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A Review of the non-medical use of Ketamine: Part 1: Use, Users and Consequences
Jansen, K. L. R. (2001) A review of the non-medical use of ketamine: part 1: use, users and consequences. Journal of Psychoactive Drugs (in press) 2. Ketamine and the dance culture 4. Near-death and near-birth experiences ABSTRACT Ketamine is a dissociative anesthetic with an accepted place in human medicine. Ketamine also has psychedelic properties, and there has been a recent increase in non-medical use linked with the growth of the 'dance culture'. This has attracted little comment in the formal literature but has been the subject of many reports in the media. Myths and misunderstandings are common. The psychedelic properties of ketamine have also led to its use as an adjunct to psychotherapy (Krupitsky & Grinenko 1997). This review is intended as a resource for the wide range of persons now requesting accurate information about the non-medical use of ketamine. It accepts the current necessity of sometimes referring to anecdotal reports while seeking to encourage an increase in formal research. The review includes the history of ketamine, its growing role as a 'dance drug', the sought-after effects for which it is taken in a non-medical context (including the near-death experience), how these are produced, common mental and physical adverse effects, and the ketamine model of schizophrenia. Ketamine dependence, its treatment, and harm minimisation issues are dealt with in Part 2. KEY WORDS Ecstasy (methylenedioxy-methamphetamine, MDMA), flashbacks, ketamine, NMDA (N-methyl-D-aspartate) receptors, near-death experience (NDE), glutamate, phencyclidine (PCP), post-traumatic stress disorder (PTSD), psychedelic, schizophrenia. I can't understand why anybody would want to take the stuff. It gives you nightmares, doesn't it? (Consultant Psychiatrist in Addictions, 1996) That 22 minute journey to becoming the intelligence at the heart of the universe remains the most powerful and cosmic experience of my life. ( Ketamine User, 1997) [both quotes are from Jansen 2000] In 1962, Calvin Stevens invented ketamine at the Parke-Davis laboratories in Michigan. The new drug was related to PCP (phencyclidine) but was shorter acting and far less toxic, producing a trance-like 'dissociative anaesthesia' (Domino 1965). Ketamine was soon launched into the 'psychedelic underground', sold as 'rockmesc' along the Florida coast, and noted in 'underground' literature (e.g. Shelton & Sheridan 1975). In 1970, the FDA approved ketamine for human use and it became popular as a battlefield anesthetic. It was (and still is) legally sold as Ketalar (Parke-Davis, for humans), Ketaset (Fort Dodge, for animals), and other brands. Warnings about the drug's potential for unauthorised use soon appeared in the medical literature (Reier 1971) as ketamine appeared more widely on the unauthorised drug market, with 'street' use of solutions first officially noted in 1971 in California (Siegel 1978). Young et al. (1977) believed that recreational use of ketamine might be partly attributed to experiences gained in Vietnam. By the end of the decade, the FDA was concerned about non-medical use (FDA 1979), especially after publication of Journeys Into The Bright World (Moore & Alltounian 1978), The Scientist: A Novel Autobiography (Lilly 1978), the report by Siegel (1978) and discussions in Psychedelic Drugs Reconsidered (Grinspoon & Bakalar 1979), Psychedelics Encyclopaedia (1978, in: Stafford 1992), and High Times (Ashley 1978). Marcia Moore was a famous author of New Age books. She first took ketamine in 1976, aged 48, with friends in California. A year later she suggested taking ketamine to Howard Alltounian, MD, an anesthetist who came to one of her workshops. After two such 'journeys' together, as they called them, they became engaged, having known each other for just a week: The spell was raying forth in a multihued canticle, a garland of love woven with bands of light - the next ten minutes or so were the most emotionally intense - the Goddess Ketamine had put the seal of approval on our union... At the point of emergence I often did weep and my tears seemed to be drops drawn directly from a shoreless sea of inexpressibly deep feelings...ketamine works primarily on the 'emotional body' whereas LSD is more mental in its effects..(Moore & Alltounian 1978) 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'. She took the drug with ever-increasing frequency, noted a rapid tolerance, her mental boundaries became more porous as 'the message of the Goddess' was interpreted as 'let the soul (the light) seep through', and there was an apparent increase in 'magical' coincidences between mental and physical events. By early 1978, she was taking the drug daily and only slept for 3 hours per night. She went to visit John Lilly, who had just been through a prolonged ketamine binge and near fatal accident. She told him that she intended 'to ride this comet through to the end': John Lilly's last words to me were: 'you'd better be damn strong if you're going to play that game'...As this book goes to press I have once again increased the doses. (Moore & Alltounian 1978). '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 (Jansen 2000). Marcia became addicted to ketamine - The drug is dangerous and its use should not be encouraged...I told her that it was a Seductress, not a Goddess. (Howard Alltounian, interviewed in Jansen 2000). 'Psychonaut' John Lilly, MD, spent decades exploring his own mind using flotation tanks, ketamine and other drugs (Lilly 1978). His first ketamine binge lasted for a year. After his wife found him floating face down in the pool and had him rushed to hospital, she tried to persuade him to seek help, telling him that ketamine had 'taken over his life', but he felt that there were 'further parameters' to be explored, and spent a month injecting himself almost hourly. He became convinced that he had to warn the government about an extra-terrestrial plot, collapsed in a toilet, and was taken to hospital again but soon returned home to continue 'exploring the parameters'. Lilly became convinced that he was a time traveller from the future, that he was controlled by a 'solid-state entity', and that there were messages for him on television. Word spread that he had a serious problem, his sources dried up, and there followed a period of 'severe psychological withdrawal' (Lilly 1978). There were further accidents and alarming events, but Lilly survived and was still using ketamine at the age of 83. The ketamine experiences Lilly described were based around contact with 'other beings' and they had an inhuman, cold and computer-like flavour, infused with the chill of space, in contrast to the earthy warmth and emotion of Moore's adventures with the 'Goddess Ketamine'. Lilly was himself sometimes seen as rather distant at this time, while Moore was concerned with love, emotion and the Earth. Journeys Into The Bright World vanished but The Scientist is still available, feeding a popular perception that ketamine is 'cold and inhuman'. It is an error to ascribe 'coldness' or 'warmth' to molecules as these are attributes of their users. Nevertheless, there is some objective support for Lilly's view that ketamine can sometimes produce an emotion-free state of 'high indifference'. Brain scans show that at psychedelic, subanaesthetic doses, the higher brain (neocortex) is very 'on' while parts of the older 'emotional' brain may be 'off', until the ketamine levels fall (Vollenweider et al. 1997a,b). This fits Moore's observation that the 'higher realms were pure mentation' and it was not until she had 'descended' that emotions returned (Moore & Alltounian 1978). 2. Ketamine and the dance culture 4. Near-death and near-birth experiences
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