Ketamine Addiction, Detox and Withdrawal

Official name: ketamine

Trade names: Ketalar; Ketanest; Ketaset

Street name: Special K; K; ket; vitamin K; cat tranquilizer

Classification: Dissociative anesthetic; analgesic; NMDA receptor antagonist

Ketamine, or Special K as it is sometimes referred to on the street, is a medication used by veterinary and medical practitioners for the primary purpose of inducing anesthesia. Classed as an NMDA receptor antagonist, ketamine works by temporarily blocking the action of the N-Methyl-D-aspartate receptor or NMDAR. It produces a state of dissociative anesthesia, which results in the following:

• Catalepsy: muscular rigidity and reduced sensitivity to pain
• Catatonia: immobility and unresponsiveness in someone who may be awake
• Analgesia: inability to feel pain
• Amnesia: impaired memory

Unlike general anesthesia, which comes with a loss of consciousness, dissociative anesthesia can be achieved while the patient is awake.

In addition to anesthesia for minor surgical procedures, ketamine is sometimes used for sedation in emergency departments, and for pain management. There is evidence that it may be an effective treatment for depression, but its use has not been approved for this purpose.

The addictive potential of ketamine stems from the fact that it generates a feeling of euphoria and a sense of the mind being separate from the body. These properties make it a popular dance club drug. There is a strong correlation between substance abuse and mental health concerns such as depression and anxiety: although ketamine produces a rush of feeling good, its long-term effects are quite the opposite.

The hallucinogenic effects of ketamine can be extremely dangerous when the drug is used improperly; therefore, it is only legally available to doctors and veterinarians. Street dealers obtain it by stealing it or diverting it.

Medical ketamine comes in the form of a colourless liquid that is injected into humans or animals. It is usually converted to powder form before being sold illegally. In this form, it can be mixed into drinks, snorted or injected.

The effects of ketamine abuse

Unlike many potentially addictive drugs that have legitimate medical use, ketamine is not easily available to people outside of the human or animal medical professions. It is not prescribed for any length of time, and it is intended to be used only in hospitals or clinics for animals or people. Any unsupervised or non-medical use is regarded as dangerous.

Like most drugs that are abused, ketamine does not affect everyone in the same way. Some of the factors that determine its effects include the following:

• The age, weight and general state of health of the individual
• The dosage and frequency of use
• The method of ingestion
• Whether alcohol or other substances are taken with the ketamine
• Whether the individual has a mental illness, such as anxiety disorder or depression

Ketamine can have some devastating short-term and long-term effects. These include the following:

• One of the side effects of ketamine use is impaired motor function and confusion about one’s surroundings. As a result, people who use ketamine are at high risk of accidental injuries, and since ketamine blocks the ability to feel pain, medical treatment may not be sought out quickly enough.
• Ketamine is a date rape drug that can be slipped into someone’s drink without their knowledge, rendering them incapable of resisting sexual assault.
• A ketamine overdose can result in an elevated heart rate and a higher risk of a stroke or heart attack. It can also lead to difficulty breathing and unconsciousness.
• Ketamine is a tranquilizer that can reduce mobility to the point where the individual is unable to ask for help if they feel that they are at risk of a medical emergency.
• Being a club drug, ketamine is often taken with alcohol or other drugs. The interactions between these substances can be unpredictable and dangerous.
• When used frequently, ketamine can have long-term adverse effects, and urinary tract issues including urotoxicity, liver damage and loss of cognitive functioning.
• Studies suggest that ketamine use by pregnant women can result in abnormal brain development in the fetus.

The ketamine comedown

Ketamine is a short-acting drug that takes effect quickly. Although these effects start to wear off after about an hour, it is common for ketamine users to experience a “comedown” that lasts for several hours after the initial high has started to dissipate. This is frequently seen in patients who are given ketamine in a medical setting: as they “come out” of their anesthesia, they may be confused and say nonsensical things.

The ketamine comedown varies in severity from person to person, and in the absence of proper medical supervision, it can be harmful to the individual. Some comedown symptoms include delirium, blurred vision, muscular weakness, anxiety, and confusion leading to aggression. Symptoms are likely to be more severe after high-dose uses of ketamine, and when ketamine has been used with alcohol or another substance.

Signs and symptoms of ketamine addiction

While different people experience ketamine addiction in different ways, there are some addiction signs and symptoms that can be seen in almost all ketamine abusers. These include the following:

• A sense of being “out of body”, as if the mind is dissociated from the body and all surroundings
• Memory loss and impaired cognitive functioning
• Slurred speech and a tendency to stumble when trying to walk
• Confusion about one’s whereabouts
• An inability to feel pain even when seriously injured

Loved ones of ketamine drug abusers might observe some of these behavioural signs of ketamine addiction:

• The individual is preoccupied with the drug, and anxious when they do not have access to it
• They spend increasing amounts of time, money and energy in their efforts to support their addiction
• They are unable to attend work or school or to maintain relationships with friends or family members
• They may become socially withdrawn and anxious

Ketamine detox and withdrawal symptoms

Unlike some drugs that are best stopped through a gradual tapering of the dose, “cold turkey” – or sudden withdrawal – is the most effective way to come off ketamine. Because this drug creates a heavy psychological dependency, such a sudden detox can be intense and frightening, as the addict experiences overwhelming cravings and a deep depression that significantly increases the risk of suicidal thoughts and actions.

Therefore, while the physical withdrawal symptoms of ketamine withdrawal do not pose a big risk to the individual, the psychological withdrawal symptoms are serious enough to warrant medically supervised detox. Moreover, detox is more medically complicated if the ketamine user is also addicted to other drugs and alcohol. Since different substances can interact in unpredictable ways, drug and alcohol detox needs to be approached with extreme care.

During the medical detox process, vital signs are monitored to ensure the recovering addict’s well-being, and that he or she is kept safe while going through withdrawal. In some cases, medication may be used to manage withdrawal symptoms. A variety of other treatment options may be used in the case of multiple drug addictions.

Ketamine withdrawal timeline

The first withdrawal symptoms make their appearance between one and three days after the last dose of ketamine. These symptoms include the following:

• Shakes and tremors
• Fatigue combined with insomnia
• Hallucinations, delusions and confusion
• A sensation of having out-of-body experiences
• Rage resulting in aggression or uncharacteristic outbursts
• Depression results in suicidal thoughts, ideation and actions
• Impaired vision and hearing
• Slurred speech
• Nausea and vomiting

These symptoms are at their most intense for the first few days, but they can persist for up to two weeks before starting to taper off. Most symptoms will have stabilized by the third week, but since ketamine can damage the neutrons in the brain, some long-term cognitive impairments and psychological issues can persist beyond this point.

Ketamine addiction rehab and recovery

Like most drug addictions, ketamine addiction rarely exists in isolation. In most cases, the addiction is a symptom of an underlying issue in the addict’s life, and it is almost never an intentional outcome of the person taking the drug. People become addicted in many ways, such as:

• Teenagers or young adults taking ketamine at dance clubs in a bid to “fit in”
• Survivors of trauma or abuse seeking the dissociative effects of ketamine in order to escape the realities of what they have experienced or witnessed
• People who are desperate for a way to manage chronic pain
• People who are suffering from the stress of major life events, such as job loss, bereavement, spousal separation, or financial or legal difficulty
• People who are seeking ways to overcome shyness or anxiety in social situations

Because these paths to addiction are so varied, it is important that treatment for ketamine addiction be customized for the individual. Each person’s journey through addiction is as unique as they are; their journey toward recovery must be similarly tailored for them, with respect for their physical, emotional, social, cultural and spiritual needs. What works for one person could be counterproductive for someone else.

A variety of treatment methods

Ketamine addiction treatment and rehab rarely consist of just one methodology. Most treatment plans involve a combination of tools and therapies that are best suited to the individual’s unique needs and circumstances. Some treatment modalities that could be used include the following:

• Cognitive behavioural therapy: explore the patterns of thinking that affect behaviour
• Dialectical behavioural therapy: introduce stress management and mindfulness tools
• Group therapy: talk and listen in a group of people with similar challenges, who “get it”
• Family therapy: repair relationships that were damaged before or during the period of addiction
• Nutrition or fitness counselling: learn how to maintain a physically healthy lifestyle to supplement the psychological counselling
• Music or art therapy: use creativity as a way to heal

Inpatient treatment vs outpatient treatment

Ketamine addiction can be difficult to overcome because of its tendency to coexist with other addictions, or with physical or mental illnesses. This is just one factor to consider when choosing between an inpatient treatment facility and outpatient treatment or partial hospitalization. Other factors include the following:

• Whether the individual has a physical or mental health concern that puts them or others at risk of harm
• Whether there is a co-occurring addiction to alcohol or another drug
• The age and general state of health of the individual, how long the addiction has been going on, and what the dosages and frequencies of use were
• The presence or absence of a solid support system in the form of close friends and family members
• How easily the individual would be able to access ketamine in their regular environment
• The person’s ability and/or need to attend work and school, and conduct regular daily activities

There are pros and cons of both inpatient and outpatient drug rehab programs. For example, an outpatient program costs less, and it allows the person to overcome their addiction in the “real world” in which they will have to function once treatment is over. On the other hand, an inpatient addiction centre includes food and shelter, allowing the addict to focus on recovery in a supervised, structured environment.

Preventing relapse

One of the biggest challenges with any addiction is the management of physical or psychological cravings that can prove to be too much of a temptation. While ketamine addiction rarely creates physical cravings, the psychological effects can be intense and overwhelming. The depression and anxiety that come with ketamine withdrawal can be so severe that the individual seeks out the drug just to get away from those symptoms.

The first step in preventing a relapse is to ensure properly supervised detox followed by a well-structured rehab and treatment program that is customized for the individual. But recovery does not end there: there are things the individual can do to reduce their risk of relapse once treatment is over. These include the following:

• Ask the rehab provider what aftercare they offer. Aftercare treatment programs can range from 24-hour availability of a crisis telephone number to an organized program that includes education sessions and follow-up counselling sessions.
• During the rehab phase of treatment, ask questions about how the tools and techniques learned can be applied to the real world. This is especially important for those in inpatient programs, who are sheltered from the rigours of life during treatment.
• Where possible, avoid relapse triggers. Relapse is most likely to happen within the first three months of completing treatment. During this time, recovering addicts should avoid the people and places most commonly associated with their addiction.
• Recognize when a craving has started, and take immediate action before it becomes unmanageable. This could mean calling a crisis number, gathering together loved ones who will keep you safe until the craving passes, or visiting a doctor or therapist.

While the risk of relapse sharply drops off after those critical first three months, some people do relapse after that. By recognizing and acting on the triggers as early as possible, ketamine addicts can recover and go on to lead happy, healthy and fulfilling lives.