Ketamine: Anesthetic, anti-depressant or party drug?

For a drug called a “horse tranquillizer,” ketamine is — scientifically speaking — very versatile. It is an anesthetic for humans and other animals.

Seven weeks after “Friends” actor Matthew L. Perry was found dead in his home in late October 2023, the County of Los Angeles Medical Examiner determined that Perry died of “chronic effects of ketamine.”

Secondary causes of death were drowning, coronary artery disease and the effects of buprenorphine, which is used to treat opioid use disorder.

AP and Reuters news agencies noted that the autopsy report stated that Perry was taking testosterone shots – she was prescribed Tamoxifen, a hormone regulator commonly taken to prevent breast cancer.

Perry’s death: Various legal drugs and ketamine

Investigators reportedly found no alcohol, illegal drugs, or drug paraphernalia, but they found nicotine vapes, nicotine lollipops, and inhalers, along with the injectable anti-diabetes drug, Tirzepatide, which, it was suggested, was used by Perry to disappear. weight.

The autopsy report lists “non-toxic levels of the benzodiazepine lorazepam” — benzodiazepines are a class of depressants that relieve anxiety and muscle tension, and reduce seizures.

But the coroner said ketamine was the main cause of Perry’s death. Perry’s friends said he was taking experimental ketamine infusion therapy to treat anxiety and depression. However, the dose of ketamine that caused Perry’s death was unrelated to experimental ketamine therapy.

Ketamine is used in health care settings as an anesthetic for humans and other animals, but the US Federal Food and Drug Administration (FDA) has not approved ketamine for the treatment of psychiatric disorders.

What are the side effects of ketamine?

Ketamine is classified as a dissociative anesthetic, with some hallucinogenic effects.

The effects of ketamine depend on the dose taken. Effects range from feeling “strange” and disconnected, to sedation and unconsciousness.

Ketamine is fast-acting and a relatively short-lived experience — compared to LSD hallucinations, a ketamine hallucination can last between 30 and 60 minutes.

Smaller doses disrupt a person’s perceptions of sight and sound, and can create a feeling of calm, euphoria and pain relief. This can leave a user feeling “out-of-body” and out of control.

Higher doses of recreational drugs create a feeling of “forgetfulness” similar to a near-death experience – also known as a K-hole.

The drug can cause amnesia, which is probably one of the reasons why it is used to “facilitate sexual assault” — as noted by the Drug Enforcement Administration of the US Department of Justice.

At still higher doses, the drug becomes an anesthetic agent, leading to sedation, unconsciousness and fatally low respiratory rates.

Ketamine is commonly used as a sedative and anesthetic in hospitals for people undergoing surgery. It is one of the safest and most effective sedatives for children who need a short, emergency hospital procedure.

How is ketamine used recreationally?

Ketamine comes as a liquid and a white powder, so it can be injected or snorted. Some people consume it as a pill, mix it into drinks, or smoke it.

The drug is sometimes mixed with other party or club drugs, including amphetamines and MDMA.

Using mixed medications can cause unintended interactions between medications and expose users to increased health risks.

A review of current ketamine use by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) stated that “various dose-dependent acute and chronic harms, including neurological and cardiovascular toxicity, health problems of mental, such as depression, and urological complications, such as bladder damage from intensive use.”

How is ketamine used to treat depression?

In 2019, the FDA approved a nasal spray based on a derivative of ketamine — esketamine — in combination with an oral antidepressant, for the treatment of depression in adults when other medications have failed to help.

But in October 2023, the FDA warned of “increased interest” in the use of compounded ketamine products for the treatment of psychiatric disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive- compulsive disorder – when neither. Ketamine or the resulting compounded drugs have been approved for safe use in humans.

In general, compounded drugs are a gray area. They can be made with drugs that are individually approved for use in humans, but the resulting drug combinations are unapproved — meaning the new mix of drugs hasn’t been tested for safety in humans. person.

Combining, as it turns out, is not illegal in itself — some patients need drugs combined (remixed, if you will) if, for example, they might have an allergic reaction to one to the elements in the original medicine.

But the use of ketamine in compounded drugs is a particular case. The FDA warns of possible abuse and misuse, leading to psychiatric events, increased blood pressure or respiratory depression. It advises against using any type of ketamine at home or anywhere else, where its use cannot be monitored by a health care provider.

Ketamine abuse and addiction research

A study published in November 2023 suggested that subanesthetic ketamine is being falsely advertised online to treat health conditions.

“Advertisers may promote intravenous infusions and/or oral formulations, which are described as an emerging treatment for mental health conditions,” the researchers wrote in a paper published by the JAMA Network.

“Despite the potential benefits of ketamine in treating select mental health conditions, well-founded concerns have been raised about the similarity to opioid prescriptions and the risk of widespread misuse,” they wrote.

Ketamine is addictive. But that’s where things get even stranger — because another study published in 2018 suggested that ketamine could be used to treat addiction.

The study found that ketamine helped keep alcoholics and cocaine and heroin clean longer. But even the researchers said: more research is needed.

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