Ketamine: Therapeutic use

Last modified: Sunday, 31. May 2009 - 4:44 pm

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.
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 S25-S30 in the mid-1990s are now selling for up to S75-S100 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.

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