Ketamine

Also known as

Vitamin K, super K, special K, K, green, donkey dust, k2, super c, lady k, ket, kit kat, ketaset, ketaject, jet, super acid, purple, mauve, super acid, special la coke, cat tranquillizers, cat valium

Classification

Hallucinogenic, anaesthetic

Overview

It's a powerful general anaesthetic which stops you feeling pain and it's used for operations on humans and animals. The effects don't last long, but until they wear off, ketamine can cause a loss of feeling in the body and paralysis of the muscles. It can also lead to you experiencing a distortion of reality .

Ketamine can -

• Reduce sensations in the body, giving you a floating or detached feeling as if the mind and body have been separated, with some people feeling incapable of moving. This has been linked to having a near-death experience and is sometimes called 'entering the k-hole'.
• Change how you see and hear things and can cause hallucinations. You can 'trip' for between half an hour to several hours, and after-effects may be felt for some hours afterwards.
• Cause confusion, agitation, panic attacks, and impairment in short- and long-term memory. Frequent use is sometimes associated with the development of depression.
• Cause very serious bladder problems in regular users. They can have problems peeing and when they do it can be very painful. Sometimes the damage is so bad that the bladder has to be removed by surgery. The urinary tract, from the kidneys down to the bladder, can also be badly affected .

What does it look like?

When used as a medical anaesthetic, ketamine is a liquid, because this makes it easy to inject.

'Street' ketamine is normally a grainy, white powder - although sometimes it can come as tablets .

The licit drug is sold as an injectable liquid, while the illicit product is more often a powder, a white crystalline substance reminiscent of cocaine .

White powder or ampoules for injection. Branded vials may be marked 'Ketalar' or 'Ketaset'. Also appears in many tablets passed off as Ecstasy .

Source

Diverted from pharmaceutical industry , . Imported from Asia and increasingly the Middle East. A small amount is diverted from hospital or veterinary supplies. Some European manufacture alleged .

Prevalence

Ketamine first found its way on to the club and rave scene in the UK in 1992 when people took it thinking they were buying ecstasy.

The DrugScope Street Drug Trends Survey 2011 reported a rise in both use of, and problems associated with, ketamine. Of the twenty areas surveyed by DrugScope, three quarters reported increases both in the general use of ketamine and in the numbers of people coming forward for help with psychological and physical problems associated with the drug.

More recently, Home Office statistics published in 2016, report that ketamine use has fallen among 16 to 59 year olds from 0.5% to 0.3%. The figures showed that around 94,000 adults had used ketamine in England and Wales in the last year. The use of ketamine has remained relatively stable, between 0.3% and 0.6%, since its use was first surveyed in 2006/07 .

Street price

According to the DrugScope Street Drug Trends Survey 2011, the national average price of ketamine is around £21 per gram .

On average, a gram of ketamine in powder form costs £20 . Highly variable; £10 - £40/g reported .

Why take it?

Sought after effects

• sense of euphoria,
• pain relieving,
• a feeling that mind is separate from the body - described as a floating feeling .

Undesired effects

• causes loss of coordination,
• numbness in limbs,
• higher doses can cause an 'out-of-body' experience - the 'K hole ,
• drowsiness,
• dizziness,
• confusion,
• hallucinations .

What are the different forms?

Ketamine is a white/transparent when pure, and often sold as a powder of tiny crystals. It is often crushed into a fine powder so it can be snorted up the nose. Occasionally the powder can be other colours, such as off-white or brown.

Ketamine also sometimes comes in pills. These could contain other drugs, which increases the risk of a bad reaction. It has even been sold as or confused with ecstasy pills.

Some people get ketamine in liquid form (or dissolve it) and inject it for a faster, stronger effect. Injecting drugs is more dangerous for many reasons. For example, it is easier to take too much and can cause injuries and infections such as HIV (sharing needles) .

Snorting

Snorting is the most common way of using it. People usually divide the powder out into lines with a card and snort it with a straw or a piece of paper. Snorting through one nostril over a long time can lead to nasal ulcers or damage the septum .

Oral

Oral use of ketamine results in slightly different effects to snorting or injecting. If taken as a bomb the effects take longer to feel and the experience will last longer. Taking ketamine orally usually results in a less intense experience. Gumming is another way of doing it. A small amount is applied on the inside of the lips or gum. This can damage your gums and lips. Gumming is not a common way of taking ketamine as most users find the taste very unpleasant .

Intramuscular injection

Injection is the most harmful way to take it. Like all other substances mentioned it's recommended that you do not inject ketamine. Injecting also increases the likelihood of becoming addicted to a substance .

How long do its effects last?

Onset of effects

• injection 1 - 5 minutes .
  • intramuscular - 2 - 7.5 minutes , < 2 minutes .
  • intravenous - 0 - 2 minutes .
• snorted 5 - 15 minutes , 7.5 - 20 minutes .
• oral 5 - 30 minutes , 5 - 20 minutes , 10 - 75 minutes .

Come up

• snorted - 5 - 10 minutes .

Peak

• injection - intramuscular - 1 - 2 hours .
• oral - 45 - 90 minutes .
• snorted - 20 - 30 minutes .

Duration of effects

• injection - 1 - 2 minutes .
• intramuscular - 1 - 2 hours .
• intravenous - 1 - 2 hours .
• snorted - 20 minutes to a couple of hours , 20 - 40 minutes , 90 minutes , 1 - 2 hours .
• oral - 90 minutes , 1 - 2 hours .

After-effects

• injection - 2 - 4 hours .
• intramuscular - 1 - 2 hours , 60 minutes .
• intravenous - 1 - 2 hours .
• snorted - 1 - 3 hours , 1 - 2 hours , 2 - 12 hours .
• oral - 40 - 80 minutes , 1 - 2 hours , 4 - 8 hours .

Pharmacology

Ketamine interacts with a vast number of receptors, channels and enzymes in the central and peripheral nervous systems (CNS and PNS) which produce the varying and dose-dependent effects associated with ketamine use. Ketamine functions in pain perception, the cardiovascular, gastrointestinal and respiratory systems by interacting with the related signalling molecules in the nervous system.

The predominant sought-after effect of ketamine for users is the 'dissociative' effect. Interactions of ketamine within the CNS (described in more detail below) results in this state of 'dissociative anaesthesia':- sensory loss and analgesia but without actual loss of consciousness .

In the CNS, ketamine interacts with -

• NMDA receptors - It has the greatest affinity (ability to bind) for NMDA (N-methyl-D-aspartate) receptors, where it acts as a non-competitive antagonist. This means it binds to and then blocks the NMDA receptors from functioning.

• Nitric oxide synthase (NOS) - ketamine inhibits NOS, and therefore the production of nitric oxide or NO (not to be confused with nitrous oxide or N2O, aka laughing gas) which plays a role in pain perception.

• Sigma receptors - ketamine has a low affinity for the sigma receptors 1 and 2 and it is thought that the analgesic effects of the sigma receptor are not activated by ketamine.

• Opioid receptors - ketamine has a preference for the mu and kappa receptors, but its affinity for these receptors is 10 times less than that for NMDA. Also, reports show that naloxone (the opiate antagonist which counteracts the effects of opiates) does not work in countering the effects of ketamine. (See the Morphine section for a fuller explanation of opiate receptors).

• Calcium channels - ketamine blocks calcium channels, which again contributes to the analgesic effects.

• Sodium channels - ketamine has shown to have local anaesthetic properties possibly due too its interaction with sodium channels found in nerve endings of pain perceiving fibres.

• Cholinergic, noradrenergic and serotonergic neurotransmission - in the spinal cord, ketamine acts to inhibit uptake of neurotransmitters involved in the pain perception. Simply put, it increases certain transmitters that work to inhibit pain .

In the peripheral nervous system, it increases catecholamines (which include adrenaline) in the cardiovascular system to increase heart rate and blood pressure (this is dose-related) and in the respiratory system which causes bronchodilation (relaxation of certain airway walls, causing them to open).

Intravenously, the onset of action is a few seconds, intramuscularly (injected into muscle/fat) it is 4 minutes .

Tolerance

Tolerance can build to the effects of ketamine over time, requiring more of the drug to reach the same level of effect .

Mode of use

There are a number of ways of taking ketamine -

• Some people swallow it in tablet form.
• Most people snort ketamine, like cocaine or speed.
• If it is liquid, it can be injected .

No method is safe, but injecting is very risky. Injecting any drug and sharing injecting equipment runs the risk of spreading a virus, such as HIV or hepatitis C. There is also the risk that veins may be damaged, which can lead to infections and/or gangrene which can result in you losing a finger, toe or a limb .

In social situations, ketamine is often used intranasally and orally. And though it can be injected, the rapid onset of effects from oral or nasal use makes it more convenient and marketable than the injectable forms . It is primarily manufactured as an injectable liquid, however, so illicit producers must evaporate the liquid to form a powder that can be snorted or compressed into pills . Each method of ingestion varies in the amount of time it takes to produce affects in the user: injection generally takes between 1 and 5 minutes; snorted ketamine between 5 and 15 minutes; and oral ingestion between 5 and 30 minutes. The hallucinatory effects of ketamine last approximately one hour or less, but the user's senses, judgment, and coordination may be affected for up to 24 hours following initial use , .

• swallowed - can be taken orally (often mixed in drinks),

• injected - can be injected into a muscle (liquid form),

• snorted - usually divided into lines and snorted (insufflated) via rolled up paper or 'bumped'/'keyed' i.e. small amount sniffed. When snorted the drug takes effect after about one minute and lasts for 20 to 40 minutes .

Ketamine powder is usually snorted or swallowed though some people do inject it. Ampoules are typically injected . It is also sometimes smoked with cannabis or tobacco .

Signs of usage

The following are common signs a person in abusing Ketamine -

• change in behaviour,
• lack of interest in usual activities,
• trouble at school or work,
• difficulties in personal relationships,
• violent and erratic behaviours,
• visiting multiple doctors offices in search of ketamine,
• stealing,
• legal troubles .

Effects

It's a general anaesthetic that can produce 'floaty' feelings, as if the mind and body have been separated. Other effects include -

• It can make you feel very chilled out and relaxed.
• It can make you physically incapable of moving. You can feel completely detached from your body and surroundings, which has been compared to having a near-death experience, sometimes called 'entering the k-hole'. For some people this is an enjoyable effect.
• Like LSD, ketamine can alter perception of time and space and can cause hallucinations. It can lead to good or bad 'trips' that can last from half an hour or so to several hours, with after-effects that may be felt for some hours .

There is no safe level of drug use. Use of any drug always carries some risk. It's important to be careful when taking any type of drug .

Ketamine affects everyone differently, based on -

• size, weight and health,
• whether the person is used to taking it,
• whether other drugs are taken around the same time,
• the amount taken,
• the strength of the drug (varies from batch to batch) .

The effects of ketamine are considered dose dependent. That is, lower doses of the drug produce varying results when compared to higher doses. A dose of 1.0 to 2.0 mg per kilogram of body weight produces an intense experience lasting about one hour. The effects include a sense of floating and dissociation, stimulation, and hallucinations. Larger doses of ketamine may produce what users refer to as a 'K-hole'. A K-hole is generally reached when the user is on the brink of being fully sedated and is likened to an out-of-body or near-death experience. High doses of ketamine may result in severe respiratory depression, muscle twitches, dizziness, slurred speech, nausea, and vomiting . One of the most dangerous effects of ketamine is the helpless and/or confused state the user may be put into after use of the drug. This causes the user to have difficulty with balance, combined with numbness, muscle weakness, and impaired vision. The combined effects can leave the user vulnerable to particular forms of crime , especially 'date rape' .

At lower doses, users report feeling disorientated, with some hallucinogenic experiences such as distorted senses of the body and limbs feeling longer or shorter. Some people feel euphoric. Limbs may feel heavy and increased effort is required to move or speak.

At higher doses, hallucinations are much more pronounced. People describe an experience that has been dubbed 'k-holing' - a feeling as though travelling along a tunnel towards a white light. Perceptions can become very altered with intensely altered awareness of sound and vision. Some users report intense 'out-of-body' experiences which can be profound and a small number of ketamine users seek out this aspect of ketamine use .

Long-term effects

• headaches,
• flashbacks,
• poor sense of smell (from snorting),
• mood and personality changes, depression,
• poor memory, thinking and concentration,
• ketamine bladder syndrome,
• abdominal pain,
• needing to use more to get the same effect,
• dependence on ketamine,
• financial, work and social problems , .

Physical effects

• flashbacks,
• amnesia,
• impaired motor functioning,
• delirium (hallucinations or disorientation),
• dramatic increase in heart rate (tachycardia),
• loss of touch with reality (derealisation),
• loss of coordination,
• sense of invulnerability,
• muscle rigidity,
• aggressive/violent behaviour,
• death from overdose - in severe instances ,
• lethargy,
• sedation,
• chest pain,
• respiratory depression,
• seizures,
• coma ,
• gustatory hallucinations,
• physical autonomy,
• physical euphoria,
• spatial disorientation,
• spontaneous tactile sensations,
• watery eyes,
• motor control loss,
• orgasm suppression,
• pain relief,
• perception of decreased weight,
• tactile suppression,
• dizziness,
• nausea,
• optical sliding .

Cognitive effects

• compulsive redosing,
• conceptual thinking,
• depersonalisation,
• derealisation,
• déjà vu,
• time distortion,
• analysis enhancement,
• dream potentiation,
• immersion enhancement,
• increased music appreciation,
• suggestibility enhancement,
• amnesia,
• analysis suppression,
• anxiety suppression,
• decreased libido,
• disinhibition,
• information processing suppression,
• memory suppression,
• personal bias suppression,
• thought deceleration,
• existential self-realisation,
• unity and interconnectedness .

Visual effects

• environmental cubism,
• environmental orbism,
• perspective distortions,
• scenery slicing,
• acuity suppression,
• double vision,
• frame rate suppression,
• pattern recognition suppression,
• visual disconnection,
• external hallucinations,
• internal hallucinations .

Auditory effects

• distortion,
• enhancement,
• hallucinations,
• suppression .

Side-effects

• feeling happy and relaxed,
• feeling detached from your body ('falling into a k-hole'),
• hallucinations,
• confusion and clumsiness,
• increased heart rate and blood pressure,
• slurred speech and blurred vision,
• anxiety, panic and violence,
• vomiting,
• lowered sensitivity to pain , , , ,
• lethargy,
• delirium,
• sedation,
• chest pain,
• respiratory depression,
• elevated heart rate,
• loss of coordination,
• muscle rigidity,
• violent behaviour,
• amnesia,
• seizures,
• coma,
• death from overdose (rare) .

Positive effects

• ego death is a state often sought in the use of psychedelics, and ketamine is often considered to be a very quick route to ego death, in a repeatable, safe way,
• some users report euphoria,
• pain relief,
• there has been some indication that ketamine, in low doses (20 - 30mg), can be an effective anti-depressant .

Negative effects

• long-term, chronic usage may lead to psychosis.
• bladder and lower urinary tract discomfort, up to and including tissue necrosis requiring replacement of bladder, ureters, and urethra, has been reported[1]. If these effects are noticed, discontinue use immediately. There is no known treatment for this except cessation of use. Symptoms may subside with discontinuation.
• Ketamine is well-known in the psychedelics community to be habit-forming. It may not be technically 'physically addictive', but certainly psychological dependence is an issue that is widely reported.
• any substance used intramuscularly or intravenously can be associated with abscesses among other hazards .

Negative physical effects can include -

• hallucinations,
• blurred vision,
• irrational behaviour,
• seizures,
• breathing difficulties,
• anxiety and racing heart .

Coming down

In the day following ketamine use, the following effects may be experienced -

• memory loss,
• impaired judgement,
• disorientation,
• clumsiness,
• aches and pains,
• depression , , .

After effects

• Ketamine takes much longer to return to a complete baseline than is immediately apparent to the user. While major effects subside in usually less than an hour, some research has shown it can take a day or longer for more subtle psychological effects to subside. For this reason, it is important to be careful with redosing and daily usage .

Overdose

If a large amount or a strong batch is taken, it could also cause an overdose. If any of the following effects are experienced an ambulance should be called straight away. Ambulance officers don't need to involve the police .

• inability to move, rigid muscles,
• high body temperature, fast heartbeat,
• convulsions,
• coma and 'near death' experiences,
• death , , .
• feeling sick and/or vomiting,
• feeling very confused,
• chest pain,
• irregular heart rate,
• being unable to move,
• violence or becoming very frightened (this may be due to hallucinations),
• loss of consciousness,
• in severe cases, ketamine can cause you to have a fit. In some cases, people have choked on their vomit when unable to move or unconscious,
• raised blood pressure .

If you think you or a friend has taken an overdose of ketamine, it is very important to seek help immediately. Call an ambulance and tell them what has been taken so that medical staff can help. You won't get into trouble for this and you may minimise or prevent any serious long-term damage .

Urinary tract effects

According to a recent systematic review, 110 documented reports of irritative urinary tract symptoms from ketamine dependence exist . Urinary tract symptoms have been collectively referred to as 'ketamine-induced ulcerative cystitis' or 'ketamine-induced vesicopathy' and they include urge incontinence, decreased bladder compliance, decreased bladder volume and painful haematuria (blood in urine).

The time of onset of lower urinary tract symptoms varies depending, in part, on the severity and chronicity of ketamine use; however, it is unclear whether the severity and chronicity of ketamine use corresponds linearly to the presentation of these symptoms. All reported cases where the user consumed greater than 5 grams per day reported symptoms of the lower urinary tract , .

Ketamine bladder syndrome

Large, repeated doses of ketamine may eventually cause 'ketamine bladder syndrome', a painful condition needing ongoing treatment. Symptoms include difficulty holding in urine, incontinence, which can cause ulceration in the bladder. Anyone suffering from ketamine bladder syndrome needs to stop using ketamine and see a health professional .

Risks

Ketamine can increase your heart rate and blood pressure. It can make you confused, agitated, delirious and disconnected from reality. It can make you feel sick, and it can cause damage to your short- and long-term memory. Other risks include -

• Because of the body's loss of feelings, paralysis of the muscles and the mind's loss of touch with reality, you can be left vulnerable to hurting yourself or being hurt by others.
• Because you don't feel pain properly when you've recently taken ketamine, you can injure yourself badly and not know you've done it.
• Ketamine can cause very serious bladder problems, with the urgent and frequen need to pee. This can be very painful and often pee can be blood-stained and can contain tissue from the wall of the bladder. Although stopping using ketamine can help, sometimes the damage can be so serious that the bladder needs to be removed by surgery. The urinary tract, from the kidneys down to the bladder, can also be badly affected and incontinence may also develop.
• Some users have been known to take higher doses as a way to control the bladder pain caused by ketamine, which in turn increases the risk of bladder damage and pain.
• Abdominal pain or 'K cramps' have been reported by many long-term users.
• Evidence of liver damage due to regular, heavy ketamine use is emerging. The liver has a range of important functions, such as cleaning your blood and removing toxic substances.
• It can make you physically incapable of moving. You can feel completely detached from your body and surroundings, which has been compared to having a near-death experience. This is sometimes called 'entering the k-hole'.
• Injecting ketamine can damage the veins and can cause serious problems such as abscesses and blood clots. Sharing injecting equipment, including needles and syringes, risks infection with hepatitis C and B viruses and HIV .

Short-term

• accidents,
• anxiety,
• panic attack,
• collapse .

Long-term

• psychological dependency,
• tolerance .

Purity

Users won't know whether any ketamine they get through a dealer, even a friend, is definitely ketamine or whether it has been contaminated (or 'cut') with any other substances.

There have been reports of ketamine being cut with the 'legal high' MXE while some people have been sold ketamine which is really MXE. MXE is chemically related to 'dissociative anaesthetics' like ketamine and has similar effects. But it is much stronger than ketamine and extra care is needed to avoid overdosing.

Only medicinal ketamine would be reliably pure .

Variable, when sold in tablets it is often mixed with a stimulant to give an ersatz ecstasy-like effect (speedy and trippy). Powders may well have been adulterated, though often this will have been with an inert bulking agent.

More often than not, it is other products which have been adulterated with ketamine, rather than ketamine itself being adulterated. So low grade cannabis resin (soap), heroin and ecstasy is sometimes cut with ketamine .

Addiction

Can you get addicted

The simple answer is - yes - you can become addicted to it. This means dependent users feel the need to keep taking ketamine, even in spite of the effects on their health. Some users will attend drug treatment services to help them stop.

Regular users can also develop tolerance to ketamine, which means they need to take increasing amounts to get the same effects.

There are no physical withdrawal symptoms, so ketamine addiction is sometimes called a 'psychological dependence'. Dependence is just another name for addiction .

Dangerous interactions

• Depressants - This combination potentiates the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it. Examples include 1,4-butanediol, 2-methyl-2-butanol, benzodiazepines, GHB, GBL, and opioids .

Dangerous

• alcohol - Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

• GHB/GBL - Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

• opioids - Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

• Tramadol .

Caution

• amphetamines - No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

• cocaine - No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

• benzodiazepines - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

• MAOIs - MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available .

Withdrawal

Ketamine withdrawal typically begins within 24 hours of the users last dose. They reach a peak within 3 to 4 days and subside within one week. Katamine addiction is largely psychological, requiring addiction treatment to overcome safely without relapse .

Withdrawal symptoms may include -

• chills,
• sweats,
• excitation,
• hallucinations,
• teary eyes,
• drug cravings ,
• tension,
• twitchiness,
• poor attention span,
• restlessness,
• cravings,
• delirium,
• flash backs,
• confusion,
• aggressive behaviour .

Drug testing

Ketamine is not tested for in standard or advanced drug tests. It is not included on the list of drugs the Substance Abuse and Mental Health Services Administration (SAMHSA) uses for employee drug testing purposes . The SAMHSA 5 includes the following drugs -

1. Marijuana, Hash,
2. Cocaine (including crack),
3. Amphetamines,
4. Opiates (heroin, opium, morphine, codeine),
5. Phencyclidine (PCP) .

This list of drugs is commonly known as the SAMHSA 5. Companies that employ commercial drivers are required to set up a drug testing program. Federal regulations in the United States require these employers to test for the five drugs listed above, and Ketamine is not something that would be tested for, unless there was reason to suspect that an individual was using it .

Specific drug tests for Ketamine

However if a specific test was requested, norketamine, the breakdown product of Ketamine, is detectable in blood and urine for 7 - 14 days and sometimes far longer in heavy users.

A blood test is the most expensive form of drug testing available. But it's also the most accurate one. Ketamine is difficult to detect in its true form; the body starts to break it down quickly. Since testing for cat valium isn't part of a standard tox screen, it must be ordered by a health care professional.

Urine tests are relatively inexpensive for drug testing purposes. They are non-invasive, and only require the subject to provide a sample after arriving at the testing facility. Once the urine sample has been obtained, it can be tested for ketamine. Some testing kits only require the tester to dip a specially treated strip into the urine to determine whether someone has been taking ketamine.

Ketamine can also be detected in a hair sample. When this type of test is ordered, it can show a history of drug use. Depending on where the norketamine is detected on the hair sample, the results will indicate a time frame for when the drug was used .

Legality

On Tuesday 10 June 2014 ketamine changed from a class C to a class B controlled drug. This means that possession of ketamine could now get you up to five years in jail and an unlimited fine, while supplying ketamine to someone else could get you up to 14 years in jail and an unlimited fine.

• Ketamine is a Class B drug which means that it's illegal to have for yourself, give away or sell.
• Possession can get you up to five years in prison and/or an unlimited fine.
• Supplying someone else, even your friends, can get you 14 years in jail and/or an unlimited fine .

What if you're caught?

If the Police catch you in possession of ketamine, they'll always take some action. This could be a formal caution, or arrest and possible conviction.

A conviction for a drug-related offence could have a serious impact. It can could make it harder, even impossible, stop you to visiting certain countries - for example the United States - and limit the types of jobs you can apply for .

Did you know?

• Like drinking and driving, driving when high is illegal - and you can still be unfit to drive the day after using ketamine. You can get a heavy fine, be disqualified from driving or even go to prison.
• Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises .

Mixing with other drugs

• High doses, especially when taken with other substances like alcohol, benzodizepines or opiates, can dangerously affect the way you breathe and how your heart works. It can lead to unconsciousness and this could mean you choke on your own vomit.
• If high doses are taken and mixed with other drugs it can cause death.
• Ketamine can also be very dangerous when mixed with ecstasy or amphetamines as it causes high blood pressure .

As an increasingly popular club drug, ketamine is often associated with polydrug use. It is most commonly mixed with other popular club drugs, such as ecstasy and cocaine (Calvin Klein or CK is a slang term for this combination). Combining ketamine with alcohol or other depressant drugs is particularly dangerous because it increases the risk of losing consciousness .

Like all anesthetics, Ketamine is not a good mixer. Respiratory depressants like alcohol and valium are particularly risky. At anything above a low level dose (50mg or less), Ketamine is so powerful and complete that for most users, combining it with any other drug only detracts from the experience.

Please note - there have been very few scientific studies into the effects of combining psychoactive drugs. The information presented here is anecdotal. It is based on the subjective reports of experienced users. Different people will respond differently to different drugs and drug combinations. Know your body .

• alcohol - can cause nausea and vomiting; can also depress respiratory system at high doses,
• amphetamines - some users add amphetamines to lower doses of Ketamine for a more MDMA/Cocaine psychedelic party drug feel,
• cannabis - ketamine amplifies certain cannabis effects, notably closed-eye imagery; no reported problems, but make sure you stub the joint out before taking ketamine,
• ecstasy (MDMA) - some like to take small K 'bumps' towards the end of their ecstasy experience; brings back the Ecstasy sensations and adds a psychedelic tinge,
• heroin - depresses respiratory system; counters the psychedelic effects of ketamine,
• LSD - no reported health problems but can make a weird trip even weirder; increases ketamine's ability to induce out of body experiences; some users report that small amounts can 'ground' the wilder aspects of LSD experience,
• magic mushrooms - simultaneous mushroom and ketamine feelings; time slow downs; no reported health problems,
• tobacco - in a Ketamine daze you could burn your house down,
• valium - you can't be any more relaxed when you're on ketamine; depressants are dangerous with ketamine .

• Ketamine + alcohol or opiates - lack of awareness of effects of the depressant drugs, which may lead to taking too much and vomiting, slowed breathing, coma and death .
• Ketamine + amphetamines, ecstasy and cocaine - enormous strain on the body, which can lead to fast heart rate .

Harm reduction

Ketamine slows reflexes and impairs coordination, so minor accidents like bumping into objects are common. Thanks to its anaesthetic effects, any sense of pain is significantly reduced, and the user may only become aware of these knocks when bruises develop later.

Ketamine severely impairs coordination so no attempt should be made to drive or operate machinery while under its effects.

Users should also be aware of distortions in perception of time and space and even relatively simple tasks such as judging distances and speed (for example crossing a busy road) can be compromised. Several deaths have occurred when people have attempted to swim on ketamine, so care should be taken to avoid bodies of water, even the bath.

Users may also experience nausea and/or vomiting. Oral use is most commonly associated with unpleasant sensations and severe side-effects. Regular use, especially in conjunction with alcohol consumption, can cause bladder infections (see 'ketamine bladder' below).

Ketamine is a drug where setting' needs to be carefully considered, it is prudent to be with friends who are not drug naïve or in an environment that you have no control over.

Ketamine is found as an 'impurity' in some 'ecstasy' tablets. Due to similarities in appearance, ketamine may also be confused with other drugs such as amphetamine and cocaine, despite the fact that the action of ketamine is very different from pyscho-stimulants. This has resulted in some users having bad experiences as they are not prepared for the effects and there is no dose tolerance between the drug types.

Ketamine has the potential to be both physically and psychologically addictive. Regular users build up tolerance and larger doses are needed to achieve the same effect. Ketamine is more psychologically addictive than the psychedelics, and use can become a daily habit. Repeated long term use can occasionally result in more severe problems like psychosis, or liver and kidney damage. Individuals who use it regularly may find it difficult to stop. It is not wise to discontinue from large doses abruptly and some degree of tailing off towards termination is suggested. When a person attempts to reduce the daily volume of a drug to which they have become dependent, it is clear that there is potential for postponing cessation repeatedly, so setting firm targets and sticking to them is crucial .

• if snorting, grind down in to a fine powder to prevent damage to your nose,
• alternate nostrils if snorting and clean your nostrils after each session to minimise damage,
• avoid using in clubs if you're an inexperienced ketamine user or you intend taking larger amounts as you can become disoriented,
• ketamine can affect your balance - try to stay in a hazard free environment,
• don't swallow the drip you may get at the back of your throat after taking ketamine as this can cause long term bladder problems,
• to avoid the drip - try light and slow rather than fast, hard snorting,
• ketamine is an anaesthetic. If you feel less pain, you are at more risk of injuring yourself,
• there is a risk of bladder problems and kidney damage with regular and heavy use,
• a sign of bladder damage is cystitis. Symptoms of ketamine-induced ulcerative cystitis include the need to pee often and blood in your urine. The damage can be permentant leading to people wetting themselves and eventually being unable to use their bladder naturally. Men will often be unable to get an errection naturally,
• regular use can also lead to 'k-cramps'. The cause of the cramps are unknown,
• to reduce the risk of k-cramps, bladder and kidney damage avoid taking ketamine regularly or at heavy doses,
• avoid mixing with other drugs especially downers such as alcohol or benzos as the effects are unpredictable and you may be more likely to overdose .

Before

• It is always advisable to test your drugs to ensure you are getting what you expect. There have been some cases where people have been sold other substances as ketamine, such as methoxetamine, which can have much stronger effects.

• Good hygiene can also reduce harm. If you are snorting ketamine, ensure you use a clean surface and an unused straw. Sharing straws or using notes can put you at risk of infections.

• Regularly snorting any drug can damage your nose. If you are going to snort ketamine, make sure it is crushed finely. Afterwards, clean your nose with water.

• Injecting ketamine causes damage to the skin and veins, leading to sores. Sharing injecting equipment risks infections such as HIV, Hepatitis B and Hepatitis C. Injecting street ketamine carries further risks as it is likely to contain other substances which may increase harm. If you are going to inject ketamine, use only medical grade ketamine liquid and always use new injecting equipment. Free needle and syringe exchange services are available around the UK. They provide sterile injecting equipment as well as advice to users .

During

• You should avoid food for at least 1.5 hours before taking ketamine. Nausea and vomiting can occur when coming up. Staying still can help with this feeling.

• It's very important to think about where you take ketamine. On high doses or in a K-hole, it is very difficult to move around, which puts you in a vulnerable position. It's best to ensure you are in a safe and familiar place if you are going to take it. It is a good idea to be with someone who is familiar with the drug. You might become quite confused and also be injured if you try to move around when taking the drug.

• It is very important to avoid driving while on ketamine. Not only is this very dangerous, it is also illegal. The drug driving limit for ketamine is 20 micrograms per liter of blood .

After

Hangover

Although the major effects of ketamine only last about 1--2 hours before users feel normal, some people have longer lasting subtle effects that might last for a couple of days. Maintaining a healthy lifestyle is important to your physical and mental wellbeing, so try to make sure that you eat well, get enough sleep, and try to get some exercise. Some people take ketamine to forget about problems in their everyday life. While this might work for a short time, it can encourage people to take ketamine more and more often which can cause a range of physical and psychological effects.

Some people take ketamine to forget about problems in their everyday life. While this might work for a short time, it can encourage people to take ketamine more and more often which can cause a range of physical and psychological effects .

Ketamine bladder

Long-term ketamine use has been shown to damage the bladder and urinary tract, causing 'ketamine cystitis' or 'ketamine bladder syndrome'. This manifests itself in symptoms such as urinary frequency, urgency, pressure, pain, incontinence and/or bleeding from the bladder. The aetiology are not fully understood, but chronic use can cause ulcers/wounds and stiffening of the bladder walls, which shrink the size of the bladder .

What are the risks of injecting Ketamine

How can you inject more safely?

When ketamine is injected and any injecting equipment is shared (needles, syringes, spoons, filters or other paraphernalia), there is a risk of contracting Hepatitis B and C, HIV (which can lead to AIDS) and other blood-borne diseases. These viruses can be extremely resilient, and normal cleaning will not eliminate them, particularly in the case of Hepatitis, which can live outside the body (in certain circumstances) for up to three months. People who are infected with these viruses usually appear healthy, and may not develop the disease for years. From the moment someone is infected however, they carry the virus in their blood, and can infect others through sexual intercourse (particularly with HIV) and sharing any injecting equipment, even spoons and filters .

Paraphernalia

If snorted - a razor blade may be used on a hard level surface (such as a mirror or glass) with the chopped powder being snorted up a paper tube or rolled banknote. If injected - needles and syringes .

Detox

If you decide to stop using ketamine, you may experience some unwanted withdrawal effects. If you do, it is a good idea to speak to a health professional who will be able to support you and signpost you to helpful services .

Some of the withdrawal effects of ketamine may include -

• cravings,
• anxiety,
• shaking,
• sweating,
• fast heart beat .

Don't hesitate to look for medical help, you won't get in trouble. Talk to your GP, who will be able to refer you on to your local addiction service .

Giving up ketamine after using it for a long time is challenging because the body has to get used to functioning without it. Withdrawal symptoms usually last for 4 - 6 days . These symptoms can include -

• no appetite,
• tiredness,
• chills,
• restlessness,
• tremors,
• nightmares,
• anxiety,
• depression,
• irregular heartbeat .

According to several research studies, there is some evidence that with repeated use ketamine users can develop a tolerance and/or dependence to the drug. Tolerance in many instances can be very high and develop rapidly to the point where after a period of time users will no longer experience the dissociative effects they first began using. Ketamine has a great deal in common with other drugs linked with dependence including stimulants, opiates, alcohol, and cannabis. A common feature of ketamine dependence is that of repeated binges where the user indulges in the drug in excessive amounts over a short period of time. To date, identifying physical withdrawal symptoms has been limited to only personal accounts, but research is ongoing .

History

Ketamine, developed in 1962, was initially promoted as a fast acting general anaesthetic . A few years later, in 1970, the federal government approved ketamine for human use, and as a result it soon became popular as a battlefield anesthetic . The first evidence of illicit abuse of the drug was on the West Coast . Later, during the late 1970's and early 1980's abuse began to increase across the country, especially among certain sub-cultures (e.g., mind explorers and New Age spiritualists) . Around the same time, new forms of the drug were being introduced into the illegal drug markets including capsules, powder, crystals, tablets, and solutions, in addition to other injectable forms . Starting in the mid-1980's another increase in the social-recreational use of ketamine was beginning to be linked to various dance cultures , initially as an adulterant - an added ingredient that can alter the effects of the drug - of MDMA (ecstasy) . In fact there are reports that party/club goers in the United Kingdom first used ketamine when they ingested a pill they thought to be ecstasy. Today, there are still valid medicinal uses of ketamine for anaesthetic reasons, though use is uncommon and tightly restricted. Illicit use today is also of great concern to many. Despite difficulty in determining its prevalence, use is higher today than it was when first introduced. Consequently, and perhaps in response to increases in recreational use, the federal government classified ketamine as a Schedule III controlled substance in August 1999, creating more stringent controls of the drug .

Ketamine, developed in 1962, as CI-581, was first synthesised by Parke-Davis scientist Calvin Stevens. Pharmacological investigations in human subjects began in 1964 and it was initially promoted as a fast acting general anaesthetic. A few years later, in 1970, it was used as a battlefield anaesthetic, as it has less effect on depressing the respiratory system than opioids.

The first evidence of illicit use of the drug was on the West Coast of America. Later, during the late 1970s and early 1980s abuse began to increase across the country, especially among certain sub-cultures (e.g. psychonauts and 'New Age' spiritualists). It was used in psychiatric and other academic research through the 1970's, culminating in 1978 with the publishing of the neuroscientist and psychoanalyst John Lilly's 'The Scientist' and Marcia Moore, who died of hypothermia in the woods behind her house after a large dose of IV ketamine. Around the same time, ketamine became widely available in a range of formulations including capsules, powder, crystals, tablets, ampoules and solutions.

Starting in the mid-1980's ketamine was beginning to be linked to 'rave' culture, partially as an experience in itself and also as a come-down, 'chill-out' antidote to the psycho-stimulants and hallucinogens popular in the culture.

Today, there are still valid medicinal uses of ketamine for anaesthetic reasons, though its use is uncommon and tightly restricted. The most common access to ketamine for users has been to obtain it through diversion from pharmaceutical suppliers of legal chemicals or theft from veterinary clinics or purchased from the East, often India, where less stringent controls have been in place in the pharmaceutical industry until quite recently. Ketamine has, over the past few years, been thought of as a 'club drug' (this term is used for a number of illicit drugs, primarily synthetics, that are most commonly encountered at parties, clubs and 'raves'). In the 'MixMag' surveys of recent years ketamine has held a place high on the list of clubbers' most frequently used drugs. This is not to say ketamine is not still popular with psychonauts, as it certainly is .

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