What is it?
Ketamine (also called “K”, “Keta”, “Special K” or “Vitamin K”) is an anesthetic and painkiller that is also used in medicine. In 2019, S-ketamine was approved in the EU as a nasal spray (Spravato®) for the treatment of otherwise treatment-resistant depression and the acute treatment of psychiatric emergencies related to depression. Ketamine can come from both medical and private/illegal manufacturing.
Ketamine can come in a variety of forms:
- as a clear, liquid solution from medical production
- as nasel-spray from medical production
- as a whitish or yellowish crystalline powder
- less often in pill-form
There are two different chemical forms of ketamine: ketamine (racemate) and S-ketamine. S-ketamine has twice the effect of ketamine and should only be dosed half as much.
| Ketamine (racemate) (e.g. trade name Ketanest®) | S-ketamine (e.g. trade names Ketanest-S® or Ketamine-)S®. |
| 1:1 mixture of S-ketamine and R-ketamine – less potent than S-ketamine | is obtained from ketamine by separating R- and S-ketamine, significantly stronger anesthetic and analgesic effect produces less frequent unpleasant hallucinations or nightmares. |
Illegally traded ketamine is often subject to strong fluctuations in active ingredient content and may be mixed with other substances and extenders. Even apparent medical products may be altered or stretched.
How is it taken?
Ketamine can be dissolved in a drink or swallowed (“bomb”), snorted, and injected. Usually, ketamine is snorted or swallowed in powder form.
The following applies to all dose information: S-ketamine should only be dosed half as high!
Sniffing:
The effect occurs after about 5-15 minutes and lasts for about 60 minutes. After-effects (feeling of weakness) may persist for 1-3 hours after consumption.
Dosage: A common dose is approximately 0.3 to 0.4 mg per kg body weight.
Eine Überdosierung kann ab 2 mg pro kg Körpergewicht erfolgen.
Swallowed:
The onset of action can take 20 minutes, depending on the stomach contents, and lasts for about 90 minutes. After-effects may persist for 4-8 hours after consumption.
Dosage: A common dose is 1.2 to 1.5 mg per kg body weight.
An overdose can occur from 5mg per kg body weight.
Injected:
If possible, only medicinally available solutions should be used.
The effect is immediate, duration of action is 30-60 minutes. After-effects may continue for 2-4 hours.
Dosage: A common dose intravenously is approximately 0.6 mg per kg body weight.
For intramuscular consumption, approximately 0.9 mg per kg body weight.
(Sources: Ketamin / drugscouts.de)
How does it feel?
Every substance has a different effect on different people. The effect of ketamine depends on personal factors (body mass, habituation, type of drink, amount ingested, on a full or empty stomach, …). An important role is played by your environment, and by your mental and physical condition.
When illegal substances are consumed, it is usually not known how much active ingredient is in the drug or parts of it. This makes accurate dosing difficult and increases the likelihood that you will experience effects you did not intend.
If you’re on ketamine, it can feel like:
- euphoria
- Intoxication
- anesthesia
- low pain sensation
- Altered perception
- hallucinations
- decreased body control, paralysis
- Impression that your body and mind are separating (dissociation, ego dissolution)
- visions, hallucinations, dreams
- Feeling of stepping out of one’s own body or being deep in a hole (“K-Hole”).
In the K-Hole you can still perceive your surroundings (limited), but you can no longer control your body. With the naked eye, it is impossible to tell from the outside if someone is in a K-Hole, asleep, temporarily unconscious, or if it is a life-threatening emergency.
Side effects and long-term impact
When doing ketamine, the following side-effects can occur:
- heightened pulse
- Nausea, Vomiting
- slowed down breathing
- Restriction of mobility, paralysis
- emotional sensation is muted
- Severe drowsiness
- unconsciousness
- Anxieties (e.g.: by experiencing the “K-Hole”)
- near death experiences
After consumption, it is likely that you will feel physically weak for some time. Also, you may not be able to remember everything.
If you consume continuously over a longer period of time, long-term side effects increasingly occur. This may include:
- Functional disorders and diseases of the urinary tract (such as cystitis).
- Gastrointestinal complaints
- Lack of concentration, memory problems
- depression or different mental problems.
- It is believed that long-term and high-dose ketamine use can cause permanent organ damage.
Overdose
Consequences of a ketamine overdose include:
- Paralysis, seizures
- Spontaneous unconsciousness (sometimes with eyes open)
- slowed breathing up to respiratory arrest (possibly also with intravenous consumption)
- epileptic seizures
- coma
- near death experiences
Consumption of ketamine has apparently already lead to death. It is not known to what extent other substances or impurities played a role.
In the case of apparent unconsciousness, it is not possible to distinguish from the outside whether the person is currently in the K-Hole, merely asleep, or it is a life-threatening emergency. Provide first aid, monitor breathing and stay with the person. Get medical help and call an emergency ambulance 112!
First aid guide for drug-related emergencies (German).
You can find more information on first aid for chemsex emergencies here .
You can also contact the following organizations:
Drug emergency telephone: 01806 313031 (24 hours) Drug emergency service: 030 19237 (24 hours)
Drug combinations
Generally speaking: consuming more than one substance at a time puts your body and your mental state under more pressure. Certain effects may be intensified, weakened or delayed by the interactions. The risk of overdose or side effects becomes unpredictable.
- Ketamine + alcohol, GHB/GBL, heroin, benzos or neuroleptics: Avoid combination if possible. High risk of respiratory paralysis, respiratory arrest!
- Ketamine + upper/stimulants, e.g. speed, crystal meth or cocaine: cardiovascular stress increases extremely. The combination of stimulants and sedatives is usually experienced as unpleasant; stimulants increase the urge to move – combined with the paralysis and decreased body control due to ketamine, accidents or injuries can quickly occur.
- Ketamine + MDMA: The mode of action of both substances work in opposite ways (anesthetize + enhance sensory perceptions). At high doses of ketamine, the combination is described as very unpleasant.
Addiction potential and withdrawal
- At high doses of ketamine, the combination is described as very unpleasant. This means you have to take more and more to feel the same effect.
You can counteract a habituation effect with longer consumption breaks. - It is possible to develop a psychological dependence – if you use daily, that increases the likelihood.
- There is currently no evidence that ketamine causes physical dependence.
- When you stop using after a long time, you will probably feel a strong craving for the drug. In addition, the patient may experience psychological symptoms such as depression, anxiety, jitteriness, and sleep disturbances.
- Some long-term users report physical symptoms such as motor impairment, tremors, dizziness, and exhaustion after cessation of use.
- Self-organized “cold turkey” withdrawal or controlled use (without medical consultation or supervision) can be physically and psychologically stressful. Find out which hospitals in your area offer medically supervised detox/addiction treatment and get support.
Safer Use
- If possible, take advantage of drugchecking offers or test a small amount at first. Illegally traded ketamine is often subject to strong fluctuations in active ingredient content and might be mixed with other substances and extenders. This makes accurate dosing difficult and makes it impossible to predict what the effect will be.
- If you swallow ketamine, the effect may be greatly delayed. Wait until the effect unfolds and do not add more!
- Always measure out your dose yourself. Do not transfer the responsibility for this to others. That way, you’re guaranteed to stay on top of things.
- It is never okay to administer substances to other people without their knowledge and consent! You endanger the life of a person and are liable to prosecution. If you witness such a situation, get help and protect the person being spiked.
- Wait at least an hour after eating before taking ketamine. Increased nausea may occur. In the state of full intoxication, you lose control over your body. In case of vomiting, it can be easier to choke on it.
- Under no circumstances should food or drink be consumed while intoxicated with ketamine. Ketamine disrupts the motor function of the mouth and throat. Swallowing or cramping in the larynx may occur – suffocation, respiratory or cardiac arrest are possible consequences.
- Consume in the company of people you trust. Ideally, there should be a sober person with you who can provide assistance in an emergency. When using ketamine, narcotic states are likely; this means you lose touch with reality, and can barely move or speak at all.
- Make sure the environment is quiet and familiar. Due to the narcotic effect of ketamine, it is not a party drug. Consumption should be planned and prepared in principle.
- Keep as calm as possible while under the influence of ketamine. Due to lack of body control, movement (e.g. dancing) can lead to accidents and injuries more quickly. Injuries are also more likely to be misjudged because of the lack of pain sensation.
- A ketamine experience can be stressful. Allow yourself enough time to process the experience and recover after consumption.
- If you feel unsafe or uncomfortable, refrain from consumption. The hallucinations and perceptual changes under ketamine can be very intense and perceived as distressing.
- Do not consume in case of hypertension, heart disorders, glaucoma, epilepsy, depression, hyperthyroidism, angina pectoris or (latent) psychosis.
- Avoid mixed use with alcohol and benzodiazepines, GHB, heroin, or tilidine, as all of these substances depress the respiratory center. There is a risk of respiratory arrest.
- Refrain from responsible activities under the influence of ketamine (e.g., driving a car/bicycle). You should not go swimming or bathing while under the influence of ketamine – risk of drowning.
Safer Sex
- Ketamine relaxes the muscles in the ass, which is why it is popular for fisting. Ketamine reduces the sensation of pain. Injuries can occur during high-injury sex practices, which increases the risk of contracting HIV and other sexually transmitted infections (especially hepatitis).
- Ketamine can be disinhibiting and cause you to pay less attention to safe sex while intoxicated. This increases your HIV and STI infection risk.
- Sex and Ketamine works only with mutual consent and great trust. Clarify in advance which sex practices you both want and which you don’t want.
- Consume only so much that you can defend yourself or still recognize the defensive signals of your partner.
- Only sleep with people who can communicate boundaries and consent! If a person is so high that he or she is no longer able to converse, he or she is also incapable of giving consent. Under no circumstances may sexual acts be (further) performed on them. This is true even if mutual intentions were previously discussed while conscious. It is a criminal offense.
- Before getting down to business, get sufficient amounts of sex utensils (gloves, condoms, lubricant) ready.
- Get tested for sexually transmitted infections at least once a year and check your hepatitis A/B vaccination status.
- If you notice any abnormalities on your penis, vulva/fronthole or bottom, you should see your doctor.
Interactions with HIV treatment
- Booster drugs (Norvir®, Tybost®) slow the breakdown of ketamine. This may cause ketamine to work harder or longer and cause increased side effects.
- Take drugs and HIV medications at different times. This might decrease the chance of side-effects. Always use a low dose when using drugs at the same time as medications.
- Since it may be a long night, bring enough medication with you and stick to your medication schedule.
- Talk to your doctor about the interaction of your HIV medications with intoxicants.
- Information on interactions between substances and HIV medications . can be found here
Counseling
- Would you like to talk about your use, have questions, or are looking for support about substance use?
- Do you want to share and/or reflect on your substance experiences with someone?
- Feeling that you are using too much?
- Are you worried about friends or acquaintances and want advice or tips on how to deal with the situation as a friend?
- Do you feel that you might be using too much? The drug advice services in your area will be happy to help you!
Sources:
- Ketamin – sauber drauf! mindzone.info
- Ketamin | drugscouts.de
- Ketamin – ein Narkosemittel als Partydroge “Special K” | Die Techniker (tk.de)
- Ketamin – drugcom
- Ketamin (chemie.de)Harm related to recreational ketamine use and its relevance for the clinical use of ketamine. A systematic review and comparison study: Expert Opinion on Drug Safety: Vol 21, No 1 (tandfonline.com) “It has been noted that ketamine, when used chronically and daily in higher doses, may result in neurotoxicity with impaired cognition (memory, learning, and executive functions), cystitis (‘ketamine bladder’) and a phenomenon known as ‘K cramps,’ consisting of symptoms ranging from vague to intense abdominal pain [23–28] and urological toxicity [29].