Recreational use of ketamine

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Ketamine poured onto glass and left to dry. For general information on this drug, including medical usage, see ketamine. Ketamine, a dissociative anesthetic with a relatively safe clinical profile, is often used as a recreational drug. It is typically used at subanesthetic doses and in both private settings and at club venues, where it initially gained popularity. Originating in the United States in the 1970s, the recreational use of ketamine has since spread to Europe, Asia, and Australia, primarily in the context of raves and parties. Despite its emergence as a club drug, a majority of the users have since relegated their use to more private settings.[1] Due to the complexity of its synthesis, ketamine is diverted from licit medical sources; however, there have been reports of industrial-scale illicit ketamine manufacture in China.[2]

Contents

1 History 2 Epidemiology
o o o o

2.1 North America 2.2 Europe 2.3 Australia 2.4 Asia

3 Illicit sale

4 Detection of use 5 Effects 6 Dependence 7 Slang terms 8 References

History
Recreational use of ketamine was documented in the early 1970s in underground literature (e.g. The Fabulous Furry Freak Brothers[3]). 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.[4] The incidence of nonmedical ketamine use increased through the end of the century, especially in the context of raves and other parties.[5][6][7][8][9] However, its emergence as a club drug differs from other club drugs (e.g. MDMA) due to its anesthetic properties (e.g., slurred speech, immobilization) at higher doses;[9] in addition, reports of ketamine being sold as "ecstasy" are common.[10] The use of ketamine as part of a "post-clubbing experience" has also been documented. [11] Ketamine's rise in the dance culture was most rapid in Hong Kong by the end of the 1990s.[9]

Epidemiology
North America
United States According to the ongoing Monitoring the Future study conducted by University of Michigan, prevalence rates of ketamine abuse among American secondary school student (grades 8, 10, and 12) have varied between 0.8-2.5% since 1999, with recent rates at the lower end of this range.[12] 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.[13] 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.[13] A total of 529 emergency department visits in 2009 were ketamine-related.
[14]

Europe
Cases of illicit ketamine use in club venues have been observed in the Czech Republic, France, Italy, Hungary, and the United Kingdom.[15] Additional reports of use and dependence have been reported in Poland[16] and Portugal.[17]

Australia
Australia's 2010 National Drug Strategy Household Survey report shows a prevalence of recent ketamine use of 0.3% in 2004 and 0.2% in 2007 and 2010 in persons aged 14 or older.[18] In a recent survey of random roadside oral fluid testing in Victoria, Australia, 1.5% of drivers tested positive for ketamine use.[19]

Asia
Hong Kong 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 The Dangerous Drugs Ordinance of Hong Kong, and statistics are made freely available online on a quarterly basis.[20][21] 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.[22] 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.[22] Taiwan 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.[23] From the same survey, a large portion (42.8%) of those who reported ecstasy use also reported ketamine use.[23] Ketamine was the second most abused illicit drug (behind ecstasy) in absconding Taiwanese adolescents as reported by a multi-city street outreach survey.[24] 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.[25] Urine sampling 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 drug abuse in the general public, of which 2.0% of the samples tested positive for ketamine use.[26]

Illicit sale

500 mg ketamine hydrochloride

Ketamine dried and scraped Ketamine sold illicitly comes either from diverted legitimate supplies and semilegitimate suppliers, or from theft of legitimate suppliers. In 2003, the US Drug Enforcement Administration conducted Operation TKO, a probe into the quality of ketamine being imported from Mexico.[27] As a result of operation TKO, US 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 US is of Mexican origin. In 2011 it is now mostly shipped from places like India as cheap as $5/gram.[27] The World Health Organization Expert Committee on Drug Dependence, in its thirty-third report (2003), [28] recommended research into its recreational use/misuse due to growing concerns about its rising popularity in Europe, Asia and North America. In the 1993 book E for Ecstasy[29] (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.[30] The former chairman of the British Advisory Council on the Misuse of Drugs, David Nutt, suggested that Ketamine should be upgraded from a class C drug due to the harm it can cause to users.[31]

Detection of use
Ketamine may be quantitated in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients, provide evidence in an impaired driving arrest or to assist in a medicolegal death investigation. Blood or plasma ketamine concentrations are usually in a range of 0.5-5.0 mg/L in persons receiving the drug therapeutically (during general anesthesia), 12 mg/L in those arrested for impaired driving and 320 mg/L in victims of acute fatal overdosage. Urine is often the preferred specimen for routine drug use monitoring purposes. The presence of norketamine, a pharmacologically-active metabolite, is useful for confirmation of ketamine ingestion.[32][33][34]

Effects
See also: K-hole

This section requires expansion. Ketamine produces effects similar to phencyclidine (PCP) and dextromethorphan (DXM). Unlike the other well-known dissociatives PCP and DXM, ketamine is very short-acting, its hallucinatory effects lasting sixty minutes when insufflated or injected and up to two hours when ingested, the total experience lasting no more than a couple of hours.[35] Like other dissociative anaesthetics, hallucinations caused by ketamine are fundamentally different from those caused by classical hallucinogens. At low doses, hallucinations are only seen when one is in a dark room with one's eyes closed, while at medium to high doses the effects are far more intense and obvious.[36] 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.[37] At sufficiently high doses (75-125 mg IM), users may experience what is called the "K-hole", a state of dissociation whose effects are thought to mimic the phenomenology of schizophrenia.[38] Users may experience worlds or dimensions that are ineffable, all the while being completely unaware of their individual identities or the external world. Users have reported intense hallucinations including visual hallucinations; perceptions of falling; fast and gradual movement and flying; "seeing God"; feeling connected to other users, objects and the cosmos; experiencing psychotic reactions; shared hallucinations and thoughts with adjacent users. John C. Lilly,[39] Marcia Moore[40] and D. M. Turner[41] (amongst others) have written extensively about their own spiritual/psychonautic use of ketamine. (Both Moore[42] and Turner[43] died prematurely in a way that has been linked to their ketamine use.) Users may feel as though their perceptions are located so deep inside the mind that the real world seems distant. Some users may not remember this part of the experience after regaining consciousness, in the same way that a person may forget a dream. Owing to the role of the NMDA receptor in long-term potentiation, this may be due to disturbances in memory formation. The "re-integration" process is slow, and the user gradually becomes aware of surroundings. At first, users may not remember their own names, or even know that they are human, or what that means. Movement is extremely difficult, and a user may not be aware that he or she has a body at all.

Dependence

Radar plot showing relative physical harm, social harm, and dependence of ketamine[44]

This section requires expansion. Ketamine's potential for dependence has been established in various operant conditioning paradigms, including conditioned place preference and self-administration; further, rats demonstrate locomotor sensitization following repeated exposure to ketamine.[45] Increased subjective feelings of 'high' have been observed in healthy human volunteers exposed to ketamine.[45] Additionally, the rapid onset of effects following insufflation or intramuscular injection is thought to increase the drug's abuse potential. The short duration of effects promotes bingeing, tolerance develops quickly, and withdrawal symptoms, including anxiety, shaking, and palpitations, present in some daily users following cessation of use.[45]

Slang terms
Production for recreational use has been traced to 1967, when it was referred to as "mean green" and "rockmesc".[46] Recreational names for ketamine include "K",[47][48] "Ket",[49] "Special K",[48] "K2",[47] "Vitamin K",[48][49] "Super K",[48] "Jet" (Texas),[48][50] "Super acid",[48] "Mauve",[48] "Special LA coke",[48] "Purple",[48] "Cat Valium",[50] "Blind Squid"[51] "Keller",[51] "Kelly's Day",[51] "New ecstasy",[52] "Psychedelic heroin",[52] "bump",[53] "honey oil".[53] A mixture of ketamine with cocaine is called "Calvin Klein" or "CK1".[54] In Hong Kong, where illicit use of the drug is popular, ketamine is colloquially referred to as "kai-jai".[9]

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