Ketamine is an anesthetic introduced in the 1960s for surgical procedures, serving as a general anesthetic. Over time, researchers identified its unique properties extending beyond surgical applications, particularly in psychiatry and chronic pain management. Despite its medical advantages, it remains a controversial substance due to its potential for abuse and its addictive effects when used outside therapeutic purposes.
In Hong Kong, ketamine use increased from 9.8% in 2000 to 37.6% in 2009, with a significant rise among individuals under the age of 21. Studies in the UK, examining 274 regular ketamine users, revealed that 60% experienced bladder or nasal complications, while 56% suffered from muscle spasms.
What is Ketamine?
Ketamine is a dissociative anesthetic with hallucinogenic effects, capable of distorting sensory perception, inducing detachment from self and surroundings, and impairing self-control. It is widely used in pediatric and veterinary surgeries and classified as a Schedule III controlled substance in the United States, making it illegal for non-medical use. During administration, it induces anesthesia, calmness, relaxation, immobility, pain relief, and temporary amnesia. Unlike other anesthetics, ketamine does not cause a sharp drop in blood pressure or breathing, making it a preferred choice in emergency settings and surgeries, especially for unstable patients.
Currently, ketamine is being researched for depression treatment through clinical trials. Studies suggest that it has rapid effects in alleviating symptoms of severe depression, particularly in patients resistant to conventional treatments. However, it is also exposed to abuse and illegal recreational use due to its hallucinogenic properties. On the black market, ketamine is available as a clear liquid, white powder, or in capsule form.
How does ketamine work in the body?
Ketamine primarily targets NMDA (N-Methyl-D-Aspartate) receptors in the brain, which are crucial in transmitting signals between nerve cells within the nervous system. By inhibiting these receptors, ketamine helps reduce neural hyperactivity linked to pain and depression. This inhibition further stimulates the release of glutamate, a rapid neurotransmitter essential for neuronal synapses, facilitating the reorganization of damaged neural networks associated with depression.
As a result of NMDA inhibition, individuals may experience detachment from reality and the body, a phenomenon used in psychotherapy to treat trauma. Ketamine, like other psychedelics, not only blocks pain signals but also alters how the brain interprets them, making it effective in chronic pain conditions where the pain is not directly tied to an identifiable physical cause, such as neuropathic pain or chronic pain without a clear organic origin.
Medical Uses of Ketamine
Ketamine is widely used in modern medical practices, with its primary applications including:
- General anesthesia: Since the 1960s, ketamine has been used as an anesthetic for surgical procedures, particularly in emergencies where traditional anesthetics are unsuitable. It is considered relatively safe for general and field surgeries.
- Pain management: Administered in low doses to alleviate acute and chronic pain, especially neuropathic pain, post-surgical discomfort, and advanced cancer pain. It may serve as an alternative or supplement to morphine.
- Treatment-resistant depression: In recent years, ketamine, particularly as a nasal spray (Esketamine – Spravato), has gained approval for treating severe depression that does not respond to conventional therapies. It is administered in specialized clinics under close medical supervision.
- Post-traumatic stress disorder (PTSD): Studies suggest that ketamine helps reduce PTSD symptoms by influencing memory processing and dissociation from traumatic experiences.
- Acute anxiety and other psychiatric disorders: Empirically used for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) in cases where other treatments have been ineffective.
- Pediatrics and veterinary medicine: Safely applied in pediatric and veterinary procedures, valued for its effectiveness and rapid onset of action.
Non-medical uses of ketamine and the risks of abuse
The non-medical use of ketamine has become a growing global concern, particularly due to its popularity among young people and its presence at parties as a recreational drug. As a psychedelic, ketamine induces a detached experience from reality and the body due to its neurological effects, making it appealing for parties due to its rapid and dissociative properties. However, shortly after consumption, users may face short-term risks, including learning and memory impairment, hallucinations, high blood pressure, insomnia, and anxiety.
Key differences between the medical use and illegal abuse of ketamine
Distinguishing between legitimate medical use and illegal abuse is essential to maximize its benefits while avoiding potential legal consequences. The key distinctions include:
| Usage and comparison aspect | Objective | Control | Dosage | Safety |
| Medical use | Specific medical conditions such as anesthesia and chronic pain | Under direct medical supervision | Precise and thoughtful | The patient is evaluated and vital signs are monitored during treatment |
| Non-medical use | The patient is evaluated, and vital signs are monitored during treatment | Without medical supervision or awareness of the risks | random | Specific medical conditions, such as anesthesia and chronic pain |
Is ketamine addictive?
Ketamine can become addictive when used non-medically or over extended periods. It induces psychological addiction by stimulating the pleasure centers in the brain, triggering euphoria that encourages repeated use. Over time, psychological dependence develops as users seek to repeat the same experience. With continued consumption, tolerance builds, requiring higher doses to achieve the desired effects as the brain habituates to prior doses. The risk of addiction escalates, leading to daily routine use and full dependence on it.
Warning signs of ketamine addiction
Addiction warning signs develop gradually, often starting slightly before becoming more evident with continued use. Early indicators include intense and urgent cravings, difficulty stopping despite awareness of harm, and repeated use without medical justification. In cases of high dosage, symptoms may escalate to loss of movement with muscle convulsions, high blood pressure, and loss of consciousness. Recognizing these warning signs early is crucial, requiring medical evaluation and serious interventions, as excessive abuse can ultimately result in fatal consequences.
Physical and psychological symptoms of ketamine addiction
The physical and psychological symptoms of ketamine are diverse and far-reaching, impacting the brain, muscles, and urinary system. These symptoms include:
Physical Symptoms of Ketamine addiction
Addiction-related symptoms often start with bladder and urinary tract issues, including pain, burning during urination, and frequent urination, which may lead to permanent bladder damage, known as Ketamine Bladder Syndrome. Additionally, it can cause digestive disorders such as nausea, vomiting, and loss of appetite. Other effects include motor imbalances, vision and hearing changes, and rapid heartbeat. The physical complications, especially those affecting the bladder, are more prevalent with chronic, medium, and long-term use.
Psychological Symptoms of Ketamine addiction
Ketamine use often leads to mental dependence, creating a strong urge for frequent consumption and a sense of emptiness without it. As the effects wear off, depression sets in, causing a sharp drop in mood, while anxiety and panic attacks arise due to heightened stress and nervousness. Additionally, hallucinations, seeing or hearing things detached from reality, may occur, alongside memory impairment, aggressive behavior, and sudden outbursts of anger. These psychological effects tend to emerge early in the course, progressively increasing with continued exposure.
Risks of long-term ketamine abuse
Long-term use of ketamine can lead to severe and sometimes permanent health and psychological damage, even without consuming high doses. These risks manifest as flashbacks, impaired sense of smell, mood fluctuations, difficulty concentrating, and memory impairment. Additionally, it may negatively affect liver and kidney function, cause abdominal pain, muscle weakness, and balance issues, posing significant health concerns over prolonged use.
Ketamine addiction treatment: Effective ways to recover
Ketamine addiction requires a comprehensive treatment approach, integrating psychotherapy, medical support, and behavioral rehabilitation, as its dependency is often more psychological than physical. Common treatment methods include:
- Cognitive Behavioral Therapy (CBT): One of the most effective strategies, CBT helps individuals understand why they use ketamine and guides them in changing thought patterns and behavioral habits.
- Group therapy and support programs: Participating in support groups promotes a safe space for sharing, helping individuals realizing they are not alone, increasing the likelihood of stabilization and recovery.
- Psychiatric and medical follow-up: Assessment of coexisting psychiatric conditions, such as anxiety or depression, may lead to the prescription of supportive medications for mood improvement and sleep regulation, though currently, there is no specific medication for ketamine addiction.
- Rehabilitation programs: Suitable for severe cases, these programs provide a controlled, stimulus-free environment, ensuring continuous psychiatric care for individuals struggling with self-control.
- Long-term follow-up, relapse prevention, and complementary therapy: Ongoing monitoring.
The role of psychological and behavioral therapy in treating ketamine addiction
Ketamine addiction recovery relies heavily on psychological and behavioral therapy, as treatment goes beyond abstinence, focusing on changing thought patterns and behaviors that drive substance use. One of the most effective approaches is cognitive-behavioral therapy (CBT), which helps individuals identify and modify distorted thoughts that justify drug use, replacing them with positive behaviors. It strengthens the ability to resist cravings, promotes healthy routines that lower the risk of relapse, and establishes a relapse prevention plan. This plan enables individuals to recognize triggers that may lead to drug abuse and develop strategies to respond appropriately when experiencing urges.
The importance of social and family support in recovery
The process of social and family support is one of the crucial elements in the success and continuity of the recovery process, and is as important as medical and psychological treatment. This process lies in strengthening the motivation for recovery. Having the support of family or friends who care about the patient makes him feel psychologically and emotionally stable and keeps loneliness away, and positive communication reduces stress and depression and promotes mental health. Helping to adhere to the treatment plan and building a safe and encouraging environment that enables the patient to attend sessions and take medications. A positive environment promotes recovery and teaches the family how to deal with the patient based on healthy relationships that support recovery.
Ketamine withdrawal symptoms and how to deal with them
Ketamine withdrawal symptoms arise from prolonged use, making the recovery process challenging as the body adjusts to functioning without the drug. This transition leads to various effects, including intense cravings for ketamine, loss of appetite, fatigue, lethargy, sweating, tremors, nightmares, and severe anxiety. Managing these symptoms effectively requires medical guidance, such as consulting a doctor or specialized therapist, engaging in individual or group psychotherapy, and maintaining rest, proper nutrition, hydration, and light exercise, which help cleanse the body and naturally enhance mood. Ketamine withdrawal symptoms may persist from several days to two weeks, depending on the duration and quantity of abuse.
Ketamine is a highly effective drug that has been utilized for years in anesthesia and has recently demonstrated success in treating psychiatric conditions such as treatment-resistant depression. While ketamine offers significant medical benefits, its misuse can result in addiction and lead to severe health and psychological complications. Understanding its risks and ensuring its usage remains under strict medical supervision is crucial to maximizing its therapeutic advantages while preventing harm. A balanced perception of ketamine allows for a safe application, ensuring it remains a valuable medical tool rather than becoming a serious health threat.
Sources:
- Drug Enforcement Administration. (2020). Ketamine. U.S. Department of Justice
- Sassano-Higgins, S., Baron, D., Juarez, G., Esmaili, N., Gold, M., & Wilkins, J. (2024). Amphetamine abuse. In M. A. Weller (Ed.),StatPearls.StatPearls Publishing
- Healthdirect Australia. (n.d.). Ketamine
