KETAMINE
Ketamine crystals often have a cylindrical or ‘sharded’ appearance.
Ketamine is a dissociative drug developed in the 1960s as an anaesthetic for surgery. Because of its dissociative and potentially euphoric effects, ketamine is used for recreational and psychedelic exploration purposes, sometimes being called “special K.”
Ketamine is also well-recognized as a therapeutic tool with rapid antidepressant effects. Over recent years, numerous studies have investigated ketamine’s mental benefits, and hundreds of ketamine wellness clinics have opened in the US and beyond.
Effects
Potential positive effects include physical euphoria, pain relief, increased music enhancement, increased energy, a sense of connection with the world, feelings of calmness and serenity, feeling light in the body and experiencing an alcohol-like state (at low doses) (1)(2)
Potential neutral effects include visual distortions, feeling dissociated from the mind and body, time distortion, shifts in perception of reality, experiencing a “K-hole”(an intense out-of-body experience) and synesthesia (mixing between the different senses). (1)(2)
Potential negative effects include short-term memory loss, confusion, disorganised thinking, being uncoordinated and finding movement difficult, increased suggestibility, psychosis, loss of consciousness, anxiety, panic and delirium. (1)(2)
A person may experience physical effects that include increased heart rate and blood pressure, increased respiration, decreased libido, dizziness, dehydration, decreased motor control, physical sedation, enhanced muscle tone, numbness and relief from pain. (1)(3)
Dosage
50-100mg: Low dose: At this dose people may experience an alcohol-like state, feelings of calmness and serenity, their body may feel slightly numb and they may experience mild cognitive dissociation. (1)
100-300mg: Moderate dose. At this dose people may experience physical disorientation, spacial disorientation, time distortion, confused thought and feelings of separation from the body.
300mg+: High dose. At this dose people may experience feeling separated from their body, confused thought and distortion of time and vision. At the higher end of this dose range, people may experience a “K-hole”which is an intense out of body experience where the user becomes unresponsive to external stimuli and may experience hallucinations.
A Ketamine-infusion treatment session, at a US clinic
Duration
Onset: 5-10 minutes (2)
Come-up: 10-15 minutes (2)
Peak: 30-60 minutes (2)
Total duration: 1-1.5 hours (2)
Aftereffects: 1-2 hours (2)
Dangers
What not to mix with
Allergy medications: Allergy medications such as Benadryl, Piriton, and Piritze can cause drowsiness and may increase the dizziness and confusing effects of ketamine.
Stimulants (e.g. amphetamine and cocaine): Ketamine and amphetamines increase the effects of each other, which can lead to unpredictable outcomes. As ketamine can increase heart rate and blood pressure, mixing ketamine with stimulants, which also have a similar effect on the cardiovascular system, could lead to heart attack and other complications.
Alcohol and GHB/GBL: Alcohol and GHB can cause ataxia (loss of control of body movements) as can ketamine. Therefore, combining these substances increases the risk of the user falling unconscious and may increase the risk of aspiration (blocked airways) from vomiting or when eating food which can be fatal.
Opioids: Opioids and ketamine have a synergistic effect which means they can increase the strength of one another. Both these drugs increase inhibition in the nervous system, which can risk memory loss, falling unconscious, respiratory depression, and aspiration. Taking these drugs together could therefore increase the risk of these dangers.
Benzodiazepines (xanax, valium, etc.): Both ketamine and benzodiazepines have inhibitory effects on the nervous system. Therefore combining these substances increases the risk of memory loss, falling unconscious, respiratory depression, and aspiration.
Monoamine oxidase inhibitors (MAOIs): Monoamine oxidase inhibitors are a family of drugs used in the treatment of depression and other nervous system disorders. There is little information about MAOIs and ketamine. However, there have been some reports of harmful combinations with MAO-A inhibitors. MAO-B inhibitors also appear to increase ketamine potency.
A detailed chart of drug interactions can be found here
What are the dangers?
Injury: Ketamine impairs motor coordination which means there is an increased likelihood of tripping over objects and falling over. Furthermore, ketamine is an anaesthetic, so any severe injury to the body may not be felt and no appropriate attention given to the damage. This risks injuries becoming worse.
Impaired Brain Function: In one study, researchers gave ketamine daily to monkeys. The daily administration of ketamine decreased the monkey’s motor activity and caused cell death in their prefrontal cortex, an area of the brain important for problem-solving skills.
Tolerance: Ketamine is clinically proven to produce tolerance. (https://pubmed.ncbi.nlm.nih.gov/31021848/) Tolerance is a reduced response to a drug when the drug is frequently used. This means higher doses of the drug are required to cause the same response, which leads people to take higher doses of the drug. Taking higher doses of ketamine, due to tolerance, increases the risk of liver and kidney damage and other unwanted effects on the body.
Substance abuse and dependence: Evidence has found ketamine has been shown to affect the reward system of the brain. This effect means people with genetic and environmental vulnerability could risk becoming addicted to the drug. Suffering drug addiction is incredibly difficult for the user and negatively affects their surrounding families and friends. Ketamine can also cause dependence, which is the need to take a drug in order to avoid withdrawal symptoms. Withdrawal symptoms of ketamine can include anxiety, paranoia, tremors, sweating, depression, restlessness, and loss of appetite.
Kidney and liver damage: Ketamine abuse is linked to toxic effects in the liver, kidneys and bladder. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421282/) These effects can lead to complications including urinary cytisus, urinary incontinence, hepatitis and severe abdominal pain called "K-cramps". In extreme cases, people may need their bladder removed.
Experiencing a psychological crisis: Although ketamine doesn't necessarily induce a classical psychedelic trip similar to psilocybin mushrooms or LSD, it can still cause a state which is far distorted from reality, notably when experiencing a "K-hole." If done in the incorrect set and setting, or if unexpected, this can be an intense experience which can be very uncomfortable and even leave somebody feeling traumatised. (https://pubmed.ncbi.nlm.nih.gov/23432384/)
How can the risks be minimised?
To avoid injury, when taking large doses of ketamine it is advisable to be in a place without trip hazards, and if severe pain is felt once the drug has worn off, then one should seek medical attention.
Avoiding frequent long-term abuse of ketamine will minimise the risk of any dangerous effects on cognition, tolerance occurring, dependence and substance abuse and kidney and liver damage.
If you or anybody you know is experiencing ketamine addiction, a list of helpful webpages are listed on the NHS website: https://www.nhs.uk/live-well/healthy-body/drug-addiction-getting-help/
If symptoms of bladder, liver or kidney disease appear, it is essential ketamine use stops as this will stop making damage to these organs worse.
When taking high doses of ketamine and intentionally entering the "K-hole" it is recommended to do this in a comfortable and quiet environment with close friends nearby. It's crucial to regulate the doses of ketamine being taken, especially when at music events and festivals as entering a "K-hole" in these places can be very overwhelming and unpleasant. For more information on psychedelic crisis harm-reduction, read under general psychedelic risks and harm-reduction advice.
What are the potential benefits of ketamine?
Scientific research has investigated using ketamine to treat:
Weblinks
Information source regarding bladder issues related to ketamine abuse including symptoms and treatment options: https://www.dchft.nhs.uk/patients/patient-information-leaflets/Documents/GUM,%20Ketamine%20bladder%20syndrome%200716.pdf.
Psychonaut Wiki page for ketamine, includes first hand ketamine experiences and has a rich source of information including history of the drug and pharmacological mechanisms: https://psychonautwiki.org/wiki/Ketamine
Drugs and me resource, a comprehensive overview of ketamine: https://www.drugsand.me/en/drugs/ketamine/
The science behind how ketamine works as a treatment for depression: https://www.youtube.com/watch?v=i28-ldmUnxo
References:
Credit to Dr Andrew Gibson for contributing his medical expertise and background in harm-reduction to the process of making this content.