Ketamine: Side Effects, Abuse and Treatment

Ketamine belongs to a class of drugs known as dissociative anesthetics. It is also known as Ketalar, Ketanest, and Ketaset. It induces a trance-like state while providing pain relief, sedation, and memory loss  Ketamine was discovered in 1962, first tested in humans in 1964, and was approved for use in the United States in 1970. Shortly after its US approval, it was extensively used for surgical anesthesia in the Vietnam War, due to its safety. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication.The wholesale cost in the developing world is between US$0.84 and US$3.22 per vial. Ketamine is also used as a recreational drug.

Ketamine is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. The anesthetic state produced by Ketamine has been termed as "dissociative anesthesia" in that it appears to selectively interrupt association pathways of the brain before producing somesthetic sensory blockade. It may selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centers and pathways (reticular-activating and limbic systems

Ketamine enhances descending inhibiting serotoninergic pathways and can exert antidepressive effects. These effects are seen in concentrations ten times lower than the needed concentration for anesthetic proposes. The effect of ketamine can be described as analgesic by the prevention of central sensitization in dorsal horn neurons as well as by the inhibition on the synthesis of nitric oxide. Ketamine can present cardiovascular changes and bronchodilatation

Effects of Ketamine

Short-Term Effects

man-feeling-effects-of-ketamine-withdrawalKetamine produces an abrupt high that lasts for about an hour. It starts around 2 to 5 minutes after the dose has been smoked or swallowed. With injection, it happens around 30 seconds after the injection has occurred.

The first feeling of the high the user will get is an overwhelming feeling of relaxation, sometimes described as a full-body buzz. Some users feel like they’re floating and some even describe it as being out of their bodies. Many experience hallucinations that can last longer than the anesthetic effects.

Higher doses can produce more intense effects, with users reporting complete and utter detachment from their bodies. The effects are similar to those described by people who have had near-death experiences, and it's described as being in the "K-hole".

Side Effects

The drug does, of course, have side effects, and these can be quite profound. Short-term side effects include bad hallucinations. As with all psychotropic drugs, the pleasantness of the hallucination depends on the user's state of mind, and if the user is seeking to escape unhappiness, the hallucinations are likely to be unpleasant.

Naturally, the side effects include:

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• Disorientation and general confusion due to the drug's anesthetic nature.
• Drowsiness.
• Increased heart rate.
• Elevated blood pressure.

Large doses of the drug can result in what some describe as the "K-hole," which can include intense and unpleasant visual and auditory hallucinations coupled with marked derealization and a frightening detachment from reality.

Perhaps more acutely problematic, users can also become quite nauseated. If this progresses to vomiting, it can be very dangerous, as those in the midst of state of dissociated confusion frequently end up supine—presenting a serious choking hazard. If you do see someone on ketamine, take a moment to roll them on their side or into the recovery position if possible to prevent this from happening. Promptly call 911 to get emergency medical assistance.

Long-Term Effects

Powdered ketamine is often cut with other drugs, so it's very hard to tell what the long-term effects can be as interactions can be very unpredictable. Consequently, the long-term effects  are varied, but they fall into several main areas.

As with any anesthetic, ketamine reduces — or even eliminates — pain. It's hard for users to tell whether they've injured themselves, so they can end up hurting themselves severely. Some people have suffered from broken legs and effectively crippled themselves because they couldn't tell that something wasn't right. Walking on a broken leg can result in compound fractures, penetration of the skin, sepsis, and serious nerve damage.

Once the effects of the drug have worn off, users might experience severe abdominal pain. It can also cause thickening of the bladder and urinary tract, and this can force some long-term addicts to have their bladders removed as the walls are too thick and prevent urine from passing through.

Other issues include kidney problems, which are caused by the drug's interaction with the kidneys as it is reduced into its metabolites.

Amphetamines should never be mixed with ketamine because they can cause very high blood pressure

Ketamine Overdose

A person overdosing on ketamine needs immediate medical attention. Call 911, as the person needs emergency medical treatment.

Symptoms of a ketamine overdose include:

Respiratory depression or stopped breathing

Involuntary muscle twitches

Dizziness

Slurred speech

Stumbling as though drunk

Nausea and vomiting

Hyperthermia, or overheating

Long-Term Harm from Abusing Ketamine

Ketamine has an intense impact on the brain, which can trigger depression, memory problems, and even psychosis among those who have a predisposition to these conditions. One of the first longitudinal studies on ketamine’s effects involved 150 participants divided into five groups. The study lasted one year, and each group took a different dose of ketamine over that year; at the end, those who used ketamine twice a month to almost daily (frequent abuse) experienced disturbances in visual memory and short-term memory recall. They experienced trouble recalling names and conversations. Those who used ketamine less frequently, but still recreationally, experienced less severe symptoms, but still suffered some memory disturbances, and reported mild delusions.

The drug has also been linked to cardiovascular and kidney function problems due to high blood pressure. People who consume ketamine regularly, or who consume too much in a binge, are at risk of damaging their lungs, kidneys, and heart.

Ketamine produces ulcers and pain in the bladder, which can lead to problems urinating. This can also lead to chronic health issues requiring long-term medical care, including infections.

Sometimes, ketamine is used as a date rape drug. A person may not know they have consumed it and experience serious physical and mental side effects. They may be a victim of sexual assault and acquire sexually transmitted infections.

It is possible to develop a physical tolerance to ketamine, especially when the drug is taken recreationally. If a person abuses ketamine, their body will rapidly develop a tolerance to the presence of the drug, so they will feel like they must take larger and larger doses to induce the original physical and psychological effects. While tolerance and addiction are not the same thing, people who struggle with patterns of substance abuse, or who are more likely to develop addiction to intoxicating substances, may abuse ketamine for the euphoria it produces.

Withdrawing from Ketamine

Since the body develops a tolerance to ketamine very quickly, a person who abuses ketamine may also develop physical dependence on the drug. This means the brain needs the presence of the drug to feel normal. Physical dependence can lead to withdrawal symptoms when the individual stops taking the drug. Ketamine withdrawal symptoms are not life-threatening, but they can be uncomfortable. As a result, it is important to work with a doctor to safely detox from ketamine and other substances because trying to quit alone can lead to relapse and overdose.

Withdrawal symptoms from ketamine last for 4-6 days and include:

Cravings for the drug

Loss of appetite

Exhaustion

Chills

Sweating

Physical shaking or tremors

Restlessness

Depression

Anxiety

Nightmares, insomnia, and difficulty sleeping

Irregular or rapid heartbeat

Treatment for Ketamine Abuse

Long-term harm from ketamine can be prevented if the person gets help from a safe detox program, overseen by a medical professional, and enters rehabilitation. There are no detox drugs, like there are for opioid or alcohol abuse, but Cognitive Behavioral Therapy in both individual and group settings has proven very effective at helping people change their behaviors around intoxicating substances, including ketamine. Rehabilitation programs offer this form of therapy, along with other therapies that can moderate withdrawal symptoms, manage chronic health issues, and offer social support to maintain recovery.