Our Next New Drug Crisis

Ketamine has a long and storied history. Developed in the early 1960s as an anesthesia, it was deemed too dangerous for people due to its “intense, prolonged emergence delirium that ultimately made it undesirable for human use.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/

More studies; more testing; and the end result — well, maybe not the END result, but the outcome at the time was that “The psychoactive properties associated with ketamine limit widespread clinical use. Even at subanesthetic doses (i.e., 0.1–0.4 mg/kg; Krystal et al., 1994), patients may experience perturbing dissociative symptoms. One study described ketamine at such doses producing four main psychological effects (Pomarol-Clotet et al., 2006): (1) a feeling of intoxication, comparable to the effects of other anesthetics and sedatives; (2) perceptual alterations in visual, auditory and somatosensory domains concomitant with symptoms of depersonalization or derealization; (3) referential ideas and delusions, often of misinterpretation and thought disorder; and (4) negative symptoms such as poverty of speech.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/)

However, it was used as an anesthetic for animals — and a diverted recreational drug for humans (Anesthesiology,V113; No3; September2010) because generally, the benefits it offers feel pretty good no matter why a person took the drug. Those benefits include pain control, forgetfulness, intoxication, disassociation, and euphoria. (https://www.health.harvard.edu/authors/peter-grinspoon-md)

It’s not different from any other prescribed mood-altering substance that has addictive properties. The trajectory of opioid use dependence has become obvious to even the least-interested observer. How often have we heard the stat that four out of five people who became addicted to heroin started with prescribed opioids…maybe not prescribed to THEM but prescribed nonetheless. Because opioids make most people feel good. If my tooth hurts and the dentist prescribes opioids, not only does my tooth stop hurting, but so does my toe, my back, my head, and eventually my emotions. And feeling that good — at least for a while — is pretty compelling. Now consider the benefits of medical cannabis. Same scenario, albeit one without the risk of death by overdose. If Dr. Feelgood in Las Vegas prescribes THC for my anxiety (despite there being no evidence of it actually helping anxiety), I’m likely to feel good — euphoric — taking it. I’ll feel relaxed; I may experience senses more fully; I may just be happier. Again, I feel good. That’s why we get high – to feel good, and it doesn’t really matter why we started getting high. (As an aside, this is one of the biggest inconsistencies about “medical marijuana”: how big of a toke do you need to take to reach therapeutic results? Yeah…no one else knows, either.)

More studies; more testing; and now it’s being hailed as a miracle drug — at least for some. And it MAY be — at least for some. But it’s still a dangerous drug with addictive properties that makes people feel good and so is rife for misuse.

In 2019 ketamine was approved to treat treatment-resistant depression (TRD), which is severe depression — often including suicidal thoughts — that hasn’t improved with other therapies. (https://www.health.harvard.edu/authors/peter-grinspoon-md)

Sounds like a life saver, right? However, the FDA-approved intranasal S-ketamine was only approved to be used in very controlled conditions. (https://medicine.yale.edu/news-article/ketamine-handle-with-care/)

Ketamine can be helpful – until it’s not. Given the strict regulations for the FDA-approved ketamine, such as providing the medication and monitoring the patient after treatment in a doctor’s office, there can be no surprise that the market found a way to use non-FDA-approved ketamine, too. Ketamine is far too often prescribed off label; clinics have popped up across the nation; psychedelic guides with no required formal education are overseeing care; illicit ketamine is widely available. (“The Ketamine Cure”; David Dodge, Nov. 4, 2021; New York Times)

The National Drug Early Warning System, NDEWS, recently reported that illicit ketamine seizures increased 349% in the US from 2017 to 2022, from 55 to 247, and the total weight of illicit ketamine seized increased 1,116.4% during that time, from 127 pounds to about 1,550 pounds. (NDEWS.org, Issue 134: May 26, 2023) Same problem; different day. People like to get high. We feel good and maybe even numb when we are. As a society, we just cannot act surprised when we have a ketamine crisis on our hands to rival the opioid crisis that we haven’t even managed yet.

I don’t have the answer, but I know wide use and availability of ketamine isn’t it.