Ketamine

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Pronunciation: KEET-a-meen

Chemical Abstracts Service Registry Number: 6740-88-1. (Hydrochloride form 1867-66-9)

Formal Names: Ketaject, Ketalar, Ketanest, Ketavet

Informal Names: Bump, Cat Valium, Green, Honey Oil, Jet, K, Kay, Kay-Blast, Kay Jay, Keets, Keller, Kellys Day, Ket, Kit Kat, Mauve, Purple, Rockmesc, Special K, Special LA Coke, Super Acid, Super C, Super K, Vitamin K

Type: Depressant. See page 19

Federal Schedule Listing: Schedule III (DEA no. 7285)

USA Availability: Prescription

Pregnancy Category: C

Uses. Ketamine is related to PCP and can produce a false-positive urine test for that substance. In contrast to the violent reputation of PCP, however, ketamine users are described as peaceful. Ketamine is likened to PCP, alcohol, and LSD—rather vague comparisons given the differences among those drugs. The substance was invented in the 1960s and was used as an anesthetic for Vietnam War combat casualties; it has been routinely used for war injuries ever since. Third World physicians report the drug is safe for surgical use outside high-tech environments. It is given as a pain reliever and, less commonly, to reduce convulsions. Ketamine is also a veterinary anesthesia drug used with wild animals ranging from giraffes and gazelles to polar bears and arctic foxes.

Success has been reported with using ketamine to supplement alcoholism therapy. Two researchers reported that ketamine therapy with 42 alcoholics produced a two-year abstinence from drinking in 15 of them, an outstanding result. Other researchers report one-year abstinence in almost 66% of 111 alcoholics who received ketamine therapy (perhaps a single dose), as opposed to 24% in 100 who did not receive ketamine. Among the 111 in the original group, 81 were tracked for two years, and 40% of the 81 remained abstinent. Of 42 who were tracked for three years, 33% remained abstinent.1 Such results have prompted researchers to speculate that ketamine may also be useful in treating addiction to drugs other than alcohol. These reported beneficial effects of ketamine are surprising. Admittedly they are related to self-insights prompted by the substance and guided by psychotherapists, but in principle a single dose of a drug is unlikely to stop addiction to some other drug.

Experiments indicate ketamine may have potential for treating migraine headache and depression, and researchers have seen evidence that ketamine may improve asthma and shrink breast cancer cells. Ketamine can reduce phantom limb pain, a strange affliction in which a person senses that an amputated limb is still present and hurting. The drug has been used in psychotherapy to help persons face and deal with unpleasant memories, a process accompanied by what researchers described as "mind expanding effects." Ke-tamine has also been investigated as a potential defense against the chemical warfare agents soman and diisopropylphosphorofluoridate.

Healthy volunteers receiving ketamine in an experiment have experienced sensations reminiscent of LSD. Researchers have described such effects as "profound" among alcoholics, and illicit ketamine users have said such effects are "intense." The substance can prompt people to feel like they are becoming transparent, blending into nearby individuals, or becoming an animal or object. Users may feel like their bodies are transforming into harder or softer substances. Persons may think they remember experiences from a past life. Some users take the drug to enter the "K-hole," a semiparalytic state described as similar to near-death experiences in which people perceive their consciousness as floating above their bodies, sometimes accompanied by meaningful hallucinations and by insights about the user's life and its proper place in the cosmos.

Examination of deaths among recreational ketamine users in New York City in a two-year period during the 1990s found none in which ketamine was the only substance in the person's body. Children have accidentally been given 5 to 100 times the normal size dose and have survived with no apparent injury.

Drawbacks. A case report tells of recreational users experiencing temporary paralysis. Nausea and vomiting have been reported, and scientific literature contains several mentions of temporary breathing interruption caused by the drug. Increased pressure within the eye (a potential problem for glaucoma sufferers) has been measured following a ketamine dose, but not all researchers looking for that effect have found it. The drug can interfere with a male's physical ability to engage in sexual activity. Experiments show that ketamine can cause brain damage in rats and that simultaneous use of nitrous oxide worsens the damaging action. Ketamine can cause nervous agitation, extra salivation, blood pressure elevation, abnormal heartbeat, and muscle injury. Persons suffering from the body chemistry disorder porphyria should exercise caution about ketamine use.

The drug can change perceptions of one's surroundings. Tests indicate ke-tamine can alter visual perception for at least 24 hours, causing people to misjudge size and speed of objects (implying that driving skills may be impaired). Long-term use may cause persistent difficulties with attention, memory, and learning ability. The substance can create amnesia about what happens while a person is under the drug's influence.

Ketamine's psychological actions have been characterized as similar to temporary schizophrenia. A study examining persons who received the drug during surgery found that upon awakening some felt they were floating; some were euphoric; some screamed in apparent terror. A study found such effects to be twice as common in female patients as in males. Such effects are stronger among alcohol abusers. The floating sensation may occur as people regain consciousness before they regain sense of touch, a sequence that would temporarily eliminate awareness of gravity. One surgery patient experienced LSDlike effects that continued even after release from the hospital. Reports exist of patients experiencing psychological effects for a year after a dose. A reviewer who examined many years of scientific reports about ketamine, however, found a consensus that long-term psychological consequences from ketamine occur no more frequently than with other anesthetics—a conclusion about incidental effects from anesthetic use, not about deliberate effects induced as part of psychotherapy or illicit use.

One authority claims that the greatest physical hazard has a psychological base, as users sometimes become indifferent about death and take risks they would otherwise avoid. Persons intoxicated with ketamine may be woozy and have lower perception of pain, conditions that can cause or worsen accidents.

Female lemmings are more susceptible to the drug than males. While the male-female difference does not necessarily carry over to humans, use of ke-tamine's anesthetic properties by sexual predators seeking to weaken victims was publicized in the 1990s. Researchers using the drug to treat alcoholism have found that ketamine makes a person more susceptible to suggestions, perhaps making a person more vulnerable to manipulation.

Abuse factors. Tolerance and dependence can develop when rats and mice receive ketamine. Those traditional signs of addictive potential seem unconfirmed in human use, but people have been known to take the drug daily for no medical purpose and to feel they have a problem with that usage.

Drug interactions. In surgery patients administering diazepam simultaneously with ketamine has diminished unwanted psychological effects such as delirium and nightmares. Midazolam may also help.

In experimentation with rats and mice the actions of ketamine and alcohol have similarities, and the two have cross-tolerance (meaning one can substitute for the other in various ways). Human alcoholics report that ketamine produces sensations like those of alcohol. A small study found that ketamine has stronger effects on perceptions and thinking skills in alcoholics than in other persons.

In rats morphine can boost some pain relief from ketamine, and ketamine can reduce pain relief from morphine. In contrast, a human experiment found that patients needed less morphine for pain relief if they also received keta-mine. In humans ketamine can boost opiate and barbiturate actions so much as to be fatal. Lorazepam can boost the sedative and amnesia qualities of ketamine in humans.

Cancer. Not enough scientific information to report.

Pregnancy. Experimentation on mice shows that birth defects can occur when ketamine and cocaine are used together, but the impact of just ketamine seems uncertain. Experiments on pregnant rats, rabbits, and dogs have produced no harm. Ketamine has harmed hamster genes when they are experimented upon outside the body. Research published as the twenty-first century began indicated that the drug may harm fetal brain development in humans.

Citing possible danger to fetus survival, one authority recommends caution about using ketamine as an anesthetic in childbirth. While the drug may pass into breast milk, nursing is considered safe for infants.

Additional scientific information may be found in:

Corrigan, I.J. "Ketamine—A New Anesthetic." Canadian Nurse 68 (April 1972): 43-44. Curran, H.V., and C. Morgan. "Cognitive, Dissociative and Psychotogenic Effects of Ketamine in Recreational Users on the Night of Drug Use and 3 Days Later."Addiction 95 (2000): 575-90. Hetem, L.A., et al. "Effect of a Subanesthetic Dose of Ketamine on Memory and Conscious Awareness in Healthy Volunteers." Psychopharmacology 152 (2000): 283-38.

Jansen, K.L. "A Review of the Nonmedical Use of Ketamine: Use, Users and Consequences." Journal of Psychoactive Drugs 32 (2000): 419-33. Krupitsky, E.M., and A.Y. Grinenko. "Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research." Journal of Psychoactive Drugs 29 (1997): 165-83.

Weiner, A.L., et al. "Ketamine Abusers Presenting to the Emergency Department: A Case Series." Journal of Emergency Medicine 18 (2000): 447-51.

Note

1. E.M. Krupitsky and A.Y. Grinenko. "Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research." Journal of Psychoactive Drugs 29 (1997): 165-83; I.P. Sivolap and V.A. Savchenkov. "Opyt Primeneniia Preparatov Ketamina v Psikhoterapii Alkogolizma [Experience in Using Ketamine Preparations in the Psychotherapy of Alcoholism]." Zhurnal Nevropatologii i Psikhiatrii Imeni S.S. Korsakova 94 (1994): 76-79. (Abstract in English.)

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