Ketamine

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Ketamine

Ketamine is a hallucinogen and a prescription-only medication that is approved as a general and dissociative anesthetic, as well as a sedative agent.1 It is also used as an animal tranquilizer.

Common Trade Names: Ketalar, Ketalar SV, Vetalar, Ketaset, Ketaject

Ketamine is an antagonist of N-methyl-D-aspartate (NMDA) and receptors in the brain. This means that ketamine can block one of the roles of NMDA receptors, which is to sensitize neurons that send pain signals. By blocking this action, ketamine can produce its analgesic (pain relieving), sedative, and dissociative anesthetic effects.1,2

As a Schedule III substance under the federal drug scheduling system, ketamine has a low to moderate potential for both physical and psychological dependence.3 However, It’s often abused for its capability to make individuals feel “detached” from their physical pain and to produce hallucinations.4 Chronic use of the drug can lead to dependence and addiction.

What Is the Medical Use of Ketamine?​​

Ketamine is commonly used for general anesthesia. It’s ideal for short-term medical procedures that don’t require the relaxation of the skeletal muscles. Ketamine can also be used as a pre-anesthetic to other anesthetic agents.1

Other medical uses of ketamine include:

  • Rapid sequence intubation
  • Bronchodilation, or the action of relaxing of the muscles in the airways to improve airflow
  • Short-term procedural sedation

Off-label, ketamine is used for pain management, including those caused by trauma and fractures.  The drug is also used to treat symptoms of depression and suicidal ideation. The drug is also being studied as a third-line medication for refractory status epilepticus (a seizure that lasts for more than 5 minutes).5

How Is Ketamine Abused?

Ketamine is a popular “club drug,” with street names like Cat Tranquilizer, Cat Valium, Kit Kat, Purple, Special K, and Super K.4 It is often abused in its powder form, whether through snorting “bumps” (lines of powder) or smoking. Meanwhile, liquid ketamine is often mixed into drinks or injected into the bloodstream.

Some of those who abuse ketamine also use it with other drugs, including amphetamine, methamphetamine, and cocaine.4

Ketamine Drug Interactions and Contraindications

Some studies have shown that ketamine can increase the sedative effects of propofol and midazolam.6,7

Meanwhile, drugs that inhibit or induce CYP3A4 and CYP2B6 (which are types of enzymes) may increase or decrease the clinical effects of ketamine. There have also been findings that using benzodiazepines with ketamine can compromise the latter’s antidepressant effects.8

Ketamine is also contraindicated in the following patients:1

  • Those with conditions that increase blood pressure
  • Those with schizophrenia
  • Those who have shown prior hypersensitivity to ketamine
  • Those who are chronic alcoholics

The drug is likewise not recommended to pregnant or breastfeeding women, since there aren’t enough studies about whether or not ketamine can pass into breast milk.1

The Side Effects of Ketamine 

Short-term use of ketamine may lead to unwanted side effects, including:1

  • Confusion
  • Dizziness
  • Drowsiness
  • Double vision (also called diplopia)
  • Dysphoria, or a feeling of dissatisfaction, restlessness, or unhappiness
  • Nausea and vomiting

In rare occasions, using ketamine may also induce hallucinations.

Other side effects include the following:1

  • Increased or decreased blood pressure
  • Increased of decreased heart rate
  • Irregular heart beat
  • Respiratory depression
  • Nystagmus, or the involuntary side-to-side, up-and-down, or circular motion of the eyes
  • Difficulty in urination
  • Increased urinary frequency
  • Urinary incontinence
  • Loss of appetite

Long-Term Effects of Ketamine

There are very few reports about the long-term effects of ketamine. However, the drug has been associated with long-lasting memory deficits.9

Symptoms of Ketamine Overdose

Two of the biggest signs of a ketamine overdose are unconsciousness and dangerously slowed breathing.4

Other overdose symptoms include:10

  • Apnea or temporary cessation of breathing
  • Hypotension or low blood pressure
  • Bradycardia or slower than normal heart rate
  • Myocardial infarction or heart attack
  • Stupor
  • Seizures

If you happen to observe these symptoms in yourself or another individual, contact emergency medical services or 911 immediately.

Signs of Ketamine Addiction

As a Schedule III controlled substance, ketamine poses a risk for psychological dependence and substance misuse.3 The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 11 criteria necessary for the diagnosis of substance use disorders, which are also applicable to ketamine addiction and other hallucinogen use disorders.11 These criteria are the following:

  • Using ketamine in excessively greater amounts or for a longer period than intended
  • Failure to cut back or stop using ketamine, despite a strong desire to do so
  • Spending a significant amount of time to get ketamine, use ketamine, or recover from using it
  • Experiencing intense cravings for ketamine
  • Using ketamine results in the inability to attend to personal responsibilities or commitments
  • Continuing to use ketamine despite it causing problems in relationships
  • Using ketamine results in giving up important activities
  • Continuing to use ketamine even when it endangers you
  • Continuing to use ketamine despite the possibility of it exacerbating existing physical or psychological conditions
  • Ketamine tolerance, which means needing to constantly increase the amount of the drug taken in order to experience desired effects
  • Experiencing withdrawal symptoms after suddenly stopping use of ketamine

Signs of Ketamine Withdrawal

Withdrawal symptoms of ketamine may include the following:12

  • Cravings
  • Anxiety
  • Shaking
  • Sweating
  • Palpitations

It should be emphasized that even if you are taking ketamine at the correct dose and schedule as part of a therapeutic regimen, it’s still possible to develop a dependence on the drug. This isn’t equivalent to addiction—a pathological pattern of continuing to use the drug despite negative consequences—but rather an indication that your body has become used to the presence of ketamine.

To avoid any negative effects, don’t attempt to just abruptly stop taking ketamine. Instead, speak to your doctor first about possibly tapering off the doses of the drug you take until such a time when you can do without it anymore. You may also want to consider going to a medical detox facility where medical professionals can help you get off ketamine in a safe and comfortable manner.

Ketamine Withdrawal Management and Detox

If you are experiencing any of the above-mentioned ketamine withdrawal symptoms or suspect that what you are experiencing are due to being dependent on the drug, it’s best to undergo ketamine detoxification. This is a medical program that aims to remove the presence of ketamine in your body. Ketamine detox is also designed to help you manage the adverse symptoms of withdrawal.

Here are some of the things you can expect while undergoing ketamine detoxification:

  • Your doctor will gradually lower your daily dose of ketamine, based on a schedule that’s designed around your condition. This will continue until it’s determined that your body can function properly without the drug.
  • You may be prescribed additional medications to manage severe withdrawal symptoms.
  • You may be given IV fluids, nutritional supplements, and other therapeutic interventions to help your body recover from ketamine use.
  • Your doctor or assigned rehab specialist will closely monitor your physical and mental health, in order to ensure your safety and comfort throughout the detox process. They are also there to provide support and motivation so you can successfully complete the program.

Ketamine Addiction Treatment Programs

It’s difficult to overcome ketamine addiction on your own. You’re going to need the support of your loved ones and, more importantly, you need to receive proper treatment from professionals who can help you achieve sobriety and prevent relapses.

There are two options when it comes to addiction treatment: inpatient or outpatient treatment. Your situation will determine which one is the most suitable treatment setup for you.

  • Inpatient ketamine addiction treatment: If you have a severe case of ketamine addiction or if you’ve had a history of non-compliance to addiction treatment, inpatient rehabilitation will likely be the better choice for you. This is an intensive treatment option in which you will stay in the rehab facility and receive constant supervision from medical professionals. You will also be exposed to a combination of treatment methods, including behavioral treatment sessions, to ensure the success of the program.
  • Outpatient ketamine addiction treatment: For mild addiction cases, outpatient rehabilitation may be the better option. This method is also recommended if you have less dangerous symptoms and can guarantee that you can comply with the treatment program. With outpatient addiction treatment, you’ll be allowed to stay in your own home and continue your usual routines. You may go to work or school, as well as fulfill your social commitments and other responsibilities. However, you’ll be required to attend treatment sessions at an assigned facility.

Reach Out Today to Receive Quality Treatment

Ketamine addiction may be difficult to overcome, but with proper treatment and support, you can triumph over this challenge. Call Better Addiction Care today at 1-800-429-7690 to speak to one of our recovery support advisors. They can help you find the best rehabilitation centers and programs to address your or your loved one’s situation.

Better Addiction Care can also help you determine suitable financing options. If you have insurance, our team can verify your policy’s coverage for outpatient and inpatient addiction treatment. Otherwise, they can give you information about other options for funding your treatment.

A Brief History of Ketamine

Ketamine is widely used as an anesthetic and analgesic. It was first discovered in 1956 as a result of continuous efforts to find a safer alternative for phencyclidine, then a popular and reliable anesthetic that caused an intense emergence of delirium in people.

Ketamine was identified by scientists at Parke-Davis Company as a short-acting analog of phencyclidine with one-tenth its potency. It underwent its first clinical trial on humans in 1964, where promising results of ketamine as a safe anesthetic and analgesic were found. The study also concluded that ketamine was not associated with emergence of delirium, which was the top concern about phencyclidine at that time. Soon after, Ketalar, the first formulation of ketamine, was approved for human use by the Food and Drug Administration.13

Ketamine Resources

  1. Rosenbaum, S.B., Gupta, V. & Palacios, J.L. (2021). Ketamine. Statpearls.
  2. Quibell, R. et al (2011). Ketamine. Therapeutic Reviews. Journal of Pain and Symptom Management.
  3. U.S. Drug Enforcement Administration. Drug Scheduling.
  4. U.S. Drug Enforcement Administration (2020). Drugs of Abuse, A DEA Resource Guide (2020 Edition).
  5. Rosati, A., De Masi, S. & Guerrini, R. (2018). Ketamine for Refractory Status Epilepticus: A Systematic Review. CNS Drugs.
  6. Hui, T.W. et al (1995). Additive Interactions Between Propofol and Ketamine When Used for Anesthesia Induction in Female Patients. Anesthesiology.
  7. Hong, W., Short, T.G. & Hui, T.W. (1993). Hypnotic and Anesthetic Interactions Between Ketamine and Midazolam in Female Patients. Anesthesiology
  8. Andrade, C. (2017). Ketamine for Depression, 5: Potential Pharmacokinetic and Pharmacodynamic Drug Interactions. The Journal of Clinical Psychiatry.
  9. Zanos, P. et al (2018). Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms. Pharmacological Reviews.
  10. Orhurhu, V.J. et al. (2021). Ketamine Toxicity. Statpearls.
  11. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  12. Morgan, C.J.A & Curran, H.V. (2010). Ketamine Use: A Review. Addiction.
  13. Mion, G. (2017). History of Anaesthesia: The ketamine Story – Past, Present and Future. The European Journal of Anaesthesiology.

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