Ketamine is a dissociative anesthetic that was developed in the 1960s to replace phencyclidine or PCP, a drug that had been used as an anesthetic but was found to be highly addictive and dangerous. Ketamine is used as an anesthetic by veterinarians, and it is currently used in initiating anesthesia for surgical patients, to sedate patients in intensive care (especially burn patients), and for other types of pain relief in some cases. Ketamine is also under investigation for its potential to be a useful treatment for individuals suffering from major depressive disorder.
The actions of ketamine are not fully understood at this time; however, it is believed that ketamine’s primary function is to block the actions of the excitatory neurotransmitter N-methyl–d-aspirate (NDMA) in the brain. This action results in the suppression of a number of functions, including the sensation of pain and perhaps even feelings of depression and anxiety.
Ketamine has hallucinogenic properties, and these properties made it popular drug of abuse among certain subcultures on the West Coast in the 1970s. Ketamine is typically marketed as an injectable drug; however, individuals who illegally obtain the drug transform it into different forms, such as powder, crystals, and tablets. The drug became popular in the dance club scene and still remains popular with young individuals due to its euphoric effects and hallucinogenic properties. It is often abused in conjunction with ecstasy. Since the drug is a Schedule III controlled substance, these uses of ketamine are obviously illicit.
Ketamine is frequently abused orally in pill form or snorted as a powder. Snorting ketamine results in the effects appearing rather rapidly (typically within 5-15 minutes after use), whereas taking ketamine in pill form results in the effects typically occurring within 5-30 minutes after ingestion. Ketamine is a fast-acting drug, and for most individuals, the effects last for about an hour. That being said, individuals who have used ketamine often experience cognitive effects, such as confusion, amnesia, problem-solving difficulties, engaging in risky behaviors such as unprotected sex, and other issues for 24 hours following discontinuation.
The Effects of Ketamine
According to the book Ketamine Use and Abuse, when administered by physicians using the drug for medicinal purposes, ketamine is generally safe. Individuals who abuse ketamine typically experience elevated mood, visual hallucinations, feeling as if events are not real, feeling as if they are detached from their body or that they are not real, and even pleasant dreams. However, there are also some known side effects that occur with repeated use of ketamine.
- Central nervous system: Ketamine may cause intracranial hypertension or increased pressure inside the skull. For individuals who are susceptible to this condition, susceptible to stroke, or have serious brain injuries, this may contradict its use. Ketamine use is also associated with the development of seizures.
- Cardiovascular system: Ketamine use is associated with the development of hypertension, hypotension, and abnormal heart rhythms.
- Gastrointestinal system: Ketamine use is known to increase nausea and vomiting, and in some individuals, it may result in serious reductions in appetite.
- Visual system: The use of ketamine may result in increased intraocular pressure, double vision, and nystagmus (abnormal eye movements).
- Psychiatric symptoms: Ketamine use may be associated with confusion, delirium, and the development of hallucinations in some individuals.
- Physical dependence and the timeline for withdrawal: For some time, there was conflicting evidence that chronic use of ketamine results in physical dependence. However, a number of case studies have been reported that indicate that physical dependence to ketamine does occur in some people. According to a 2012 review in the journal Addiction, the key issues with withdrawal from ketamine are cravings, anxiety, sweating, shaking, and heart palpitations when individuals stop using the drug. Despite a number of sites outlining a specific timeline for ketamine withdrawal, according to this professional review, a specific ketamine withdrawal syndrome had not yet been described. Based on the information provided in the review and several other sources, it appears that in most individuals the symptoms peak within 48-96 hours and subside after that point.
Treatment for Ketamine Addiction
Individuals who have substance use disorders will need professional treatment to assist them in recovery. Individuals who have developed a hallucinogen use disorder as a result of ketamine use will require a couple of special considerations and need to engage in intensive treatment. Treatment may entail the following:
- Assessment: Individuals wishing to get into a program of recovery should first have a full and complete assessment that covers their history, any psychological issues, any medical problems, and any social/relational issues they may have. This allows for the individual to be treated as an entire person and to address all issues that can foster substance use.
- Withdrawal management: Because there is evidence that chronic use of ketamine does result in at least mild physical dependence, it is important that individuals attempting to recover from ketamine abuse consider withdrawal management as the first step in their program. Because there is quite a bit of conflicting information regarding the withdrawal process from ketamine, it would be best that these individuals seek a residential withdrawal management program where they can be observed and given attention on the spot. Physicians can administer drugs like benzodiazepines to manage withdrawal symptoms and drugs like naltrexone to manage cravings.
- Aftercare: Following the withdrawal management process, an individual should actively remain in a treatment program. At a minimum, this treatment program should include involvement in some form of specialized counseling or therapy to assist the individual in identifying issues that foster their addiction, develop coping skills, develop stress-reduction techniques, and develop a long-term program for relapse prevention.
- Support: Individuals in recovery will need support from family members, other individuals in recovery, friends, and other professionals involved in treatment in order for them to be successful. Often individuals can get involved in social support groups, such as 12-Step groups, that are ongoing and allow them to maintain a strong social support network for years following their entry into recovery. Other forms of social support include support from family, family therapy, psychoeducation courses, and involvement in community mental healthcare activities.
- Other: Other forms of intervention or support targeted at the individual case should also be instituted when needed. For instance, individuals with substance use disorders often need help finding employment or getting specific training. A vocational rehabilitation specialist can help with this. Individuals may need assistance with finding a place to live, and a case manager or social worker can help with this. Other supports should be given as needed to ensure that the individual can maintain long-term recovery.