What is Ketamine?
Ketamine (brand name: Ketalar) is a dissociative injected anesthetic (blocks sensory perception) that has been available by prescription in the U.S. since the 1970s for human and veterinary uses. They approved Esketamine (Spravato), the S-enantiomer of racemic ketamine in 2019 for treatment-resistant depression and for use in depressed patients with acute suicidal ideation or behavior. can you overdose on ketamine?
Dissociative drugs can lead to distortion of sights, colors, sounds, self, and one’s environment. It is available in a clear liquid or off-white powder form for intravenous injection or as a nasal spray. Examples of other dissociative drugs include phencyclidine (PCP) and dextromethorphan (DXM).
In the U.S., ketamine is classified as a schedule III drug under the DEA Controlled Substances Act; however, it is not classified as an opioid (narcotic) or barbiturate.
Why do people use ketamine medically?
- It can provide pain relief and short-term memory loss (for example, amnesia of a medical procedure).
- In surgery, doctors use it as an induction and maintenance agent for sedation and to provide general anesthesia.
- People also use it for pain control in burn therapy, battlefield injuries, and in children who cannot use other anesthetics due to side effects or allergies.
- Ketamine, through blocking at the N-methyl-D-aspartate (NMDA) site, has rapid action in controlling symptoms of depression and acute suicidal ideation.
- At normal doses, people often prefer it as an anesthetic in patients at risk of bronchospasm and respiratory depression.
How does it look, taste and smell?
What does it look like?
- A clear liquid, when used in medicine.
- A grainy white or brown crystalline powder when sold on the street
- Tablets, although this is less common.
What does it taste/smell like?
Ketamine tastes bitter and unpleasant.
How do people take it?
People use ketamine in medicine as an anesthetic for humans and animals.
- By snorting it as a powder : Most people who take powder ketamine will snort it. Users often talk of taking a ‘bump’, meaning they snort a small amount of ketamine. In the UK, snorting is the most common way to take it.
- By injecting it : People who regularly use ketamine sometimes inject it to get a bigger hit. They usually inject it into a muscle.
- By swallowing it as a tablet : Some people swallow it in tablet form, but this is less common.
- By bombing : Some people ‘bomb’ it, which is swallowing the powder wrapped in a cigarette paper.
Pharmacology of Ketamine
Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, and it blocks HCN1 receptors. However, at higher doses it may also bind to the opioid mu and sigma receptors. It disrupts the neurotransmitter (brain chemical) glutamate. Glutamate is involved with learning, memory, emotion, and pain recognition. It can exhibit sympathomimetic activity which can lead to rapid heart rate and elevated blood pressure.
It is related to phencyclidine (PCP), but has less than 10% of the potency of pure PCP.
This agent is a lipid soluble compound, has an initial rapid distribution and large volume of distribution, with a half-life of 10 to 15 minutes. Secondarily, the drug distributes into peripheral tissues with a slower elimination half-life of up to 3 hours, undergoes hepatic metabolism and you excrete it in the urine. Can you overdose on ketamine.
How can you abuse Ketamine?
In addition to its legal, medical uses, ketamine and and synthesized analogs have become drugs of abuse with hallucinogenic properties. People also use it as a “date rape” drug.
When people abuse, they typically insufflate (“snorted” up the nose) in social situations. They also inject, consume orally as a liquid, or smoke in marijuana or tobacco. People frequently abuse it in combination with other substances, such as cocaine or amphetamines. Use with multiple drugs has been fatal.
When misused, it is often sourced via the illegal diversion of prescription products, but analogs may be found on the streets.
How Quickly Does Ketamine Work?
- An injection yields a quick response, with effects occurring in seconds to minutes.
- “Snorting” leads to effects in roughly 5 to 15 minutes (this is the most common method of abuse).
- Oral consumption requires between 5 and 30 minutes.
The effects of abuse typically last 1 to 2 hours, but it can affect the users judgement, senses and coordination for up to 24 hours or longer. As a result, sensations the user may seek include floating, stimulation and visual effects.
High doses may dangerously reduce breathing, lead to muscle spasms or weakness, dizziness, balance difficulty, impaired vision, slurred speech, nausea and vomiting, and severe confusion.
Ketamine Health Hazards & Side Effects
You can link the abuse of ketamine with short-term and long-term problems:
- Short-term: Problems with attention, learning, and memory; dreamlike states, hallucinations; sedation; confusion; loss of memory; raised blood pressure; unconsciousness; dangerously slowed breathing.
- Long-term: Ulcers and pain in the bladder; kidney problems; stomach pain; depression; poor memory.
The most common side effects associated with ketamine when used medically are nausea, vomiting, dizziness, diplopia (double vision), drowsiness, dysphoria (unease, restlessness), and confusion. There is also the risk of HIV, hepatitis, and other infectious diseases from shared needles.
Ketamine use can be fatal in people who are alcoholics or acutely intoxicated with alcohol. There are animal reports of an increased risk of toxicity when you combine ketamine with caffeine. Theoretically, this may be a concern in people who consume energy drinks, often done at nightclubs where people abuse ketamine. Can you overdose on ketamine.
Central nervous system side effects such as agitation are less intense than those seen with PCP abuse.
For those who abuse ketamine via insufflation (“snorting”) adverse reactions may be less serious, but still present. Fast heart rate, high blood pressure, hallucinations, and impaired consciousness upon presentation to the emergency department may be most common effects with “snorting”.
Tolerance can build to the effects over time, requiring greater doses of the drug to reach the same level of effect. Reports suggest that the dissociative effect may also disappear over time. The dissociative effect alters the users perception of light and sound and produces feelings of detachment from self and surroundings.
Withdrawal may occur after chronic, extended use of ketamine. Withdrawal symptoms may include chills, sweats, excitation, hallucinations, teary eyes, and drug cravings. Can you overdose on ketamine.
- With an overdose of ketamine, you should contact emergency care, such as 911 immediately.
- There is no antidote for this drug. Treat overdose situations with symptomatic and supportive care in the hospital setting. In the emergency department, adverse effects typically resolve in 1 to 3 hours.
- You can use benzodiazepines such as lorazepam if needed for seizures, excitation, or muscle rigidity.
- Respiratory support is rarely needed, but assisted ventilation or supplemental oxygen may be required. Respiratory depression may be more likely if combined with sedatives.
- Refer those who abuse this drug for drug counseling.
Extent of Abuse
The only known source of ketamine is via diversion of prescription products. Illicit production usually involves evaporating the liquid from the diverted injectable solution to produce a powder that is formed into tablets or sold as a powder for intranasal use.
- Widespread ketamine abuse began in the late 1970s as subcultures experimented with the drug.
- Ketamine has more recently been used as a “club drug”, often by teens and young adults at dance “rave” parties. It is most commonly abused by those 16 to 25 years of age.
- It has also been used in instances of “date rape” due to its strong side effect of confusion coupled with amnesia.
Is Addiction possible?
Yes. People who become addicted to ketamine will keep taking it – whether they’re aware of the health risks or not. Also, others will attend drug treatment services to help them stop.
People who use ketamine regularly can develop a tolerance to it, which could lead to them taking even more to get the effects they’re looking for.
There are no physical withdrawal symptoms with ketamine, so ketamine addiction is sometimes called a psychological dependence.
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