Ketamine in society and culture

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Ketamine has had a wide variety of medicinal and recreational uses since its discovery in 1962.

Contents

Generic names

Ketamine is the English generic name of the drug and its INN Tooltip International Nonproprietary Name and BAN Tooltip British Approved Name, while ketamine hydrochloride is its USAN Tooltip United States Adopted Name, USP Tooltip United States Pharmacopeia, BANM Tooltip British Approved Name, and JAN Tooltip Japanese Accepted Name. [1] [2] [3] Its generic name in Spanish and Italian and its DCIT Tooltip Denominazione Comune Italiana are ketamina, in French and its DCF Tooltip Dénomination Commune Française are kétamine, in German is Ketamin, and in Latin is ketaminum. [2]

The S(+) stereoisomer of ketamine is known as esketamine , and this is its BAN Tooltip British Approved Name while esketamine hydrochloride is its BANM Tooltip British Approved Name. [4]

Brand names

Ketamine is sold throughout the world primarily under the brand name Ketalar. [2] [3] It is also marketed under a variety of other brand names, including Calypsol, Ketamin, Ketamina, Ketamine, Ketaminol, Ketanest, Ketaset, Tekam, and Vetalar among others. [2] [3]

Esketamine is sold mainly under the brand names Ketanest, Ketanest-S, and Spravato. [4]

Ketamine clinics

After the publication of the NIH-run antidepressant clinical trial, clinics began opening in which the intravenous ketamine is given for depression. [5] [6] This practice is an off label use of IV ketamine in the United States, though the intranasal version of esketamine has been approved by the FDA for treatment of depression [5] [7] In 2015 there were about 60 such clinics in the US; the procedure was not covered by insurance, and people paid between $400 and $1700 out of pocket for a treatment. [8] It was estimated in 2018 that there were approximately 300 of these clinics. [9] The number of clinics has been increasing rapidly. [9]

A chain of such clinics in Australia, run by Aura Medical Corporation, was closed down by regulatory authorities in 2015. They found that the clinics' marketing was not supported by scientific research and the chain sent patients home with ketamine and needles to administer infusions to themselves. [10]

While ketamine is legally marketed in many countries worldwide, [2] it is also a controlled substance in many countries. [11]

Australia

In Australia, ketamine is listed as a schedule 8-controlled drug under the Poisons Standard (October 2015). [12] Schedule 8 drugs are outlined in the Poisons Act 1964 as "Substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence." [13]

Canada

In Canada, ketamine has been classified since 2005 as a Schedule I narcotic. [14]

Hong Kong

In Hong Kong, since 2000, ketamine has been regulated under Schedule 1 of Hong Kong Chapter 134 Dangerous Drugs Ordinance. It can be used legally only by health professionals, for university research purposes, or with a physician's prescription. [15] [16]

Taiwan

By 2002, ketamine was classified as class III in Taiwan; given the recent rise of its prevalence in East Asia, however, rescheduling into class I or II is being considered. [17] [18]

India

In December 2013, the government of India, in response to rising recreational use and the use of ketamine as a date rape drug, has added it to Schedule X of the Drug and Cosmetics Act, requiring a special license for sale and maintenance for two years of records of all sales. [19] [20]

United Kingdom

In the United Kingdom, it became labeled a Class C drug on 1 January 2006. [17] [21] On 10 December 2013, the UK Advisory Council on the Misuse of Drugs (ACMD) recommended that the government reclassify ketamine to become a Class B drug. [22] On 12 February 2014 the Home Office announced it would follow this advice "in light of the evidence of chronic harms associated with ketamine use, including chronic bladder and other urinary tract damage". [23] [24]

The UK Minister of State for Crime Prevention, Norman Baker, responding to the ACMD's advice, said the issue of ketamine's rescheduling for medical and veterinary use would be addressed "separately to allow for a period of consultation". [23]

United States

Because of the increase in recreational use, ketamine was placed in Schedule III of the United States Controlled Substance Act in August 1999. [25]

Recreational use

Ketamine solution poured onto glass and left to dry Ketamine Crystals.jpg
Ketamine solution poured onto glass and left to dry

Recreational use of ketamine was documented in the early 1970s in underground literature (e.g., The Fabulous Furry Freak Brothers ). [26] It was used in psychiatric and other academic research through the 1970s, culminating in 1978 with the publishing of psychonaut John Lilly's The Scientist, and Marcia Moore and Howard Alltounian's Journeys into the Bright World, which documented the unusual phenomenology of ketamine intoxication. [27] The incidence of non-medical ketamine use increased through the end of the century, especially in the context of raves and other parties. [28] [29] [30] [31] [32] Its emergence as a club drug differs from other club drugs (e.g., MDMA), however, due to its anesthetic properties (e.g., slurred speech, immobilization) at higher doses; [32] in addition, reports are common of ketamine being sold as "ecstasy". [33] In the 1993 book E for Ecstasy [34] (about the uses of the street drug Ecstasy in the UK), the writer, activist, and ecstasy advocate Nicholas Saunders highlighted test results showing that certain consignments of the drug also contained ketamine. Consignments of ecstasy known as "strawberry" contained what Saunders described as a "potentially dangerous combination of ketamine, ephedrine, and selegiline", as did a consignment of "Sitting Duck" ecstasy tablets. [35]

The use of ketamine as part of a "post-clubbing experience" has also been documented. [36] Ketamine's rise in the dance culture was most rapid in Hong Kong by the end of the 1990s. [32]

Ketamine use as a recreational drug has been implicated in deaths globally, with more than 90 deaths in England and Wales in the years of 2005–2013. [37] They include accidental poisonings, drownings, traffic accidents, and suicides. [37] The majority of deaths were among young people. [38] This has led to increased regulation (e.g., upgrading ketamine from a Class C to a Class B banned substance in the U.K.). [39]

Unlike the other well-known dissociatives phencyclidine (PCP) and dextromethorphan (DXM), ketamine is very short-acting. It takes effect within about 10 minutes, [40] while its hallucinogenic effects last 60 minutes when insufflated or injected, and up to two hours when ingested orally. [41]

At subanesthetic doses—under-dosaged from a medical point of view—ketamine produces a dissociative state, characterised by a sense of detachment from one's physical body and the external world which is known as depersonalization and derealization. [42] At sufficiently high doses, users may experience what is called the "K-hole", a state of dissociation with visual and auditory hallucinations. [43] John C. Lilly, Marcia Moore, D. M. Turner and David Woodard (amongst others) have written extensively about their own entheogenic use of, and psychonautic experiences with, ketamine. [44] Turner died prematurely due to drowning during presumed unsupervised ketamine use. [45] In 2006 the Russian edition of Adam Parfrey's Apocalypse Culture II was banned and destroyed by authorities owing to its inclusion of an essay by Woodard about the entheogenic use of, and psychonautic experiences with, ketamine. [46] : 288–295 

Because of its ability to cause confusion and amnesia, ketamine has been used for date rape. [40] [47]

Slang terms

Production for recreational use has been traced to 1967, when it was referred to as "mean green" and "rockmesc". [48] Recreational names for ketamine include "Special K", [49] "K", [50] [49] "Kitty", "Ket", [51] "K2", [50] "Vitamin K", [49] [51] "Super K", [49] "Jet", [49] [52] "Super acid", [49] "Mauve", [49] "Special LA coke", [49] "Purple", [49] "Cat Valium", [52] [53] "Keller", [53] "Kelly's Day", [53] "New ecstasy", [54] "Psychedelic heroin", [54] "bump", [55] "Majestic". [56] A mixture of ketamine with cocaine is called "Calvin Klein" or "CK1". [57] In Hong Kong, where illicit use of the drug is popular, ketamine is colloquially referred to as "kai-jai". [32]

Usage

North America

According to the ongoing Monitoring the Future study conducted by University of Michigan, prevalence rates of recreational ketamine use among American secondary school students (grades 8, 10, and 12) have varied between 0.8 and 2.5% since 1999, with recent rates at the lower end of this range. [58] The 2006 National Survey on Drug Use and Health (NSDUH) reports a rate of 0.1% for persons ages 12 or older with the highest rate (0.2%) in those ages 18–25. [59] Further, 203,000 people are estimated to have used ketamine in 2006, and an estimated 2.3 million people used ketamine at least once in their life. [59] A total of 529 emergency department visits in 2009 were ketamine-related. [60]

In 2003, the U.S. Drug Enforcement Administration conducted Operation TKO, a probe into the quality of ketamine being imported from Mexico. [61] As a result of operation TKO, U.S. and Mexican authorities shut down the Mexico City company Laboratorios Ttokkyo, which was the biggest producer of ketamine in Mexico. According to the DEA, over 80% of ketamine seized in the United States is of Mexican origin. As of 2011, it was mostly shipped from places like India, as cheap in cost as $5/gram. [61] The World Health Organization Expert Committee on Drug Dependence, in its thirty-third report (2003), [62] recommended research into ketamine's recreational use due to growing concerns about its rising popularity in Europe, Asia, and North America.

Europe

Cases of ketamine use in club venues have been observed in the Czech Republic, France, Italy, Hungary, The Netherlands, and the United Kingdom. [63] Additional reports of use and dependence have been reported in Poland and Portugal. [64] [65]

Australia

Australia's 2019 National Drug Strategy Household Survey report shows a prevalence of recent ketamine use of 0.3% in 2004, 0.2% in 2007 and 2010, 0.4% in 2016 and 0.9% in 2019 in persons aged 14 or older. [66]

Asia

In China, the small village of Boshe in eastern Guangdong was confirmed as a main production centre in 2013 when it was raided. [67]

Established by the Hong Kong Narcotics Division of the Security Bureau, the Central Registry of Drug Abuse (CRDA) maintains a database of all the illicit drug users who have come into contact with law enforcement, treatment, health care, and social organizations. The compiled data are confidential under The Dangerous Drugs Ordinance of Hong Kong, and statistics are made freely available online on a quarterly basis. [68] [69] Statistics from the CRDA show that the number of ketamine users (all ages) in Hong Kong has increased from 1605 (9.8% of total drug users) in 2000 to 5212 (37.6%) in 2009. [70] Increasing trends of ketamine use among illicit drug users under the age of 21 were also reported, rising from 36.9% of young drug users in 2000 to 84.3% in 2009. [70]

A survey conducted among school-attending Taiwanese adolescents reported prevalence rates of 0.15% in 2004, 0.18% in 2005, and 0.15% in 2006 in middle-school (grades 7 and 9) students; in Taiwanese high-school (grades 10 and 12) students, prevalence was 1.13% in 2004, 0.66% in 2005, and 0.44% in 2006. [71] From the same survey, a large portion (42.8%) of those who reported ecstasy use also reported ketamine use. [71] Ketamine was the second-most used illicit drug (behind ecstasy) in absconding Taiwanese adolescents as reported by a multi-city street outreach survey. [72] In a study comparing the reporting rates between web questionnaires and paper-and-pencil questionnaires, ketamine use was reported a higher rate in the web version. [73] Urine samples taken at a club in Taipei, Taiwan, showed high rates of ketamine use at 47.0%; this prevalence was compared with that of detainees suspected of recreational drug use in the general public, of which 2.0% of the samples tested positive for ketamine use. [74]

Law enforcement

In the late 2010s and early 2020s, law enforcement agencies in some U.S. states began directing paramedics to use ketamine to sedate people under arrest, sometimes under the auspices of treatment for the controversial diagnosis "excited delirium". [75] [76] [77] [78] [79] [80] The American Society of Anesthesiologists and American College of Emergency Physicians oppose the use of ketamine or any similar agent to incapacitate someone solely for a law enforcement purpose. [81]

Use in humor and internet memes

A joke about ketamine and the Lego Star Wars minifigure Yoda has become a popular internet meme. The joke revolves around the character having a perceived addiction to the drug and killing people with the car Honda Civic. It derives from a cabrio car playable in the 2007 cult classic video game Lego Star Wars: The Complete Saga 's "Lego City" bonus level. [82]

Related Research Articles

<span class="mw-page-title-main">MDMA</span> Psychoactive drug, often called ecstasy

3,4-Methyl​enedioxy​methamphetamine (MDMA), commonly known as ecstasy, and molly or mandy, is a potent empathogen–entactogen with stimulant and minor psychedelic properties. Investigational indications include as an adjunct to psychotherapy in the treatment of post-traumatic stress disorder (PTSD) and social anxiety in autism spectrum disorder. The purported pharmacological effects that may be prosocial include altered sensations, increased energy, empathy, and pleasure. When taken by mouth, effects begin in 30 to 45 minutes and last three to six hours.

<span class="mw-page-title-main">Ketamine</span> Dissociative anesthetic and anti-depressant

Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression and pain management. It is a novel compound that was derived from phencyclidine in 1962 in pursuit of a safer anesthetic with fewer hallucinogenic effects.

<span class="mw-page-title-main">Oxycodone</span> Opioid medication

Oxycodone, sold under various brand names such as Roxicodone and OxyContin, is a semi-synthetic opioid used medically for treatment of moderate to severe pain. It is highly addictive and is a commonly abused drug. It is usually taken by mouth, and is available in immediate-release and controlled-release formulations. Onset of pain relief typically begins within fifteen minutes and lasts for up to six hours with the immediate-release formulation. In the United Kingdom, it is available by injection. Combination products are also available with paracetamol (acetaminophen), ibuprofen, naloxone, naltrexone, and aspirin.

<span class="mw-page-title-main">Phencyclidine</span> Dissociative hallucinogenic drug, mostly used recreationally

Phencyclidine or phenylcyclohexyl piperidine (PCP), also known in its use as a street drug as angel dust among other names, is a dissociative anesthetic mainly used recreationally for its significant mind-altering effects. PCP may cause hallucinations, distorted perceptions of sounds, and violent behavior. As a recreational drug, it is typically smoked, but may be taken by mouth, snorted, or injected. It may also be mixed with cannabis or tobacco.

<span class="mw-page-title-main">Recreational drug use</span> Use of drugs with the primary intention to alter the state of consciousness

Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an intoxicating effect. Recreational drugs are commonly divided into three categories: depressants, stimulants, and hallucinogens.

<span class="mw-page-title-main">Substance abuse</span> Harmful use of drugs

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

<span class="mw-page-title-main">Club drug</span> Category of recreational drugs

Club drugs, also called rave drugs or party drugs, are a loosely defined category of recreational drugs which are associated with discothèques in the 1970s and nightclubs, dance clubs, electronic dance music (EDM) parties, and raves in the 1980s to today. Unlike many other categories, such as opiates and benzodiazepines, which are established according to pharmaceutical or chemical properties, club drugs are a "category of convenience", in which drugs are included due to the locations they are consumed and/or where the user goes while under the influence of the drugs. Club drugs are generally used by adolescents and young adults.

A date rape drug is any drug that incapacitates another person and renders that person vulnerable to sexual assault, including rape. The substances are associated with date rape because of reported incidents of their use in the context of two people dating, during which the victim is sexually assaulted or raped or suffers other harm. However, substances have also been exploited during retreats, for example ayahuasca retreats. The substances are not exclusively used to perpetrate sexual assault or rape, but are the properties or side-effects of substances normally used for legitimate medical purposes. One of the most common incapacitating agents for date rape is alcohol, administered either surreptitiously or consumed voluntarily, rendering the victim unable to make informed decisions or give consent.

<span class="mw-page-title-main">Speedball (drug)</span> Combination of narcotics

Speedball, powerball, or over and under is the polydrug mixture of a stimulant with a depressant, usually an opioid. The most well-known mixture used for recreational drug use is that of cocaine and heroin; however, amphetamines can also be mixed with morphine and/or fentanyl. A speedball may be taken intravenously or by nasal insufflation.

<span class="mw-page-title-main">Nimetazepam</span> Benzodiazepine medication

Nimetazepam is an intermediate-acting hypnotic drug which is a benzodiazepine derivative. It was first synthesized by a team at Hoffmann-La Roche in 1964. It possesses powerful hypnotic, anxiolytic, sedative, and skeletal muscle relaxant properties. Nimetazepam is also a particularly potent anticonvulsant. It is marketed in 5 mg tablets known as Erimin, which is the brand name manufactured and marketed by the large Japanese corporation Sumitomo. Japan is the sole manufacturer of nimetazepam in the world. Outside of Japan, Erimin is available in much of East and Southeast Asia and was widely prescribed for the short-term treatment of severe insomnia in patients who have difficulty falling asleep or maintaining sleep. Sumitomo has ceased manufacturing Erimin since November 2015. It is still available as a generic drug or as Lavol.

<span class="mw-page-title-main">Drug</span> Substance having effect(s) on the body of an individual

A drug is any chemical substance that when consumed causes a change in an organism's physiology, including its psychology, if applicable. Drugs are typically distinguished from food and other substances that provide nutritional support. Consumption of drugs can be via inhalation, injection, smoking, ingestion, absorption via a patch on the skin, suppository, or dissolution under the tongue.

<span class="mw-page-title-main">Esketamine</span> Medication

Esketamine, sold under the brand names Spravato and Ketanest among others, is the S(+) enantiomer of ketamine. It is a dissociative hallucinogen drug used as a general anesthetic and as an antidepressant for treatment of depression. Esketamine is the active enantiomer of ketamine in terms of NMDA receptor antagonism and is more potent than racemic ketamine.

<span class="mw-page-title-main">Mephedrone</span> Synthetic stimulant drug

Mephedrone, also known as 4-methylmethcathinone, 4-MMC, and 4-methylephedrone, is a synthetic stimulant drug of the amphetamine and cathinone classes. Slang names include drone, M-CAT, White Magic, meow meow and bubble. It is chemically similar to the cathinone compounds found in the Khat plant of eastern Africa. It comes in the form of tablets or crystals, which users can swallow, snort or inject, producing effects similar to those of MDMA, amphetamines and cocaine.

Substituted amphetamines are a class of compounds based upon the amphetamine structure; it includes all derivative compounds which are formed by replacing, or substituting, one or more hydrogen atoms in the amphetamine core structure with substituents. The compounds in this class span a variety of pharmacological subclasses, including stimulants, empathogens, and hallucinogens, among others. Examples of substituted amphetamines are amphetamine (itself), methamphetamine, ephedrine, cathinone, phentermine, mephentermine, tranylcypromine, bupropion, methoxyphenamine, selegiline, amfepramone (diethylpropion), pyrovalerone, MDMA (ecstasy), and DOM (STP).

<span class="mw-page-title-main">Methoxetamine</span> Dissociative drug

Methoxetamine, abbreviated as MXE, is a dissociative hallucinogen that has been sold as a designer drug. It differs from many dissociatives such as ketamine and phencyclidine (PCP) that were developed as pharmaceutical drugs for use as general anesthetics in that it was designed specifically to increase the antidepressant effects of ketamine.

Illegal drug abuse is the action of using drugs that are prohibited by the government or strictly controlled by means of prescription to alter one’s consciousness and emotions. The Hong Kong government has a zero tolerance policy against illegal drug use. Drugs such as cannabis and ecstasy, which can be considered recreational drugs in other countries are all illegal in Hong Kong.

<span class="mw-page-title-main">Arketamine</span> Chemical compound

Arketamine (developmental code names PCN-101, HR-071603), also known as (R)-ketamine or (R)-(−)-ketamine, is the (R)-(−) enantiomer of ketamine. Similarly to racemic ketamine and esketamine, the S(+) enantiomer of ketamine, arketamine is biologically active; however, it is less potent as an NMDA receptor antagonist and anesthetic and thus has never been approved or marketed for clinical use as an enantiopure drug. Arketamine is currently in clinical development as a novel antidepressant.

<span class="mw-page-title-main">Norketamine</span> Major active metabolite of ketamine

Norketamine, or N-desmethylketamine, is the major active metabolite of ketamine, which is formed mainly by CYP3A4. Similarly to ketamine, norketamine acts as a noncompetitive NMDA receptor antagonist, but is about 3–5 times less potent as an anesthetic in comparison.

<span class="mw-page-title-main">2-Fluorodeschloroketamine</span> Chemical compound

2-Fluorodeschloroketamine is a dissociative anesthetic related to ketamine. Its sale and use as a designer drug has been reported in various countries. It is an analogue of ketamine where the chlorine group has been replaced by fluorine. Due to its recent emergence, the pharmacological specifics of the compound are mostly unclear, but effects are reported to be similar to its parent compound, ketamine.

<span class="mw-page-title-main">2-Oxo-PCE</span> Chemical compound

2-Oxo-PCE is a dissociative anesthetic of the arylcyclohexylamine class that is closely related to deschloroketamine and eticyclidine, and has been sold online as a designer drug.

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