Cognitive deficits as well as increased dissociation and delusions were observed in frequent recreational users of ketamine. Ketamine tolerance rapidly develops, even with repeated medical use, prompting the use of higher doses. Additionally, the rapid onset of effects following insufflation may increase potential use as a recreational drug.
One of the biggest concerns surrounding acute ketamine use is that it reduces awareness of the immediate environment, thus exposing the user to potential physical harm (46). The content of hallucinations may be unwanted, which are typically referred to by users as ‘falling into the K-hole’, and in some cases can be significantly unpleasant. Importantly, in the last reported year, 2008, for the first time a substantial minority of seizures (14%) were reported from outside of this region, suggesting a widening of ketamine supply (41). Global reports of ketamine seizure rose from negligible amounts in 1999 to over 11 metric tonnes in 2007, with nearly all of this in East and South-East Asia, where ketamine seizures exceeded that of heroin (41, 42). Finally, ketamine potentiates gamma-aminobutyric acid (GABA) synaptic inhibition, through weak GABAA receptor agonism (27, 28), but this is not thought to be clinically significant (3).
Benzodiazepines can also mitigate the psychomimetic effects (delusions and/or delirium), hypertension, hyperthermia, and seizures that may be caused by high ketamine doses. However, there are no FDA-approved medications that are able to manage a ketamine overdose. In most instances of ketamine overdose, supportive care is sufficient.
The precise prevalence of recreational, non-medical ketamine use is unknown; small single country studies suggest that the background population use rates of ketamine are low, between 0.1 and 4% of those surveyed (summarised in Table 2) (31–34). Recreational use of ketamine was first reported amongst those with access to the drug, particularly medical professionals, in 1967 (5). Recreational, non-medical ketamine is available to users in powdered, capsule, and liquid formulations. Intravenous, intramuscular, subcutaneous, oral, nasal, and rectal administration are described both therapeutically (3) and for recreational, non-medical ketamine misuse (7). In addition, there is an accumulating literature on ketamine-related chronic toxicity, in particular neuropsychological and urological effects.
During July 2019–June 2023, ketamine was detected in What are the implications for public health practice? Allow trained medical personnel to handle treatment procedures. Symptoms may include urinary urgency, frequency, and pain. Long-term ketamine use can also lead to bladder dysfunction, known as ketamine bladder syndrome. Withdrawal symptoms emerge with sudden cessation after long-term use. Chronic ketamine misuse is linked to psychological issues, including anxiety disorders, major depression, and psychosis.
Ketamine is used as an anesthetic in surgery for adults and children. It can have effects within seconds, and the effects wear off within 15 to 20 minutes. Additionally, ketamine can cause you to be briefly confused after waking up from surgery. This drug can cause a sense of dissociation from reality and may lead to fleeting hallucinations. Ketamine has a rapid action that diminishes sensation, prevents pain, induces sleep, and inhibits memory. Ketamine is available as ketamine hydrochloride, in a generic formulation and as the brand Ketalar.
A 2019 large-scale study found that written reports of ketamine experiences had a high degree of similarity to written reports of NDEs in comparison to other written reports of drug experiences. Studies indicate that ketamine-induced cystitis is caused by ketamine and its metabolites directly interacting with urothelium, resulting in damage of the epithelial cells of the bladder lining and increased permeability of the urothelial barrier which results in clinical symptoms. Ketamine, generally, stimulates breathing; however, in the first 2–3 minutes of a high-dose rapid intravenous injection, it may cause a transient respiratory depression. Ketamine anesthesia commonly causes tonic-clonic movements (greater than 10% of people) and rarely hypertonia. Psychotomimetic effects decrease when adding lamotrigine and nimodipine and can be counteracted by pretreatment with a benzodiazepine or propofol.
There are no FDA-approved medications to treat ketamine addiction. A mental health professional can help find the best treatment options for you. There are many safe and effective ways of treating depression besides ketamine. People who have a psychological dependence or addiction to ketamine may also find it difficult to function normally in their daily life.
The evidence for a dose-dependent relationship is strengthened by evidence from a case report of a palliative care patient whose urinary symptoms paralleled the use, discontinuation, reintroduction, and repeat discontinuation of analgesic ketamine (91). Additionally, the bladder is exposed to ketamine and its active metabolites for over a week following a single dose of ketamine (14, 15), which suggests frequent ketamine users would have a prolonged exposure. Tolerance is considered to be a major factor in the development of dependency (82) and is a well-recognised characteristic of frequent ketamine use, with intranasal doses of up to 130 mg/kg reported (79, 81). Frequent ketamine use is also typified by increased dissociative and depressive symptoms (66), as well as a subtle visual anomaly (68).
As the dose increases, the person feels like a separation from reality. Ketamine is a safe drug if used in a controlled way. In addition, the agent is used as general anesthesia to sedate the patient and muscle relaxation.
Addiction Treatment
- Under small doses, the effect is a euphoric “body high,” or a state of extreme relaxation, making it a popular club drug.
- This effect has however led to recreational, non-medical misuse and there has been evidence of this since 1967 (5).
- Extensive first-pass hepatic metabolism of ketamine to its main metabolite norketamine substantially reduces its bioavailability following either oral or rectal administration (see Table 1) (3, 8–10).
- Likewise, snorting and injecting ketamine are common ways to consume ketamine, so this permits quick entry into the bloodstream.
- The optical rotation of a given enantiomer of ketamine can vary between its salts and free base form.
- Physiologically, ketamine inhibits the activity of several signaling networks in the brain that coordinate to regulate normal homeostatic functions including breathing, heart rate, metabolism, and cognitive functions.
It is sometimes used off-label for pain relief and can provide sedative effects. As a Schedule III drug, ketamine is available for medicinal use with a prescription. Ketamine was first used in medical procedures for anesthesia in the 1960s. This article will also look into trusted treatments that can help overcome ketamine misuse. There are different ways to identify a person the signs of a potential ketamine addiction. Widely known for its medicinal properties, ketamine’s effects have made it a popular addition to the party scene.
Risk of physical harm
Ketamine does not have the reputation for deadly overdoses, like opioids or other drugs, but the short-term and long-term effects of the drug can still lead to dangerous consequences. Liver and urinary toxicity have been reported among regular users of high doses of ketamine for recreational purposes. At lower, sub-anesthetic doses, it is used as a treatment for pain and treatment-resistant depression. While ketamine overdoses are not strongly linked to death, consuming large amounts of this drug can be fatal. Communicate the suspected ketamine overdose, any observed symptoms, and relevant medical history.
Recreational use
Ketamine should only be taken under medical supervision for approved medical purposes. Recognizing these signs is vital for seeking immediate medical assistance and ensuring the well-being of the affected individual. This information assists medical practitioners in tailoring their responses and providing appropriate care. Upon the arrival of medical emergency services, provide detailed information about the situation. The first and most immediate step is to call 911 to summon professional medical care. Chronic use can exacerbate existing mental health conditions and trigger the onset of new psychiatric disorders.
It later gained prominence for its rapid antidepressant effects discovered 5 key differences between crack and cocaine in 2000, marking a major breakthrough in depression treatment. Ketamine’s clinical and antidepressant effects can be influenced by co-administration of other drugs, though these interactions are variable and not yet fully understood. For example, some experts have attributed the higher incidence of ulcerative cystitis in recreational users to the adulterants with which the drug is mixed. Recreational, non-medical ketamine use is an important public health issue, with evidence of its increasing use in certain population sub-groups, the youth clubbing scene in particular. There are no reports of spontaneous resolution of either symptoms or pathology in persistent ketamine users, and both recurrent symptoms and/or worsening pathology are reported in those who return to ketamine use (89, 91).
- The antidepressant effect of ketamine is diminished at 7 days, and most people relapse within 10 days.
- Ketamine can be administered during abdominal operations, orthopedic procedures, surgical burn treatment, some dental procedures, and many other types of surgery.
- A dose-dependent relationship was reported on 1-year follow-up, with frequent users being more delusional than infrequent, abstinent, and non-users, respectively (66).
- In the long-term there is evidence of psychological dependency and strong evidence for deleterious neuropsychiatric and urological effects.
- This variability underscores the importance of proper medical supervision when using ketamine for therapeutic purposes.
Urological toxicity
Ketamine use and administration require careful consideration of potential drug interactions and contraindications. People are also at a higher risk of physical harm/accidents while under the influence of ketamine. The risk of death from ketamine use alone is rare due to its ability to cause unconsciousness with minimal impact on airway reflexes or blood circulation. Initially synthesized as a safer alternative to phencyclidine (PCP), ketamine is recognized for its unique mechanism of action, rapid onset, and versatility in both clinical and research settings.
If you suspect someone is experiencing a ketamine overdose, call emergency services immediately. However, misuse of ketamine can lead to an increased risk of overdose, posing severe health risks. Ketamine is a dissociative anesthetic drug, approved by the United States Food and Drug Administration (FDA), that was initially developed for human and veterinary medical use.
Among people receiving esketamine, 12.1% (2.5 to 24.4%) encountered some relief at 24 hours, and 10.3% (4.5 to 18.2%) had few or no symptoms. There were 18.7% (4.1 to 40.4%) more people reporting some benefit and 9.6% (0.2 to 39.4%) more who achieved remission within 24 hours of ketamine treatment. A Cochrane review of randomized controlled trials in adults with major depressive disorder found that when compared with placebo, people treated with either ketamine or esketamine experienced reduction or remission of symptoms long covid alcohol intolerance lasting 1 to 7 days. The Canadian Network for Mood and Anxiety Treatments (CANMAT) recommends esketamine as a third-line treatment for depression. Esketamine was approved as a nasal spray for treatment-resistant depression in the United States and elsewhere in 2019.
The 6 Stages of Mental Health Recovery
Management of cholangiopathy may require Take Suboxone properly pain management and, where necessary, biliary stenting to alleviate obstructions. Benzodiazepines are recommended as initial treatment to reduce agitation, excess neuromuscular activity and blood pressure. The half-life of ketamine in humans is between 1.5 and 5 h. The elimination of ketamine is primarily by the kidneys, though unchanged ketamine accounts for only a small percentage in the urine. Norketamine, the dehydronorketamine isomers, and hydroxynorketamine have pharmacological activity.
Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Recreationally used ketamine takes the form of a clear liquid that is injected into the bloodstream or mixed into drinks or a white powder that can be inhaled or smoked (DEA, 2020). Ketamine is widely used for its sedation capabilities and ability to relieve acute and chronic pain (DEA, 2020; Goordeen et al., 2022; Orhurhu et al., 2023a). Ketamine is approved by the Food and Drug Administration (FDA) as a general anesthetic that can be used alone or in combination with other medicines to assist during and prior to surgeries (DEA, 2020; Goordeen et al., 2022; Mayo Clinic, 2025; NIDA, 2024). Since paralysis is a side effect of ketamine, if individuals start vomiting, they may choke on their vomit.