Yet another drug headline with ketamine in the news lately, after a recent study in Bristol (Mason, et al, 2010) found that some users are suffering long-term bladder damage – a few even needing their bladders replaced at the tender age of twenty.
A Class C drug in the UK (or Schedule III in the US), ketamine is not generally seen to be one of the more harmful illegal drugs. The evidence to date seemed to show ketamine to be a relatively safe drug when coming from pure, pharmaceutical grade vials. Originating as a liquid, ketamine is usually ‘cooked’ into a crystalline powder which can be snorted like cocaine, although heavier users prefer to use the liquid form for intramuscular injections, as would be given in a medical setting.
Ketamine is widely stereotyped as a ‘horse tranquilizer’. Actually ketamine is an anesthetic that has been used in both human and veterinary medicine since the 1960s (although less so in humans today due to some patients’ negative reactions to hallucinations or ‘emergence reactions’ as the medical community calls them).
In much smaller (recreational) doses, ketamine can have paradoxical stimulatory and dissociative effects. Some users take small ‘bumps’ up the nose when out clubbing – others take a larger dose to find themselves in the famed ‘k-hole’, a dissociated state where one can have out-of-body and near-death experiences, or seemingly travel to other mystical and magical places.
While ketamine is generally associated with the dance and rave scene, at these higher doses ketamine is safest taken at home, in a familiar environment to offset the possible dangers of being in a dissociative state in public surroundings. Many taking ketamine fall into the ‘psychonaut‘ category, like this user in a UK study on ketamine use (Muetzelfeldt, et al, 2008), who stated that ketamine allowed “new ways of thinking and an understanding of the mind/body question which 3 years of a philosophy degree could not reach.”
There is some interesting potential for ketamine use in exploring consciousness and success has been documented using ketamine to treat alcoholism and depression. What doesn’t seem to be properly investigated is the extent to which ketamine is harmful to the body, and in what quantities it becomes so.
The most obvious danger of ketamine is of injuring oneself while in the dissociative state. This has been the downfall of several respected members of the psychonaut community such as D M Turner:
“On New Years Eve, 1996, the noted author and lay-psychedelic researcher known only by the pseudonym D.M. Turner drew a hot bath, injected himself with an unknown amount of ketamine, and settled in for the last trip of his life. When his body was found weeks later, the cause of death was determined to be natural causes. It is assumed that Mr. Turner lost consciouness at some point during the evening, slid under the water, and quietly drowned.”
Another tragic loss to the community was Marcia Moore, the heiress to the Sheraton Hotel fortune, a yoga teacher and world famous writer on astrology and ‘hypersentience':
“Marcia Moore named what she perceived to be the ‘highest’ level of her experiences ‘the cosmic matrix’ or ‘cosmatrix’, the source from which everything was said to be derived. She noted that ketamine produced a ‘higher, clearer and more real trip’ than LSD, although some people just felt ‘disconcertingly whacked out’, and that ketamine produced fragmentation into subpersonalities, including her role as ‘priestess of the Goddess Ketamine’. ‘The Priestess’, aged 50, disappeared on a freezing winter’s night in January, 1979. Her bleached skeleton was found two years later. She had gone at night into a nearby forest, and frozen to death after injecting herself with all the ketamine she could find.”
Aside from the danger of unsupervised pyschonautic exploration, the overall health risks of ketamine cannot yet be quantified. The Bristol study was not large enough to extrapolate the correlation between ketamine use and bladder destruction for light recreational users, with some in the study reporting incredibly heavy use of more than two grams a day (and others refusing to report the extent of their use altogether). Indeed perhaps another unexplored aspect of ketamine use is its potential for addiction; while not physically addictive, there seems to be a high potential for compulsive use to become a serious issue (even for its most thoughtful and educated users, as seen with D M Turner, Marcia Moore, and John Lilly).
Reading through frequent ketamine users’ discussions and reports online, aside from the common bladder complaints, there is recurring talk of what have been mysteriously termed ‘k-cramps’ – a kind of severe gastric pain. As the 2008 UK study cited above states:
“The classification of ketamine-associated ulcerative cystitis has recently been established, however the etiology and treatments of ‘K-cramps’ are still unknown. Nevertheless, it seems to be a prevalent symptom which may represent a broader public health concern if the use of ketamine continues to increase.”
Unaddressed by the medical community at large, here’s one user’s description of his ‘k-cramps':
“Ketamine causes ulcers in high habitual dosing. There is little information on this on the internet but if you search just hard enough you will hear rumors of it. Well why isn’t this a known fact? Well one would have to take ketamine daily or semi daily at least to get this nasty side effect.
I was unfortunate enough to have this happen on 3 separate occasions. The first time on a cruise ship, resulting in collapsing on the deck screaming for my life, which resulted in a diagnosis of ‘gastritis’ and a double shot of morphine. The second time at home which kept me pent in bed in the fetal position a few days. The third time in the snow in the midst of a rock scramble/ice climb, which made for a difficult, cold, and dire crawl two miles to safety.
From communication with 3 other habitual ketamine abusers this phenomena was familiar with all 3 and equally as gruesome. For the record all 3 consumed a minimum of 3-5 grams a week often more.
Now the physiology of it seems to be a disruption in the pH of the gall bladder causing an ungodly acid reflux. (literally feels like the acids going to eat clear through to your skin)
The way to end the agony is stop using ketamine till it subsides. It can take up to 3 days for it to go away with abstinence. Pink Bismuth (pepto bismol) was found to alleviate some of the pain, as did pain killers. Thought I would share as it took me nearly a year to figure it out, and found next to no information on the net about it.”
This is but one of dozens of reports of excruciating pain by ketamine users, accounts that can be found by googling ‘k-cramps’ and ‘ketamine’.
Once thought to be a ‘safe’ drug in terms of abuse due to the absence of physical dependence, ketamine is now known to be associated with bladder dysfunction when abused, but its effects on the gall bladder, liver and gastrointestinal system have been largely ignored.
The only two studies relevant to this phenomena I’ve been able to locate originate from Hong Kong, where ketamine has long been the party drug of choice. Those more medically inclined may find the following two studies of interest, certainly a place to start for UK and US investigation into this phenomena:
“Dilated common bile ducts mimicking choledochal cysts in ketamine abusers”
(Wong, et al., 2009)
“Upper gastrointestinal problems in inhalational ketamine abusers”
(Poon, et al., 2010)
As a general explanation for these mysterious pains, one American periodical notes:
“In addition to urological problems, ketamine abusers may develop hepato-biliary toxicity manifested as recurrent epigastric pain, abnormal liver function, and biliary tree dilatation. The proposed mechanism for ketamine-induced cystitis is direct toxicity of ketamine metabolites on urinary tract mucosa. Because ketamine is metabolized in the liver and excreted in bile, mucosal toxicity has also been postulated as the cause of dilated bile ducts.”
The Daily Transmission does not believe any drugs should be illegal, but if one is to have a classification of drugs surely it should be based on relative harm. The UK has LSD and MDMA in Class A, cannabis in Class B, and ketamine in Class C. The US has cannabis, LSD, and MDMA as Schedule I, and ketamine as Schedule III.
David Nutt, the UK government’s former chief drugs advisor, was proposing reclassification of drugs such as MDMA, cannabis, and ketamine based on scientific evidence. Then he was sacked for being out of line with government policy. Which leaves us with politicians upholding the status quo at the expense of the health of the people.
I can’t see what kind of logic these categorizations are meant to be based on, but it would seem its time for a serious rethink (and some proper research) before more and more people find their way from the ‘K-hole’ to ‘K-Hell’.
‘Ketamine-associated lower urinary tract destruction: a new radiological challenge’
(Mason, et al, 2010)
‘Journey through the K-hole: Phenomenological aspects of ketamine use’
(Muetzelfeldt, et al, 2008)
For one of the more complete accounts of ketamine use and its effects, see Karl Jansen’s “Ketamine: Dreams and Realities”
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