Ketamine
Learn more about ketamine, a tranquilizer and frequent party drug.
Overview
Common Nicknames
Ket, K, special k
Drug Class
Dissociative anaesthetic
Drug Form
Crystalline powder
Route of Administration
Insufflation
What is the science of Ketamine?
Ketamine is a drug used by doctors worldwide as an anaesthetic, sedative, and, more recently, to treat depression. It is a small molecule that can bind to many of the receptor types found on the surfaces of human neurons. The most important of these is the NMDA receptor, which is normally activated by glutamate, the most commonly-used neurotransmitter in the brain. Ketamine prevents the NMDA receptor from opening in response to glutamate, slowing down the activity of the neuron the receptor is on. Because so many neurons use glutamate and have NMDA receptors, this can have a wide range of effects, including making neurons release more GABA, the ‘anti-anxiety’ neurotransmitter associated with drugs like Xanax and Valium. All of this, combined with its effects on the dopamine, opioid and serotonin receptors, gives ketamine pain-relieving, anaesthetic, psychedelic and antidepressant properties, which vary depending on the dose. Physical effects may include an increase in blood pressure, heart rate, and an opening of the airways. When ketamine is used clinically, there are two variants, [R]- and [S]-Ketamine, which bind receptors in a slightly different pattern (ketamine bought on the street is likely to be a mixture of both). Research suggests that ketamine can help the brain make new connections in the prefrontal cortex and the hippocampus, which are brain areas associated with consciousness, behaviour, and memory.
What are the risks?
Fatalities or hospitalisation from ketamine almost always occur from the combination with other drugs, particularly alcohol. Taking ketamine with stimulants (such as cocaine and ecstasy) may overload your heart. Depressants such as alcohol, GHB or heroin make the effects of ketamine stronger. This could make you fall unexpectedly unconscious, and you may be at risk of stopping breathing or suffocating on your own vomit.
Habitual ketamine use is well-known to be damaging to the bladder. Ketamine-induced urinary cystitis results in pain when urinating and a feeling that your bladder has got smaller or that you need to pee all the time. There have been reports of long-term ketamine users requiring bladder transplants.
Ketamine can make you vulnerable to accidental injury and death; even smaller amounts might reduce your ability to make sensible decisions or recognise hazards, like roads, cold temperatures, or bodies of water. Being on ketamine could also make you vulnerable to crimes like robbery or sexual assault.
Like any drug bought from a drug dealer or online, it’s not possible to guarantee the contents of a bag of ketamine just from looking at it or trying it. Other drugs or compounds may be mixed in, and these could have dangerous, unaccountable effects, which may occur at lower doses than those of ketamine.
How might the drug make you feel?
Ketamine affects your conscious experience. A dose of ketamine insufflated (snorted) will typically take effect in 5-10 minutes, reach its peak in 15-30 minutes, and last for around an hour. At lower doses, the effect may feel similar to alcohol, reducing inhibitions and anxiety. As dosage increases, the psychedelic properties cause confusion, hallucinations, a sense of dissociation from time and space, and potentially feelings of anxiety and unease. It can reduce the ability to control your movements, including to speak, and the anaesthetic and analgesic (pain-killing) effects cause a numbness that could have dangerous consequences. At higher doses still, you may enter a state of profoundly altered consciousness known as a ‘k-hole’, in which your experience of reality is almost completely detached from what is actually going on around you. Depending on your surroundings and your mental state before taking the drug, this may be a stressful experience, and being physically incapacitated could put you at risk if you are in an unsafe environment. At the highest doses, a complete loss of consciousness can be achieved, which is what allows ketamine to be used as a surgical anaesthetic.
Is Ketamine addictive, and what are the long-term effects?
It is possible to become addicted to ketamine. Some people take ketamine outside of a party setting for its dissociative and mood-altering effects. Tolerance can build up, and users may require a higher dose to get the same effects; this can be a warning sign of addiction. Some users have to attend detox clinics, and even if the addiction has led to bladder issues, they may still take ketamine to relieve the pain, causing more harm.
Long-term use of ketamine at higher doses can have lasting effects on your body. It can lead to uropathy, kidney problems, stomach pain, clinical depression, and a deterioration of your memory. Bladder disease can encourage more ketamine use or prevent users from quitting, as ketamine temporarily eases the pain. Additionally, the psychological effects of chronic use can have negative effects on work, relationships, and education.
Harm Reduction and Drug-Drug Interactions
There are always risks to using ketamine. However, if you do take drugs, you can make simple choices to improve the chances of a good experience. Here are some things to consider: drug testing kits can be ordered online, and testing services are present at many festivals. It is advisable to test your ketamine before taking it, as some batches can be especially strong or cut with other substances, which can lead to death. First-time users should start with a lower dose, and all users should remember to take less than they think they need and wait for the previous dose to fully take effect before taking more. Consider your state of mind before taking ketamine to avoid an anxious, exaggerated response to the drug.
Ketamine has interactions with more than 400 other drugs. It shouldn’t be used in conjunction with stimulants or depressants, as both will have negative effects on your body and could be fatal. The most common drug interaction that causes users harm is with alcohol, which can slow your breathing and lead to unconsciousness. Depressant drugs have a major interaction with ketamine, such as benzodiazepines and opioid analgesics, which can cause respiratory depression. Other interactions worth noting include antidepressants and sympathomimetics such as vasopressin. Another common medication with an interaction is theophylline; taken together, the threshold for seizures could be lowered, which can be dangerous if you take theophylline to control your seizures. Ketamine also has interactions with some foods, including grapefruit and grapefruit juice, leading to high levels of toxins in your body.
Medical Uses
Ketamine has been used in research as a pre-clinical model of schizophrenia in rodents to test new antipsychotics. Today, ketamine therapy for treatment-resistant depression is gaining popularity. This typically involves a controlled dose of ketamine administered intravenously in a medical setting. Clinical trials are also underway to harness the neuroplastic effects of ketamine in therapy for other psychiatric disorders, such as the reduction of alcohol relapse.
Myths and Misconceptions
Ketamine is horse tranquiliser
Ketamine is used to sedate or anaesthetise a wide range of animals, including horses, but also humans. In fact, it’s one of the most widely used drugs by medics worldwide, particularly in lower-income, disaster or emergency settings, because of its low cost and safety, and because it’s injectable, rather than a gas.
Ketamine is not addictive
Although ketamine doesn’t have withdrawal symptoms like cocaine or opioids, it can still affect the reward pathways in the brain that cause addiction. Many people who become addicted to ketamine find that they are using the drug to self-medicate. If you use ketamine, be mindful of your motivations for doing so, and remember that there are drug and mental health services available if you need support.
Ketamine is not a psychedelic
‘Classical psychedelics’ are those which target the 5-HT (serotonin) receptors. However, this classification leaves out many drugs which we know also produce a psychedelic experience and have similar effects. There has been a shift, therefore, to classify psychedelics under a new term – psychoplastogens, drugs that open a critical window of neuroplasticity. This state of plasticity may be what gives the drugs their clinical benefits.
I will experience a k-hole if I have ketamine therapy
Whilst a k-hole is entirely possible, it is not always going to happen every time you take ketamine. A k-hole more often happens at high doses of ketamine. Clinically administered ketamine will be highly controlled doses so that this is avoided. It is important to understand that medical-grade ketamine will differ from ketamine that you could buy on the street, and the dose in a medical setting will be tightly controlled so that your experience is more likely to be positive.
Ketamine therapy is too experimental and untested
The pharmacology of ketamine is well understood, and it has decades of research supporting its use. Ketamine is a Schedule 2 drug, whilst most other psychedelics are Schedule 1. This makes research into the drug less restricted, and so the psychiatric applications of ketamine are more developed.