A condensed version of this article appeared in a previous issue of VICE Magazine.
In emergency rooms across the country, ketamine is used every day to sedate people in pain. It's a staple in an ER doctor's medicine box, typically used to anaesthetise people who are having something unpleasant done to them, like draining an abscess or popping a shoulder back in. A slew of research in recent years has also found that ketamine may be a viable treatment for depression. The American Psychiatric Association is even expected to pass official guidelines this year regarding its use as an antidepressant.
But there's another big use for ketamine. It's found on dancefloors across North America and Europe every weekend, as thousands of ravers use it to get wobbly in the early hours of the morning. In 1999, the Drug Enforcement Administration deemed it a drug prone to abuse, and classified it as a Schedule III Controlled Substance.
Given what's medically known about ketamine—that it numbs the senses and has an impact on brain function—it's not hard to imagine why some people imbibe it off-label. But to try and get a deeper understanding as to why people take ketamine to go clubbing, THUMP reached out to an expert.
Dr. Andrew Monte is the assistant professor of emergency medicine and medical toxicology at the University of Colorado. He studies what illicit substances do to the body, and is especially interested in what he calls "novel and synthetic drug abuse" which is doctor-speak for "club drugs." Here, he explains what ketamine is, what its side effects are, and how to stay safe when taking it.
Hi Dr. Monte. What's ketamine?
Dr. Andrew Monte: It's a central nervous system sedative. It's also used as a general anesthetic, so a medication that doctors and veterinarians will use for surgeries.
What are some of the psychiatric and physiological effects of ketamine?
At a low dose, it's a sedative. As the dose increases, it becomes what we call a "dissociative anesthetic," which means the central nervous system becomes almost disconnected from the body. This allows a physician or veterinarian to do painful procedures without the person or animal feeling those effects. So we're talking about dissociating the capacity for mental thought and response to painful stimuli. At a much higher dose, it becomes a general anesthetic, causing people to essentially go into a coma.
What about side effects?
There are three major groups of side effects. The first is any cardiovascular side effect, which is increased heart rate and blood pressure. The second is the neuropsychiatric effect, a phenomenon that we call an emergence reaction, which is where people wake up in an agitated and uncomfortable state, almost like emerging from a bad trip. And the third is relatively uncommon, but it's a life-threatening side effect: laryngospasm, when the vocal cords spasm. If that happens, a person needs to have CPR, or mouth-to-mouth. Occasionally in the hospital, people will have to be put on ventilators for that. It's an uncommon side effect, but it certainly does happen.
Why do you think people take ketamine to party?
This concept of dissociative anaesthetic is appealing to festival-goers and users at clubs, because it certainly does cause hallucinations. If you have the right dose, you'll go into the "K-hole" that you read about, where you'll get good hallucinations and a numbing sensation in the arms and legs. When dosed perfectly—which is a very difficult thing todo—it's probably a very appealing sensation. But dosing is the tricky part. Too little, and you don't get much effect at all. A little more than that, and you can get into that "K-hole"; it becomes a dissociative anaesthetic, and you sit around and you don't remember anything. A little bit more than that, and you can potentially fall into a coma.
"When dosed perfectly—which is a very difficult thing to do—it probably is a very appealing sensation."—Dr. Andrew Monte
Is it safe?
We use ketamine every single day in our emergency department for painful procedures. We use it to drain abscess, to reduce fractures and shoulder dislocations; we'll even use it for some patients who need sedation for things like asthma. Some of the side effects can actually be helpful clinically—if someone's critically ill and has low blood pressure or heart rate, yet they need to be sedated for a procedure, then this drug is helpful because it raises the heart rate.
It's safe in the hospital, but we're giving it under controlled circumstances for specific indications under very close monitoring. And we've got several tools at our disposal to rectify any adverse drug events.
What about outside of the hospital?
What you buy on the street is not necessarily what you think you're buying. I do some research on novel and synthetic drug abuse, and this summer we surveyed some people at music festivals in Colorado and tested the ones who said they'd used ketamine. We tested a person who said they'd used ketamine and we found no ketamine in them at all, but found dextromethorphan [cough syrup] instead. There are also several ways to take this drug—you can take it as a pill, snort it, or inject it, which is most dangerous. Each will have a different effect. The deaths reported with ketamine have predominantly been in combination with other drugs.
When you put all that together, not knowing what drug you're getting, the fact that people cut the drug with other things, and the unpredictability of the clinical effects associated with different routes of administration make this a very complicated drug for a clubgoer to take into account, which is where the real danger lies.
If taking ketamine recreationally, how can people be as safe as possible?
The first thing is to do this with someone you trust—someone who could help you should you get into trouble. If you end up getting laryngospasm, you need someone OK with giving you mouth-to-mouth resuscitation. If you have an emergence reaction—where you wake up in an agitated state—you need someone there who you can trust to help bring you back down and get you to a safe place.
People who are generally anxious shouldn't use the drug at all. There's also this concept of "setting the dream," which I actually use in the emergency department. When I administer this drug in the hospital, I set people's dreams. I tell them to think about a place where they really want to go on vacation, or ask them to think about the happiest times in their lives, and they start to think about that and have a "pleasant trip," for lack of a better term. If someone comes into this already upset and agitated, there's a much higher risk they're going to have a bad reaction.
Still, my biggest warning against it is that you often think you're getting ketamine, but in the vast majority of cases, I'd say ninety percent of the time, you're not.