This article originally appeared on VICE US.
Ketamine, the hallucinogenic anaesthetic increasingly being used to treat mental health and chronic pain, is at the center of two lawsuits alleging that prescriptions of the drug made people carry out extreme acts of violence.
Despite there being no historical evidence linking the drug to violent behavior, the two lawsuits, which both involve ketamine prescribed for chronic pain, will serve as a warning to the rising number of clinics using potent, controlled drugs to treat highly vulnerable patients.
In the first case it is alleged that ketamine given to an Albuquerque man by doctors caused him to set himself on fire. He died from his injuries.
In 2017, Gabriel Saenz was receiving ketamine infusion therapy for chronic migraines at the Injection and Infusion Clinic of Albuquerque. Two days after his final treatment, Saenz, 32, “stabbed himself multiple times, inhaled combustible fuel, and set himself on fire,” according to the lawsuit, which was first reported by the Albuquerque Journal.
Saenz’s family is now seeking unspecified damages from the clinic and its founder, Jason Duprat. They allege the clinic failed to properly screen Saenz for mental health issues and didn’t follow up with him after treatment. Duprat declined to comment directly on the case, but told VICE: “It is important to consider the many confounding factors that could have contributed to such behavior, days after treatment.”
Katherine Devine, who took ownership of the clinic after the episode, told the Journal that “obviously, this case is quite sensational, and there are a lot of other factors involved.” She denied the allegations and mentioned that she’d never heard of a case where ketamine, the effects of which usually subside after a matter of hours on account of its short half-life—caused a manic episode 48 hours after infusion. The clinic told VICE: “Our clinic complies with ketamine administration guidelines. We are proud of our many successes with crippling depression, PTSD and chronic pain.”
In the second case, police were called to a “rape in progress” at the home of Joseph Branchflower, a real estate agent and former pastor on the night of April 3rd, 2018, in Vancouver, Washington.
The previous month, Branchflower had been prescribed a nasal spray of ketamine by his doctors at Oregon Health Science University (OHSU) to treat chronic pain in his lower back and groin. The prescription was for a dose of up to 150mg, dispensed using five to ten sprays in alternating nostrils every three to four hours (meaning he could have ended up using around 600mg a day). Branchflower took the drug every day for about three weeks.
According to a police report of the April 3 incident, 43-year-old Branchflower was naked, and acting as if he was either high on drugs or mentally ill. He made death threats at officers who reported Branchflower shouted that he wanted to "fuck his wife and that's all."
The officers entered the home with a police dog and found Branchflower in the master bedroom clutching a bong. The dog bit Branchflower on the arm before the bong was thrown and hit one of the deputies on the head. Branchflower punched another one of the officers in the face, bloodying his lip. Finally, an ambulance arrived and paramedics administered a sedative. He was charged with the attempted rape of his wife and assault against the responding officers and spent 45 days in jail. He was later evicted from his home.
All charges against Branchflower were later dropped. Supported by a report by a pharmacologist and anesthesiologist, Branchflower blamed the episode on a high dose of ketamine prescribed by his doctors, who he is now suing for $8.2 million. Branchflower, who is also suing the pharmacy that prepared the ketamine, alleges that it was this prescription that prompted a “severe episode of dissociative behavior” that he claims he has little to no memory of. According to the lawsuit, the pharmacologist described Branchflower’s episode as a “gross overdose” of ketamine.
If the dose described in Branchflower’s lawsuit is accurate, it’s a high one. An ongoing clinical trial for intranasal ketamine for cancer pain is using a max of 50mg per patient. A paper on the treatment of chronic pain with ketamine published in January describes a recommended dose for applying ketamine via nasal spray of 0.2mg to 1mg per kg bodyweight. The police report lists Branchflower’s weight as 220lbs, so at max, he should have been taking 100mg per day. The Saenz lawsuit does not mention a dosage.
But what’s odd about these two lawsuits is that ketamine isn’t known to cause violence or suicidal thoughts. If anything, it causes the opposite. Ketamine is a powerful sedative, often used to tranquilize patients who are severely agitated and acting violently. The drug is stocked in most emergency rooms because it’s also an powerful painkiller that doesn’t have some of the same risks as opioids.
"I don’t know of any literature on that,” said Celia Morgan, a professor of psychopharmacology at the University of Exeter, when asked whether she had ever heard of ketamine causing violence. “Certainly that’s not a reported side effect in any ketamine users or any of the trials with healthy people or patients. I’d be interested to know if this was totally out of character or if they had histories of violent behavior.”
Morgan said it was important to consider the influence of mental health problems on people’s reactions to drugs. “Our studies have shown that people who use large amounts of ketamine over a long period do seem to have some paranoid thoughts, but it’s not clear if these come from long term ketamine use or if they were like that before." She said medical centers prescribing ketamine usually screen for psychosis before giving the drug.
"Ketamine is an anaesthetic, so most people aren’t doing a lot of moving while affected by it,” said Karl Jansen, a physician and the author of Ketamine: Dreams and Realities, adding that blaming drugs for violent behavior is nothing new. “Egregious acts have been attributed to the effect of pretty much all mind-altering chemicals." Earlier this year Matthew Brown, a Canadian hockey player at Mount Royal University, was acquitted of breaking and entering and aggravated assault after blaming his actions on magic mushrooms.
Ketamine is best known as a dental or battlefield anaesthetic, but is also snorted in lines as a recreational “rave” or after party drug. At high doses, it can make people feel like they’ve dissociated or left their body—known as a K-Hole—that some describe as like a near-death experience. Although most popular in the UK, there are also reports of the drug being increasingly used by U.S. clubbers.
For patients with hard-to-treat depression or post-traumatic stress disorder, ketamine can be highly beneficial, reaching patients in ways that other drugs may have failed. Some patients with suicidal thoughts who take ketamine report their symptoms evaporating in just a few hours, although the results may fade after several weeks and not all patients respond.
This sparked a trend in clinics prescribing ketamine off-label to treat a broad range of mental health problems using slow drip (infusion) injections. In recent years, ketamine has started to be used for treating chronic pain as an alternative to opioids.
Ketamine has been the center of lawsuits before, but those cases typically revolve around its sedative effects.
“I have not heard of or had personal experience with patients becoming violent on ketamine,” said Steven Mandel, the founder and president of Ketamine Clinics in Los Angeles. “In fact, in most cases, the opposite is reported. Patients are sedated and less active. Ketamine does not share the agitating features of stimulants or other ‘uppers’ that have a reputation for violence.”
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