Ketamine is such a big, complicated story, there are at least four different parts to it - there’s Spravato, Johnson & Johnson’s blockbuster drug; there’s the wilder off-label generic ketamine market; there’s ‘home ketamine’ telehealth providers like Mindbloom; and then there’s the booming black market. There’s also a weird dissonance in ketamine media coverage - either exciting articles about ketamine’s therapeutic potential, crisis stories from the apparent epidemic of ketamine addiction among British youth, or the long fall-out from the death of Matthew Perry.
All of this makes covering ketamine quite challenging, and I’ve been working on this brief guide for several months, along with Ed Prideaux and Joy Krecké, interviewing many experts in the field. What follows are 18 brief points, covering everything you need to know about ketamine but were afraid to ask: the good, the bad, the ugly; the history, the spirituality, the science, and the naked capitalism. We’ll hear many accounts of ketamine’s unique and life-saving anti-depressant effects, as well as harrowing accounts of the risk of excessive recreational use.
What does ketamine do?
Ketamine is derived from phencyclidine (PCP / angel dust) which in turn is derived from petrol. It blocks NMDA receptors in the brain which receive the amino acid glutamate. This is the main protein used in synapse excitation / communication in the brain. Ketamine produces anesthesia in high doses, and altered states / dissociative effects in lower doses.
The dissociative effects arise because ketamine disrupts the connection between the cortex and the limbic system (which is involved in emotion and memory processing), leading to the numbed, floating sensations. The rapid anti-depressive effects - the reason there’s so much interest in ketamine - arise because turning off glutamate receptors in some parts of the brain leads to a surge in glutamate in other areas, and the forming of new synaptic connections.
Who discovered ketamine?
Ketamine was synthesized in 1962 by the American chemist Calvin L. Stevens at Parke-Davis Laboratories in Detroit. It was developed as part of a research program to find safer alternatives to phencyclidine (PCP), which caused intense hallucinations and agitation. Edward Domino from the University of Michigan conducted the first human trials of ketamine as an anesthetic. He coined the term “dissociative anesthesia” after observing that patients were conscious but detached from their environment. Ketamine was approved by the FDA in 1970 for medical use, particularly for anesthesia during the Vietnam War. It is widely used in hospitals, in vets (hence the label / slur that it’s a ‘horse tranquilizer’), and as a ‘chemical restraint’ by emergency rooms and police in some countries.
The first ketamine psychonauts in the 1970s
People began exploring ketamine for recreational, spiritual and psycho-explorative uses in the late 1960s and early 1970s. Two early psychonaut champions of ketamine for spiritual exploration were John C. Lilly and Marcia Moore.
John C. Lilly was a promising if eccentric polymath - a physician, neuroscientist, psychologist and ethologist, who explored how to de-program and re-program the mind using techniques like flotation tanks, audio loops, and psychedelic drugs. He is particularly famous today for two things - his weird experiments with dolphin communication, and his decades of experimentation with, and addiction to, ketamine. He would embark on weeks-long binges, sometimes injecting himself every hour, and proved himself unwilling or unable to stop, despite warnings from friends that he was damaging his mind and career. He once almost drowned on ketamine in a flotation tank. He ran an informal group of 10 ketamine experimenters, two of whom died in ketamine-related accidents. He became convinced ketamine put him in touch with various spiritual / cosmic entities, including a malevolent entity called the Solid State Intelligence, and a more benevolent entity called the Earth Coincidence Control Office. Here he is talking about one ketamine encounter (to be clear, he was pretty eccentric before he took ketamine)…
Marcia Moore was a New Age writer and heir to the Sheraton fortune. She first tried ketamine in 1976, and felt she had a profound spiritual experience. She then married an anesthetist called Dr Howard Alltounian, who had access to medical ketamine, and the two embarked on an intense love affair and mutual exploration of the psycho-spiritual potential of ‘the goddess ketamine’, as Moore called the drug. They wrote a book called Journeys Into the Bright World about their explorations: ‘this unique substance could be safely, easily and advantageously applied toward the psychospiritual regeneration of planet Earth.’
Moore was a prophet of today’s booming ketamine industry:
I envisioned groups of people inhaling ketamine vapors and then lying back while positive affirmations were systematically stamped into their psyches. What a beautiful way to treat obesity, depression and addictions.
But what started off as a holy sacrament became a daily dissociative, which Moore took every day to relax. Marcia disappeared in 1979, and her husband suggested she may have wandered out into the cold night, high on ketamine, and then died. However, James Penner and Ed Prideaux suggest she may have actually been murdered by Alltounian - as they discussed in this article.
First pioneer of ketamine therapy: Salvador Roquet
Psychiatrist Salvador Roquet experimented with psychedelic therapy at the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (Social Security Institute for State Workers, or ISSSTE) in Mexico, from 1965 to 1972.
His methods were highly unconventional. He treated people for a range of different disorders in groups of 15-30, with a range of different drugs given to different patients, such as ketamine, psilocybin, peyote and datura. The group would prepare with yoga, and then be given the drugs, guided into a padded room, and then subjected to an assault on the senses - a porn movie would be projected on one wall and the film The Dirty Dozen projected onto another, pounding music would be played with flashing lights, while images of skulls and corpses flashed onto the walls. At dawn, classical music would play while a video of a child being born was projected onto the walls.
Roquet claimed: ‘We have 2,000 case histories and recordings of over 900 group sessions. I can say that 85% had very positive results….The 15% who were not helped had, at worst, ‘indifferent’ reactions.’ I am sceptical of this claim - Roquet’s methods sound more like torture to me.
In fact, the line between psychedelic therapy and torture was blurred in the 60s (the CIA was, after all, the main sponsor of psychedelic research in the 50s and 60s), and Roquet sometimes used psychedelics to interrogate and ‘reprogram’ imprisoned leftist student activists in Mexico, such as Federico Emery Ulloa - although he used mescalin for this interrogation, not ketamine.
In 1972, Roquet visited the Maryland Psychiatric Research Centre and introduced researchers there including Bill Richards, Stan Grof and Richard Yensen to ketamine, and to his unconventional methods. They were very impressed. He was then arrested in Mexico for these same methods, but released after a senator defended him for his excellent work in reprogramming radical leftist students. Roquet still exercises a big influence over a whole school of ketamine psycho-spiritual healing in the US, through figures like Francoise Bourzat, Richard Yensen, and their students. Both Bourzat and Yensen were accused of unethical boundary violations by clients / patients.
A visit from the astral police
From the 1980s onwards, ketamine was investigated as a treatment for alcoholism by two Russian psychiatrists in St Petersburg - Evgeny Krupitysky and Igor Kungertsev. They initially tried to instigate bad trips and then get alcoholics to associate the intense suffering with alcohol - sort of a Clockwork Orange-style aversion therapy. However, they said that, instead, the clients had profound mystical and religious experiences (even though this was in the largely-atheist USSR). This led them to explore the ketamine-induced mystical experience as a means to heal deep-seated psychological problems (a method also explored by Salvador Roquet and, later, by British psychiatrist and ketamine author Karl Jansen).
Igor Kungertsev also mentions this funny anecdote:
About one year after we began our study, a group composed of two men and one woman appeared at our hospital who were very strange looking, wore strange clothes, and had strange, shiny eyes that seemed out of focus. They called themselves “magicians”, and said that they sensed in their meditations and magic practice that in this hospital, some people were throwing other souls into the “astral plane”. They had come to see what we were doing, like “astral police”. Prior to this, we had not published the results of our work, and only a few professionals knew about it. Also, this hospital is situated in the suburbs of St. Petersburg, and is not widely known. So we described our work and showed them our hospital. They approved! They also told us that they themselves used ketamine for their underground magic practice.
Ketamine takes off as an anti-depressant
Ketamine began to take off as an off-label treatment for depression around 2010. Early pioneers included Alison McGinnes, who began offering ketamine therapy at Kaiser Permanente; Steve Levine, who launched a ketamine therapy network called Actify; Philip Wolfson at the Ketamine Research Centre; and Raquel Bennett, organizer of the Kriya Conferences of 2015-2019. Pioneering early trials were conducted by the Yale psychiatry team - John Krystal, Gerard Sanacora, Samuel Wilkinson and others.
Ketamine had three great market advantages as an off-label treatment for depression. First, it’s fast-acting, with anti-depressant effects felt within 24 hours of treatment (SSRIs are slower to take effect). Second, adverse effects are low when it’s safely provided. Third, you can make a lot of money from it. As Alex Belser and Raquel Bennett wrote in 2020: ‘It costs a few pennies to manufacture a dose of ketamine, and the end-cost to a provider is less than $2 per dose of ketamine.’ But clinics can charge clients between $200 and $2000 a ‘dose’ (depending on things like whether the treatment includes therapy sessions).
As a result, there were hundreds of new ketamine clinics by 2012, ketamine made the cover of Time magazine in 2017, and in 2019, Johnson & Johnson got its esketamine nasal spray, Spravato, approved as a treatment for depression by the FDA.
What’s special about ketamine as an anti-depressant
Joy Krecké, a CPEP researcher who is studying ketamine at University of Exeter, says:
I think ketamine has unique properties that no other treatment for depression has shown so far. For some people, its rapid antidepressant and anti-suicidal effects can be life-changing, helping them move out of a deeply depressed crisis state rapidly and effectively. Unlike SSRIs, which can take weeks to work, ketamine can create a window that allows patients to engage with other forms of treatment, such as psychotherapy, once they are no longer in acute crisis.
Chronic depression is an awful subjective experience, that can drive people to suicide. Ketamine sometimes (perhaps in 40% of cases) gives people rapid relief from that, within 24 hours. That’s much faster than SSRIs, and the adverse effects from monthly ketamine treatment appear to be lower than SSRIs.
If you go to the Reddit page for ‘Therapeutic Ketamine’ there are many stories like this:
Ketamine saved my life. After my third infusion, my youngest son hugged me and told me "Mommy, you're so nice". When I think of my childhood PTSD, I recall it with no emotion whatsoever. It happened but it's all in my past, with no effect on my present. Ketamine gave me a new lease on life and it's helped me more than years of meds, therapy, and two psych hospital stays.
Ive been doing Infusions and troches for my chronic nerve pain. Its only been a few months so far but its been amazing. My pain level has never been this low, and the added mood boost effects are very welcome. ive been on so many different meds with awful side effects and little benefit, ketamine is by far the the most effective thing ive ever tried.
Without ketamine I would not be here today. It stopped the horrifying flashbacks, nightmares, turned the PTSD almost off, and turned the volume on the suicidal ideation way down.
Ketamine saved my life! I’ve had MDD and generalized anxiety disorder my entire life and TRD for about 6 years. Nothing is as effective as ketamine.
Ketamine is a life saver. After trying ever antidepressant medication it was a last ditch effort after an attempted suicide. I went from a mood of 2/10 to now 8/10. I had the 6 set of infusions and now tapered to quarterly and at home losenges 2 times a week. The inital fee was super expensive but now it is totally manageable having to only go 4 times a year and my at home costs $40 a month
The first time I heard about ketamine’s life-saving anti-depressant properties was when I interviewed Tom Morgan about his spiritual emergency (interview here). Tom tells me:
I was in a virtually catatonic state after two years of treatment-resistant depression. I was given 8 sessions of intravenous ketamine at Columbia Medical. The first 7 were fun drug experiences. The 8th and final was an express elevator to hell. It didn't feel cathartic, but it ultimately seemed to be what made the difference. I had a vast emotional release of crying afterwards then was returning to life within a week. Did the ketamine itself save me? Impossible to tell. But it definitely helped me access something my conscious mind couldn't reach, or at least wasn't willing to.
The main drawbacks with ketamine as depression treatment are that you need to keep taking it, it can occasionally lead to dangerous addiction (which in turn really messes up your bladder), and it’s rarely covered by insurance, except for Johnson & Johnson’s FDA-approved Spravato.
Spravato - the first psychedelic blockbuster
Johnson & Johnson managed to get a form of ketamine patented by focusing on one compound of it - esketamine - and arguing that its nasal spray was a novel form of delivery. It was rolled out in a Risk Evaluation and Mitigation Strategy (REMS), which means clinics have to follow tight procedural and reporting requirements set by the FDA and drug developer.
J&J says it has 140,000 users worldwide, and Spravato got approved in China this year. It reportedly costs patients around $5000 for the first month and then between $2500 and $3500 a month for maintenance. These costs are sometimes covered by insurance. Many patients have been taking it for several years.
How effective is it? As far as I can see, not massively effective - the effect size for depression is small, and only 30% or so are in remission after treatment, plus there is no apparent effect for suicidality. People have to keep taking it to keep the depression at bay, and some have now been taking it for six years, since it launched (without many adverse effects apparently).
Nonetheless, if you call ketamine a psychedelic, then Spravato is the first ‘psychedelic blockbuster’, ie its annual sales are greater than $1 billion. That’s one of the reasons other big pharma companies like Abbvie and Otsuka are interested in psychedelic drugs and think they could be the ‘future of mental health’, as one pharma executive put it to me.
Steve Levine, formerly a ketamine business founder, who now works at psilocybin start-up Compass Pathways, says of Spravato:
The presumption was Spravato wasn’t as effective as ketamine infusions and it wouldn’t compete. But it’s done very well and they now have five years of REMS data, with a safety profile that looks really good.
However, others I spoke to wondered if insurance companies will keep paying for such an expensive treatment for years, especially if new psychedelic treatments appear which perhaps don’t require such regular doses.
How to civilize the wild west of off-label ketamine clinics
Ketamine infusions are apparently more effective than the Spravato nasal spray - the remission rate is 40% after four or five infusions, but again, the treatment needs to be maintained indefinitely. It can be somewhat cheaper than Spravato, but it’s not typically covered by insurance and it’s proven hard for any big company to emerge as a leader in the off-label market, so it’s remained smaller companies competing aggressively for market share, and sometimes suddenly going bust (see Field Trip, Ketamine Wellness Centers and others).
Because there is no FDA approval and no REMS, providers can offer off-label ketamine for whatever they want, however they want. There are ketamine spas, ketamine massages, ketamine yoga, ket-itation, surf-and-ketamine retreats, ketamine churches, ketamine for pain, depression, ADHD, addiction, bipolar, anxiety, grief, creative inspiration, anything you want.
There is no agreed protocol - sometimes it’s offered with preparation and therapy, other clinics just put clients in a room with a drip. What’s the recommended dose? Alison McInnes, vice-president at Osmind, says:
In clinical trials, dosing is typically capped at 0.5 mg/kg. But in real-world practice, the average dose is closer to 1 mg/kg - double that amount. Does that make a difference? Yes, it does. But has that been proven to be safe? No, unfortunately it hasn’t.
McInnes adds that adverse events are not typically collected in off-label clinics ‘so there’s just no recording of adverse events and nowhere for patients to write about adverse events’.
Concerns about over-prescribing, illegal prescriptions, and rising black market use and addiction led the former head of the DEA to compare the ketamine market to the early days of the opioid crisis and to promise a crackdown on misprescribing clinics. ‘There’s just a lot of increasing scrutiny,’ says McInnes. ‘And people don’t know - could there come some type of intensive regulation?’
In response, a ketamine industry association called AKSP3 - The American Society of Ketamine for Physicians, Psychotherapists & Practitioners - is trying to get providers to agree to standards and protocols. In addition, figures including Yale’s Gerard Sanacora have been trying for years to get providers to sign up for a patient registry to keep better track of outcomes. Rupert McShane, a veteran ketamine researcher and provider at Oxford University, is developing an adverse events measure for clinics to use.
Steve Levine of Compass says:
The problem is that I don't know that any of these efforts will have teeth necessarily because, by its very nature, the off-label ketamine industry isn't particularly interested in being regulated, and it tends to attract customers, and I say customers on purpose, rather than patients, that also are probably less interested in regulation, otherwise they might be getting Spravato. And I don't know that there's really a mechanism to enforce more of this tracking.
One hopeful development some experts pointed to is state initiatives to get ketamine treatments covered by Medicaid (like this initiative in Wisconsin). Payers can then stipulate how the treatment is provided. Others think the FDA might approve some form of racemic ketamine in order to give it some method of controlling the ketamine infusion market. A company called NRX has an FDA application under consideration at the moment for its ‘preservatives-free formulation’ of ketamine for suicidal ideation.
9) Is ketamine more effective with therapy?
That’s what some veterans of the field argue - that ketamine will only ever be a temporary dissociative without accompanying therapy and lifestyle changes. But have there been trials comparing ketamine treatment with or without therapy? This trial found no significant difference with therapy versus without. This small trial suggested CBT might extend the anti-depressant effects of ketamine.
Joy Krecké of Exeter University says:
The rationale is that ketamine produces a window of increased neural plasticity or psychological openness; ketamine-assisted psychotherapy aims to use that window to consolidate new learnings. There’s some evidence for this - in my PhD supervisor Celia Morgan’s KARE trial, ketamine + psychotherapy was the most effective of all conditions, also still at 6 months. That trial suggested "a possible beneficial effect of adding psychological therapy alongside ketamine treatment." Currently, MORE-KARE a phase III double-blind, randomised controlled, multi-site trial for reduction of alcohol relapse is running and will produce more data for ketamine treatment with and without psychotherapy.
10) At-home ketamine innovation and concerns
During the pandemic, at-home providers of ketamine lozenges appeared and grew very fast (you’re stuck at home, bored and depressed, who wouldn’t want to order some legal ketamine direct to your door!) The biggest company, Mindbloom, claims it has sold 600,000 sessions since it launched in 2019. A competitor called Joyous claims it has 70,000 clients, another called Better U says it has 16,000 clients, and another called Journey Clinical reportedly has a network of over 2000 therapists providing ketamine therapy via Zoom.
The rapid growth and lack of oversight of this market have provoked a lot of concern, especially when Mindbloom started offering ‘home injectables’, ie injectable ketamine delivered to your door. There have been concerns about the aggressive advertising policies of at-home providers on social media.
Steve Levine says:
We've seen the proliferation of mail-to-home ketamine, and that, to me, straddles the line between this gray area of legal off-label prescribing and what may border on illegal behavior, which looks a bit more like drug dealing, although, of course they would I'm sure argue ferociously against that.
Dylan Beynon, CEO of Mindbloom, has indeed argued vociferously against what he sees as media stigmatization of ketamine and ketamine clinics ganging up against telehealth providers (the ASKP3 published a statement expressing concern at Mindblooms’ injectables program), although even he has expressed concern about competitor Joyous’ ‘daily microdosing’ regime.
There is some evidence of risks from at-home ketamine - there have been case studies of accidental overdoses, and one survey found that 55% of all Americans and 58% of millennials who tried at-home ketamine therapy reported accidentally or purposefully using more than the recommended dose. Critics of telehealth providers say they don’t expect a regulatory crackdown on providers, pointing out that Dylan Beynon’s wife, formerly of Mindbloom, now works at DOGE, founded by fan-of-ketamine Elon Musk. He doesn’t seem to be so close to Trump these days, however.
11) What are the adverse events of ketamine?
Adverse effects of ketamine include falling in a k-hole - a sensation, unpleasant for many, of being so dissociated you’re unable to move; having a bad trip or terrifying hallucinatory experience; experiencing resurfaced trauma (there are many anecdotes of people suddenly ‘uncovering’ memories of childhood abuse and then sometimes wondering if they’re real. But I think the biggest risk with ketamine, particularly with recreational use of ketamine, is that you get dependent on it, you start to use it more and more often, your tolerance goes up, and you’re using it more and more and can’t stop. I’ve read accounts from people on the ketamine addiction Reddit page who have lost their job and their friends and family, they’re in physical agony, they hate themselves, and they still can’t stop taking ketamine regularly.
Ketamine addiction leads to severe physical issues, particularly on the bladder. The first signs are ‘ketamine cramps’ - stabbing agonising pain which the person sometimes does more ketamine to cope with - then incontinence, then the bladder shrinking and sometimes having to be removed entirely. It sounds fucking horrible to be honest. In addition, ketamine addiction can sometimes lead to severe weight loss and anorexia. Prolonged abuse can also lead to cognitive problems. And sometimes ketamine abuse leads to death, as it did in Matthew Perry’s case. In that case, it was a ketamine-related accident (he passed out and drowned in a pool), and apparently that’s the case in most ketamine deaths - it’s rarely the principal cause.
12) How addictive is ketamine and why?
Ketamine gives people a numb, dissociated feeling, and also sometimes a spiritual high and sense of revelation. People can get attached to both - the feeling of disconnection, the freedom from pain, and the spiritual high and sense of revelation. Tolerance to the drug goes up very quickly so they can need more and more to get back to ‘that place’. So people can apparently become addicted even more quickly than to opiates, although it is much less physically addictive and one doesn’t get the same cold turkey withdrawal symptoms, apparently.
But how common is ketamine addiction? One High Times journalist, Rameses Sputz, estimated that ‘more than half of those who have tried and liked K have become involved in the trap of repeated use…in most cases this syndrome in some way de-structures, disorganizes and even threatens their lives’. Psychiatrist Karl Jansen, in his book Ketamine: Dreams and Realities, writes:
My view is that ketamine is far more likely to create periods of dependence than any other psychedelic drug, but that the “more than half” estimate is too high and would not be supported by a general survey of users. In my opinion, the group who lose control over their use is unlikely to exceed 15% of those who find the experience rewarding .
Joy Krecké of Exeter University says:
The risk of becoming addicted to ketamine seems to depend a lot on the context in which it is used. For someone receiving ketamine in a controlled clinical setting, alongside a therapist and as part of treatment for conditions like depression, addiction, or PTSD, the risk is likely to be much lower. In contrast, the risk is higher among teenagers or young adults using ketamine recreationally, for example, at raves, festivals, or while socialising, particularly when use involves repeated, increasing doses. And there is again a different level of risk for individuals obtaining ketamine through mail-order services to treat their depression, without supervision or accompanying therapy, as is the case in the US.
13) Does ketamine medical use ever lead to illegal ketamine abuse?
Yes, sometimes. That’s what happened to Matthew Perry - he was treated with ketamine therapy for addiction to other drugs, then he became addicted to ketamine, and got hold of it illegally both from misprescribing doctors and from drug-dealers.
But how rare are such instances, outside the world of wealthy celebrities? One study of people receiving medical ketamine treatment found ‘some reports of risky behaviors such as openness to using other psychedelics or ketamine used recreationally as a substitute for alcohol’. If you look at the Reddit page for ketamine addiction, some people there say they began on legal ketamine treatments and then became dependent and turned to the black market. Here is a published case study of a person who became addicted following ketamine treatment for depression. However, this systematic review of clinical trials found it was very rare - four cases out of 2174 (although one would have to ask how well these trials assessed abuse outside of the trial).
Professor Celia Morgan, a ketamine expert at University of Exeter, says:
I've spent quite a lot of time on the Reddit pages for ketamine therapy and ketamine addiction. And you can see signs that people are escalating doses, they're drug-seeking from other providers, there's a few case studies of people going over state lines, getting ketamine infusions in different states. I get a sense that there's something sort of simmering. I think the mail order unregulated space that we see in the US is really worrying for that, potentially.
15) Is there an epidemic of ketamine abuse in the UK, and US?
There is a lot of concern about ketamine use and abuse among young people in the UK at the moment - it’s often in the news, and the government has expressed concern, with House of Commons Leader Lucy Powell saying in January that the government will do ‘whatever it takes’ to clamp down on rising ketamine use among teenagers. The BBC’s flagship investigation program, Panorama, devoted a show to ‘Britain’s ketamine crisis’ this year.
The stats are concerning. UK wastewater monitoring by the government shows an estimated 85% rise in ketamine consumption between 2023 and 2024. Ketamine use among 16–24-year-olds has surged by 231 % since 2013. Deaths involving ketamine have increased by 650% since 2015, with an average of one ketamine-related death per week reported in recent years. Addiction services like the Priory Group report ketamine becoming the "word of the year" among clinicians, with treatment inquiries up 523% over five years and a further 5 % increase year-on-year in 2024.
Celia Morgan at University of Exeter says:
Why has it become so popular? A lot of reasons, and some of them are really pragmatic - it's cheaper than drugs like cocaine [it costs £10-20 a gram versus around £100 a gram for cocaine], it's short-acting, people who take ketamine recover from it. There's no hangover like with MDMA. Because of its short-acting nature, people are more likely to binge on it, and that's where you see people settling into these patterns of repeated use, getting seduced by ketamine, and doing it multiple times overnight and then maybe over a weekend, and that creeping into the weeks. We've also seen a trend for people to take ketamine instead of drinking because potentially, alcohol’s become more expensive, and ketamine doesn't have the kind of hangover effects.
What about the US? The addictive potential of ketamine is still overshadowed there by the opiate crisis, but there are indications of rising recreational use. Ketamine use increased 81% from 2015 to 2019, and 40% from 2021 to 2022, but was still only used by 0.28% of the population. There are reports of high ketamine use in psychedelic circles, like at Burning Man, and Matthew Perry and Elon Musk have given it a relatively bad name, but at the moment, the opportunity from ketamine therapy seems to be outweighing concerns about the risk of ketamine addiction.
16) What is the best public health response to ketamine addiction?
The UK government is debating reclassifying ketamine as a class-A drug, raising the sentence for possession and supply. Drug policy reform organisation Transform thinks a better response would focus on harm reduction education, suggesting higher sentences do not affect drug use. Indeed, ketamine use continued to rise over the last two decades as it went from Class C to Class B, so there’s little reason to expect re-classifying to Class A will dampen demand.
An alternative approach is better education about the risks of recreational abuse, balanced with information about ketamine’s potential when used in safe medical settings. Social media is full of glowing accounts of recreational or medical ketamine use, and few warnings of risks.
Joy Krecké says:
My personal experience working with Psycare organisations (festival harm reduction services) and spending time in festival and club settings is that many users have limited knowledge about ketamine and the risks or adverse effects linked to frequent use. In my experience, the most abusive and risky patterns of ketamine use usually appear in those unaware of its potential harms, or in individuals who engage in high-risk polydrug use like combining it with alcohol or other sedative drugs.
Another important component of a public health response would be to improve access to effective addiction treatment. Most individuals with ketamine use disorder do not seek treatment, and existing services are often perceived as ineffective. There is no evidence-based treatment program for ketamine addiction.
In conclusion:
If ever a drug merited the label pharmakon, meaning a substance that can be both a poison and a cure, it’s ketamine. It has unique fast-acting anti-depressant qualities, making it a life-saver for many people. At the same time, recreational use also raises unique risks of addiction and horrible physical side effects.
I enjoyed reading this, as someone who loved to inject large doses in my thigh muscle! I will be three years sober in April.