Ketamine: anesthesia, antidepressant or party drug?

Scientifically speaking, ketamine is a very versatile drug called a “horse tranquilizer.” It is an anesthetic for humans and other animals.

Seven weeks after “Friends” actor Matthew L. Perry was found dead in his home in late October 2023, the Los Angeles County Medical Examiner determined that Perry died of “acute effects of ketamine.”

Secondary causes of death included drowning, coronary artery disease, and the effects of buprenorphine, which is used to treat opioid use disorder.

The AP and Reuters news agencies noted that the autopsy report stated that Perry had taken testosterone – she had been prescribed tamoxifen, a hormone regulator commonly used to prevent breast cancer.

Perry’s death: Various legal drugs and ketamine

Investigators reportedly found no alcohol, illegal drugs or drug paraphernalia, but they did find nicotine vapor, nicotine sticks and an inhaler, as well as the injectable diabetes drug Tirzepatid, which Perry is believed to have used to lose weight. weight.

The autopsy report lists “nontoxic levels of the benzodiazepine lorazepam” — benzodiazepines are a class of antidepressants that relieve anxiety and muscle spasms and reduce seizures.

But the coroner said ketamine was the main cause of Perry’s death. Perry’s friends said he had been using experimental ketamine infusion therapy to treat anxiety and depression. However, the dose of ketamine that caused Perry’s death was not related to the experimental ketamine treatment.

Ketamine is used as a medical anesthetic for humans and other animals, but the US Food and Drug Administration (FDA) has not approved ketamine for the treatment of psychiatric disorders.

What are the effects of ketamine?

Ketamine is classified as a dissociative anesthetic with hallucinogenic effects.

The effects of ketamine are very dependent on the dose used. The effects range from a “weird” and disconnected feeling to sedation and unconsciousness.

Ketamine is a fast-acting and relatively short-lived experience – compared to LSD hallucinations, ketamine hallucinations can last 30-60 minutes.

Smaller doses distort a person’s sight and sound perception and can create a feeling of calmness, euphoria and pain relief. It can leave the user feeling “out of body” and out of control.

Higher doses of stimulants create a feeling of “forgetting” similar to a near-death experience – also known as the K-hole.

The drug can cause amnesia, which is perhaps one of the reasons why it is used to “facilitate sexual violence” – as stated by the US Department of Justice’s Drug Enforcement Administration.

At even higher doses, the drug becomes an anesthetic agent, leading to sedation, unconsciousness, and a life-threateningly slow respiratory rate.

Ketamine is commonly used as a sedative and anesthetic in hospitals for surgery. It is one of the safest and most effective sedatives for children who need short emergency procedures in the hospital.

How is ketamine used recreationally?

Ketamine is a liquid and white powder, so it can be injected or snorted. Some people take it as a pill, mix it with drinks, or smoke it.

The drug is sometimes mixed with other party or club drugs, including amphetamines and MDMA.

The use of drug mixtures can cause unintended interactions between drugs and expose users to greater health risks.

An analysis of the current use of ketamine by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) found “a variety of dose-dependent acute and chronic harms, including neurological and cardiovascular toxicity, mental health problems such as depression, and urological complications such as bladder damage from intensive use.”

How is ketamine used to treat depression?

In 2019, the FDA approved a nasal spray based on a ketamine derivative – esketamine – along with an oral antidepressant to treat depression in adults when other medications have failed.

But in October 2023, the FDA warned of “increased interest” in the use of compounded ketamine products in the treatment of psychiatric disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder, when neither ketamine nor the resulting combination drugs are approved for safe use in humans.

In general, compounded drugs are a gray area. They can be made with drugs that are individually approved for human use, but the resulting combination drugs are not approved—that is, the new drug combination has not been tested for safety in humans.

Mixing, as you know, is not illegal per se – some patients need to have their medicines mixed (if you like) if they may have an allergic reaction to one of the ingredients in the original medicine, for example.

But the use of ketamine in compound drugs is a special case. The FDA warns of potential abuse that leads to psychiatric events, increased blood pressure, or respiratory depression. It advises against using any form of ketamine at home or anywhere a health care provider cannot monitor its use.

Research on Ketamine Abuse and Dependence

A study published in November 2023 suggested that subanesthetic ketamine was being falsely advertised online as a treatment for health conditions.

“Advertisers may promote intravenous infusions and/or oral formulations described as an emerging treatment for mental illness,” the researchers wrote in an article published by the JAMA Network.

“Despite the potential benefits of ketamine in the treatment of certain mental illnesses, legitimate concerns have been raised about similarities to opioid prescribing and the risk of widespread abuse,” they wrote.

Ketamine is addictive. But that’s where things change even more — because another study published in 2018 suggested that ketamine could be used to treat addiction.

The study found that ketamine had helped to keep recovering alcoholics and cocaine and heroin addicts clean for longer. But even those researchers said: more research is needed.

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