Ketamine

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KETAMINE

OFFICIAL NAMES: Ketamine hydrochloride, Ketaject, Ketaset, and Ketalar.

STREET NAMES: K, ket, quick, Lady K, special K, vitamin K, Kit-Kat, green, blind squid, jet, super acid, honey oil, cat valium, super C

DRUG CLASSIFICATIONS: Schedule III, dissociative anesthetic

OVERVIEW

The original name for ketamine was CI581. Its discovery is credited to Dr. Calvin Stevens of Wayne State University who isolated the compound in 1961. The pharmaceutical giant Parke-Davis funded its development as an alternative to the anesthetic phencyclidine or PCP.

Ketamine is a fastacting intravenous or intramuscular anesthetic used primarily by veterinarians. It has unique hypnotic (sleep-producing), analgesic (pain-relieving) and amnesic (inducing short term memory loss) properties that in proper doses does not depress breathing, making it highly prized by surgeons. No other drug in clinical use combines these three important features.

Ketamine was first used clinically in 1970, and was thought to be an ideal anesthetic agent. The U.S. military put it to use in Vietnam as an easily administered battlefield drug. It had a wide safety margin in terms of its dosage, making it ideally suited to the chaotic atmosphere of the battlefield.

But as its use increased, so did reports of its hallucinatory side effects. Significant numbers of patients who were given the anesthetic, whether on the battlefield or in hospitals, reported visions of interactions with dead friends and relatives, angels, and other religious figures when they began regaining consciousness.

Physicians began administering tranquilizers to block the hallucinations associated with ketamine's "emergent state," a condition that refers to the patient's return to consciousness. By both official and unofficial channels, word of the drug's intense hallucinogenic effect spread among doctors, scientists, veterinarians, and academics and found fertile ground in an emerging subculture rapidly becoming dominated by psychedelic drug use.

Given the popularity of marijuana, LSD, mescaline, cocaine, and heroin, the use of ketamine in the 1970s and 1980s remained largely confined to either experimental therapeutic use, or what has been described by author Jay Stevens as "the neuro-consciousness frontier," a small group of accredited and unaccredited individuals who experimented with the effects of hallucinogenic substances.

The man most closely associated with early ketamine experimentation and research was John C. Lilly,M.D., an accomplished researcher made famous by his groundbreaking early work in the early neurosciences. (Lilly died in 2001.)

Lilly's research, which electronically mapped the brain's pain and pleasure pathways, opened the door to decades of neural imaging advances. He invented the isolation tank and explored the effects of sensory deprivation; he was also responsible for trail-blazing work in human-dolphin communication—efforts that were later popularized in the films Altered States and The Day of the Dolphin.

What is not as well known is that Lilly also had a chronic problem with ketamine abuse. In his disturbing 1978 autobiography The Scientist, Lilly relates that in taking ketamine for his migraines, he felt transformed by the drug's hallucinogenic effects. In his words, ketamine gave him the ability to "look across the border into other realities."

His tolerance and dependence built up quickly. Within several months, Lilly was injecting the drug several times a day and reaching dosages of 50 mg an hour for stretches lasting up to 20 hours. His case is exceptional, but it is often cited to counter claims that ketamine is not addictive.

With law enforcement officials tightening their grip on the distribution of marijuana, heroin, cocaine, LSD, and other high traffic drugs throughout the late 1970s and early 1980s, interest in what came to be known as designer drugs and later club drugs greatly increased. Ecstasy (MDMA) made its debut in New York and London's gay club scenes in the late 1980s and early 1990s and spread rapidly into the club-going mainstream.

The combination of a large and growing youth market for ecstasy in the United States and Britain, coupled with higher rates of intervention by police, led to a search for new experiences and cheaper alternatives, and ketamine, not yet illegal, quickly filled the void.

In 1995 ketamine was added to the Drug Enforcement Administration's (DEA) Emerging Drugs List. Four years later, in August of 1999, ketamine became a federally illegal (Schedule III) drug in the United States.

Ketamine, though used with much less frequency than MDMA and methamphetamine, is increasingly popular among young people. References to its use are abundant in rave and dance culture. Popular musicians such as Madonna and the Chemical Brothers have also incorporated mention of ketamine usage into their music.

CHEMICAL/ORGANIC COMPOSITION

The chemical composition of ketamine hydrochloride is C₁₃H₁₆CINO. The formal name for the chemical is 2-(2-chlorophenyl)-(methylamino)-cyclohexanone hydrochloride. The chemical structure and effects of ketamine are similar to those of PCP, which it was developed to replace, but ketamine is much less potent and its effects are of much shorter duration.

Ketamine is characterized as a dissociative anesthetic. The term "dissociative" refers to the severing of normal thought processes from consciousness, making the user feel removed from the physical body. Ketamine chemically interferes with the brain's ability to monitor and regulate higher functions, such as memory, perception, and motor activity. The drug has little impact, meanwhile, on lower functions that regulate the heart rate and breathing, which is why it is such an effective surgical anesthetic.

Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, meaning that it interferes with the brain's ability to receive, process, and broadcast certain signals. Specifically, ketamine interferes with the ability of the receptors to receive escitatory amino acids or EAAs, the chemical neurotransmitters in the brain that make brain cells fire in tandem with millions of others. The simultaneous firing of cells along established pathways are what allows the brain to regulate movement, register pain, recall a memory, or initiate any multitude of the brain's higher functions.

Scientists are only now beginning to discover why ketamine works the way it does. NDMA receptors in the human brain are densely localized in the cerebral cortex and hippocampus, areas that are important for higher functions like memory creation and retrieval. Ketamine, by blocking NDMA receptors, effectively disables the normal functioning of the hippocampus, accounting for short-term disorientation and memory loss.

A 1998 study using data from positron emission tomography or PET scans on humans also demonstrated that ketamine stimulates the release of dopamine, the brain's pleasure chemical. Most drugs of abuse spur the forced release of dopamine, reinforcing pleasurable associations in the user.

Ketamine belongs to the same family of drugs as dextromethorphan (DXM), which is found in some brands of over-the-counter cough syrup; nitrous oxide, better known as "whippets," so named because of the metal whipped cream chargers the gas is commonly packaged in; and phencyclidine (PCP), also known as angel dust.

Ketamine also shares a close chemical kinship to prescription drugs Tiletamine and Memantine. Tiletamine is used in combination with zolazepam as a veterinary anesthetic under the brand names Zoletic and Telazol. Memantine is derived from the anti-influenza drug amantadine, and also works to block NDMA receptors. Memantine has been approved for use in Parkinson's disease and dementia in the elderly. It is also being used experimentally with AIDS patients for the treatment of HIV encephalopathy.

INGESTION METHODS

Ketamine is sold to veterinary offices and hospitals in liquid form under the brand names Ketaject, Ketaset, and Ketalar. When properly administered as an anesthetic in a clinical setting, it is usually delivered by intra-muscular injection, though small children and the elderly may receive oral doses.

Ketamine may be procured illegally in its original clear liquid state, and can either be injected, mixed with another liquid and drank, or dribbled over cigarettes and tobacco and smoked. It is far more common, however, for users and dealers to evaporate or "bake" ketamine into a powder.

In economic terms, dealers and middlemen have ample incentive to dilute or "cut" other substances into

the ketamine to stretch a limited supply. Frequently, ketamine is cut with other stimulants, additives, or opiates, compressed into pills or loaded into capsules, and sold as something else entirely.

A study conducted in Australia, which analyzed the purity of ecstasy tablets seized by police, for example, found on average the MDMA content to be a little more than a third of the total—the rest being a mix of heroin, PCP, speed, caffeine, ketamine, and other fillers.

Nasal ingestion

Ketamine is usually snorted as a powder, either cut into lines or delivered in small "hits" or "bumps" of varying size. Thumb-sized plastic "bullet" dispensers are in common use, and deliver preset 30–50 mg doses per nasal hit. Larger bullets most likely contain larger intake chambers.

The impact of ketamine on the user at a low dosage differs dramatically from its impact at a higher dosage. This gives ketamine what is known as a steep dose response curve. Ketamine also differs from other inhalants in that the onset of its effects can take anywhere from five to 15 minutes, depending on the person's height, weight, tolerance, and other factors. Ketamine also lingers in the system for up to an hour, and its effects are cumulative.

Even experienced users, not mindful of the response lag or other variables, frequently ingest more than they intend and end up in what is commonly referred to as a "K-hole"—a state of near paralysis if not complete unconsciousness.

The low-dose threshold, the amount by which most users will begin to feel the effect of the drug, begins with ketamine at about 10 mg. A 10–30 mg nasal dose of ketamine will render most users light-headed, with mildly altered visual and tactile senses.

The medium-dose threshold is anywhere between 30 and 70 mg (a single inhaled hit for many) and results in pronounced disorientation, audio and visual distortion, and a loss of muscle coordination.

The high-dose threshold is the maximum dosage a person can tolerate before losing consciousness entirely. Most users will lapse into a dissociative state at dosages of between 100 and 150 mg, with the rest succumbing at 150–225 mg. Vomiting is not uncommon at high doses. Doses at or near 250 mg will render most users unconscious from 30 minutes to three hours or more.

Oral ingestion

Mixed with water or another liquid, the oral ingestion of ketamine differs from nasal ingestion in several important respects. First, it takes longer for the drug to take effect (up to 20 minutes on a medium-full stomach) and the effect of the drug lasts much longer, from three to six hours or more depending on the dose. The threshold tolerances between light, moderate, strong, and anesthetic doses are also somewhat higher when ingested orally.

Increasingly, ketamine is being sold in press-pill or capsule form. There is no way to accurately gauge how much pure ketamine is being consumed when purchased in this form or with which other drugs (heroin, caffeine, methamphetamine, etc.) it has been combined.

Intramuscular injection

When injected intramuscularly (into muscle as opposed to a vein), ketamine's impact is more immediate (about 90 seconds) and the tolerance threshold is much, much lower. Very small differences in the amount of the drug entering the system have profoundly different effects on the user.

Taking ketamine by injection is dangerous. The risks of accidental death or permanent injury from over-dose by injection are greater than with any other method.

THERAPEUTIC USE

Ketamine has been approved for both human and animal use as an injectable anesthetic in medical settings since 1970. About 90% of the ketamine legally sold in the United States in 2001 was intended for veterinary use, and over the past several years medical usage of ketamine has remained fairly constant. Production of ketamine, however, has increased almost 40% over the last six years, indicating a great deal of the substance is being diverted for illegal use.

Ketamine and other NMDA antagonists were first thought to be wonder drugs. Not only were they excellent anesthetics, but they appeared to offset brain damage from strokes, head injuries, hypoxia, polio, and a variety of other conditions. Euphoria over their potential was eventually dampened by reports of their hallucinatory side effects and brain damage where the drugs were most active.

Ketamine, like MDMA, was once thought to hold great promise for use in the field of experimental psychotherapy. Though the drug has been sidelined for this purpose in the United States, its use in Russia's reformed psychiatric establishment is yielding some interesting results.

Russian studies conducted in the early-to mid-1990s suggests ketamine can contribute to stabilizing positive psychological changes reached in therapy and enhance personal growth. Another author suggested that it may enhance the creative activities of patients and harmonize their relationships with other people. In 1997, a ten-year review of ketamine-assisted treatment of alcoholism in Russia resulted in the publication of several controversial abstracts. One clinical trial comparing ketamine psychedelic therapy (KPT) and conventional treatment found that 73 out of 111, or 66%, of patients who received ketamine-assisted therapy remained alcohol free after one year compared to just 24% (24 out of 100 patients) who were counseled by conventional methods. Changes in brain metabolism were also cited, which may have reinforced the patients' desire to stay sober.

Research continues to illuminate different aspects of ketamine pharmacology, some of it promising enough to indicate that new clinical uses (principally in the field of anesthesiology) for the drug will be approved. It is still used as a general anesthetic for children and geriatric patients because it is well tolerated. Benzodiazepine-based tranquilizers are used to keep the auditory and visual hallucinations to a minimum.

USAGE TRENDS

Before the late 1980s, ketamine was not widely abused. In 1984, the Department of Health and Human Services recommended the DEA classify ketamine and products containing it under Schedule III of the Controlled Substances Act (CSA). But citing too few reports of a problem, the DEA postponed action.

Indications of ketamine's growing popularity as an illicit drug soon emerged, however. Veterinary clinics and animal hospitals were broken into with increasing frequency and reporting their stocks of ketamine stolen. In 1997, an advisory from the American Veterinary Medical Association urged its members to install burglar alarms and to keep ketamine under lock and key. By that time the agency had documented hundreds of such burglaries.

Closer monitoring of ketamine supplies has made it more difficult to obtain. Traffickers are still able to maintain their supplies of the substance, but the impact of the supply squeeze occasionally puts the price of the drug beyond the reach of many. Anti-theft measures and the attention of law enforcement have restricted access to the drug so much that doses that sold for $25–$30 in the mid-1990s are now selling for up to $75–$100 in areas of high demand.

The clandestine manufacture of ketamine has not been noted by authorities. In contrast to its chemical cousin PCP, synthesizing ketamine outside of a major laboratory is very difficult. If the supply situation remains unchanged or worsens (from the point of view of the illegal user) ketamine use will likely decline in favor of cheaper and more readily available alternatives.

Club drugs and raves

The increase in drug use among adolescents is tied by many experts to the growth of "raves" or "trances," all-night dance parties that cater to young audiences. Rave culture is well-advanced and international in scope. It has its own dominant fashions, its own style of music (hypnotic and psychedelic electronica), a preferred style of dance, and its own ethos (peace, love, unity, and respect). It also harbors a dominant social environment that encourages the liberal use of drugs such as MDMA (ecstasy), GHB, LSD, methamphetamine, rohypnol, and ketamine. These "club drugs" or "designer drugs" have surged in popularity over the last decade because of their association with these large-scale events. However, ketamine is not as regularly used as other club drugs because of its unpleasant side effects.

The increase in drug use over the last ten years among adolescents has led some health officials to argue that recreational drug use (meaning drug use on which the user is not dependent) is becoming normalized within youth culture. These officials say the social costs and constraints associated with drug use, for example, being labeled as "druggies" by their peers, are breaking down and that the implications for future usage trends are ominous.

Whether this argument proves to be accurate or not, it is certainly true that there is a strong correlation between attending these rave events and drug use. A 1998 British Crime Survey reported that 80% of club goers used drugs at some point in their lives compared to 52% of the general population. A 1999 report found that while 10% of the British population reported using illegal drugs in the last year, some 55% of club goers said they planned to use ecstasy or an amphetamine on that particular night.

Because alcohol is often not available at raves, there is usually no age restriction to admission. Rave attendees are generally between the ages of 15 and 25, and this data is remarkably uniform internationally. In Australia, the mean age of surveyed club goers was 18.9 years. An analysis of club drug use demographics in Britain showed a decrease in the age of users, from the mid to late 20s to the early 20s and late teen years. The same holds true in the United States.

Age, ethnic, and gender trends

Hospital data collected by the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, suggests the age of the typical American club drug user is between 18 and 25. Whereas only 20% of all drug-related emergency room visits involved patients 25 and under, this age group accounts for 58% of ketamine incidents, 67% of all recorded MDMA incidents, 50% of recorded GHB incidents, and 46% of all LSD incidents.

Traditionally, males predominate in drug usage; that pattern is also shifting. Young women are partaking in club drugs as never before. In Britain, the male to female ratio of 2:1 has eroded. In the United States, differences in gender regarding club drug use have all but disappeared.

Racially, white patients account for 61% of all drug-related hospital visits in the United States, followed by black (26%) and Hispanics (11%). With the exception of rohypnol, the 69–80% of all club drug incidents recorded by Drug Abuse Warning Network (DAWN) involve white, non-Hispanic patients—a fairly typical reflection of the U.S. population. A far larger share (56%) of rohypnol mentions are attributed to Hispanic patients, but this may have to do with the small sample size available to researchers.

DAWN says emergency room visits associated with club drug use of ecstasy increased 58% between 1999 and 2000 (from 2,850 to 4,511). The report offers no evidence of a similar surge over the same period for GHB, ketamine or rohypnol, though it should be noted that ecstasy tablets sold anywhere in the world are routinely cut with other drugs, ketamine included.

In its review of emergency room data, DAWN found 263 mentions of ketamine between 1999 and 2000. The study also reported that more than 70% of drug-related emergency room visits resulted from simultaneous use. Though alcohol was most frequently mentioned as being used in conjunction with other drugs, 37% of emergency room episodes involving ketamine and 15% involving GHB also included concurrent use of ecstasy.

The gay community

Though data on the regular party-going subset of the gay community is comparatively sparse, the research that has been conducted indicates gay men of a much broader age demographic are users of ketamine and other club drugs.

Dr. Grant N. Colfax of the San Francisco Department of Public Health surveyed nearly 300 gay and bisexual men in the San Francisco area attending what are known as circuit parties—large scale gay dance parties, predominantly male and similar in scope and attendance to rave events.

Most of the men surveyed by Colfax reported using at least one recreational drug when attending an out-of-town circuit event, and though these results are not typical of gay men in general, within this subset of the community, recreational drug use appears to be the norm.

A full 80% of those surveyed by Colfax reported taking ecstasy; 66% took ketamine; 43% took crystal methamphetamines; and 29% took so-called "liquid ecstasy" or GHB.

Some of ketamine's dangers are behavioral. Many users say that in low doses ketamine acts as an aphrodisiac and that it lowers sexual inhibitions. In the age of HIV and AIDS, the use of ketamine in sexual situations can lead to uncharacteristic recklessness.

Researchers and social workers in the AIDS field say the use of ketamine and other inhibition-relaxing drugs during sex may push sexual partners to do things they would not otherwise do. Use of the drug is worsening already complacent attitudes, especially among young gay men, about the need to protect themselves from HIV infection.

MENTAL EFFECTS

Within five minutes of taking ketamine, users generally feel a non-localized numbness, a heaviness in the limbs, blurred vision, muffled or distorted hearing, and a floating sensation. Users say the drug creates feelings of detachment and introversion.

At higher doses, ketamine leads to pronounced changes in judgment, distorted vision, auditory hallucinations, such as humming or buzzing, and marked disorientation. Some users report a profound impact on the perception of time, which appears to slow to a complete halt in the emergent, or heavily hallucinatory state.

Visions of life and death, some calming, others frightening, have been reported. Religious hallucinations, out-of-body experiences, and a pronounced dissociative state that some have called another plane of consciousness are also credited to ketamine. While in what is referred to as K-land or the K-state, users claim to gain insights into their personalities, the people they know, and the workings of the universe.

Even experienced users misjudge the dosing and land in a life-threatening K-hole. In addition to vivid hallucinations, this state may be punctuated by convulsions, respiratory depression, and loss of consciousness. Memory is also acutely affected. Users may not remember taking the drug, or who or where they are. Users may experience bouts of paranoia or anger.

The ketamine "high" usually can last anywhere from 45 minutes to an hour. However, depending on the dosage, tolerance, and method of ingestion, the drug's effects can linger for four hours or more. Like most anesthetic agents, it may take the user 24–48 hours before they feel "normal" again.

PHYSIOLOGICAL EFFECTS

Reported physical effects of ketamine use include an initial energy rush, numbness, and irregular muscle coordination. Large amounts can cause anesthesia and muscle spasm. Eating and drinking alcohol before taking ketamine (as with other anesthetics) may cause vomiting. If this is combined with unconsciousness, there is an acute danger of choking or death.

As an anesthetic, ketamine increases sympathetic nervous activity, which results in an increased heart rate, increased blood pressure, some dilation of bronchial tubes, pupil dilation, and related secondary effects.

Specifically, blood pressure rises by about 25%, and the heart rate is increased in the area of 20%. There is wide variation in the kinds of responses individuals can have to the drug, and occasionally, alarming increases in blood pressure can occur.

At low and moderate (subanesthetic) doses, users have difficulty walking; balance and muscle control are compromised. Vision is blurred and distorted, which can worsen a user's disorientation. Speech is slurred, and there is numbness in the extremities. At higher dosages, standing becomes difficult or impossible. Users are prone to collapse and may lapse in and out of consciousness.

Harmful side effects

Multiple, repeated dosing of ketamine is common by most users, as is its combination with other drugs. Too many "bumps" in a row or within a small window of time frequently knocks users out cold, putting them into the anesthetic condition for which the drug was manufactured. This K-hole can last up to two hours or more, depending on the dose. The K-hole is frequently preceded by nausea or vomiting.

Adverse effects noted with the anesthetic use of ketamine include the sudden loss of respiratory function, spasms of the trachea or larynx, and vomiting. Literature on the emergency treatment of ketamine overdose is rare. Clinical recommendations advise making sure the airway is clear, that breathing is continually monitored, and that the heart rate remains steady.

On its own, ketamine toxicity is less of a concern than accidents caused by the intensity of the dissociative state and loss of muscle coordination and control. However, given that ketamine is frequently taken with other drugs such as alcohol or ecstasy, clinical reports on the dangers of its recreational use are probably inadequate.

A study conducted in Britain reported that ketamine's impact on short-and long-term memory can linger for up to three days after a dose. Researchers looked at a broad array of memory functions, word association and language tests, attention span, and other factors related to mood. Though some recovery was noted 72 hours after ketamine usage, the researchers noted lasting impairments related to language and some aspects of memory.

Injecting ketamine intramuscularly carries with it risks common to cocaine and heroin addicts and other injection-drug users. Sharing needles can lead to the transmission of blood-borne viral infections such as HIV and hepatitis B and C, as well as increased risk of escalation of drug use and overdose.

Long-term health effects

A review of current data suggests all dissociative anesthetics cause brain damage if used heavily. Dissociatives include ketamine, dextromethorphan (or DXM), phencyclidine (PCP or angel dust), nitrous oxide (whippets) and dizocilpine (MK-801). All are N-methyl-D-aspartate (NMDA) antagonists, meaning they temporarily block a crucial neurotransmitter in the brain.

Research conducted by Dr. J.W. Olney revealed the existence of small vacuoles (essentially, very tiny holes) in the brains of mice given high doses of dizocilpine or MK-801. The tiny holes are now called Olney's lesions and the condition is formally referenced in the medical community as NMDA antagonist neurotoxicity or NAN. NAN has also been tied to ketamine and PCP use, even in commonly-used doses.

Though more study is needed, reports of ketaminerelated brain damage are growing more numerous, and the types of impairment people report experiencing (slurred speech, memory loss, difficulty concentrating) are directly tied to the centers of the brain most affected by the drug.

All dissociative anesthetics are extremely toxic to developing fetuses and should never be used during pregnancy. Severe brain damage and mental retardation may result.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

The consumption of more than one drug over a small window of time and mixing two or more drugs together for a blending of effects is characteristic of club-drug use. As discussed above, ketamine is often mixed with alcohol, GHB, MDMA (ecstasy), rohypnol, and methamphetamine. Some 37% of reported ketamine combination episodes are linked with ecstasy.

Each drug affects the body in a characteristic way. MDMA and methamphetamine for example, are vasoconstrictors, which decrease blood flow to certain parts of the body. Ketamine is a vasodilator, a drug that increases blood flow. Mixing a vasoconstrictor with a vasodilator (combining ecstasy and ketamine, for example) can dramatically increase blood pressure in the user and boost the risk of sudden cardiac arrest or stroke.

Ketamine should never be used with other drugs that decrease breathing; these include alcohol, barbituates, or Valium. Users mixing these drugs risk slowing their breathing and heart rates to dangerously low levels—starving their brains of oxygen and risking permanent brain damage if not death.

TREATMENT AND REHABILITATION

Though ketamine is still not thought to be physically addictive, dependence on the drug can be developed quickly in some people. Individuals can be so drawn to the feeling of detachment it provides and the emotional insights the drug is said to give to some users that walking away from repeated use may prove impossible for some.

Tolerance, dependence, and withdrawal indicators have been observed in a number of studies. Users who are fond of its escapist qualities say it has a high potential for psychological dependence and that tolerance to the drug develops fairly quickly.

Symptoms reported by ketamine users who have stopped using the drug include drug craving, persistent amnesia, slurred speech, and difficulty concentrating. Frequent and persistent use of ketamine over extended periods of time have led to reports of marked personality changes in the user and evidence of brain damage.

Treatment for ketamine dependence may involve psychotherapy or a 12-step program. Antidepressants may be used to treat depression that resulted in the drug use.

PERSONAL AND SOCIAL CONSEQUENCES

Because of its hallucinatory qualities, ketamine is sometimes compared with other psychedelics, including LSD, mescaline, and psilocybin. There is no evidence to support that these types of drugs "cause" long-term psychotic or schizophrenic behaviors, but individuals with an underlying mental condition may find the drug experience triggers an outbreak of the disease.

Anecdotal evidence suggests that psychotic breaks and schizophrenia-like symptoms are far more frequent with heavy or regular dissociative anesthetic use than any other type of psychedelic.

Because of its pain-killing properties, ketamine can expose its users to grievous injury that may not become apparent until hours later. The sudden loss of consciousness associated with higher doses of ketamine can become life-threatening if the user is driving a car or swimming. Professionals caution that ketamine impairs judgement, mental sharpness, and muscle coordination for up to 24 hours after it is taken, long after the immediate effects of the drug have worn off. As discussed earlier, ketamine is also associated with the relaxation of sexual inhibitions, which can be dangerous if one of the partners has HIV.

LEGAL CONSEQUENCES

On August 12, 1999, the U.S. Drug Enforcement Administration made ketamine a Schedule III drug. Schedule III drugs are approved for medical use, though their recreational use or abuse "may lead to moderate or low physical dependence or high psychological dependence." Possession of ketamine in the United States is illegal without a prescription or license to distribute.

Penalties for possession of Schedule I and II drugs (methamphetamine, heroin, cocaine, PCP, LSD, and marijuana among others) are far more severe than are the penalties for possession of Schedule III drugs, but they should not be dismissed entirely. Federal sentencing guidelines for possession of ketamine, regardless of the quantity, stipulate prison terms of not more than five years and individual fines of not more than $250,000. Second time offenders will almost certainly earn jail time, with a sentence determined by the judge but not to exceed 10 years. The fine is also doubled, to $500,000.

When ketamine is used by an individual in the commission of another crime, such as rape, the penalties are particularly severe. Rape of a victim who is "physically incapable of declining participation" in the sex act is punishable by fines and imprisonment up to 20 years. Moreover, the rapist does not necessarily have to be the one who drugged the victim; he could be just taking advantage of an existing situation.

A rapist who "renders another person unconscious" or "substantially impairs the ability of that other person to appraise or control conduct" could be sentenced to life in prison.

See also Ecstasy (MDMA); GHB; PCP; Rohypnol

RESOURCES

Books

Jansen, Karl. Ketamine: Dreams & Realities. Sarasota, FL: Multidisciplinary Association for Psychedelic Studies, 2001.

Rudgley, Richard. The Encyclopedia of Psychoactive Substances. New York: Little, Brown and Company, 1998.

Stafford, Peter. Psychedelics Encyclopedia. Berkeley, CA: Ronin Publishing, 1992.

Stevens, Jay. Storming Heaven: LSD and the American Dream. Berkeley, CA: Atlantic Monthly Press, 1987.

Periodicals

Cloud, John. "Is Your Kid On K?" TIME Magazine 150, no. 16 (October 20, 1997).

Curran, Valerie H., and Lisa Monaghan. "In and out of the K-hole: A comparison of the acute and resudual effects of ketamine in frequent and infrequent users." Addiction 96, no. 5 (May2001): 749-760.

Curran, Valerie H., and Celia Morgan. "Cognitive, dissociative, and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later." Addiction 95, no. 4 (April2000): 575-591.

European Union. European Monitoring Center for Drugs and Drug Addiction. "Report on the Risk Assessment of ketamine in the Framework of the Joint Action on New Synthetic Drugs." (September 25, 2000).

Krupitsky, E.M., and A.Y. Grinenko. "Ketamine Psychadelic Therapy (KPT): A Review of the Results of Ten Years of Research." Journal of Psychoactive Drugs 29, no. 2 (April-June1997): 165-183.

Lenton, Simon, Annabel Boys, and Kathy Norcross. "Raves, Drugs and Experience: Drug use by a sample of people who attend raves in Western Australia." Addiction 92, no. 10 (April1997): 1327-1337.

McKinney, Merritt. "Gay Men May Take Health Risks at 'Circuit Parties.'" Journal of Acquired Immune Deficiency Syndromes 28(2001): 373-379.

Quittner, Jeremy. "All mixed up." The Advocate (May 22, 2001).

Riley, Sarah J., G. Charlotte, D. H. Danielle, and M. Cadger. "Patterns of Recreational Drug Use at Dance Events in Edinburgh, Scotland." Addiction 96, no. 7 (July 2001): 1035-1047.

Sack, Kevin. "For Gay Men, HIV Peril and Rising Drug Use." The New York Times January 29, 1999.

United States Department of Health and Human Services. Sub-stance Abuse and Mental Health Services Administration. Drug Abuse Warning Network. "The DAWN Report: Club Drugs." (December 2000).

United States Office of National Drug Policy. "Pulse Check: Trends in Drug Abuse." (Mid-Year 2000).

University of Oxford. "Administering a Ketamine Anesthetic." Practical Procedures 4, Article 5 (1994).

Weir, Erica. "Raves: A Review of the Culture, the Drugs and the Prevention of Harm." Canadian Medical Association Journal162, no. 13 (June 2000): 1843-1849.