“Ketamine’s such a waste of a drug. All you do when you’re on ketamine is go: ‘Oh, I’m on drugs. I don’t feel good, I don’t feel bad, I’m just on drugs’” Moby

Ketamine (K, special K, super K, ketalar, green) is categorized as a short acting dissociative anesthetic, because it gives a sense of detachment. Due to its colorless and odorless nature, it is commonly used as a date-rape drug. In sufficient doses, a person under influence can wake up hours or even days later, usually unaware of their surroundings and having no recollection of the past few days. Hence, oblivious people are at a risk of unwillingly being exposed to the drug especially in social settings such as bars or nightclubs.

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It is used in powdered, typically white or yellowish in appearance, or liquid form as an anesthetic usually on animals. Due to the various types of availability, it can be injected, snorted, or added to cigarettes or joints. Ketamine was added to the list of controlled substances in 1999. It is used as an anesthetic, sedative for intensive care patients and to treat chronic pain. The drug is often used in conjunction with other drugs to modulate its effects.

Ketamine was discovered in 1962 by Parke-Davis and is on the list of World Health Organization’s list of essential medications due to its extensive use as an anesthetic and painkiller. It is available as a generic medicine. Ketamine was used prominently as an anesthetic in the Vietnam War. Most of the ketamine distributed in the US is stolen from legitimate sources such as clinics or pharmacies. It is widely used as an anesthetic in veterinary practices.

Ketamine is similar in nature to phencyclidine (PCP), due to its dissociative effects. Other drugs of such effect are Dextromethorphan (DXM) and Nitrous Oxide, more commonly known as laughing gas. It is more potent than coke if compared weight to weight. Ketamine produces an intense high that lasts for an hour, and starts within 2 to 5 minutes of its intake. It produces a surge of relaxation and fully body buzz. Individuals looking to experience a euphoric rush, should avoid this drug since it is a downer, a drug that decreases mental activity. Some users feel like floating and an out-of-body experience is achieved when the dose is strong enough. Many users feel hallucinations that can last longer than the sedative effects.

Higher dosages of ketamine can produce more intense effects, where some users have experienced complete out of body detachment. The effects are similar to a near death experienced, dubbed the “K-hole”.

K-hole

K-hole is an informal term for the extreme state of dissociation felt by the users when ketamine dose is potent enough. This state of dissociation can be so overwhelming that it can mimic near-death experiences, followed by delusions, paranoia and hallucinations. First time users should be aware of this phenomenon and remain careful since accidental overdose could “send” users to the K-hole and may cause irreparable psychological damage.

Since, ketamine suppresses breathing unlike other common anesthetics, it stimulates the circulatory system instead of depressing it, it is used in countries with poor resuscitation equipment. Due to the sedative nature of the drug, it can be used as an emergency medication for people suffering traumatic shock who are at a risk of hypotension.

Ketamine’s Use As An Antidepressant

Each year 13 to 14 million Americans are diagnosed with depression, of which 30 to 40% do not get better using standard antidepressants. This increases the risk of patients diagnosed with depression to seek drug use as an alternative, or even leads to suicide. In a few clinics around the country, people who could not be cured by standard treatments are being treated with ketamine to control their symptoms of depression. Ketamine is also used to treat patients with high suicidal tendencies.

A UK study found that ketamine successfully limits symptoms of depression in patients who weren’t responding to standard treatments.  Small randomized tests showed that a single infusion of ketamine significantly reduced depression symptoms, especially in patients who had been taken off antidepressant medication. However, most of the patients relapsed within a week. Ketamine is classified as class C drug because of its use as a recreational drug.

28 patients with treatment resistant depression were treated over three weeks with either three or six ketamine infusions (0.5 mg/kg over 40 minutes). The patients’ memory was tested and follow ups were conducted for six months. patients reported their mood symptoms by text or via email. The results published in the Journal of Psychopharmacology showed that three days after the final infusion, depression levels had decreased by 50% in eight patients (29%) and four of these patients had gone into remission. Only 3 patients 11% reported a positive response and four of these had gone into remission, but all eight responded after the second infusion. The response duration of the third ketamine infusion lasted between 25 to 168 days with the median being 70 days.

Eight patients (29%) dropped out of the study: two because of acute adverse reactions (one had a vasovagal episode during the infusion, and another experienced a panic attack), five because of failure to benefit or anxiety, and one for unrelated reasons. Side effects included nausea, vomiting, mood swings, a manic episode, and a panic attack. No patient experienced kidney problems observed in individuals who take ketamine in high doses. Ketamine had suppressed the region of the brain that is active during depression. Although ketamine provided a safe treatment but due to the fact that many patients relapsed, the goal is to prolong the effects either by changing dose or duration or by combining ketamine with other medication.

Ketamine As A Suicide Preventing Aid

Suicide is the 15th most common cause of death worldwide. It is the second leading cause of death in people aged 15-29 years and was responsible for 39 million disability adjusted life years in 2012. The risk of suicide significantly increases in individuals with mental health problems. Risk assessment constantly proves to be a challenge to many health experts since it is quite difficult to accurately assess patients’ suicidal tendencies because there are a lot of factors at play including their genetics, social environment and the need to openly discuss their issues. Hence newer techniques are constantly being explored. One of these techniques is ketamine.

According to  a 2015 study, ketamine maybe an effective tool to treat depression and possibly prevent suicide. Ketamine possesses unique antidepressant effects that are quick acting through the NMDA receptors in nerve cells. It suppresses depressive symptoms hence limiting suicidal thoughts within hours. One RCT using an active placebo (midazolam) showed that 53% of patients treated with ketamine scored 0 on three different measures of suicidal ideation 24 hours after infusion compared with 24% of those treated with midazolam (P=0.03). More significantly, the effects of one infusion can last for days.

Despite these fascinating results, the data on ketamine and suicide is still limited and future studies need to be conducted focusing on possible side effects, optimal treatment duration and dosage, safety, and long term practicality. Till then ketamine remains at least a backup plan for psychiatrists in treating suicidal people of all ages.

Ketamine As An Analgesic

Patients frequently require undergo painful, distressing, unappealing procedures for treatment and therapy. The use of various analgesic, sedative, and anesthetic agents has been outlined in several well referenced guidelines. Several classes and types of analgesic agents are available, each used in different medical procedures. Benzodiapines, opioids and barbiturates are quite commonly used as analgesic agents, evidence for use of other sedatives is emerging and there is a lot of research and trials conducted to back up this evidence.

The success of an analgesic can only be measured if the procedure was completed pain-free. The American College of Emergency Physicians states that the literature supporting the safety and efficacy of procedural sedation and analgesia in the emergency department is robust. A review of 165 patients’ states that success rates varied from 64% with midazolam to 96% with propofol whereas a prospective cohort of 92 adult patients undergoing procedural sedation had a success rate of 99% with intravenous ketamine.

Potential adverse effects of all sedatives include airway blockage, nausea, hallucinations and high blood pressure.  Phencyclidines (ketamine): ketamine is closest to a true “complete” anesthetic agent in that it produces anxiolysis, amnesia, immobilization, and profound analgesia. It is suitable for brief, painful procedures requiring sedation.

A prospective cohort study of 92 adult patients found that ketamine was safe for adult procedural sedation in the emergency department; no serious adverse effects were associated with its use, although 13% of patients experienced agitation during recovery. Hence ketamine analgesia with propofol sedative would be the ideal solution.

Why Is Ketamine Addiction So Common?

Many people abuse drugs to feel good about themselves. Most drugs are abused because they release dopamine in the body, giving the user intense feeling of pleasure. This initial high is then followed by other effects which differ from drug to drug. Stimulants such as ecstasy get the heart racing and increase energy and focus, whereas drug such as marijuana and heroin relax the body.

Some people take drugs because the feel pressured to do better or enhance their physical or mental performance which causes them to experiment with drugs and continue indulging in performance enhancing drugs or steroids.

Moreover many drugs help people who suffer from anxiety, depression or social awkwardness. These drugs give them confidence and help relieve stress. Hence stress plays a major role in people taking up drugs, continuation of drugs or drug relapses in recovering patients.

Ketamine abuse is so common since most ketamine can be illegally acquired from many vet clinics due to its use an animal tranquilizer.

How Addictive Is Ketamine?

Like with all drugs, there comes a certain level to addiction, tolerance development and risk involvement. Ketamine is no different and is extremely addictive and dangerous due to the side effects it causes.  it is, however, different from drugs such as alcohol and heroin, in that it doesn’t cause physical addiction. There is a major difference between being physical dependence and addiction. Physical dependence means that a person’s body adapts to the drug, requiring more of the drug to achieve the same effect. Addiction, on the other hand, is characterized by not being able to stop using the drug, failing to meet work, social or family obligations.

Hence becoming addicted to ketamine depends on what it is being used for. If ketamine was medically prescribed, let’s say as a sedative, it is less likely the person will become addicted to it, since the medical experts know what optimum dosage will be most effective. On the other hand, if a person uses ketamine purely for recreational purposes, the chances of them getting addicted exponentially increase, because they constantly increase their dosage to feel the same effects of the drug. ketamine’s addiction arises from the fact that it disrupts brain’s chemical balance and alters neurotransmitters. The impairment of users’ cognitive skills, leaves them exposed to being addicted and makes it harder for them to quit.

Moreover, it can be extremely difficult to kick the ketamine habit, if the ketamine addiction arose due to medical reasons, for example if a doctor prescribed ketamine for treatment of an injury, other anitbiotics might feel inadequate at treating the patient’s pain due to ketamine’s fast acting effects, over time if the patient’s pain becomes unmanageable, the patient will use more of the drug to ease his condition, hence the chances of becoming addicted increase significantly. But luckily treating ketamine is manageable if done right.

How To Reduce Harm And Risk Associated With Ketamine Use?

Like any drug ketamine has its own set of risk associated with its usage, most of which could prove fatal, especially in high dosages. Most of the risk associated, includes accidental damage during stages of intoxication, and when combined with other drugs such as alcohol. Luckily most of these risks can be minimized, when the user fully understands how the drug functions and affects an individual.

Reduced risk is associated when ketamine is taken in small doses and in form other injections, since syringes directly pass the drug into the bloodstream. Remain well hydrated to reduce urinary tract infections. Most importantly, the user should remain under constant attention and should not be left alone, or be left in situations in which drug use could increase personal vulnerability, as there is a high probability of inflicting self-harm. Ideally, the individual should be left under the care of a non-drug affected person.

Administering ketamine yourself could be extremely dangerous and one should avoid it all costs, especially if one is under the influence and tries to mix with alcohol or start an IV line. Mislabeled drugs or buying from an unknown source or from someone new could be risky, hence should be avoided.

Generally speaking, tolerance can be prevented if the drug is taken in small infrequent doses. Avoid drugs with other harmful substances such as alcohol, CNS depressants or stimulants. One should plan ahead in case of intoxication. Use of a drug for the first time should be avoided if the person is alone or already intoxicated with another substance; recommend that having a non-using trusted person present can be helpful if adverse reactions occur. Explain what is expected on cessation of drug use and outline when help should be sought.