About Ketamine AKA “Special K”
A dissociative anesthetic available by prescription only, ketamine (also called Vitamin K, Special K and Bump) comes as a clear liquid or as a crystalline, white powder. Used as a human or animal anesthetic tranquilizer on people undergoing major surgery, ketamine is difficult to make outside a specially equipped laboratory. Consequently, most illegal ketamine sold on the streets has been stolen from vet offices or hospitals.
History of Ketamine (“Special K”)
Patented in 1966 for animal and human use, it was officially approved by the U.S. FDA in 1970 for human consumption. Severely injured Vietnam soldiers received ketamine injections in the field for pain relief and anesthesia purposes. Upon returning home, Vietnam veterans who remembered how euphoric and numb ketamine made them feel probably helped popularize this drug within recreational drug user circles.
Today, the World Health Organization lists ketamine as an “essential medicine” because of its strong analgesic and anesthetic properties. According to the WHO: “ketamine…does not require reliable electricity supply, oxygen, highly trained staff or monitoring systems to administer…making ketamine critical in surgery in low- and middle-income countries and in conflict and disaster zones where such resources are often unavailable”.
Intended Use of Ketamine
Also known as “Special K”, Ketamine is a prescription only Schedule III drug used to begin and maintain anesthesia during surgery. In addition to being a powerful pain reliever and sedative, The U.S. Drug Enforcement Agency includes ketamine in its list of controlled substances because of its “moderate to low potential for physiological and physical dependence”. Other Schedule III drugs include testosterone, anabolic steroids and Tylenol with codeine.
Ketamine primarily acts as an antagonist for the NMDA receptor. Antagonism of this receptor results in an anesthetic and analgesic state. The patient usually becomes amnesic, hallucinogenic, and dissociative while under the effects of Ketamine. This permits the surgical procedures to be performed without the patient feeling pain or remembering the procedure. The drug works efficiently on both humans and animals, making it a preferred anesthetic for both traditional doctors and veterinarians.
Elicit Use Of Special “K”
Illicit use of ketamine is quite common, in part because the drug is much easier to obtain than other illicit drugs that produce similar effects. The main reason it is easier to obtain is because veterinarians often keep a large supply of the drug and usually have fewer safeguards than doctors or pharmacies on their medicine supply. As a result, the majority of illegal ketamine sold originally was intended for use on animals.
Listed as a Schedule III drug by the U.S DEA, ketamine is desired by drug abusers for its hallucinogenic, sedative effects that resemble the effects of LSD or PCP but without the stimulatory response. Ketamine is mixed with water and injected intravenously, snorted as a dry powder or add to marijuana joints and smoked.
Another reason that it is a commonly abused drug is that it is quite easy to use. Ketamine can be injected, ingested, or snorted, all for roughly equal effect. It easily dissolves into liquid and can be easily mixed in with food. It ranks up with popular drugs like cocaine and marijuana for ease of use.
The primary benefit that addicts seeks when abusing ketamine is the hallucinatory effect which is actually considered a minor negative side effect by the medical profession. These hallucinations usually kick in within a few minutes of use and usually last for about an hour or two, depending on dosage and body weight. While experiencing these hallucinations, the user is almost always completely desensitized from the real world.
Ketamine effects last up to 45 minutes when injected and up to 60 minutes if snorted. Reports of ketamine abusers experiencing hallucinatory dreams and feelings of dissociation 24 hours after taking ketamine have also been described.
Danger of “Special K” Addiction
Ketamine is not widely considered a significant threat for addiction. Like many psychedelic drugs, it generally produces a psychological addiction, rather than a physical addiction, if it produces an addiction at all. The rare physical addiction is usually associated with a loss of appetite, nausea, and vomiting, and can easily be identified by these signs.
Ketamine’s Side Effects
The primary side effect of ketamine is an effect that is considered the primary benefit by physicians. Users of ketamine almost always enter an anesthetic state where they lose all motor functions and have no sensory connection to reality. In a controlled environment, like a surgical theater, this is not a threat. However, outside of a controlled environment, this can result in car accidents, falls, and failure to provide essential care for dependent, and social problems.
Additionally, all of the following side effects are possible with ketamine use and can be quite dangerous when medical professionals are not present to provide assistance:
- Changes in heart rate and blood pressure
- Nausea and vomiting
- Visual impairments, including double vision and tunnel vision
- Respiratory difficulty
Pharmacodynamics of Ketamine
Considered a dissociative anesthetic (i.e., ketamine gives users the feeling that their body is separated from their mind), ketamine molecules bind to the PCP-binding site of the NMDA receptor complex. In fact, ketamine is a derivative of phencyclidine (PCP), a 1950s pharmaceutical anesthetic later banned in the 1960s due to its unstable, hallucinogenic effects. Some opioid receptors are also implicated in promoting pharmacological symptoms of ketamine use.
In contrast to other sedating anesthetics, ketamine actually stimulates heart rate, blood pressure and other components of the cardiovascular system. When used in prescribed doses, it mildly suppresses respiration, increases release of plasma cortisol, prolactin and blood glucose and may help to reduce intraocular pressure.
Ketamine and the Brain
Structurally similar to phencyclidine (PCP), ketamine induces dysphoric and analgesic sensations by targeting opiate receptors and blocking release of dopamine. Inhibition of peripheral and central cholinergic transmission is thought to contribute to users experiencing visual and auditory hallucinations.
Within a few seconds of injecting ketamine, users will feel the effects of nearly 95 percent of the ketamine dose as the drug is distributed quickly throughout the brain and other body tissues. Psychological and physiological reactions to ketamine abuse include:
- Extreme sedation/having vivid dreams while sedated
- Feeling invulnerable to dangerous situations
- Disorientation and distractibility
- Claiming to have out-of-body experiences/watching one’s self from a distance
- Remaining uncommunicative to others
- Slurred speech
- Distorted perceptions regarding sounds, time and surroundings
- Insensitivity to pain
Psychological & Physical Side Effects of Ketamine Abuse
When administered by professional healthcare providers, ketamine is indeed safe and useful as an anesthetic and analgesic. When taken in higher than recommended doses, ketamine will produce symptom similar to Ecstasy side effects:
- Increased sociability
- Dissociative sensations/living in a “different” reality
- Vertigo-induced nausea
- Classic NDE visions (traveling through a tunnel, seeing dead family members, feeling beatific)
- Auditory hallucinations
Overdosing on ketamine may cause arrhythmia, tachycardia, brachycardia, spiking blood pressure, skin rash, vomiting, double vision, severe respiratory depression and possible shock. A 2013 study investigating the long-term effects of ketamine on chronic ketamine users found that users exhibited “impaired cognitive processing speed, verbal learning and verbal fluency in addition to deficits in visual recognition memory and verbal memory”. Researchers concluded that chronic ketamine abuse caused “impairments to different areas of medial temporal and frontal functioning”.
Ketamine abuse has also been linked to serious bladder and urinary tract disorders, bladder shrinkage, incontinence and kidney damage. A review examining medical records of heavy ketamine users reported the experiences of a London urologist who had to surgically remove the damaged bladders of four out of 20 ketamine abusers. This is due to ketamine’s ability to eventually force apoptosis, or cellular death via intracellular toxin release.
While physical addiction is rare, if it should occur, ketamine has some very nasty withdrawal symptoms. In addition to enduring the above side effects at greater potency, ketamine withdrawal also commonly results in a loss of motor skills and coordination. Finally, withdrawal from ketamine is particularly difficult because a common withdrawal symptom is depression, which results in a lack of will to continue with the withdrawal process.
Since dependence and tolerance to ketamine will likely develop following extended use and abuse, ketamine addicts usually suffer addiction withdrawal symptoms including psychotic features such as false beliefs, delusions and hallucinations. Consequently, ketamine addicts should seek detoxification in a medically supervised facility, followed by addiction counseling and aftercare support.
Does Ketamine Reduce Depression?
In 2006, the National Institute of Mental Health discovered ketamine introduced intravenously provided relief of major depression symptoms in some individuals. This placebo controlled, randomized study involved 18 patients suffering depression resistant to standard treatments (counseling, cognitive behavioral therapy, antidepressants). After receiving one dose of ketamine, over 70 percent of patients reported a significant improvement in symptoms within 24 hours. The other 30 percent reported they were “nearly symptom free” after one ketamine dose.
Another study investigating the efficacy of ketamine for depression found that five out of 10 patients clinically diagnosed with depression and treated twice a week with ketamine achieved remission from their symptoms. In this study, ketamine was infused at lower rates than in previous experiments but accomplished similar success and tolerability than single infusions.
How Ketamine Works to Relieve Depression
Biological mechanisms supporting antidepressant properties of ketamine are still unclear. However, early research shows that ketamine blocks a certain brain receptor called the NMDA receptor. Vital to normal development of the nervous system, to regulating breathing and reinforcing processes involved in neuroplasticity, memory and learning, NMDA receptors blocked by ketamine decreases release of brain chemicals that contribute to its antidepressant effects. Also important is the ability of ketamine to promote release of BDNF (brain-derived neurotrophic factor), a substance found depleted in the brains of people with major depressive disorder.
When physicians or psychiatrists prescribe ketamine for depression, patients will need to have intravenous injections performed at their doctor’s office. Ketamine is not currently available as a traditional prescription medication obtained at pharmacies.
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