In the year 1962, ketamine was synthesized for the first time. Its development began mostly due to the need to find a new desirable replacement for phencyclidine, an anesthetic that, while safe, had several undesirable effects. Similar in structure to phencyclidine, it was not as potent and was used for the first time on humans just two years later. These studies affirm that the drug was indeed safe, and clinical information showed a good anesthetic effect with fewer side effects. Ketalar, the first branded form, was approved in the United States in 1970. Since then, new brands such as Vetalar, Ketaset, Calypsol, and Ketaject, have become popular.
In the early 1970s, it was found that the drug had hallucinogenic and dissociative effects that made it desirable for recreational use. It was seen that the drug also had addictive potential, with the development of tolerance and withdrawal symptoms when the drug was stopped.
It is used primarily for anesthesia during surgical operations, though it also finds minor use in ketamine therapy centers to manage depression. It finds less use these days due to the development of alternative drugs. What is ketamine used for in modern practice, why is it used less, and how addictive is this drug?
What is Ketamine?
Since its launch on the market as Ketalar, this is a drug valued for its effectiveness in providing anesthesia for surgical procedures. Many people also contact centers that treat depression via ketamine therapy. Unlike most anesthetics, it does not put the patient to sleep but puts them in a dissociative state while sedating them and relieving pain. It has a rapid time of onset, acting within 5 minutes of being administered. It was valuable in the Vietnam War due to this.
It is used more often in veterinary medicine than it is in human medicine. It is used to provide anesthesia in smaller animals, and to induce anesthesia and manage pain in horses.
The fact that it caused hallucinations pushed it away from first choice use in humans.
However, in settings where mechanical ventilation is not present during surgery, this medication is valued for its reduced respiration effect.
Ketamine Drug Classification
It is a legal drug marketed openly in many countries. Nations like the United States have ketamine clinics where the drug is used for the management of depression. However, it is simultaneously classified as a controlled substance in many nations. These countries include:
- Hong Kong
- United Kingdom
- United States
In the United States, this drug is a Schedule III drug, due mainly to its recreational use tendency. According to information from the Drug Enforcement Agency, a Class III drug is one that has a potential for abuse, in which abuse may lead to “low or moderate physical dependence or high psychological dependence.”
Ketamine Dosage Forms and Strengths
It is available in different forms, which are:
- Injectable solution (for intravenous or intramuscular use)
When sold illegally, the drug is sold as a powder, which is sometimes formulated into tablets or capsules.
The injectable solution comes in different strengths, either 10mg, 50mg, or 100mg per milliliter. This solution can also be used orally.
Oral formulations are relatively new. The tablets come in 10mg, 20mg, 40mg, and 80mg formulations. The capsules are available at 30mg or 60mg.
Ketamine and Alcohol: A Dangerous Combination
These two are both drugs that have a majorly sedative effect. When used together, they have a synergistic effect. The fact that alcohol is so easily available makes it a drug frequently used recreationally in conjunction with it.
When these two drugs are used together, the potentiated depressive effect can have some very serious consequences, including the following:
- A decline in cognition: The ability to process information and make rational decisions can be dangerously affected by a person who abuses these drugs together. Bad decisions may be made, and this can include how they further administer the drug in this state. The risk of overdose becomes increased.
- Reduced respiratory function: While this drug on its own reduces breathing less than other anesthetics when it is paired with alcohol, this can depress breathing to a dangerous level where the patient may eventually not receive enough oxygen. This can lead to passing out, coma, and even death.
- Reduced motor function: Under the influence of these two drugs, motor function is greatly impaired. Paired with the impairment in judgment, individuals may drive vehicles or perform other actions that may put others at risk.
- Cardiovascular risk: These two drugs tend to have effects on the cardiovascular system when paired. This risk of serious complications is increased in people with pre-existing heart conditions. It can cause increased blood pressure, chest pain, and an increase in heart rate. If care is not taken, it can ultimately result in a stroke or a heart attack.
Like many drugs used recreationally, addiction is a major concern following the abuse of this medication. Long-term use results in intolerance, which means the individual needs to use higher doses to achieve the same effect as before. This has been proven in animal models. The development of tolerance is rapid. One case demonstrated an increase from 50mg occasionally to 500mg taken up to five times a day, within 2 years. The individual moved upwards to intramuscular doses north of 700mg multiple times a day. With high doses such as these, the risk of side effects is much greater.
For individuals who suddenly lose access to the drug and are no longer able to use it, either voluntarily or involuntarily, they may experience withdrawal symptoms, more frequently psychological.
Many studies have been done to observe the chronic consequences of abuse. While the majority of the studies were not able to demonstrate complications from chronic abuse, the few that did showed psychological effects. One case had a patient who had impairment in the recall of information and worsened attention. There have also been established neurotoxic effects seen in the brains of long-term addicts.
Ketamine Addiction Symptoms
In addicts, tolerance results in them using larger doses, which may have toxic effects on their bodies. Some of these clinical features include:
- Reduction in appetite
- Pelvic pain
- Urinating more frequently
Ketamine Psychological Addiction
In patients with psychological dependence, they begin to neglect social contact and the occupational aspect of their lives to fuel their dependence on the medication. They can lose their jobs, and the financial situation may suffer as a result of this, especially as most of their money is used on obtaining the drug. This dependence, along with tolerance, means that they are using the drug more and in higher doses, increasing the risk of serious consequences, such as permanent brain damage.
Patients with psychological addiction to ketamine tend to experience the following behavioral symptoms:
- The drug is used daily
- There is a loss of interest in activities not involving the drug
- Persistent thoughts around the next dose of the medication
- Recognizing the negative impact of the drug but continuing usage
- Changes in behavior at work or school
Ketamine User Statistics
This drug has been abused for decades, so several studies have been done to determine the most commonly affected demographic and the effects it has on the population. With the increase in ketamine clinics, these numbers are going up.
How Many Active Ketamine Users Are There?
In the United States, over 300,000 individuals admitted to the use of this medication within the last year, according to the National Survey on Drug Use and Health in 2018. Approximately 3.6 million people above the age of 12 had used it before.
15,801 individuals between 12 and 17 years of age claimed to have used the drug before, with this number jumping to almost half a million for people between 18 and 25 years of age.
Ketamine Withdrawal Symptoms
In a patient who has abruptly stopped the drug, they may begin to experience withdrawal symptoms. These symptoms are mostly psychological, with few physical symptoms experienced. These include the following:
- Psychotic symptoms (delusions and hallucinations)
- Cognitive impairment
- Impairment in motor skills
- Hearing loss
Ketamine Withdrawal Duration
Due to some of the psychological withdrawal symptoms exhibited when the drug has been stopped, addicts can pose a danger to themselves as well as others. Withdrawal should always be supervised by trained clinicians.
Two case studies done were able to establish a range of 48 hours to 6 days before the cessation of withdrawal symptoms. However, some symptoms of withdrawal, such as vivid dreams and hallucinations, may be present weeks after the last dose.
Ketamine Addiction Treatment
Ketamine addiction treatment is a concerted effort between the patients, the patients’ loved ones, and the healthcare professionals that typically manage the patient’s gradual withdrawal from the drug. Typically, the first step is to do a ketamine drug test to determine the level of ketamine in the body.
Based on the results, the doctor will select an appropriate detox program. Then you will need to choose outpatient or inpatient addiction treatment programs.
There are a few questions that should be asked to make the right choice, and some of them are:
- Does the patient have specific complications resulting from the addiction that requires access to specialized hospital equipment or facilities?
- Does the patient suffer from co-occurring personality, psychiatric or psychological disorders that will require constant supervision by a trained healthcare professional?
- Does the patient have some personal problems with other people that may make outpatient treatment complicated and difficult?
- Does the patient have a conducive environment to stay in where there will be no likelihood of temptation by other addicts?
If the answer to one or more of these questions is yes, then it is most preferable for the patient to consider the inpatient or residential treatment option. The advantages of inpatient treatment are numerous and include:
- Access to specialist personnel and equipment will assist in making the detoxification process and painless and comfortable as possible
- Round the clock care and supervision by qualified people
- A conducive, supportive, and non-judgmental environment where the patient can let go of anxiety and other psychological inhibitions
- Interaction with other addicts is of great therapeutic value
- The implementation of various forms of therapy, including group therapy, individual therapy, cognitive behavior therapy, etc. which are tailored to suit the specific needs and accelerate the recovery process
- This form of treatment has the highest success rate
Why Should Ketamine Addicts Have Inpatient Treatment?
Advantages of inpatient treatment for addicts include:
- The safe, painless, and comfortable detox process
- Round the clock monitoring by specialists and professionals
- Anxiety-free environment
- Support from other recovering addicts
- Customized and effective therapies
- Inpatient therapy has the highest success rate
Ketamine addiction treatment continues even after the end of substance abuse rehabilitation because it is imperative not to fall into the same habits that lead down the road to addiction.
Outside veterinary medicine, this drug is being used less in clinical settings. The potential for hallucinations, as well as the risk of dependence, make this a drug that modern doctors don’t readily use.
- It is a controlled substance in many countries, including the United States
- It can be used as a solution or tablets and capsules.
- Ketamine therapy is increasingly used to manage depression.
- Combining it with alcohol can lead to potentially fatal complications
- Dependence on the drug has been observed, and there is the risk of permanent brain damage
- Over 300,000 active users in 2018
- Treatment for addiction should always be handled by professionals
There are numerous Ketamine side effects, and some of these can not be reversed once they start. The withdrawal symptoms make it a difficult drug to quit, so attempts should be made only after contact with ketamine treatment centers.
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