Ketamine holds immense potential for healing; however, like any powerful tool, it can cause harm when used improperly. With the increasing number of press articles featuring celebrity figures such as Elon Musk, Chrissy Teigen, and Matthew Perry, either responsibly using or abusing ketamine, it becomes crucial to fully comprehend the risks associated with ketamine, especially in recreational use, and its potential for addiction. Ketamine is frequently mislabeled as 'dangerous' and is often implicated as the culprit of problems. In actuality, it is the individuals who make irresponsible decisions in their use. Ketamine is remarkably safe when used under medical supervision. The level of danger depends entirely on the situation, the dose, and the context of its use (e.g., driving or swimming while intoxicated). It is critical to recognize that using ketamine without proper medical guidance and monitoring can pose risks of harm and addiction.
In today's discussion, we will delve into the safety of ketamine, exploring potential side effects, risks, and addiction. Join me as I discuss three ways to avoid the misuse of ketamine, focusing instead on harnessing its maximum potential benefits to promote profound and lasting healing.
Ketamine has a long history of medical use spanning over fifty years, primarily being employed as an anesthetic for procedural sedation and used in emergency situations. It continues to be one of the most commonly used drugs in emergency departments and operating rooms, largely due to its safety profile. Ketamine is a vital medicine in the pediatric population, on the battlefield, and in hospital settings, earning its place on the World Health Organization's list of essential medications.
One of the key advantages of ketamine over other anesthetic agents is its preservation of airway reflexes. This means there is limited concern about compromising breathing, and it can even slightly stimulate heart rate and blood pressure, rather than dropping them to dangerously low levels, as seen with most other anesthetic agents (e.g., Propofol). Additionally, ketamine has minimal interactions with other medications, allowing for safe co-administration with drugs like antidepressants. Ketamine proves to be an attractive option when patients are experiencing both physical and psychological acute distress.
While ketamine is commonly used as an anesthetic due to its rapid onset, efficacy, and safety, (particularly in emergency settings) its application in ketamine therapy for the treatment of mental health disorders involves subanesthetic dosages—significantly lower, approximately one hundred-fold less. This substantially reduces potential risks for side effects or complications, explaining why ketamine therapy is offered in outpatient, or even home, settings. However, it is important to note that this doesn't eliminate all risks, and close supervision and monitoring during administration remain essential.
Paraphrasing the remarks made by Steven Mandel, M.D. of Ketamine clinics Los Angeles during a recent webinar, where he spoke alongside Sam Mandel; in a clinic, your caregiver assumes responsibility for most aspects of your care. As you distance yourself from that environment, the patient must increasingly bear the responsibility for potential risks. And when bad things happen, help is limited.
Nausea is a rare side effect associated with ketamine, seen more with higher doses or when combined with movement or intense visual stimuli. With an incidence of approximately 1 in 100 patients specifically experiencing nausea at our clinic, it can be easily and effectively treated with oral or intravenous anti-nausea medications, such as Zofran (ondansetron). At Innerbloom Ketamine Therapy, clients wear eyeshades and remain still during sessions to minimize potential discomfort associated with movement or visual stimulation. Additionally, if patients have a predisposition for nausea, we may choose to administer anti-nausea medication prior to starting an infusion as a preventative approach to further lessen the potential for onset.
The infusion session is commonly characterized as a pleasurable experience, although certain sessions may pose emotional challenges. Ketamine has the potential to bring forth memories or internal issues that individuals may have consciously or subconsciously concealed or ignored. This is the stage where the healing process unfolds, and a certain level of anxiety is anticipated and considered normal. Ketamine, being a medication with psychedelic properties, may be perceived as unusual or unlike any experiences individuals have encountered before, particularly for those unfamiliar with altered states of consciousness. Some may undergo spiritual or mystical experiences, and others describe ketamine therapy as one of the most meaningful and profound moments in their lives.
Mild elevations in heart rate and blood pressure are typical responses to ketamine and usually do not require treatment. The ketamine experience may evoke emotional responses, and a psychological reaction is expected, at least to some degree, which may contribute to changes in heart rate and blood pressure. Monitoring is essential during ketamine therapy, and intravenous medications are available to address any concerning elevations, should they occur. Medications can also be prescribed for use before an infusion if a patient is prone to these reactions.
Other rare issues associated with ketamine include low oxygen levels (hypoxia) and laryngospasm. While hypoxia is uncommon, a medical provider in a clinic setting will be equipped with oxygen supplementation if needed. Laryngospasm, though even more rare, with an incidence of 0.3% when used at anesthetic doses and can be associated with rapid administration of the medicine. It can be addressed with a jaw-thrust maneuver; however, it requires immediate attention and an individual trained and prepared to perform this maneuver. The Innerbloom Ketamine Therapy protocol involves a slow intravenous infusion over forty minutes, along with supervision from myself, a trauma surgeon, to minimize risks. Although exceedingly rare, this unique potential risk makes me especially uneasy about the thought of at-home ketamine use or even in any other monitored setting without a trained professional able to swiftly respond should there be an immediate need.
Ketamine abuse, characterized by daily intake and high dosage can lead to a condition termed ketamine-associated cystitis or interstitial cystitis. This condition manifests with lower urinary tract symptoms such as lower abdominal pain, painful urination (dysuria), frequent urination, the sensation of needing to urinate more frequently (urgency), inability to urinate, or blood in the urine (hematuria). Complications may include impaired kidney function and bladder hardening with a decreased ability to hold higher volumes of urine.
Treatment involves discontinuation of ketamine, which may be sufficient to restore normal bladder function. In severe cases, surgical procedures such as stenting, placement of drainage tubes into parts of the urinary tract system, or reconstructive surgery of the bladder may be required.
To provide perspective, interstitial cystitis is observed in severe cases of recreational ketamine abuse, where users consume ketamine daily, often multiple times a day, and at dosages 50-100 times in orders of magnitude greater than those used in clinical therapeutic settings. At Innerbloom Ketamine Therapy, infusions are dispersed over a course of two to six weeks. Due to the vastly lower dose and infrequent use, in contrast to recreational abuse, interstitial cystitis is very rare and not expected to be encountered in a clinical setting.
Ketamine, when associated with recreational or at-home misuse, has the potential to be addictive. Consider it a red flag when other ketamine clinics or providers deny this fact.
While one should not expect physical withdrawal symptoms as in the case of alcohol, benzodiazepines (e.g., Xanax), or opioids (e.g., Percocet) cessation, ketamine misuse and abuse in a recreational or at-home setting can lead to psychological addiction, which may be particularly challenging for individuals to overcome. Several factors contribute to its potential for addiction:
If you or someone you know is struggling with drug addiction please seek help. If you are experiencing a medical emergency please call 911.
Substance Abuse and Mental Health Services Administration Hotline: 1-800-662-4357
American Addiction Centers – Recovery.org 24/7 Hotline call or text 1-539-208-1422
California Addiction Hotline 1-866-210-1303
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