What is Ketamine?
Ketamine (brand name Ketalar) is a dissociative anesthetic (blocks sensory perception) that has been available by prescription in the U.S. since the 1970s for human and veterinary uses. 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. Other dissociative drugs include phencyclidine (PCP) and dextromethorphan (DXM).
- Ketamine can provide pain relief and short-term memory loss (for example, amnesia of a medical procedure).
- In surgery, it is used an induction and maintenance agent for sedation and to provide general anesthesia.
- 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.
- This drug is also under research and holding promise as a treatment for severe depression in difficult cases.
- It is often preferred as an anesthetic due to a lower chance for depressed breathing, as often occurs with opioids.
Pharmacology of Ketamine
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. This drug disrupts the neurotransmitter (brain chemical) glutamate. Glutamate is involved with learning, memory, emotion, 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 is excreted in the urine.
How is Ketamine Abused?
In addition to its legal use as an anesthetic, ketamine has become a drug of abuse and recreational drug and has hallucinogenic properties. Dangerous designer drugs, which are synthesized analogs of the original drug, have been developed as well.
For recreational purposes is illicitly sourced via the diversion of prescription products.
When abuse, it is typically insufflated (“snorted” up the nose) in social situations. It is also injected intravenously or intramuscularly, consumed orally as a liquid, or added to marijuana to smoke. In the U.S., ketamine is in schedule III under the DEA Controlled Substances Act; however, it is not classified as a narcotic.
How Quickly Does Ketamine Work?
- An injection yields a quick response, with effects occurring in 1 to 5 minutes.
- “Snorting” takes roughly 5 to 15 minutes.
- Oral consumption requires between 5 and 30 minutes.
The effects of abuse typically last 1 to 2 hours, but the users judgement, senses and coordination may be affected for up to 24 hours or longer. Sensations the user may seek include floating, stimulation and visual effects.
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.
Binge use, where the user indulges in the drug in excess amounts in a short period of time has been reported, as well.
Ketamine Recreational Dose Ranges
|75 to 125 mg||Intramuscular (IM) injection|
|60 to 250 mg||Insufflation (intranasal or “snorting”)|
|50 to 100 mg||Intravenously (IV)|
|200 to 300 mg||Orally (by mouth)|
Source: Up to Date, 2018
Abuse of large doses can also lead to powerful visual hallucinations that are intensified by environmental stimuli. Coma and deep unconsciousness can occur. When higher doses of ketamine are abused, or during emergence, it is reported to produce and vivid dreams and an “out-of-body”, “K-hole” or “near-death” hallucinogenic experience, often reported as terrifying.
In smaller doses, such as those typically used recreationally, ketamine can lead to various effects such as:
- feelings of calmness and relaxation, relief from pain
- depressed mental state
- detached feeling from body
- slurred speech
- diminished reflexes
- hallucinations lasting from 30 to 60 minutes
- nystagmus (repetitive, uncontrolled movements of the eyes)
Ketamine Health Hazards & Side Effects
The intensity of side effects are related to the dose of the drug consumed. Reported side effects may include:
|Low-to-moderate doses||Higher doses|
|Cardiovascular||Chest pain, elevated or depressed heart rate, high blood pressure, low blood pressure (rare).||Chest pain, dangerous changes in blood pressure, heart rate.|
|Central Nervous System (CNS)||Agitation, alterations in sight, sound, shapes, time, and body image, confusion, detached feelings, dizziness, drowsiness, flashbacks, hallucinations, lethargy, loss of coordination, numbness, sedation.||Amnesia (memory loss), coma, delirium, elevated body temperature, fear, hallucinations or terrors (k-hole effect), panic, seizures, violent behavior.|
|Gastrointestinal||Nausea and vomiting.||Nausea and vomiting.|
|Renal||Kidney toxicity (with chronic abuse).||Kidney toxicity (with chronic abuse).|
|Respiratory||Increase in breathing rate.||Respiratory depression (with rapid, high doses and if combined with alcohol or other CNS depressants).|
|Other||Salivation (IV use), spasm of the larynx (rare).||Severe anxiety, fear, panic, anxiety, exaggerated strength, and aggression, muscle rigidity, respiratory depression, death from overdose, especially if combined with alcohol, other CNS depressants).|
Sources: Up to Date, 2018; NIDA, FDA product label 2018.
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.
The risk of HIV, hepatitis, and other blood-borne infectious diseases exists for those who share needles when drugs are used recreationally.
- With an overdose of ketamine, emergency care, such as 911, should be contacted immediately.
- There is no antidote for this drug. Overdose situations are treated with symptomatic and supportive care in the hospital setting. In the emergency department, adverse effects typically resolve in 1 to 3 hours.
- Benzodiazepines such as lorazepam may be used 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.
- Those who abuse this drug should be referred for drug counseling.
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