When journalist Anna Silman started reporting on ketamine five years ago she did so because people in her friend group had begun taking the drug recreationally. She was intrigued by the ways that interest in psychedelic-assisted therapy meant more people were taking ketamine, both with a prescription and without one too. But as she started to see friends struggle with dependency, something other countries have been ringing the alarm about for years, she began to wonder whether the U.S. has been too naive. We hear from a woman we’re calling Olivia, just a few months out of rehab, who thinks the risks of ketamine have been severely underestimated.
Psychedelics are now at the center of a global conversation about mental health, mysticism, and even how we experience illness and death. In Altered States, host Arielle Duhaime-Ross explores how people are taking these drugs, who has access to them, how they’re regulated, who stands to profit, and what these substances might offer us as individuals and as a society. Listen to more episodes here.
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[00:00:00] Anna Silman: In 2019, I was a writer at New York Magazine, and when I went out on weekends, I noticed that people were doing a lot of ketamine. People were kind of using it like they would use cocaine. And I wrote this trend piece, which was just kind of observing that it was the trendy drug amongst creative New Yorkers, people in Silicon Valley, people kind of in my social orbit.
[00:00:21] Anna Silman: And one of the people I talked to for the piece was a friend of mine who we’re calling Olivia.
[00:00:27] Olivia: It sickens me thinking back on it. Like, I felt so cool that I was being interviewed for this cut article and I was the forefront of this new trendy drug. Like, I thought it was a trendsetter. I thought it was the cool thing.
[00:00:41] Anna Silman: Olivia was one of the many people who helped me document the rise of ketamine. Neither of us thought much of it at the time, but recently I met up with Olivia in Canada to better understand how her relationship to ketamine changed. From a fun, casual thing on nights out, to an unexpected nightmare that [00:01:00] changed her whole life.
[00:01:02] Anna Silman: But let’s start at the beginning. Olivia said she first tried ketamine in college.
[00:01:07] Olivia: I remember the first time I tried it, it was in my apartment and it was with four friends, like this French guy, he was known to love ketamine. We had been partying and it was probably like one in the morning. And he was like, well, do you guys want to try ketamine?
[00:01:23] Olivia: And you know, at that time in my life, when you’re in your early twenties, you’re like, whatever, I’ll try anything once.
[00:01:28] Anna Silman: Meanwhile, I was seeing more and more ads on Instagram and TikTok telling me to try ketamine therapy at home, and how amazing it was at treating things like depression and anxiety. They sounded like this.
[00:01:43] Archival: What if there was a place where you could go and just be?
[00:01:51] Anna Silman: These ads made ketamine seem like a wonder drug.
[00:01:58] Archival: Embrace higher perspectives [00:02:00] and open new pathways for true transformation and positive change to take hold. This place is available. Let’s Mindbloom.
[00:02:15] Anna Silman: Pretty magical, right? Maybe even a little creepy. But nothing in these ads mentioned an important truth about the drug, which is that for some people it can be highly addictive.
[00:02:31] Arielle Duhaime-Ross: Over the past few years, the United States has seen a steep rise in the popularity of ketamine, both as a recreational drug and as a buzzworthy new treatment for depression. But as ketamine becomes more common, how should we think about the very real and serious consequences that can come with its prolonged use?
[00:02:52] Arielle Duhaime-Ross: Today on the show. Are we in the middle of a ketamine reckoning? I’m talking to Anna Silman, a features [00:03:00] correspondent at Business Insider, about what she’s learned in her years reporting on the drug. I’m your host, Arielle Duhaime-Ross, and this is Altered States.
[00:03:13] Arielle Duhaime-Ross: Anna, welcome to the show.
[00:03:15] Anna Silman: Hi, thank you so much for having me.
[00:03:17] Arielle Duhaime-Ross: So, over the past six years, you followed ketamine’s rise as both a party drug and as a medical treatment, specifically for depression. And it seems like this drug has a pretty multi faceted identity, which we’ll definitely dive into. But first, can you tell me, when did you start getting interested in covering ketamine?
[00:03:37] Anna Silman: Yeah, so my interest in ketamine started around 2018 or 2019, when it seemed to be popping up at every party I was at. One of my friends who always seemed to have a baggie on her was Olivia. You heard her at the beginning of this story.
[00:03:51] Olivia: My name is Olivia and I’m 34. I am in a creative field. Ever since I was a kid, I was very artsy, I was a [00:04:00] painter, I love crafting.
[00:04:02] Anna Silman: Yeah, you’re the queen of crafts.
[00:04:05] Anna Silman: Olivia just gave me these. bracelets that she made as this is her new beading hobby. My new hobby. We met and became friends in New York. We found out that we both grew up in Canada in the 90s. She was raised in a white wealthy suburb and she said at home she felt a lot of anxiety.
[00:04:24] Olivia: My parents are Asian, and they immigrated here in the late 70s, and they didn’t really speak a lot of English, and growing up it was just like very chaotic. We never spoke about emotions. It was always about doing things. I was never taught really how to process my emotions or even identify them. It always felt very stressful, like I just wanted to run away and get away from that environment.
[00:04:48] Arielle Duhaime-Ross: So how did she get introduced to ketamine? Did she know anything about it at the time?
[00:04:53] Anna Silman: The first time she tried it was when she was in college. This would have been about 2009 or 2010.
[00:04:58] Olivia: I didn’t actually really do [00:05:00] any hard drugs until I got to New York. And the first thing I tried was cocaine. And I fell in love with that.
[00:05:06] Olivia: I was like, oh my god, this feels amazing. And ketamine was pretty new in the scene when I got there and I befriended a lot of Europeans and, you know, we started partying, we went to raves. I’d never done anything like that. And I heard about ketamine. Um, it was kind of like this ambiguous drug. For me, at least, when I’m younger, I have this association of like good and bad drugs.
[00:05:30] Olivia: You’re like, bad drugs are like heroin. You would never touch those. Those are dirty drugs and like meth or whatever it is. And the good, like, you know, acceptable drugs would be like MDMA or like ecstasy, you know, uh, mushrooms and stuff. And ketamine for me actually fell into the more dangerous, like kind of dirty quote unquote drug because I don’t think many people understood what it was.
[00:05:55] Anna Silman: Yeah. I feel like when we were younger, ketamine had this sort of scary or [00:06:00] dark association as this drug that was out of the mainstream and that you would never touch.
[00:06:05] Olivia: Exactly.
[00:06:06] Olivia: Yeah. So like when I first heard about it, it was like a horse tranquilizer. I’m like, why would I want to do a horse tranquilizer?
[00:06:11] Olivia: Are you insane?
[00:06:13] Arielle Duhaime-Ross: You know, I’m pretty sure my first encounters with the drug was actually through music. A bunch of bands I listened to as a teen referenced ketamine fairly regularly. Like there’s this 2005 Cocorosie song called K Hole. It’s this beautiful haunting song with like a heart melody and I think it has like the this slow beatboxed beat.
[00:06:33] Archival: Tiny spirit in a K-hole, bloated like soggy cereal. God will come and wash away.
[00:06:45] Arielle Duhaime-Ross: It’s a great song. I had it stuck in my head for like a whole year. And I remember not knowing what a K-hole was. I actually had to look it up because at the time I didn’t know anybody who was, you know, talking about taking the drug openly.
[00:06:58] Arielle Duhaime-Ross: So for all of the people [00:07:00] out there who are still in that place right now, what exactly is ketamine and how has it been used over time?
[00:07:07] Anna Silman: So, ketamine is often referred to as a psychedelic, but there’s actually a lot of debate over whether it really is one. Technically, it’s a dissociative anesthetic, which means it has a range of properties, including sedating ones, hallucinogenic ones, and stimulating ones depending on the dosage. Ketamine was first patented in the U. S. in 1966 as a medical anesthetic for surgery. It was also used to treat soldiers on the battlefield during the Vietnam War. And then in 1970, the FDA approved it as a drug for medical use in the States. It also became really common in veterinary medicine, which is why you’ve probably heard it referred to as a horse tranquilizer.
[00:07:46] Arielle Duhaime-Ross: So how does ketamine go from a drug used for surgery to a drug used for depression? That seems like a pretty big shift.
[00:07:55] Anna Silman: Yeah, it is. So in the 90s, researchers at Yale were studying ketamine and the [00:08:00] neurotransmitter glutamate. Most antidepressants work on serotonin or dopamine. These are other neurotransmitters.
[00:08:06] Anna Silman: But ketamine is different in that it targets these glutamate receptors. There are now a number of really solid studies showing that patients who take ketamine intravenously, even just once, have a significant reduction in symptoms of depression in less than 24 hours.
[00:08:20] Arielle Duhaime-Ross: That’s fast.
[00:08:21] Anna Silman: Totally. When other treatments for depression, like SSRIs, can take months to kick in, this could be a potentially life saving intervention for suicidal patients.
[00:08:31] Arielle Duhaime-Ross: Wow, okay. And at some point in the middle of all of this, ketamine also makes its way onto the streets?
[00:08:39] Arielle Duhaime-Ross: Yeah, ketamine has long had this whole other life as a rave drug. It was big in the 80s and 90s, until the DEA classified it as a controlled substance in 1999. But by the mid 2000s, it was kind of making this comeback as a party drug.
[00:08:54] Arielle Duhaime-Ross: And that’s when it started showing up in Olivia’s nights out in New York. [00:09:00]
[00:09:00] Olivia: When I was in New York, when I first got there, I was just doing a lot of cocaine. But then I kind of needed like a downer. So eventually I kind of was like, okay, maybe I’ll try out ketamine. And at first when I did, I was like, Oh, I don’t know. Like that was a weird feeling. I wasn’t that drawn to it. And then I kind of started doing it more and more. It’s like, Oh, I tried it once now. What’s, what is it like a second time to do it again? And then, you know, eventually it became this thing that I was just doing consistently.
[00:09:30] Arielle Duhaime-Ross: So Olivia goes from thinking ketamine is a quote bad drug to taking it all the time. Did she tell you why?
[00:09:38] Anna Silman: Olivia told me that for her, Ketamine basically became a substitute for booze.
[00:09:43] Olivia: So it’s interesting because I’m Asian and I get that thing when I drink, I get really bright red and then I pass out and I really have a very low tolerance.
[00:09:52] Anna Silman: She has this thing called alcohol flush syndrome that ultimately makes it really hard to break down alcohol.
[00:09:58] Olivia: I have this adverse feeling. My heart [00:10:00] starts pounding. I feel really hot and it feels very uncomfortable. But ketamine gave me that feeling of like that woozy kind of like inhibitions are kind of lowered without making me feel like I was dying. And it only lasted for like 20 minutes and then all of a sudden I was like fine again.
[00:10:19] Arielle Duhaime-Ross: I really get wanting a way to wind down without alcohol. Anna, can you tell me more about what a ketamine trip actually feels like?
[00:10:26] Anna Silman: So ketamine’s a kind of strange drug in that its effects are really different depending on what dose you take. Ultimately, it really changes the quality of time and space.
[00:10:37] Anna Silman: At a lower dose, it can create kind of a dizziness goofy, woozy feeling, like Olivia describes it, as being kind of like alcohol. It can also make you feel dissociated, which is why it’s a good anesthetic. And then at higher doses, it can have this really psychedelic feeling in terms of visual effects and consciousness expansion.
[00:10:56] Anna Silman: And many of those effects are viewed positively by people who use ketamine. [00:11:00] And then if you take too much, you risk falling into what’s called a K hole, like we heard in that Cocorosie song. Which is basically the full dissociative experience where you’re immobilized, you feel completely disconnected from your body in reality.
[00:11:12] Anna Silman: And that can be really scary, especially if you’re not expecting it. But eventually, Olivia wound up in a K hole. And she liked it there. At least at first.
[00:11:23] Olivia: I remember the first time when I got in a K hole. It’s like you’re in this three dimensional world where you feel like everything is connected and you see these like crazy colors and like everything was broken up into checkers and you’re flying through the air and it’s really indescribable and I felt like I was getting a little insight into a new dimension that no one has ever seen.
[00:11:51] Olivia: I was like, oh my, it was like alien to me. And I think it’s the same thing that you get with psychedelics, kind of [00:12:00] reconfigures the connections in your brain. For me, I always tend to get myself into these, like, hamster wheel anxiety circles, like, I think growing up in Asian culture, too, it was very demanding, because, like, for me, my brain is always like, you’re not enough, you got to do more.
[00:12:16] Olivia: That’s, like, how I normally talk to myself. It’s a very critical and harsh tone, and ketamine would kind of, like, block that.
[00:12:25] Arielle Duhaime-Ross: Anna, what Olivia told you there about how ketamine would help her block out negative self talk, could that be related to how ketamine has been reported to help people with depression in clinical settings?
[00:12:38] Anna Silman: It could be. A lot of people who use ketamine for depression say that it basically halts the cycle of looping and obsessive thoughts. We still don’t know exactly how it works in the brain, but we do know that people who are depressed or people who’ve experienced chronic stress tend to have weakened synaptic connections in the brain, and ketamine seems to regrow or strengthen these connections.[00:13:00]
[00:13:00] Anna Silman: But there are other theories too.
[00:13:02] Arielle Duhaime-Ross: So does the excitement around ketamine’s potential use for depression, does that end up impacting the world of illicit drugs too?
[00:13:11] Anna Silman: We can’t say for sure, but there definitely seems to be a correlation. So this researcher on club drugs, Joseph Palomar, who works at NYU, conducted surveys at New York nightclubs and festivals from 2016 to 2019, which is right around the time there’s all this positive press about ketamine’s impact on mental health.
[00:13:28] Anna Silman: And what he found was that the percentage of respondents who said they’d used ketamine in the past year nearly tripled in that time.
[00:13:35] Archival: Ketamine, a hydrochloride tranquilizer used in veterinary practice for the sedation of animals and reptiles
[00:13:42] Anna Silman: That’s from a 2016 show called Ketamine the Musical that played at this club in New York called House of Yes.
[00:13:49] Archival: physiopathic paralysis, effects in humans in powdered form, extreme state of euphoria, [00:14:00] hallucinations, out of body experiences.
[00:14:03] Anna Silman: One of the founders of the club said, quote, Ketamine is to my community what cocaine was to Studio 54. And it’s not just a New York thing. At this point, Elon Musk and Chrissy Teigen, Sharon Osbourne, they’re all talking about it.
[00:14:18] Arielle Duhaime-Ross: Okay, that’s a really random list of celebrities just all united by ketamine.
[00:14:23] Anna Silman: Yes, a very random list. And ketamine also really gets a boost on TV shows like Industry and the White Lotus.
[00:14:31] Archival: I totally forgot that I sessioned ketamine in here, Paula. I’m so stacked. Hawaiian K-hole.
[00:14:40] Anna Silman: It’s also been swept up in the wellness craze of self care and biohacking, especially in Silicon Valley, where there’s a lot of people who want to optimize not just their productivity and their longevity, but also their very consciousness.
[00:14:53] Arielle Duhaime-Ross: So ketamine is in the zeitgeist, it’s in the clubs, what’s going on on the legal, medical side of things? How are [00:15:00] doctors using it with patients?
[00:15:02] Anna Silman: So as early as around 2010, which is after all this promising research around mental health and ketamine starts coming out, uh, clinics start to open and they’re providing intravenous ketamine.
[00:15:13] Anna Silman: Now there’s about 500 to 800 of these across the country.
[00:15:17] Arielle Duhaime-Ross: Wow. That’s a lot.
[00:15:18] Anna Silman: Yeah, it’s really, it’s really grown. So that’s one legal way to get it. And then another is by mail order. So mail order ketamine really took off at the start of the COVID pandemic in 2020. Back then the federal laws for telemedicine were changed.
[00:15:34] Anna Silman: So basically they allowed doctors to prescribe drugs like ketamine online and pharmacies to send it in the mail. But there’s also been a bunch of criticism of these companies saying that they don’t screen people well enough or that there’s risks with sending people home ketamine to use unsupervised.
[00:15:49] Arielle Duhaime-Ross: Right. This has been a problem not just with ketamine, but also with, you know, drugs like Adderall, for instance, right? Like the whole telemedicine prescription thing has been an issue that the government has been talking [00:16:00] about for quite some time.
[00:16:01] Anna Silman: Exactly. And we saw a crackdown on some of those Adderall providers, so it’ll be interesting to see what happens.
[00:16:06] Arielle Duhaime-Ross: So, this idea that people, you know, they get ketamine and they can take it at home unsupervised, is that really how it’s happening when you do mail order ketamine? Like, you don’t have to go anywhere or be with anyone to take it, it’s just like you’re being treated at home using any other standard prescription sedative?
[00:16:24] Anna Silman: It’s intended for you to take at home alone.
[00:16:26] Arielle Duhaime-Ross: Okay, and the way they’re providing this, you know, we’ve talked about like IV ketamine, right? I’m assuming that they’re not mailing IV bags.
[00:16:33] Anna Silman: No, these are lozenges that you put under your tongue. The concerning part is that sometimes the doses they’re sending out can really vary.
[00:16:41] Anna Silman: At this point, it’s, it’s very much a wild
[00:16:43] Anna Silman: west.
[00:16:44] Arielle Duhaime-Ross: Wow. Okay. That’s, um, probably not great. What does the business picture look like? How much money is being generated by the sale of legal ketamine? Do we know?
[00:16:54] Anna Silman: This is another thing where it’s hard to get an exact number. But some estimates say that industry revenues are about three [00:17:00] billion right now, which is a 70 percent increase from where they were in 2018.
[00:17:04] Anna Silman: And by 2030, that number is projected to be nearly seven billion. So where I live in New York, there’s a number of these clinics and they charge about $400 to a thousand per session. A lot of these places, they kind of look like boutique wellness studios. They’re full of beanbag chairs and candles and they pitch ketamine as like a spa day or retreat for your brain.
[00:17:25] Arielle Duhaime-Ross: So did Olivia ever use one of these clinics?
[00:17:28] Anna Silman: She didn’t. She did at one point say that she tried to get ketamine through Mindbloom, but kind of gave up because she needed a doctor’s note and it was just easier to buy it on the street. And Olivia actually mentioned that even the mere presence of these clinics and all the wellness language that surrounded them made her feel like it was okay to take it, that it was even good for her.
[00:17:50] Olivia: In America, I think now, with this new research of therapeutic uses and like people are getting it at clinics, you kind of have this association of like, it’s okay to do it. [00:18:00] It was normalized and just was like, okay, yeah, this is like a way to check out. This was a way to disassociate. Like, amazing.
[00:18:08] Arielle Duhaime-Ross: Anna, what am I supposed to make of the fact that a drug with a dissociative quality has now become, as you wrote, the drug of a generation?
[00:18:17] Anna Silman: Yeah, I know it doesn’t seem that intuitive when you hear about it, but I actually heard from a lot of people that in today’s go go go culture, people don’t have time to be hung over. Um, they don’t want to feel like crap in the morning after drinking a bunch and doing a bunch of coke. But ketamine has a really short window of action, like half an hour, so it’s actually easy for people to do and still be sharp for work the next morning.
[00:18:39] Anna Silman: And also, in a world where we’re constantly tethered to our phones and social media and the 24 hour news cycle, ketamine kind of allows you to switch off your brain and disconnect. It’s like a mini vacation from reality, like putting your whole life on airplane mode.
[00:18:55] Arielle Duhaime-Ross: Yeah, I get why that would be attractive for some people.
[00:18:58] Anna Silman: Yeah, and that’s something that made [00:19:00] Olivia want to keep using it. But when you need to check out of your life constantly because you don’t have any other ways of coping, then the recreational use of ketamine can quickly turn to dependence.
[00:19:12] Arielle Duhaime-Ross: That’s after the break.
[00:19:23] Arielle Duhaime-Ross: So one thing I’ve heard about ketamine is that it’s been popular internationally for a while. Olivia talks about being introduced to it by this French guy, but I’m curious about ketamine outside of the US.
[00:19:36] Anna Silman: Yeah, Olivia actually has a really interesting story about going to Hong Kong in her early teens.
[00:19:41] Anna Silman: Obviously, New York and Hong Kong have a lot of similarities. They’re both huge cities, super fast paced. And while she’s in Hong Kong, she starts to notice these signs.
[00:19:50] Olivia: I saw on the subway, there was like this ad and it was like, if you have a ketamine problem, like call this hotline. And I would like go to the airport. And [00:20:00] I remember like seeing like these things are like things that you should not carry when you travel because you’re going to get arrested. And it would be like crocodile skins or like handguns and handcuffs. And then it’d be like a powdery ketamine. And I’m like, huh. It was just interesting that Ketamine was like the one they really focused on.
[00:20:15] Anna Silman: So I looked into this and Ketamine was actually the most misused psychotropic drug in Hong Kong from 2006 to 2014, as early as 2015, the BBC was even running reports about China’s ketamine craze, where they interviewed people in rehab.
[00:20:33] Archival: The craving was really strong. Every morning I wanted to snort ketamine.
[00:20:38] Archival: At night the drug kept me up. It totally screwed up my life. Many experience lasting damage to their brains and also their bladders. Some have had to have their bladders removed. A heavy price to pay.
[00:20:55] Arielle Duhaime-Ross: I’ve actually heard of this, uh, I did some like Googling and a lot of the news reports on YouTube [00:21:00] about ketamine addiction, many of which actually come from the UK, are with young people who’ve lost control of their bladders.
[00:21:07] Anna Silman: Yeah. So the Global Drug Survey found that one in four people who use ketamine regularly have symptoms of what has been known as ketamine bladder syndrome. That can lead to incontinence, kidney failure, even people needing their bladders surgically removed. And you’re right. This is a major thing in the UK.
[00:21:25] Anna Silman: Vice did a special in 2022 that mentions this thing called Bristol Bladder.
[00:21:30] Archival: Bristol is basically the spiritual home of ketamine. It’s where there’s more ketamine seizures than anywhere else in the UK. It all started in the 80s when some Bristol hippies were backpacking around India and realized that you could buy it over the counter there, and you can make tons of money if you brought it back to the UK.
[00:21:47] Archival: And now it’s one of those popular drugs in the free party scene here. There’s even a term that people use, Bristol Bladder, to refer to the erosion of the bladder wall from prolonged ketamine use.
[00:21:59] Arielle Duhaime-Ross: [00:22:00] Man, that’s really awful. It sounds like other countries have known about how much harm this drug can cause when it’s abused for a while now.
[00:22:08] Arielle Duhaime-Ross: But as you’ve written, this wasn’t really in the American discourse at the time of your first story. You published it in 2019. So when did you start to realize that there was something missing here?
[00:22:19] Anna Silman: So I was a business insider, and I started talking to more and more people who were realizing that their ketamine use had spiraled out of control, which was also the case for Olivia.
[00:22:29] Olivia: At the end of 2021, things got really bad. And I remember the first time, um, that it really hit me, it was a problem was. When I felt really congested, obviously, because I was doing a lot of drugs and I told work and that was a time when people were very sensitive. Like if you felt even the slightest bit sick, they’re like, stay home.
[00:22:46] Olivia: We don’t want you getting other people sick. And so I stayed home and I started doing ketamine during the day. And this was again, a line had drawn line was like, I’m not going to do it every day. And then the next line was like, I’m never going to do it during the day at least. And then I started doing it from like [00:23:00] 10 in the morning until like evening.
[00:23:02] Olivia: And That was really scary to me. And it was just, I would like lose the day.
[00:23:11] Olivia: I couldn’t remember what would happen. I really just could not stop. Like when I did not have the ketamine, I was itching for it so badly. Like it was always about, I had to have ketamine on me. And if I didn’t have it on me, that’s all I could think about is like how I could acquire ketamine. And I didn’t realize how dependent I was on it.
[00:23:33] Arielle Duhaime-Ross: Wow. Okay. So, Olivia is really, sounds like ketamine is basically all that she can think of at this point, which yes, absolutely does sound like addiction. She says she’s even itching for it, which is really addiction language. How did she go about getting all of this ketamine?
[00:23:52] Anna Silman: When she first started doing it, it was mostly from friends and then through drug dealers.
[00:23:57] Olivia: I would get it from a friend who would know a [00:24:00] friend. And back in the day, actually, I remember getting it like super pure. Like this one friend I had, she got it from a friend who worked at a veterinarian and it was like in a bottle, it was liquid. And I remember like cooking it for the first time. And I would like, it’s, It was really interesting.
[00:24:16] Olivia: Like you, so like the way you do it, it’s like you pour it on a plate, you have like the heat, you’re putting it on the stove, you heat it up and then it becomes crystallized and then you scrape it and then it becomes all this powder. And like, I don’t know, now thinking about it, I’m like, this sounds crazy.
[00:24:28] Olivia: Like, you know, it’s like making meth and like your RV or something. But like at the time, I don’t know, like I didn’t really think twice about it. And I think the thing is ketamine was always kind of like the cheaper option. Like cocaine is so expensive and it just becomes more and more expensive. Like, I don’t know, a gram used to be like a hundred and I’m sure now it’s like, like 130 or something.
[00:24:49] Olivia: And like, we’re talking American dollars and ketamine. I remember when I first started, well, I didn’t pay for a lot of it, but then it was, I think it was like around like 60 or 50 for a [00:25:00] gram. And it’s like, well, yeah, it’s like much lasts a lot longer and a lot cheaper. And so. Yeah, it was just more affordable.
[00:25:09] Olivia: It was like the cheap man’s drug, I guess.
[00:25:11] Arielle Duhaime-Ross: Did anyone know she was taking ketamine like this at the time?
[00:25:16] Anna Silman: So a few months into this, she eventually ends up telling her boyfriend.
[00:25:20] Olivia: He started trying to set these boundaries of kind of like, okay, if you’re going to do it, at least do it in the living room so I can see how much you’re doing.
[00:25:27] Olivia: And I would placate him and fawn and be like, yeah, of course, of course I’ll let you know. And then I would do it. break that promise and I would still be doing it. And I would come home at night after work, I would do it in the bathroom secretly. That was my place to do it. And, um, he would find out cause I would, you know, be such a mess.
[00:25:43] Olivia: He would pick me up off the ground and it just, it really took a toll on our relationship to a point where he was kind of like, I’m done.
[00:25:50] Anna Silman: And that breakup really became the catalyst for Olivia to tell her friends first, and then her family.
[00:25:57] Olivia: When I first told my parents, well, the funny [00:26:00] thing was I had to get really high in order to even get the courage to tell them.
[00:26:04] Olivia: And I think that helped my argument in a way, because they could see what it was like for me being high and how scary it was. I was like so out of it and I was actually kind of taken back at how they reacted because like my mom was so empathetic and I remember it was such a relieving thing because I was like, Oh my God, okay, they still will call
[00:26:24] Olivia: me their daughter. They’re not going to kick me out of her life.
[00:26:27] Arielle Duhaime-Ross: I got to say, I’m particularly impressed. Um, that, you know, having gone through this breakup, she didn’t. decides on her own to tell her friends and tell her family. I think that that is something that is particularly difficult. Um, often things can get so bad that you just get confronted by your, your family members and your friends.
[00:26:48] Arielle Duhaime-Ross: But Olivia actually did the terribly scary thing and, and talked to people about it and asked for help. That’s huge.
[00:26:56] Anna Silman: Yeah, and I mean, I think the one thing was that she was really good [00:27:00] at hiding it. She was really good at presenting this facade of being okay and being together and being collected, which she kind of honed her whole life.
[00:27:07] Anna Silman: And so it really, it really did surprise us when we found out just how bad it had gotten.
[00:27:14] Arielle Duhaime-Ross: Were you among the friends who were told at this point?
[00:27:18] Anna Silman: Yeah, I was. She kind of told us all at once she told us that her and her boyfriend had broken up and we were like what why you guys are great and then she was like and I’ve been doing ketamine and we were like ketamine like what happened and it’s just kind of yeah Caught us all off guard
[00:27:37] Arielle Duhaime-Ross: Wow So what happens from there?
[00:27:41] Anna Silman: So Olivia goes to rehab in the spring of 2022 for a month
[00:27:45] Olivia: When I first went to my first rehab, I told them ketamine, and they didn’t really even know what it was. Like, I’m sure the clinicians were like, yeah, we know what ketamine is, but like, they didn’t have a specific program to treat ketamine. There was no specific curation of, like, the nuances of why I was so [00:28:00] drawn to the ketamine.
[00:28:00] Olivia: And it was because, like, you know, it does have all these benefits of how it can help with depression and all that stuff. So, like, as much as ketamine, I know, was destroying my life, it was also helping me get through it.
[00:28:13] Anna Silman: Well, and I remember too, like it was around this time I started thinking about writing kind of a follow up article thinking about ketamine and addiction and why wasn’t this part of the conversation.
[00:28:24] Anna Silman: And I started researching and, you know, trying to talk to addiction counselors and it really seemed like they didn’t know about it.
[00:28:34] Olivia: Yeah, like it wasn’t until my second stint in rehab, which was like earlier this year, that I finally met, like, I probably have met like hundreds, if not thousands of people in recovery.
[00:28:44] Olivia: The first person I finally met whose primary DOC, as they would call it, drug of choice was ketamine.
[00:28:52] Arielle Duhaime-Ross: It’s actually really interesting that it wasn’t until this year that Olivia met someone like her in rehab whose drug of [00:29:00] choice is ketamine. What do we know about ketamine addiction generally?
[00:29:04] Anna Silman: We don’t know that much.
[00:29:05] Anna Silman: One ketamine researcher I spoke to said that to his knowledge there haven’t been any widespread studies in the U. S. to try and understand ketamine and addiction. A lot of the data that we do have comes from other countries. I did speak to one drug counselor in California though. And he said every single one of the ketamine users that he’s counseled became dependent after being prescribed it legally.
[00:29:28] Arielle Duhaime-Ross: Okay, so that’s a little concerning. I will say, though, that I do know quite a few people who have taken ketamine legally, and you know, those people haven’t become addicted, at least that I know of.
[00:29:42] Anna Silman: Yeah, I mean, this is a very small sample size. This is one person’s anecdote. We don’t know how many people are suffering like Olivia, and we don’t know, you know, how much the increase in legal ketamine has contributed to people who are struggling with dependency on their own.
[00:29:58] Anna Silman: We don’t have enough [00:30:00] information. However, I do think there is more and more conversation lately, and that’s partly due, I hope, to reporting like mine, and to people like Olivia speaking out about their stories. For example, the Ketamine Addiction group on Reddit, which I used a lot in my reporting, had 1, 800 members when I published my feature last year, and now it has over 6, 000.
[00:30:20] Arielle Duhaime-Ross: Okay, so huge increase. And I’m assuming that another thing that has put the spotlight on ketamine is also the death of Friends actor Matthew Perry.
[00:30:28] Anna Silman: Yeah, and I think a lot of people may have heard about ketamine for the first time through this awful story, but as you probably know if you’ve read the news, Matthew Perry was found dead in his pool after taking ketamine, and then five people were recently charged in the case, including two doctors, and I think that has really caused a major reckoning for the ketamine industry.
[00:30:48] Arielle Duhaime-Ross: So, coming back to Olivia, you told me that she went to rehab in 2022. What happened after that?
[00:30:54] Anna Silman: Well, she came home and tried to resume her normal life, but as is pretty typical for people [00:31:00] struggling with addiction, she relapsed soon after. Do you mind if we talk a bit about the night you ended up in the ER?
[00:31:06] Olivia: Yeah. You know, it’s, it’s hard. And I guess again, this goes back to the, you know, the sick beauty of ketamine is like, it makes me forget about the things I want to forget. And when, when I came out of rehab, I was hoping I would get back together with my boyfriend and I had dinner with him. And he was kind of like, this was the first time he was like, you know, No, like we’re not getting back together and it hit me and I fell into this intense, deep depression and I was like, my life is over.
[00:31:37] Olivia: I literally was just doing ketamine nonstop. I was also doing Xanax at the time and I didn’t realize mixing benzos with ketamine is actually really dangerous because it could stop your breathing. And I knew my family and friends were reaching me, but I didn’t want to answer the phone because it was.
[00:31:53] Olivia: This dramatic cry for help that I didn’t realize I was doing, but I was just like, I wanted him to be this [00:32:00] knight in shining armor. And I thought if I were to dangle the possibility of me dying, he would be like, okay, like, let me come and save you. Like that was my last resort of saving my relationship. I didn’t know what to do.
[00:32:11] Olivia: One of my friends finally was able to get into my building and he’s like, Um, a psychiatrist friend of ours and he was like, listen, like, I’m going to take you to the ER. Uh, and I was like, I’m not going, he was like, if you’re not going to go with me, like I’m going to call an ambulance. And I was like, okay, health insurance wise, I know an ambulance going to cost a million dollars.
[00:32:29] Olivia: So fine. I will take a cab, we’ll go to the ER. And it was one of the scariest, I guess, experiences of my life. I thought it was just like, okay, yeah, I’m going to go get checked out and then I’ll come home. I didn’t realize I would end up in the psych ward for a night because they would label me as like overdosing and high that. They were worried that I was on suicidal watch.
[00:32:46] Anna Silman: Right. Yeah. I remember it was like 1am and like our friend called us and said, you’re in the hospital. And I came to visit and it was so surreal. Like, cause I mean, I think you were kind of like high at the time. Like, [00:33:00] and I dunno, it was sort of surreal. Like, We, like, got candy and we’re playing, like, Kinect 4, and it was, like, 2 in the morning, and then they, like, wheeled you away to, like, the psych ward, and I was just like, how did this happen?
[00:33:14] Anna Silman: Like, ketamine is supposed to not be addictive.
[00:33:17] Olivia: And this is the thing, it’s like, yeah, it’s just like, you know, looking back on it, it was so obvious, like, okay, now I can see it in hindsight.
[00:33:24] Anna Silman: But I think none of us realized, like, the pull of the ketamine was so, like, strong, like, mhm. Like,
[00:33:32] Olivia: it’s like being possessed. I applaud people who are recovering alcoholics because, like, being able to resist something you see at every single street corner, at every hotel, at every airport, I would not be able to do that. It’s like, the second, like, I even start thinking about ketamine, like, in the early days of my recovery, it was, I had to instantly, I would relapse again.
[00:33:53] Anna Silman: Which is like, it brings us to an interesting moment because that was right at the time that there was this ketamine boom in the [00:34:00] States where suddenly there was influencers on TikTok talking about ketamine. And it was, there were these glossy ads that were kind of positioning it as a cure all and no one was talking about addiction.
[00:34:11] Anna Silman: And meanwhile, you’ve just come out of rehab and suddenly you’re getting like targeted ads saying like, depressed? Try ketamine.
[00:34:18] Olivia: What’s a hilarious thing was when my psychiatrist was reaching out to like addiction therapist to like see if there was someone that was specialized in ketamine addiction, it would be the actual opposite.
[00:34:27] Olivia: She would get, she’d be like, oh, like ketamine research to like help with depression. She’s like, no, no, no, my client doesn’t need to do ketamine. She needs to stop doing.
[00:34:35] Anna Silman: Yeah. So tell me about. What do you think of companies selling mail order ketamine kits, marketing it on Instagram?
[00:34:41] Olivia: Yeah. So I remember once I, once I came out of rehab, I started getting these ads on Instagram and I was like, this is insane. Like the fact that I can get ketamine shipped to me, but it was really expensive when it first started coming on the scene. Like it would be thousands of dollars to get like, I don’t know, like a few infusions and like the [00:35:00] dosage they would give you is also pretty low. I remember finding out it was. The first time I was surprised how low the dosage was, but I can see how people who would be introduced to ketamine in like a clinical setting and then finding out that buying a bag is like 60 versus spending 6, 000 on like four sessions in a clinic. The choice is obvious.
[00:35:18] Arielle Duhaime-Ross: I mentioned Matthew Perry earlier, and I’m just going to come back to that for a second. There’s this clip that’s been making the rounds. It’s the head of the DEA, Anne Milgram, talking about the case.
[00:35:29] Archival: It started with two unscrupulous doctors who were violating, really, we charge violating their oath, which is to take care of their patients and instead supplying Matthew Perry with enormous quantities of ketamine in exchange for huge amounts of money.
[00:35:45] Archival: And then it switched to the street where Matthew kicked. Where Matthew Perry was buying the ketamine from two drug traffickers on the streets of Los Angeles.
[00:35:54] Arielle Duhaime-Ross: And in this clip, she compares ketamine to the beginning of the opioid epidemic.
[00:35:59] Archival: Where [00:36:00] many Americans became addicted to controlled substances in doctor’s offices, and through medical practitioners, that then turned into street addiction as well.
[00:36:10] Arielle Duhaime-Ross: What do you make of that? Is ketamine actually the next OxyContin?
[00:36:15] Anna Silman: Well, ketamine doesn’t have the physical withdrawal symptoms that people get with like alcohol or opioids where you can get really sick if you stop taking the drug. It also doesn’t have the same risk of deadly overdose, so it’s really not the same in that respect.
[00:36:29] Anna Silman: And yeah, there’s also promising data showing that ketamine could help people who are struggling with alcohol and opioid addiction, which of course is complicated. But there are also parallels, I think, particularly in the way that we’re seeing ketamine marketed as a sort of miracle drug, a cure all with few side effects.
[00:36:49] Anna Silman: It kind of reminds me of the way that Purdue Pharma used to market Oxycontin, which is a point Olivia herself makes.
[00:36:55] Olivia: To be honest, I think ketamine is going to be the next opioid. epidemic [00:37:00] because it’s like, you know, at first everyone saw it as a cure. They were only focusing on the good sides of it and they didn’t realize the repercussions.
[00:37:07] Olivia: It was the same thing when like Oxycontin came on the scene, right? They’re like, you know, it can solve your pain and they’re obviously going to market it in a way because they’re profiting off of it. And it’s not like in, you know, like in Canada you have free healthcare, in London you have NHS, but in America it’s all about capitalism.
[00:37:24] Arielle Duhaime-Ross: I understand Olivia’s concern here and the feeling that there’s this entire money making system behind this drug that you’re addicted to and that system is failing to protect people in favor of profits. I do want to ask though, a lot of ketamine clinics have been closing recently, right? Despite all of the profits that we talked about earlier.
[00:37:44] Arielle Duhaime-Ross: So what’s going on there? How are we supposed to square those two things?
[00:37:48] Anna Silman: So, in 2023, we saw the industry contract a lot. There were a number of major chains shutting their doors. For example, Ketamine Wellness Centers, one of the biggest chains in the U. S., [00:38:00] who operated 13 sites out of 9 states, shut all their clinics in 2023.
[00:38:05] Anna Silman: There was another company called Fieldtrip that shut down a ton of their clinics, even though they’d raised over 100 million in venture capital. And that happened largely because there was a bubble. And I think because ketamine was the only psychedelic drug people could legally prescribe, a lot of money was poured into it by people who were excited about the field overall.
[00:38:24] Anna Silman: But the business model to support it just wasn’t there. And that remains a big question for the industry.
[00:38:33] Arielle Duhaime-Ross: How is Olivia doing now?
[00:38:37] Anna Silman: She’s doing okay. Yeah, she’s four months sober, um, which is great. She had to move out of New York and she’s back in Canada just kind of to get away from Ketamine. Um, but I was really moved to hear her speak so insightfully about what she’s been through.
[00:38:53] Olivia: Being finally stable and able to like, understand my thoughts and not feel [00:39:00] crazy.
[00:39:00] Olivia: Like literally I was insane. And like being sobering up for four months, I’m able to label my emotions and not just Check out. Check out. Being sober now, I know I can deal with these things and they’re manageable, and I don’t need a drug for me to go from zero to a hundred, and I know chasing that feeling is also not healthy because it’s not sustainable.
[00:39:24] Arielle Duhaime-Ross: So Anna, you’ve been observing ketamine’s uses and impacts as a reporter for a while now, but also as a friend, right? How have those two viewpoints impacted how you think about ketamine now.
[00:39:37] Anna Silman: I think there’s a tendency for discourse in the states around drugs to be very black and white. We’re living in the shadow of the war on drugs, which shut down research for decades and really harmed black communities in particular by demonizing all psychoactive substances.
[00:39:52] Anna Silman: So there’s that on the one hand. And then on the other hand, we have the opioid crisis, where pharma companies really failed to educate the [00:40:00] public about the risks of what they were peddling as miracle drugs. So I think the hard part with these two shadows hanging over us is finding a middle ground and acknowledging that there’s no such thing as a miracle cure, and that you have to educate people about the risks while also acknowledging their potential to help people and not cutting off access to the people who need it most.
[00:40:20] Anna Silman: I think what I’m hearing a lot from people in the industry is the worry that any bad press is going to lead to a moral panic, where we get another big government crackdown. And then the flip side is that there’s all this hype and failure to acknowledge the risks at all. So, yeah, it’s a really hard needle to thread.
[00:40:37] Anna Silman: But we have to try, because as Olivia says, if she had known what the risks were, she might never have picked ketamine up in the first place.
[00:40:50] Arielle Duhaime-Ross: This episode was reported by Anna Silman and produced by Cassidy Rosenblum. Altered States is a production of the UC Berkeley Center for the Science of Psychedelics [00:41:00] and PRX. Adizah Eghan is our senior editor. Jennie Cataldo is our senior producer. Our associate producer is Cassidy Rosenblum. Our audio engineers are Tommy Bazarian and Terence Bernardo.
[00:41:12] Arielle Duhaime-Ross: Fact checking by Graham Heysha. Rotating BCSP script readers are Michael Pollan, Michael Silver, and Bob Jesse. Our executive producers are Jocelyn Gonzalez and Malia Wollan, and our project manager is Edwin Ochoa. I’m your host, Arielle Duhaime-Ross. Be sure to subscribe, rate, and review Alter States wherever you get your podcasts.
[00:41:33] Arielle Duhaime-Ross: Most well known psychedelics remain illegal around the world, including the United States, where we live. It is a criminal offense to manufacture, possess, dispense, or supply most psychedelics with few exceptions. Altered States does not recommend or encourage the use of psychedelics or offer instructions in their use.[00:41:53] Arielle Duhaime-Ross: We’ll be back next [00:42:00] week.