Ketamine is a synthetic drug. It’s a leading anesthetic in veterinary medicine, and it is used on humans for some surgical procedures as well.
Ketamine is also used illegally as a street drug. Also called Special K, Vitamin K, and Jet, it’s a very addictive drug that is known to create hallucinogenic effects and an out-of-body experience.
Ketamine was first made in 1962 by Dr. Calvin Stevens at Parke Davis Laboratories. The researchers there were looking for an anesthetic alternative to PCP (phencyclidine), which had initially been developed as a human anesthetic but proved unsuccessful as it caused seizures and neurotoxicity in patients.
Ketamine is a dissociative anesthetic. Unlike other anesthetic induction agents (like benzodiazepines) which produce anesthesia mainly through sedation, ketamine uses hallucinogenic and analgesic (painkilling) effects. It also uses amnestic-related reactions that affect memory.
In 1970, ketamine was approved by the U.S. government for human use and marketed as a fast-acting general anesthetic. It became a choice anesthetic for battlefield use and in burn medicine settings.
It soon hit the streets on the West Coast as an illegal drug and became popular, particularly in the New Age and on the spirituality scenes, as levels of drug abuse rose across the country in the late 1970s and early 1980s.
Perhaps sensing a demand in the market, dealers released new forms of ketamine on the street market. It became more widely used and available in a powder, liquid, or capsule form.
Ketamine use again began trending in the mid-1980s in various dance subcultures, often used along with MDMA (ecstasy, Molly) to alter its effects. In fact, many users weren’t aware that they were taking a potent anesthetic; they thought they were taking only ecstasy.
Soon, however, ketamine earned its own reputation as well as loyal users in the club drug scene. Special K became widely known for its trancelike effects and the out-of-body experiences people experienced after using it.
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Ketamine remains a commonly used drug that recreational users typically seek out for an extreme or hallucinogenic high as well as drug abusers who have become dependent on ketamine or dissociative drug experiences.
In many ways, ketamine has been somewhat overshadowed by both the dissociative drugs it closely resembles — PCP, likely because of its more extreme and violent side effects, and the club drugs it’s so often grouped with (MDMA being the most popular). Perhaps because of this, research on ketamine remains slim, and it’s nearly impossible to estimate the current use of ketamine across the country.
The most recent study on ketamine-specific use was conducted in 2015 by the Substance Abuse and Mental Health Services Administration (SAMHSA). According to the study, at that time, 3 million (1.1 percent) people, age 12 and older, had tried ketamine in their lifetime.
In recent years, ketamine has also made headlines as a possible antidepressant, with supporters claiming the drug offers fast-acting relief for those who have severe depression or suicidal thoughts, and that it could possibly have beneficial long-term effects on brain chemistry. It reportedly has been used off label as an antidepressant for years.
People who abuse ketamine as an antidepressant cite its unpredictability and possible long-term effects, like damage to the brain and bladder toxicity. They also argue that less dangerous substances, like magnesium, are capable of producing the same effects as ketamine.
Ketamine is a dissociative anesthetic. During surgical procedures in which ketamine is used as the anesthetic, the patient is put in a trancelike state of detachment, unaware of their surroundings, often with their eyes remaining open.
Ketamine is a complex drug that interacts with many biochemical receptors. Perhaps most notably, it interacts with NMDA (N-methyl-D-aspartate) receptors, which (among other things) act in governing glutamate, the most abundant neurotransmitter in the brain and central nervous system.
Through ketamine’s interactions with receptors, it depresses sensory receptors in the cortex and parts of the limbic system and thalamus, which play a part in memory development and peripheral sensory awareness. High doses of ketamine leave the user unable to process pain and memories normally. They may become unaware of their surroundings and the sensations in their body.
Ketamine also produces painkilling effects through its interactions with nitric oxide (NO), a central and peripheral pain-related neurotransmitter.
Ketamine interacts with many other neurotransmitters. Research is being done on its interactions with opioid receptors.
The short-term effects of ketamine vary depending on the dosage. As it is a dissociative drug, it will create feelings of being separated from one’s body, surroundings, and oneself. Higher doses can cause hallucinations, delusions, and even amnesia. There are other effects such as:
Street ketamine is often cut with other drugs, which is one reason why it’s so unpredictable, and its reported long-term effects are so varied.
Because of limited research, the long-term effects of ketamine on the brain and its neurotransmitters are largely unknown. However, a study conducted with magnetic resonance imaging at Sun Yat-sen University in Guangzhou, China, indicated that repeated ketamine use did cause long-term damage to the brain, with drug-caused legions remaining for up to 12 years after use.
Long-term effects include:
Date rape drug: As it gained popularity in the club drug culture, ketamine became known as a date rape drug. Odorless and easy to disguise, ketamine has been used to assault unsuspecting and unknowing users, leaving them defenseless and often completely unaware of what was happening.
K-holes: Large doses of ketamine — doses larger than between 1.0 to 2.0 mg (milligrams) per kg (kilograms) of body weight — may produce an experience known as a K-hole. Usually lasting about an hour, a K-hole is experienced when the user is on the verge of being fully sedated. During the experience, users may feel as though they are floating and completely detached from their body and reality. According to the Center for Substance Abuse Research (CESAR), short-term effects from such a high dose of ketamine can include respiratory depression, involuntary muscle twitches, and vomiting.
Other drugs disguised as ketamine: As a street drug, ketamine is unregulated. Other drugs, such as GHB, PCP, and methamphetamine, may be sold as ketamine. Dosing is also highly unpredictable as other drugs may be cut or included in a user’s dose of ketamine, possibly resulting in an overdose.
Because of limited research on ketamine, little information is available on how addictive the drug is.
According to CESAR, there is indication that users become dependent on ketamine. These indications include:
Currently, more discussion is underway about ketamine’s addiction levels, especially as they relate to the opioid receptors the drug interacts with.
A recent study conducted by Stanford University and published by the American Journal of Psychiatry indicates that the antidepressant effects of ketamine (that have been promoted in recent years as a potential treatment for severe depression and suicidal thoughts) were actually the result of ketamine acting with an opioid-like effect.
The study indicated that like an opioid, ketamine provided fast-acting relief to those suffering from depression. Also like an opioid, it would also cause users to become highly addicted and dependent on the drug.
Those who still champion ketamine as a potential game-changer for the treatment of depression say the study’s findings aren’t conclusive, some arguing that the drug’s effects have little to do with the opioid receptors.
Someone on a very high dose of ketamine will likely be able to be identified as high on something, appearing very out of it, perhaps hallucinating or out of touch with reality. They may also seem to experience no pain and have trouble balancing or speaking.
Someone who is experiencing a lower dose of ketamine, or a user who isn’t actively on the drug but is addicted and a frequent user, may be harder to recognize. They may exhibit some of the following signs:
A trained addiction professional familiar with ketamine abuse can work with an individual and their support system to create a recovery plan. This will include withdrawal support and addiction therapy.
With help, people can leave ketamine abuse in their path and move toward a better future.
(2013) Special K: A review of Ketamine. Jason Jones M.D. and Christine Van Dillen M.D. University of Florida, Gainesville. from https://emergency.med.ufl.edu/files/2013/02/KetamineReview-JonesVanDillen.pdf
(October 2013) Ketamine. Center for Substance Abuse Research (CESAR). from http://www.cesar.umd.edu/cesar/drugs/ketamine.asp#7
(April 2016) Abstract: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. National Center for Biotechnology Information. from https://www.ncbi.nlm.nih.gov/books/NBK424847/table/appd.t6/
(December 2014) Special K, a Hallucinogen, Raises Hopes and Concerns as a Treatment for Depression. Andrew Pollack. The New York Times. from https://www.nytimes.com/2014/12/10/business/special-k-a-hallucinogen-raises-hopes-and-concerns-as-a-treatment-for-depression.html
(July 2013) Abstract: Brain Damages in Ketamine Addicts as Revealed by Magnetic Resonance Imaging. Frontiers in Neuroanatomy. Chunmei Wang, Dong Zheng, Jie Xu, Waiping Lam, and D. T. Yew. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713393/
(June 2018) Ketamine: Old Drug, New Tricks. Emily Deans M.D. Psychology Today. from https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201806/ketamine-old-drug-new-tricks
(October 2017) What are the Uses of Ketamine? Kathleen Davis F.N.P. Medical News Today. from https://www.medicalnewstoday.com/articles/302663.php
(August 2018) Ketamine, A Promising Depression Treatment, Seems to Act Like An Opioid. Jon Hamilton. National Public Radio (NPR). from https://www.npr.org/sections/health-shots/2018/08/29/642700616/ketamine-a-promising-depression-treatment-seems-to-act-like-an-opioid
(December 2014) Drug Facts: Club Drugs (GHB, Ketamine, and Rohypnol). National Institute on Drug Abuse. from https://www.drugabuse.gov/sites/default/files/drugfacts_clubdrugs_12_2014.pdf
(August 2018) Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism. Nolan R. Williams M.D. Stanford University School of Medicine. from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18020138