Ketamine hydrochloride has a wide range of effects on the human body including analgesia, anaesthesia and hallucinations.
Ketamine is primarily used as a general anaesthetic, usually in combination with some sedative drug. It is used in intensive care, for analgesia (particularly in emergency medicine), and treatment of bronchospasm. It is also an anaesthetic in veterinary medicine and often missed referred to as a ‘horse tranquilliser’.
Medically, Ketamine is generally deemed to be a safe anaesthetic and has been used in medicine since the late 1960s. From a medical point of view, ketamine has a good record relative to other drugs.
Ketamine is a totally unnatural drug and to date has never been found within any plants or animals. Many hallucinogenic drugs are found in plants. Many naturally occurring chemicals in your brain are also found in plants. The neurotransmitter serotonin, for instance, is derived from tryptophan, found in bananas and pineapples and serotonin itself is found in stinging nettles and other plants. LSD is a close relative of drugs in the ergot fungus and morning glory seeds, while psilocybin is found in magic mushrooms. This relationship between plants and the brain extends to caffeine, opiates, cocaine, cannabis and many other drugs but not Ketamine. (K. Jansen 2005)
Ketamine can be sold in either powdered, crystal or liquid form. In powdered form, its appearance is similar to that of cocaine and can be snorted, injected, or placed in a drink. It is also possible to smoke the drug in a joint or pipe, usually mixed with cannabis and tobacco.
Ketamine is very short acting, its hallucinatory effects lasting fifteen minutes when snorted or ten minutes when injected and up to an hour when ingested, the total experience lasting no more than a couple of hours. The onset is much quicker if smoked 10-15 seconds or 30 seconds when injected. Smoking the drug is reported to have a fundamentally different experience. At lower doses ketamine can act as a stimulant and if injected could quickly suppress breathing.
Ketamine experiences may involve reports of floating in the air or space, and these states may be described as ecstatic or insightful. This is commonly referred to as the ‘K Hole’.
Like other drugs of this class such as phencyclidine (PCP), ketamine induces a state referred to as ‘dissociative anaesthesia’ and is used as a recreational drug.
Ketamine is a core medicine in the World Health Organisation’s “Essential Drugs List”, which is a list of minimum medical needs for a basic health care system. It is not a tranquilliser and is used in the NHS not only on the young or elderly but is finding a much wider application among adults with regards to pain management and depression.
Daily users of ketamine are deemed to be psychologically dependent on the drug. There are no clear reports of a physical withdrawal syndrome from ketamine in humans that do not also involve other drugs.
On 21 June 2007, a Hong Kong Medical Journal posted a report regarding the misuse of ‘street ketamine’. The report suggested that long-term use may result in damage to the liver or urinary bladder, or even acute renal failure.
In a study of 9 daily Ketamine users, Shahani et al found “marked thickening of the bladder wall, a small capacity, and perivesicular stranding, consistent with severe inflammation”.
Cessation of ketamine use, with the addition of pentosan polysulfate, appeared to provide some symptomatic relief. Numerous other clinical and anecdotal reports from across the world are starting to see isolated incidences involving ketamine use and urinary tract, bladder and kidney damage.
The use of ketamine has been linked with a wide range of unpleasant mental effects. The list includes anxiety, panic attacks, flashbacks, post-traumatic stress disorder, persistent perceptual changes, mania, depression, suicide, insomnia, nightmares, night terrors, an unpleasant feeling of being unreal or that the world is unreal, paranoia and other false beliefs that overvalue one’s role in the scheme of things (grandiose delusions), persistent hallucinations, automatic behaviour, fragmentation of the personality and aggression.
Treatment of depression
Paradoxically, the National Institute of Health News reports that a study of 18 patients has found that ketamine significantly improved treatment-resistant major depression within hours of injection. The improvement lasted up to one week after the single dose. The patients in the study were previously treatment-resistant, having tried an average of six other treatments that failed. NIMH director Dr. Thomas Insel said in the paper:
“To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose. These were very treatment-resistant patients.”
Similar studies were carried out by Liebrenz et al, who substantially helped a 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and benzodiazepine dependence by administering an intravenous infusion of 0.5 mg/kg ketamine over a period of 50 minutes.
The commonest mistakes in harm reduction leaflets are claims that ketamine is a “downer.” This is because of the outward appearance of the user on large doses. Ketamine is more likely to act as a stimulant especially in small doses and possibly in the long term. Most information focuses on “overdose” (usually not an issue though there have been deaths due to overdose there are normally other drugs and health issues present) and vomiting (not as common as often claimed, unless the user has been drinking and research in this area is lacking), and not to mention that the main danger is falling over.
- • Difficulty with walking and balance resulting in falls is a common problem:
- •Snorting powders can eventually damage the linings of the nose and impair the sense of smell.
- • Injecting carries a risk of hepatitis, HIV and other infections if shared or unclean equipment is used.
- •Ketamine pills can start very quickly in a person with an empty stomach, sometimes in as little as 10-15 minutes, much faster than most drugs taken by mouth other than alcohol.
- •Oral doses can also take over an hour to work, especially if there is food in the stomach. This time delay can lead to taking more pills, in the mistaken belief that the pills must be weak. Pills result in more physical effects that will last longer.
- •Guard against vulnerability and forgetfulness by making sure you’re with people you can trust.
- • If your bladder is affected and If you sit in the bath to soothe the pain there is a risk of unconsciousness and drowning.
- • Benzodiazepines slow the breakdown of ketamine in the liver. They increase problems with memory, attention, and coordination.
- • Mixing ketamine with other drugs or alcohol will make problems worse.
- • Avoid severe and long-lasting abdominal pain (referred to as K cramps) by not swallowing the drug or stopping completely
- • If you have a panic or anxiety attack stay with your friends. Make sure someone is looking after you.
- • If you experience urination problems be aware that the symptoms will not respond to cystitis treatments, some users have reported that symptoms are relieved to some degree with cessation
- • Give yourself breaks between sessions or daily use
- • If you feel depressed and anxious when stopping or reducing ketamine use, get some professional help to manage your symptoms during a gradual reduction.
- • Injecting ketamine brings the additional risks of damaging your veins, skin
infections and contracting blood-borne viruses such as Hepatitis or HIV.
- • Get safer injecting advice from your nearest needle exchange.
- •Some users may suffer depression related or unrelated to Ketamine use. The brain can make serotonin out of tryptophan in the diet, and higher levels of serotonin have been claimed to reduce depression, anxiety, insomnia, and craving.
- •Pineapple, banana, turkey, chicken, yoghurt, unripened cheese, and chocolate are rich sources of tryptophan. Combining these foods with pasta, cereals, or bread may enhance the absorption of tryptophan into the brain. Tryptophan supplements are not recommended in pregnant women, asthmatics, or people with autoimmune conditions.
Alway seek medical advice and mention ketamine use to the doctor.
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