The drug ketamine is a synthetic drug that is classified as a dissociative anesthetic. These drugs provide sedation as well as feelings of detachment from the self or reality. It is used medically for anesthesia, particularly for burn victims (though it is used more often by veterinarians than for humans in this capacity), and for pain relief. There is a body of ongoing research that has investigated its potential in the treatment of major depressive disorder that suggest it might be useful in this capacity. At the time of this writing, the Food and Drug Administration (FDA) is fast-tracking forms of ketamine for approval in the treatment of depression.
Ketamine was developed in the 1960s and originally used as replacement for phencyclidine (PCP). However, the drug became a significant drug of abuse and had serious side effects; as a result, it has been regulated for use only very specialized cases. The mechanism of action for ketamine is not fully understood, and research suggests that ketamine may affect numerous neurotransmitters in the brain; however, it appears that one of its primary actions is to block the release of the excitatory neurotransmitter N-methyl-d-aspartate (NMDA).
NMDA is an excitatory neurotransmitter of the glutamate class of neurotransmitters, which are the most prevalent excitatory neurotransmitters in the brain. When excitatory neurotransmitters are released in the central nervous system, they speed up the function and firing of neurons in the brain and spinal cord. Blocking the release of NMDA facilitates the anesthetic and dissociative actions of ketamine while not making individuals overly sedated when used at therapeutic levels.
Ketamine is a controlled substance. It is classified by the United States Drug Enforcement Administration (DEA) as a Schedule III substance.
The abuse of ketamine appears to have started in the 1970s on the West Coast. The popularity of the drug is due to its hallucinogenic effects, and during this period of time, hallucinogens had become quite popular. The drug was most commonly used as an injectable; however, abusers were also able to extract the ketamine from liquid solutions to develop powders and pill forms.
Ketamine has been used as a date rape drug (see below). Some of the medicinal brand names for ketamine include Ketaset and Ketalar. Common street names for ketamine include special K, K, kit kat, and cat valium.
The latest data from the Substance Abuse and Mental Health Services Administration (SAMHSA) provide estimates of use and abuse of ketamine in the United States.
- In 2015, it was estimated that more than 3 million individuals over the age of 12 used ketamine; in 2016, this estimate was 3.4 million.
- Ketamine use in individuals between the ages of 12-17 years old was estimated to be 50,000 in 2015 and 47,000 in 2016.
- Ketamine use in individuals between the ages of 18 and 25 years old was estimated to be 636,000 in 2015 and 549,000 in 2016.
- Ketamine use in individuals over the age of 26 in 2015 was 2.3 million; in 2016, it was estimated to be 2.8 million. This group demonstrated the largest increase in the use of ketamine in 2015 to 2016.
Most often, ketamine is abused in pill or powder form (most often via snorting). The drug is often taken in conjunction with alcohol. Snorting the drug results in a quicker onset of action (5-15 minutes), whereas using the drug in pill form involves an onset of action that takes 5-30 minutes. The dissociative hallucinogenic effects that occur as a result of using the drug are typically relatively short-lived (about an hour), whereas more serious cognitive effects, including confusion, disorientation, and amnesia, may continue for several hours after ingestion. Ketamine is a well-studied substance that typically produces:
- A hypnotic state at low doses (very mild sedation, hallucinations, and dissociative effects)
- More lethargy and confusion at higher doses
- A reduction in the subjective experience of pain
- Significant problems forming new memories while under the influence of the drug
- In some cases, increased sympathetic nervous system activity (the part of the nervous system outside the brain and spinal cord that increases the functioning of the body).
The effects of ketamine are dose-dependent, and its ability to produce amnesia and lethargy is more pronounced in nonmedicinal doses (the types of doses that are typically used by abusers and are far larger than medicinal doses). Symptoms that are typically experienced in abusers include:
- Becoming disoriented, losing touch with reality, and/or feeling extremely vulnerable or sociable
- Significantly impaired motor coordination, muscle rigidity, sweating, and increased heart rate
- Insomnia, irritability, increased aggression, and amnesia
- Potential liver and brain damage in chronic abusers
- Potential cardiovascular effects in chronic abusers
- Serious effects from overdose that can include organ damage and even death
Concerns of Mixing Alcohol with Other Drugs
- Crystal Meth
- Crack Cocaine
- Bath Salts
Using Ketamine with Alcohol
According to SAMHSA, alcohol is one of the most commonly abused drugs in the United States, second only to tobacco products. Alcohol is a central nervous system depressant drug that has numerous actions, including increasing the levels of the inhibitory neurotransmitter gamma aminobutyric acid (GABA) and reducing the effects of excitatory neurotransmitters such as NMDA. When ketamine is used with alcohol, effects are enhanced as the drugs are synergistic (produce similar effects).
Alcohol can produce many of the same effects as ketamine, and when these two drugs are taken in conjunction, one needs less of either drug to experience and enhance the effects of either drug. This can result in a very dangerous situation.
- The impairment of an individual’s reflexes and motor coordination is significantly increased under the influence of both drugs. This can result in potential for accidents or other mishaps, particularly if the person is operating heavy machinery, such as driving an automobile.
- The effects on a person’s cognition are enhanced when these drugs are combined. This means that the individual will experience a rapid decline in their ability to make rational decisions, communicate with others, and even remember events that occurred while under the influence of both drugs.
- When these drugs are combined, potentially dangerous symptoms can occur, such as hallucinations, dissociative experiences, psychosis, depression, and the potential for seizures. Other issues, such as extremely increased heart rate and increased urination and sweating (which can lead to dehydration), can also lead to potentially significant issues.
- There is a significant increased strain on the individual’s organ systems as a result of combining these drugs. The cardiovascular effects that occur with both drugs are increased. There is a significant burden on the liver because it must metabolize alcohol first, which can result in dangerous levels of ketamine remaining in the system for longer than they normally would. These effects trickle down to other important systems, such as the kidneys.
- Both of these drugs have serious potential overdose effects. Since the effects of each drug are enhanced when they are taken in conjunction, one needs a smaller amount of either drug to experience potentially severe overdose effects from either drug.
- Chronic abuse of alcohol is associated with a severe form of a substance use disorder. Combining ketamine and alcohol on a regular basis increases the risk for developing physical dependence on one or both drugs and for the development of a severe substance use disorder that can be very complicated and difficult to treat.
There is a litany of potential long-term effects due to the combination of these drugs, such as serious liver disease (increased potential to develop cancer, alcoholic hepatitis, or even cirrhosis); cardiovascular effects (increased potential for heart attack or stroke); increased potential for issues with the kidneys; decreased functioning of the immune system, which can lead to increased susceptibility to disease; and an increased potential to develop forms of cancer in areas other than the liver, such as gastrointestinal cancer, throat cancer, etc.
A Date Rape Drug
As mentioned above, ketamine is one of the drugs that have been recognized by the DEA and other sources as a potential date rape drug. Its strong dissociative effects, when combined with alcohol, can lead to individuals being taken advantage of. Individuals under the influence of both of these drugs may become victims of crimes or even engage in criminal activities that they normally would not engage in.
The majority of sexual assaults are associated with alcoholic use, and combining ketamine with alcohol only increases this potential. In addition, individuals under the influence of ketamine often suffer amnesia for events that occurred while they had the drug in their system, and these effects are enhanced when ketamine is combined with alcohol.
Potential Symptoms of Ketamine Use and Abuse
People who use and abuse ketamine in conjunction with alcohol may present with the following symptoms:
- Dilated pupils
- Profuse perspiration
- Sluggishness or seeming mellow
- Appearing irrational, such that the person’s casual conversation is hard to follow and they seem to wander from subject to subject when they talk
- Visual hallucinations or dissociative experiences (stating that they are outside their body).
- Aggressiveness and irritability
- Significant problems with walking and motor coordination
- Urinating frequently
- Paranoia or suspiciousness
Treatment for Ketamine Abuse
Chronic use of ketamine does produce tolerance to the drug; however, it is still not clear if individuals develop physical dependence on ketamine. It is certainly possible to experience depression, lethargy, severe cravings, etc., when discontinuing ketamine. On the other hand, chronic use of alcohol leads to a serious syndrome of physical dependence that can potentially be fatal due to seizures that may occur.
Long-term effects of the chronic abuse of both drugs is not well studied, but it can be surmised that serious issues with tolerance and withdrawal symptoms would be present in individuals who chronically abused alcohol and ketamine. Anyone who has abused these drugs separately or in conjunction with one another for any significant period of time requires a formal treatment intervention that would include medical management, therapy, peer support group participation, and other interventions as identified in a thorough assessment of the individual’s physical, emotional, and social functioning and situation.
Attempting to stop using these drugs without consulting with a formal mental health professional will inevitably result in failure and can have serious and even fatal consequences, particularly when individuals who relapse have lost some of their tolerance to the drugs. In this situation, it is far easier to overdose on these drugs and suffer potentially serious and even fatal effects.