Ketamine

Common or street names: K, Special K, K2, Vitamin K, Super K, Super C, Lady K, Ket, Kit Kat, Ketaset, Ketaject, Jet, Super Acid, Green, Purple, Mauve, Super Acid, Special LA Coke, Cat Tranquilizers, Cat Valium1

What is Ketamine?

Ketamine (Ketalar) is a dissociative general anesthetic that has been available by prescription in the U.S. since the 1970s for human and veterinary uses. It has also been used for pain control in burn therapy, battlefield injuries, and in children who cannot use other anesthetics due to side effects or allergies. Pharmacologically, ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, but at higher doses may also bind to the opioid mu and sigma receptors. It is related to phencyclidine (PCP), but has less than 10 percent of the potency of pure PCP.1

Ketamine has become a drug of abuse and recreational drug. Ketamine for recreational purposes is sourced illegally via the diversion of the prescription products. Ketamine is available in a clear liquid or off-white powder form. Ketamine may be injected intravenously or intramuscularly, consumed orally, or added to marijuana and smoked.2 In the U.S., ketamine (Ketalar) is in DEA schedule III drug under the Controlled Substances Act; however, it is not classified as a narcotic.1

Abuse of ketamine can lead to powerful visual hallucinations that are intensified by environmental stimuli. When higher doses of ketamine are abused, it is reported to produce an “out-of-body”, “K-hole” or “near-death” hallucinogenic experience, often reported as terrifying. More recently, ketamine has become popular in the U.S. as a “club drug”, often used by teens and young adults at dance “rave” parties. Ketamine has also been used in instances of “date rape” due to its strong side effect of confusion and/or amnesia.2

Ketamine Health Hazards & Side Effects

Tolerance can build to the effects of ketamine over time, requiring more of the drug to reach the same level of effect. Reports suggest that the dissociative effect may disappear over time. Dissociative means that drug alters the users perception of light and sound and produces feelings of detachment from one's self and surroundings. Binge use, where the user indulges in the drug in excess amounts in a short period of time has been reported, as well.1

Other reported side effects include:

  • lethargy
  • delirium
  • sedation
  • chest pain
  • hallucinations/terrors
  • respiratory depression
  • elevated heart rate
  • loss of coordination
  • muscle rigidity
  • violent behavior
  • amnesia
  • seizures
  • coma
  • death from overdose (rare)

A 2011 clinical review of over 110 cases describes lower urinary tract toxicity, also known as ketamine-induced vesicopathy, in association with chronic ketamine abusers. The syndrome results in symptoms such as urge incontinence (strong, sudden need to urinate due to bladder spasms or contractions), decreased bladder volume, detrusor muscle overactivity, and blood in the urine. Stopping ketamine use is the only effective treatment to decrease symptoms and prevent failure of the kidney function.3

Withdrawal may occur after chronic, extended use of ketamine. Withdrawal symptoms may include chills, sweats, excitation, hallucinations, teary eyes, and drug cravings.

With an overdose of ketamine, emergency care, such as 911, should be contacted immediately. There is no antidote for ketamine. Overdose situations with ketamine are treated with symptomatic and supportive care in the hospital setting. Benzodiazepines may be used if needed for seizures or excitation. Respiratory support is rarely needed, but assisted ventilation or supplemental oxygen may be required.

Extent of Use

The only known source of ketamine is via diversion of prescription products. There have been reports of veterinarian offices being robbed for their ketamine stock. Also, according to the DEA, a major U.S. source of illicit ketamine arrives across the border from Mexico.2

Widespread ketamine abuse began in the late 1970s as subcultures (e.g., mind explorers, new agers, spiritualists) experimented with the drug. Ketamine may be injected intravenously or intramuscularly, used intranasally (“snorted”), consumed orally, or added to marijuana and smoked. In social situations, illicit ketamine is most frequently used orally or intranasally.

As reported in the 2011 Monitoring the Future Survey, the annual prevalence of ketamine use in grades 8, 10, and 12 in 2011 was 0.8%, 1.2%, and 1.7%, respectively. These rates have fallen since the early 2000’s, when rates were roughly 1.6%, 2.1%, and 2.5% in grades 8, 10, and 12, respectively.4

Illicit production of ketamine 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. Injection of ketamine produces the fastest response, with effects occurring in 1 to 5 minutes; “snorting” takes roughly 5 to 15 minutes; and oral consumption between 5 and 30 minutes. The effects of ketamine abuse typically last 1 to 2 hours, but the users judgement, senses and coordination may be affected for up to 24 hours or longer.1

Doses of 1 to 2 milligram per kilogram of body weight produce intense hallucinogenic and dissociative effects for roughly one hour. Sensations may include floating, stimulation and visual effects. Larger doses may result in the “k-hole”, where users are near full sedation and is said to mimic an “out-of-body” or “near-death” experience. High doses may dangerously reduce breathing, lead to muscles spasms or weakness, dizziness, balance difficulty, impaired vision, slurred speech, nausea and vomiting, and severe confusion.

See Also:

References:

  1. CESAR. Center for Substance Abuse Research. University of Maryland. Ketamine. Accessed March 29, 2012. http://www.cesar.umd.edu/cesar/drugs/ketamine.asp
  2. DEA Fact Sheet, www.justice.gov
  3. Middela S., Pearce, I. Ketamine-induced vesicopathy: a literature review. International Journal of Clinical Practice 2011;65: 27-30.
  4. Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2011. Accessed April 2, 2012, http://monitoringthefuture.org/pubs/monographs/mtf-overview2011.pdf

Last updated: 2014-05-18 by Leigh Anderson, PharmD.

Hide
(web4)