K. Special K. Super K. Vitamin K. Cat Valium. Cat Tranquilizer. Kit kat. Street names of the generic FDA approved drug that’ll leave you dragging your piss-filled half comatose corpse along hallway walls in hopes of encountering a toilet. Ketamine. One might ask, “Should I try Ketamine? If so, do I snort it? Do I eat it? Do I fill a clean and sterile needle with Ketamine juice and inject it straight into my eyeballs?”. Well, person reading this, all your suggested questions (and more) will be answered in the short essay below. I wrote this essay for the coolest college class ever called “Drugs and the Brain”. Ever since then I’ve been liberally dosing my morning smoothies with a Ketamine-infused kombucha. It is now August 7th, 2022, and the voices in my head could not be happier with my decision. Cheers! “K?”, the voices whisper to me. “K.”, I solemnly reply. ______________________________________________________________________________ Ketamine was originally developed for anesthetic purposes in 1962. Following its release for public use in 1970, Ketamine quickly became a drug of recreation for those in the “club” or “rave” culture. This essay will highlight the recreational use of Ketamine and the chemical effects it has on the brain, the effects it has on its users, and the effects it has on society. When Ketamine is administered into the human body, there are several ways in which the drug can get into the bloodstream. Ketamine can be administered intravenously, intramuscularly, orally, nasally, rectally, or subcutaneously. The intranasal method of administration is by far the most popular method, with 99% of users taking the intranasal route of administration (Reynaud-Maurupt, Bello, Akoka, & Toufik 2007). Although the intranasal route of administration is the most popular, it is not the most efficient. The intravenous method of administration is considered to be the “ideal route” (Li & Vlisides, 2016) because this form of administration dumps the Ketamine right into the bloodstream thus shortening the time it takes for the drug to get into the brain. With a distribution half-life of 10 minutes (Sassano-Hoggins, Baron, Juarez, Esmaili, & Gold, 2016), Ketamine quickly travels throughout the body and ultimately leaves an accumulated concentration of it in the brain. At the chemical level, once Ketamine passes through the blood brain barrier, it reaches the lipid membrane in which the brain’s receptors are located. Ketamine then antagonizes NMDA receptors by binding to a site within the channel pore to reduce the amount of time the channel is open; ketamine can also allosterically antagonize the NMDA receptor by decreasing the channel opening frequency (Li, Vlisides, 2016). By mediating the amount of NMDA that passes through brain cells, Ketamine effectively modulates emotional responses, learning, and memory. Along with being an antagonist for NMDA, Ketamine also increases the activity of Dopamine, Norepinephrine, and Serotonin (Sassano-Hoggins et al., 2016). Ketamine is also an agonist for the Opium receptors in the brain, leading to analgesic and euphoric effects that are mediated through Opium receptors (Sassano-Hoggins et al., 2016). At the clinical level, Ketamine proves to be a useful anesthetic and provides profound analgesia and sedation without significantly compromising respiratory function. However, users reported having unpleasant experiences such as a longer time coming out of anesthesia, increased frequency of unpleasant dreams, and hallucinations; the increasing quantity of these unpleasant reports led to a decline in medical Ketamine use for humans. At lower doses, Ketamine will give its users hallucinations, distortions of time and space, and mild disassociation (Li, Vlisides, 2016). Other symptoms of higher, yet, subanesthetic doses of Ketamine include a psychedelic state of mind resembling schizophrenic psychosis, pronounced derealization & depersonalization, alterations in bodily perception, impairments in proprioception, and preoccupation with unimportant sounds (Sassano-Hoggins et al., 2016). As dosage increases, Ketamine users report having feelings of intoxication, perceptual alterations in auditory and visual senses, symptoms of depression or derealization, referential ideas & delusions, misinterpretations, and thought disorder (Li. Vlisides, 2016). A high dosage of Ketamine may also include schizophrenia-like symptoms and perceptions that are completely separate from reality (Li, Vlisides, 2016). High dosages of Ketamine lead to a feeling that many users call being “lost in the K-hole” (Sassano-Hoggins et al., 2016). The K-hole is what Ketamine users refer to when they are in an extreme state of disassociation. Users feel as if they are exiting out of their own body. Often, this “K-hole” experience is undesired as it is associated with a feeling of morbidity (Reynaud-Maurupt et al., 2007). Other undesirable effects may include, but are not limited to, dizziness, loss of one’s senses, vomiting, inability to communicate, anxiety & distress, blackouts & comas, weight loss, joint pain, and gingivitis (Reynaud-Maurupt et al., 2007). According to users, the risks connected with Ketamine use are mainly of social or psychosocial nature. These risks include, but are not limited to, the inability to defend oneself, inability to feel pain, losing control of oneself, anxiety, hallucinatory troubles, disorientation, depressive symptoms, and memory troubles (Reynaud-Maurupt et al., 2007). Because these risks are so dangerously debilitating, the usage of Ketamine inhibits the user from reacting properly in the event of an emergency. Due to this lack of reaction, the use of Ketamine has been linked to assaults, rapes, and domestic accidents (Reynaud-Maurupt et al., 2007). Long term use of Ketamine can lead to a host of cognitive deficits such as schizophrenia-like symptoms, cognitive impairment in working memory, impairment in long & short term memory, persistent dissociative & depressive disorder, and delusional thinking (Sassano-Hoggins et al., 2016). Aside from the negative cognitive effects of chronic Ketamine use, there are also physiological detriments that manifest due to the prolonged consumption of Ketamine. Chronic users of Ketamine report lower urinary tract symptoms such as dysuria, suprapubic pain, painful hematuria, and moderate to intense abdominal pain which is caused by Ketamine induced toxicity to the gastrointestinal system (Sassano-Hoggins et al., 2016). Only a year after the release of the public use of Ketamine, reports of the recreational misuse of the drug began to be documented; the reports of Ketamine misuse increased during the 1990’s (Sassano-Hoggins et al., 2016) mainly being concentrated at raves, clubs, festivals, or parties. Ketamine use was almost entirely restricted to the United States, but after 1980, the drug went international and rose to prominence as a “club drug” (Sassano-Hoggins et al., 2016). Ketamine quickly assimilated itself into “rave” culture because it allowed its users to hallucinate and fall into a stimulated sense of euphoria (Reynaud-Maurupt et al., 2007). After a rave when the music is dying down and the attendees are exiting the venue, Ketamine users will often take the drug when they feel like their initial high is coming down to “keep the party going” (Reynaud-Maurupt et al., 2007). Many people who a part of this “rave” or “dance culture” tend to be polydrug users, often mixing Ketamine with other substances such as LSD, alcohol, and amphetamines. The purpose of mixing these substances is to maximize hallucinogenic effects while minimizing anesthetic effects (Reynaud-Maurupt et al., 2007). In a set of data that was collected between July 2002 and June 2003, 70% of respondents were recruited through the techno-festival scene, while 30% were recruited through addiction centers and treatment organizations. Among these respondents, Ketamine was generally a substance that was experimented with or used by polydrug users, meaning that Ketamine was most likely being mixed with other psychoactive drugs during sessions of administration (Reynaud-Maurupt et al., 2007). 40% of these users claimed to have taken Ketamine 2-9 times during their lifetime, while 41% of users claimed to have taken Ketamine 10 or more times. Of the 41% group, users were more likely to be male, living alone, in precarious living conditions, and having no job nor unemployment benefits (Reynaud-Maurupt et al., 2007). If an individual is a part of the rave culture, the amount of times the individual takes Ketamine correlates with the amount of times that person has been to a techno fest. According to a data set of n=249 respondents, a group who had taken less than 10 doses of Ketamine in their lifetime had 72% of individuals attend 10 techno festivals or less, with 41% attending more than 10 festivals. By comparison, the group who had taken 10 or more doses of ketamine in their lifetime had 23% of individuals attend 10 techno festivals or less, with 59% attending more than 10 festivals (Reynaud-Maurupt et al., 2007). Aside from the experience of a trippy rave or a crazy party, users also take Ketamine for its spiritual benefits. Users report feeling detached from oneself or going through a regeneration, causing feelings of lightness, floating, calming, and euphoria (Reynaud-Maurupt et al., 2007). Although the out of body experience is a feeling that is more often endured than sought after, the introspection that this feeling generates seems to be beneficial for some individuals. These individuals claim to find “hidden dimensions” of oneself by opening “doors to a reality you wouldn’t see otherwise” and claiming that Ketamine “puts you face to face with your own self” (Reynaud-Maurupt et al., 2007). This allows for users to reflect on their own life without having to filter their inner thoughts & emotions through their past emotions or past experiences. Regarding the production and distribution of Ketamine, if an individual doesn’t have a “nurse friend” who can smuggle Ketamine out of a lab, the individual must resort to using outside sources to get the drug. According to the DEA, Mexico is a major global supplier of illicit Ketamine; India is also involved with the smuggling of ketamine to the US (Hoggins et al., 2016). Ketamine is commercially available in an aqueous form, which is usually injected, but once the Ketamine goes through a dehydration process, it becomes a powder which can then be illicitly distributed in capsules, tablets, crystals, or the powder itself (Sassano-Hoggins et al., 2016). To make connections across chemical and personal levels, I am first going to reiterate some information stated earlier. Ketamine antagonizes NMDA, which means that Ketamine effectively blocks the receptor for NMDA – the neurotransmitter that modulates learning and memory. So, because chronic Ketamine users are constantly blocking the learning and memory neurotransmitter (NMDA), it is likely that there will be some form of modification, or perhaps even deficit, in learning and memory. As an example, let’s say that there is a student who uses Ketamine chronically, but still goes to class every day. Unless this student is taking notes, the student will likely not remember the information discussed in class because any information accumulated would have a difficult time being retained due to the antagonization of the NMDA receptor, thus creating a learning deficit that may last for as long as the individual continues to take Ketamine. This learning deficit could be one of the factors determining if an individual continues to pursue an education. According to the same data set of n=249 individuals, there is, in fact, a correlation between education and the amount of Ketamine used in their lifetime. Of the group of individuals that took less than 10 doses of Ketamine, 71% of them pursued a post-secondary education. Of the group that took 10 doses or more of Ketamine, only 24% of them pursued a post-secondary education (Reynaud-Maurupt et al., 2007). In conclusion, Ketamine, like most drugs, has practical clinical uses, but also has a high potential for recreational use and abuse. It is important to develop a knowledge of this, and other drugs, because so long as there are animals called humans that walk this planet, there will always be a demand for psychoactive & mild altering drugs. Whether for clinical reasons, or personal reasons, the more knowledge you have about a specific drug or drugs, the better equipped you will be to handle the situations in which those drugs are involved in. WORKS CITED Li, L., & Vlisides, P. E. (2016). Ketamine: 50 Years of Modulating the Mind. Frontiers in Human Neuroscience, 10, 612. Reynaud-Maurupt, C., Bello, P. Y., Akoka, S., & Toufik, A. (2007) Characteristics and Behaviors of Ketamine Users in France in 2003. Journal of Psychoactive Drugs, 39,1. Sassano-Hoggins, S., Baron, D., Juarez, G., Esmaili N., & Gold, M. (2016). A Review of Ketamine Abuse and Diversion. Depression and Anxiety, 33, 718-727.
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