The UK has seen an increase in the number of ketamine users in the last couple of decades, particularly among young adults. Ketamine was initially used in the medical sphere in the 1960s but has been used recreationally since the 1990s. The substance is an anaesthetic. This means that it has some sedative properties and can also act as a powerful analgesic. The specific effect that ketamine has is referred to as ‘dissociative anaesthesia.’
The rise of ketamine use has seen an increase in the awareness of ketamine-related complications, including the development of dependency and complicated physical and mental health effects.
Ketamine is perplexing due to its dual nature; it is used in medical and veterinary contexts, but its recreational use can result in unpleasant and, at times, even life-threatening symptoms.
How does this duality exist? What makes ketamine so dangerous, and what are the repercussions of the effects it has on the body? How common is chronic ketamine use, and are there ways to treat it?
Ketamine: The history
Following this breakthrough, researchers turned their attention to the potential utility of ketamine in medicine for humans. Studies revealed that whilst under the effects of ketamine, ‘surgical incisions’ could be made without patients feeling them. In 30 instances, surgeons could carry out a full surgical procedure.
When they published their findings, the researchers exclaimed that Sernyl (a trade name for ketamine) ‘was undoubtedly the most potent general analgesic agent used in clinical medicine.’ However, doubts were raised when it became clear that patients were experiencing ‘excitatory effects’ for up to twelve hours following the surgeries. These effects also included psychotic symptoms.
Since its development, ketamine has been used as an anaesthetic across the world. The need for open medical access to ketamine for surgery is the deciding factor in the World Health Organisation’s decision not to fully control the drug globally.
However, there has been a simultaneous movement as this research has been conducted. The use of ketamine has increased since the 1990s. It peaked in the year between 2019 and 2020, and continued data analysis suggests ketamine levels are still relatively high in the United Kingdom specifically.
Ketamine: The statistics
- Ketamine use peaked in England and Wales between 2019 and 2020, with 0.8% overall usage and 3.4% among young adults (16-24 years old).
- Police recorded a substantial increase in ketamine confiscations from 149 to 653 between 2017 and 2018, a 30% rise in just one year.
- Despite this, the World Health Organization (WHO) opposes placing ketamine under international control, citing its belief that ketamine abuse doesn’t pose a global public health threat. That control could limit access to essential anaesthesia and pain relief in parts of the developing world.
What is ketamine?
Ketamine is a synthetic drug. It is a ‘dissociative anaesthetic’ and is also used for its analgesic properties.
Ketamine is also known by a range of street names, including:
- Cat Valium
- Cat Tranquilliser
- Kit Kat
- K
- K-Hole
- Special K
- Vitamin K
- Special la Coke
- Super Acid
- Purple
- Purple Drank
Chemistry
Ketamine is used in some medical procedures. It has been on the WHO essential medicines list since 1985 due to its status as ‘the most widely used agent in the world’ for the sedation of children and adults.
The chemical name for ketamine is 2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone. Its effects include ‘sedation, immobility, amnesia, and marked analgesia.’ These effects make it very well suited to medical use. However, ketamine also alters sensory perception and mood and can provoke hallucinations. Ketamine can produce an ‘out of body’ response that some have described as dissociation, hence the description of ketamine as a dissociative anaesthetic.
Is ketamine addictive?
Ketamine primarily acts by binding with NMDA receptors, although it also engages with opioid and sigma/phencyclidine receptors. By inhibiting N-methyl-d-aspartate receptors (NMDAs), which are glutamate receptors, ketamine slows down the firing of brain cells, leading to an anaesthetic effect.
The interaction with opioid receptors allows ketamine to influence the brain’s opioid system, which is associated with pain management. This can result in both short-term and long-term alterations in pain perception.
Through its impact on key neurotransmitters, ketamine disrupts normal brain functions, affecting mood, pleasure, pain, and reward. Over time, these interactions become linked to drug-taking experiences.
Associations form between reduced anxiety, pain relief, and reinforcement, contributing to the development of addiction over time.
Addiction happens in a cycle:
- Initial use
- Repeat use
- Withdrawals
- Cravings
With the initial use of ketamine, you may not feel that many effects, especially once the high has worn off. The issue begins to develop as repeat use begins. Repeat use can catalyse the changes to neurotransmitter activity that can establish an activity as addicting. This then leads to the body withdrawing from a substance, leading to cravings.
The impact of ketamine use
Ketamine is a dissociative anaesthetic. It can also create hallucinogenic effects in the user. This means that ketamine effectively has a dual mechanism of action in the brain and, therefore, can cause two sets of symptoms – one related to its dissociative effects and one to its hallucinogenic properties.
These effects can be felt in both the body and the brain.
Ketamine’s effects on the body
Ketamine use can put you in physical danger, both during the period of the high and afterwards, in the form of long-term side effects.
- nausea and vomiting
- increase in blood pressure
- increase in heart rate
- faster breathing
- difficulty maintaining homeostasis; higher temperature than normal
- auditory and visual hallucinations
- poverty of speech
- ketamine cravings and withdrawals
- desensitisation and paralysis of the muscles
- risk of physical harm
- pain in the abdomen (known as ‘K cramps’)
- damage to the renal system
- issues with the bladder and kidneys, which can lead to incontinence
Ketamine and overdose risk
Besides specific risks, perhaps the most significant danger associated with ketamine is the risk of overdose. The likelihood of mortality increases, particularly when ketamine is part of polydrug use involving substances like alcohol. Concurrent use of multiple substances heightens the risk of toxicity.
The challenge with polydrug use lies in the unpredictable interactions between different substances. This complexity contributes to a significant number of overdoses, both intentional and fatal.
The UK government recommends routine drug testing, including overdose analysis in postmortems through toxicology reports. These reports provide valuable data, allowing us to comprehend the effects of specific substances and track trends in fatalities and general usage over specific periods.
A meta-analysis of three databases containing this data revealed 312 overdose cases associated with ketamine, with 138 ketamine-related deaths. The majority of these fatalities were linked to polydrug use involving ketamine.
Ketamine’s effects on the mind
One study found that ketamine induces symptoms ‘similar to those of schizophrenia’ in users. This included the development of both negative and positive symptoms.
Negative symptoms describe ‘a lessening or absence of normal behaviours and functions.’ An example of a negative symptom of ketamine may be catatonia.
Positive symptoms are the opposite; they are the development of experiences we do not typically have, such as hallucinations.
- perceptual changes; auditory and visual hallucinations
- paranoia
- apathy
- catatonic posturing (not responding to the environment)
- dissociative effects: feeling as though you are not in your body
- ‘disorganisation of thought’
- Development of ketamine addiction
- Changes to the structure and function of the brain
- Damage to short and long-term memory
- Development of flashbacks
The combination of the numbing and catatonic qualities of ketamine combined with the perceptual changes it causes can increase the risk of users coming to serious physical harm. During a ketamine high, you may be more at risk of seriously injuring yourself in an accident. You may also be at an increased risk of violent crime during your intoxication.
Ketamine’s effects on society
Societal cost of ketamine use
There are concerns that the use of ketamine is increasing. Increased drug use is associated with complex socioeconomic health and social issues, including a rise in crime, homelessness, unemployment and unmet treatment needs. All of these instances require funding to be adequately addressed and supported.
The UK government estimated that drug-related harm costs society around £20 billion each year. The development of the ‘Joint Combating Drugs Unit’ has pledged £900 million towards the costs of drug-related harm for 2024-2025.
Use among young people
Data indicates that ketamine is most likely to be used amongst young adults in the UK. With the highest prevalence of use being amongst 16-24 year olds, there is a risk that younger users of ketamine could develop addictions at very young ages. This could be the catalyst to using other substances, or ketamine use could become a long-term issue over a number of years.
This exacerbates the fact that ‘adolescence is [already] a developmental period associated with the highest risk for developing a substance use disorder.’
Studies have shown that drug use in young people can affect brain development, causing potential cognitive deficits in key areas such as decision making, concentration and memory.
Whilst addiction can be managed with appropriate treatment, there is no solid cure for addiction. This means there is an increased risk of a generation going into their 20s and 30s already struggling with substance use.
The law: Ketamine
In the UK, Ketamine is a Class B drug. This means that it ‘should be controlled under the Misuse of Drugs Act 1971’.
Part of this control includes the potential legal consequences of possessing, selling, supplying or producing ketamine outside of the legal channels of authorised medicine.
If you are found to be possessing ketamine, you could face up to 5 years in prison or an unlimited fine (or on some occasions, both).
If you are found to be involved in the supplying or producing of ketamine, you could face up to 14 years in prison or an unlimited fine (or, on some occasions, both).
Ketamine was initially categorised as a Class C drug. It was not until 2014 that it was reclassified as a Class B in order to better reflect the dangers of the drug.
Signs of ketamine addiction
Under the disease model of addiction, we consider addiction to be a condition rather than a choice. That means that addictions, like other conditions, have a range of symptoms associated with them.
Addiction cannot be contained to one sphere of life; that means that addiction affects us bodily, mentally, and behaviourally.
- atypical sleeping patterns (including insomnia and sleeping at odd times of the day)
- extreme mood swings
- feelings of confusion, as though ‘in a daze
- hallucinations (seeing or hearing things that other people do not)
- feeling scared or paranoid
- appearing agitated
- red or flushed skin
- impacted speech – slurring of words
- reduced attention to hygiene
- reduced attention and involvement with hobbies and usual social activities
- increased time spent with new individuals or groups
- lack of contact with family, friends and children
- difficulty meeting work requirements
- difficulty meeting school, college or university requirements
- social withdrawal
- appearing to be deceitful or lying more frequently
- financial difficulties
- engagement in criminal activity
Ketamine users may also find that their general health worsens. This can be due to the strain on the body from consistent use of the drug or from fear of accessing medical help.
There can be anxiety around seeking treatment for medical conditions outside of addiction, as individuals may fear that they could be judged for their current (or previous) use of drugs. This can lead to the development of serious illnesses alongside the general deterioration of health over time. It can also be particularly dangerous for individuals with preexisting conditions, who may need regular contact with medical professionals to manage them.
Treatment for ketamine addiction
There are a number of options when it comes to treatment for ketamine addiction. This includes both detoxification and psychological therapies.
Most rehab providers will provide the option of both inpatient and outpatient rehab. This allows the individual to choose which mode of care suits their current needs and lifestyles.
Regardless of the mode of treatment, support options will largely remain the same. They often include:
- Cognitive behavioural therapy (CBT)
- Dialectical Behavioural Therapy (DBT)
- Experiential Therapy
- Group Therapy
- Individual Therapy
- Psychodynamic Therapy
- Psychotherapy
- Twelve Step Facilitation Therapy (TSF)
- Alcoholics Anonymous (AA)
- Narcotics Anonymous (NA)
The aim of ketamine addiction rehab is to allow you time to focus on your recovery in a supported environment. Rehab can provide you with a break – some time to actively attend to your physical and mental health in an attempt to take the steps towards long-term recovery.
Kick start your ketamine addiction rehab journey today by contacting an addiction specialist or GP and begin the process of combating your addiction.
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