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    Is ketamine a party or date rape drug? Is it a miracle drug to treat depression or substance use? Is it a drug to put people and animals under during surgery or to control pain? The answer is yes to its many uses. Ketamine is used as a recreational drug as well as for medical purposes.  As a recreational substance, it can cause a person to feel disconnected from reality — like they are in a dreamlike state.  In the medical world, it is used as a short-acting medication to sedate a person or animal.  It has also been used off-label to treat chronic pain linked to cancer or migraines.

    In recent years, it has gained popularity as a potential mental health treatment, particularly for severe depression. It may also be useful for treating substance use disorders. However, its benefits, dosage and long-term effects are still under investigation, and it may be risky to use without medical supervision.

    What is ketamine?

    Ketamine is manufactured as a liquid that can be injected into the body, inhaled through the nose or taken through a tablet. It’s a form of hallucinogen which means that it can cause a person to feel detached from reality – it’s like living in a movie or a dream.

    It is used as a general anesthetic[1] during medical procedures to make a patient unconscious. For example, it can be used in emergency departments when fixing broken bones or painful wounds. In low doses, it can be used by doctors to treat severe pain. It is also used in veterinary clinics for animals.

    Also known as special K, super K and vitamin k, among other slang terms, in illicit use, ketamine is swallowed or evaporated to form a snortable powder. It is odorless and tasteless, so it can be added to beverages without being detected, and it can cause memory loss. Because it has been used to commit sexual assaults due to its ability to sedate unsuspecting victims, ketamine is also considered to be a “date rape” drug.

    Why do people use ketamine?

    While ketamine use is generally rare among individuals in the United States, it has increased in recent years.[2]

    People who use ketamine illegally are usually doing so for its mind-altering effects. Ketamine in lower doses can act as a stimulant. In higher doses, it can cause dream-like states and hallucinations, and often complete feelings of being disconnected from reality. People who use it report sensations ranging from a pleasant feeling of floating to being completely separated from their bodies.

    Similar to LSD and PCP, ketamine’s effects have made it a “club drug,” used by individuals going to events like raves.

    Signs of ketamine use include:

    • Altered behavior; can be more mellow or have more energy
    • Irritable or agitated
    • Depression
    • Slurred speech
    • Rapid eye movements
    • Difficulty sleeping
    • Significant mood changes
    • Nausea and vomiting
    • Skin redness or flushing

    Not everyone will react to ketamine in the same way. Differences in body type, age, the strength of the ketamine being taken and one’s own ability to handle the drug can mean that individual experiences are wildly different from one another.

    What are the negative effects of ketamine?

    Some ketamine experiences involve a terrifying feeling of almost complete sensory detachment that is likened to a near-death experience. These experiences, similar to a “bad trip” on LSD, are called the “K-hole.” This can make someone feel completely frozen and immobile, and sometimes causes psychosis.

    Low doses of ketamine may result in problems with attention, learning ability, and memory. In high doses, ketamine can cause delirium or extreme confusion, memory loss, problems with physical movement, high blood pressure, and depression. There is also the possibility of breathing problems that can be fatal.

    Flashbacks have been reported several weeks after ketamine is used. Ongoing use may also cause restlessness, depression, thinking difficulties, loss of consciousness and memory loss. Psychosis (e.g., seeing and hearing things that aren’t real or extreme fear) can also last after someone stops ketamine use.

    Additionally, it is possible to overdose on ketamine, particularly if it is mixed with other substances.[3] Using ketamine along other hallucinogens like magic mushrooms or LSD can significantly increase the effects of both, which can put an individual at danger of serious accidents. Ketamine combined with opioids or alcohol can cause an individual to pass out, vomit or even fatally overdose. Ketamine-related poisonings have also increased in recent years.

    It is also important to note that standard drug tests are unlikely to detect ketamine in the body. One of the safest ways to ingest ketamine is through a nasal spray, which helps an individual control how much they are taking.

    Does ketamine treatment work for depression?

    Recent research[3] has found that ketamine therapy can help to relieve severe depression other treatments have not helped. This is often called “treatment-resistant depression.” Although there are different definitions of treatment-resistant depression, it generally means that antidepressant(s) or other common therapies have not worked to reduce symptoms.

    In 2019, the FDA approved a ketamine nasal spray. It is called esketamine[4] and is sold under the brand name of Spravato. It is recommended to treat major depression, suicidal thinking and treatment-resistant depression for adults over the age of 18. It is only available by prescription and must be taken at a certified doctor’s office or clinic. Because of the risks associated with the medication, patients must be monitored by their healthcare provider for at least two hours after receiving a dose.

    Many studies have shown that ketamine therapy can effectively treat depression.[5] The benefits can be felt very quickly, sometimes within 40 minutes, though this depends on the way it is administered (through an IV, the nose, etc.). The effects generally do not last very long, peaking at a few hours and generally impacting a patient for a few days to a week, which also depends on how it is administered. As a result, it is not yet known if this treatment is effective in the long term, or if it can only provide temporary relief from depression symptoms. On-going maintenance treatment may be needed, depending on the patient.

    Small research studies[6] show that it may be safe and effective for treating depression in adolescents between the ages of 12 and 17. However, more research is needed to determine if this can help young people. Spravato is not approved for children.

    Ketamine therapy for depression does not work for everyone. Stephen Petrow[7] , a contributing writer for the Washington Post, shared his experiences with ketamine after years of treatment with antidepressants and talk therapy. “In the days that followed I still didn’t feel like myself. Detached. Untethered. Scared. In a world of my own. Several friends noticed this difference in me, with one asking me directly if I was at risk of self-harm.”

    Can ketamine be used to treat other mental health disorders, including substance use?

    Ketamine therapy may be able to treat autism[8], OCD[9], bipolar disorder[10] and chronic pain. Its effect on these disorders is currently being studied.

    Ketamine is also being researched to treat alcohol use disorder. In one study[11], people with severe alcohol problems who were given ketamine with counseling had more non-drinking days than a control group.

    Ketamine therapy may be useful in preventing people from returning to heroin use[12]. It has been shown to be helpful in controlling cravings for people using cocaine. While ketamine therapy shows a great deal of promise for addiction treatment, more research is needed.

    Does ketamine work for pain management?

    Ketamine has also risen in popularity for its potential to help manage pain.

    Some research shows that using small doses of ketamine can be effective in treating chronic pain, especially in the short-term.[10] It is also appealing as an alternative to opioids for pain relief.

    However, research on this topic is still limited. Most insurances do not cover the use of ketamine outside of surgery. Many are also concerned that the ketamine field is largely unregulated, which can put patients at risk of unsafe treatment settings and adverse effects.[11]

    Additionally, the long-term effects of using ketamine for pain management are not yet known. High doses have been shown to cause bladder damage. There is also evidence that people who use ketamine frequently in high doses can have impaired brain functioning, such as memory loss.[12]

    Where can people get ketamine therapy?

    In addition to the certified doctors and clinics[13] mentioned for esketamine, ketamine clinics are emerging around the country to provide therapy. In many cases, they may offer treatment “off-label[14],” which means it is not specifically approved to treat mental health issues.

    Therapy can happen in many different ways. These include:

    • Medical: This treatment will usually take place in a hospital or clinic setting. The ketamine is given via an IV or through the nose, typically by an anesthesiologist.
    • Psycholytic: In this treatment, ketamine is used along with therapy such as cognitive behavioral therapy (CBT) or psychoanalysis.
    • Psychedelic: High doses are given to the patient to create a “mystical experience.” In this treatment, the mind is thought to be able to heal itself, and a therapist is used only as support.

    Some clinics are legitimate and certified, but some are not. It is important to thoroughly research treatment centers to make sure that they are as safe as possible and have certified doctors on hand.

    Mail-in kits are also available at a lower cost from companies such as Mindbloom[15]. Through these programs, participants are sent a kit with instructions to do their sessions themselves. These sessions are not supervised and may only come with limited support from a professional.

    What does ketamine therapy cost?

    Ketamine is not taken as a daily pill like some medications. Usually, multiple treatments are required over a period of weeks or months, which factors into costs. On-going maintenance doses may also be needed.

    Ketamine treatment can be expensive and is often not covered by insurance, especially if it is used off-label. It’s best to ask insurance companies if they will pay and how much. They may also require a pre-authorization. The company that offers Spravato provides payment assistance for some insurance plans.

    At a clinic, sessions can generally cost between $500-1000 per session, depending on how the drug is given (for example, IV treatments may be more expensive). Mail-in kits are generally cheaper, with weekly costs starting at around $80-100 dollars. However, these kits do not include as much support as a clinic might offer.

    Because these treatments take place over the course of several sessions – often at least six – they can get very expensive. Full sessions of self-administered[16] treatment can cost upwards of $3000. A course of treatment in a clinic can cost up to $5000.

    Is ketamine therapy safe?

    When used for mental health treatment, ketamine can be safe if supervised by a certified doctor or clinic. They provide monitoring and are trained to address any concerns that might arise. Side effects can include feeling an upset stomach, problems thinking, dizziness, increased blood pressure and trouble breathing as well as seeing or hearing things that are not real.

    Many ketamine clinics are not regulated and are not in a medical setting. Because this is such a new treatment, and there are so many ketamine clinics – perhaps thousands – across the country, it can be difficult to know what their standards are for safety. Treatment is not always monitored, leaving room for unsafe treatments.

    Additionally, ketamine is not approved by the FDA for the treatment of any psychiatric disorder[17]. In fact, it has issued a warning to patients and health care professionals about the potential risks associated with ketamine treatment, having not yet determined if it is safe and successful in treating mental health and substance use disorders.

    Because there is still so much ongoing research on the topic, and there are limited guidelines for all the possible uses, it can be hard to properly train[18] enough providers to provide ketamine treatment.

    Long-term use[19] can also cause bladder damage and cognitive impairment, meaning problems with thinking, memory and focus. Other negative side effects include mood swings, changes in blood pressure and dizziness. There is also the risk of dependence and misuse, although this is more unusual in legitimate treatment programs.

    If you believe that your loved one could benefit from ketamine treatment, speak to a doctor and/or psychiatrist first. It is best used under medical supervision. Remember that there are many approved forms of treatment for depression[20]. Help your loved one find what works best for them. If you are concerned that they are using ketamine illegally, or are otherwise worried about their substance use, you can find our support services here.