants.
Side effects from abusing ketamine include:
- Impaired motor function
- Loss of physical coordination
- Paradoxical stimulation
- Tachycardia, or rapid heartbeat
- Derealization, or losing touch with reality
- Delusions of grandeur
- Muscle rigidity
- Violent or aggressive behavior
A person who takes ketamine consistently may experience flashbacks, like LSD flashbacks. They are also at risk for overdose.
Ketamine’s potency is considered dose-dependent. About 1-2 milligrams per kilogram of a person’s body weight produces a euphoric high lasting for around one hour. However, larger doses, or taking more before the first dose metabolizes out of the body, can lead to the K-hole: when the person becomes completely sedated and has an out-of-body, or near-death, experience. The individual will likely be helpless, confused, and out of touch with reality, which makes them extremely vulnerable to harm.
Ketamine is sometimes used as a date rape drug. A larger dose of ketamine will lead to an overdose.
A person overdosing on ketamine needs immediate medical attention. Call 911, as the person needs emergency medical treatment.
Symptoms of a ketamine overdose include:
- Respiratory depression or stopped breathing
- Involuntary muscle twitches
- Slurred speech
- Stumbling as though drunk
- Nausea and vomiting
- Hyperthermia, or overheating
Long-Term Harm from Abusing Ketamine
Ketamine has an intense impact on the brain, which can trigger depression, memory problems, and even psychosis among those who have a predisposition to these conditions. One of the first longitudinal studies on ketamine’s effects involved 150 participants divided into five groups. The study lasted one year, and each group took a different dose of ketamine over that year; at the end, those who used ketamine twice a month to almost daily (frequent abuse) experienced disturbances in visual memory and short-term memory recall. They experienced trouble recalling names and conversations. Those who used ketamine less frequently, but still recreationally, experienced less severe symptoms, but still suffered some memory disturbances, and reported mild delusions.
The drug has also been linked to cardiovascular and kidney function problems due to high blood pressure. People who consume ketamine regularly, or who consume too much in a binge, are at risk of damaging their lungs, kidneys, and heart.
Ketamine produces ulcers and pain in the bladder, which can lead to problems urinating. This can also lead to chronic health issues requiring long-term medical care, including infections.
Sometimes, ketamine is used as a date rape drug. A person may not know they have consumed it and experience serious physical and mental side effects. They may be a victim of sexual assault and acquire sexually transmitted infections.
It is possible to develop a physical tolerance to ketamine, especially when the drug is taken recreationally. If a person abuses ketamine, their body will rapidly develop a tolerance to the presence of the drug, so they will feel like they must take larger and larger doses to induce the original physical and psychological effects. While tolerance and addiction are not the same thing, people who struggle with patterns of substance abuse, or who are more likely to develop addiction to intoxicating substances, may abuse ketamine for the euphoria it produces.
Withdrawing from Ketamine
Since the body develops a tolerance to ketamine very quickly, a person who abuses ketamine may also develop physical dependence on the drug. This means the brain needs the presence of the drug to feel normal. Physical dependence can lead to withdrawal symptoms when the individual stops taking the drug. Ketamine withdrawal symptoms are not life-threatening, but they can be uncomfortable. As a result, it is important to work with a doctor to safely detox from ketamine and other substances because trying to quit alone can lead to relapse and overdose.
- Cravings for the drug
- Loss of appetite
- Physical shaking or tremors
- Nightmares, insomnia, and difficulty sleeping
- Irregular or rapid heartbeat
Treatment for Ketamine Abuse
Long-term harm from ketamine can be prevented if the person gets help from a safe detox program, overseen by a medical professional, and enters rehabilitation. There are no detox drugs, like there are for opioid or alcohol abuse, but Cognitive Behavioral Therapy in both individual and group settings has proven very effective at helping people change their behaviors around intoxicating substances, including ketamine. Rehabilitation programs offer this form of therapy, along with other therapies that can moderate withdrawal symptoms, manage chronic health issues, and offer social support to maintain recovery.