A 2022 review noted that studies use such varied protocols for treating anxiety with ketamine that it is difficult to draw clear conclusions about its effects. Our services provide targeted, age-appropriate substance misuse services for young people, that put the young person at the centre of treatment. Symptoms of ketamine overdose include loss of consciousness, extremely slow heart rate, low blood pressure, seizure, coma and can be fatal. Recently, there has been a decrease in the number of people who use ketamine as a hallucinogenic drug due to efforts made by governments, training, and courses to prevent drug abuse by creating rehab programs81,82. A study conducted in 2019 appraised the effect of a brief information, motivation, and behavior skills (IMB) program and an education-as-usual (EAU) program in increasing awareness about ketamine abuse83.
Additional to its effect at the NMDAR, ketamine interacts with other receptor systems as well, including opioidergic, muscarinic and monaminergic receptors. Relatively little is known about the contributions of these receptor systems to the various effects of ketamine 32. Studies in mice lacking the μ-opioid receptor suggest a role of the μ-opioid receptor in ketamine-induced acute analgesia 33.
- Emergency medicine providers should be aware of the various mechanisms to treat ketamine toxicity and to prevent acute complications such as rhabdomyolysis, seizures, and chronic complications such as psychiatric disturbances and ulcerative cystitis.
- Also, providers should consider intoxication with alcohol, amphetamine, cocaine, LSD, MDMA, and salicylate, as well as delirium tremens from alcohol withdrawal.
- A study conducted in 2019 appraised the effect of a brief information, motivation, and behavior skills (IMB) program and an education-as-usual (EAU) program in increasing awareness about ketamine abuse83.
- Other effects of ketamine that may contribute to its analgesic behaviour include enhancement of descending inhibition (see below) and anti-inflammatory effects 29–31.
- Patients suffering from chronic pain or those taking opioids prior to surgery may react differently to ketamine, needing careful assessment and monitoring70.
Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs.
- At lower doses, the drug induces a state of mild dissociation with vivid hallucinations and the distortion of time and space (such as melting into the surroundings and out-of-body experience) 32,64.
- We recently treated 50 CRPS-1 patients with a 100 h intravenous treatment of low dose ketamine and concluded that the benefit from ketamine administration exceeded the risks 4.
- Safety is really where things open up, because this is a drug that affects perception and can cause hallucinations and visions.
- Upon termination of the ketamine infusion the enzymes slowly returned to normal (normal values reached within 3 months).
The Alcohol & Drug Services
Thanks to an interesting loophole in the laws governing drug advertising, ketamine is now marketed for the management of any number of different psychiatric illnesses. Depression, anxiety, post-traumatic stress disorder, and chronic pain are the big ones, but it’s also being marketed for other uses, ranging from Lyme disease to alcoholism to opioid addiction. One effective approach involves ketamine-assisted therapy (KAT) administered at doses of 1 to 1.5 mg/kg via intramuscular injection, combined with a Community of Practice (COP) framework78. A COP is a collaborative group with shared interests that aims to achieve both personal and collective goals, measuring outcomes one to two weeks after completing a 12-week program68. A final issue is the fact that chronic pain patients are treated in an inpatient setting. This is expensive and there is an urgent need for a reliable oral or transmucosal ketamine preparation.
History and Physical
Still, we should also keep in mind that chronic pain patients, treated with ketamine for longer periods of time, might experience similar adverse effects. Therefore, patients should be monitored closely and ketamine treatment should be terminated immediately when severe adverse effects are observed. In clinical practice, ketamine is considered safe, and in general, side effects are well tolerated. We recently treated 50 CRPS-1 patients with a 100 h intravenous treatment of low dose ketamine and concluded that the benefit from ketamine administration exceeded the risks 4. Cvrček 54 evaluated the side effects of a 3 month oral ketamine treatment (30 mg five times a day) in patients with diabetic polyneuropathy and post-herpetic neuralgia.
Adverse effects of ketamine use
Postoperatively, ketamine significantly reduces pain intensity and opioid requirements3-5. Ketamine has a direct negative inotropic effect and an indirect stimulatory effect on the cardiovascular system 12,63. Myocardial depression is observed after high dose ketamine infusion or during repeated (within minutes to hours) dosing of ketamine. Cardiovascular stimulation already occurs after low dose ketamine infusion and is characterized by tachycardia, systemic and pulmonary hypertension, and increases in cardiac output and myocardial oxygen consumption 12,32,63,64.
These reports (mostly derived from experimental studies) are at best preliminary and large randomized controlled trials in chronic pain patients are required to address these issues. CV function should be constantly monitored to determine the necessity for advanced airway treatments such as endotracheal intubation or non-invasive breathing systems like BiPAP or CPAP, continuous pulse oximetry, blood pressure, and heart rate. CV indicators should be monitored with special attention paid to any major changes that necessitate treatments such as IV antihypertensive medicines or the care of new dysrhythmias46,47. Continuous cardiac monitoring, supine patient placement with head elevation, prompt access to advanced airway equipment, and having a skilled emergency department physician are all strategies for mitigating these hazards45.
Selection criteria for patient selection based on medical history and current medications
Investigating alternative formulations and administration routes may enhance safety. Advancing knowledge of ketamine’s therapeutic window and risks will promote its safe clinical integration. Recently, North American print media have shifted to portraying ketamine as a therapeutic antidepressant rather than a substance of abuse41.
Recent studies, including systematic analyses, indicate that ketamine demonstrates rapid antidepressant effects in both adolescents and older adults, but the quality of evidence remains variable88. These findings highlight the necessity for well-designed randomized controlled trials to further assess ketamine’s therapeutic potential and optimize treatment outcomes across different demographics. As mentioned before a large body of evidence regarding the risks of ketamine comes from studies on the recreational use and chronic abuse of ketamine. Still, there is a large body of evidence from controlled studies in volunteers and patients as well as case reports that delineates the risks and side-effects of ketamine use. Ketamine is not currently approved by FDA for the treatment of any substance use disorder. Patients who experience symptom relief after intoxication should have continuous monitoring for 1 to 2 hours after their last symptom resolves.
Most users experience brief but terrifying hallucinations described as vivid, dream-like experiences distorting vision and sound, sensory perceptions, time, and space. Ketamine produces out-of-body dissociative experiences, causing feelings of disconnectedness, which may be perceived as observing themselves from afar. The hallucinations typically last 30 to 60 minutes when introduced intravenously or intramuscularly, though effects can linger one to two hours or longer.
The Danger of ‘America First’ in Global Health
The Loop welcomes the further investment in evidence-based approaches and support to reduce drug-related harm. The government has launched a new campaign to alert young people to the dangers of ketamine, counterfeit medicines and adulterated THC vapes. Acute kidney injury, electrolyte abnormalities, liver failure, and rhabdomyolysis may also occur. Giving up important social, occupational, or recreational activities because of ketamine.
Higher doses can lead to a “K-hole,” characterised by extreme dissociation and loss of bodily control. Typically, drug companies are restricted to marketing and promoting their products only for FDA-approved indications. But in the case of ketamine, the product is being marketed and promoted by clinics and telehealth companies that aren’t manufacturing the drug. Individuals who take ketamine recreationally report sensations, such as being separated from their body or a pleasant feeling of floating.
The Ketamine Side Effect Tool (KSET) is a complete system built specifically for this purpose, with modules for screening, baseline assessment, acute therapy, and follow-up to measure both immediate and long-term adverse effects63. To address issues including momentary dissociation, hypertension, and nausea, practitioners should educate patients, maintain a calm treatment atmosphere, and be ready to change doses or deliver more drugs why do people take ketamine risk factors and dangers as needed. Specific tools such as the clinician-administered dissociative states scale (CADSS) are used to assess dissociation levels64. Ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the NMDAR 8,23.
