- Special K
Ketamine, a synthetic drug not known to occur in nature, was first synthesized in 1962. In 1970, the Food and Drug Administration approved the medicine, trade-named Ketalar, for use as an anesthetic.
Ketamine is used widely as an anesthetic, especially for children and soldiers, and as an animal tranquilizer. It is also sometimes used to treat chronic pain. At lower doses, ketamine can alter one’s perception and sense of time and space. At higher doses, the drug can cause a dissociative state, sometimes called a “k-hole,” during which people experience oblivion and are unable to perceive or interact with the outside world. These effects have some overlap with the general effect profile of classic psychedelics.
Clinically, ketamine is administered intravenously, by intramuscular injection, or as a lozenge placed under the tongue. Outside of medical settings, powdered ketamine is also snorted.
In the 1970s, use of ketamine recreationally or as a tool for personal exploration began to increase. It was popularized in books like The Scientist by John Lilly and Journeys into the Bright World by Marcia Moore and Howard Alltounian.
The leading theory about how ketamine works is that it acts on receptors for the neurotransmitter glutamate, which may play a role in regulating mood. Over the last twenty years, numerous studies have suggested that ketamine can be used to treat chronic depression, bipolar depression, obsessive compulsive disorder, anxiety, and post-traumatic stress disorder. Some participants in clinical trials reported side effects including headache, dizziness, nausea, blurred vision, drowsiness, and poor memory, but these resolved quickly after treatment sessions. Prolonged ketamine exposure has been associated with neurodegeneration in newborn rhesus monkeys. Some people become addicted to ketamine, which can be very difficult to overcome.
In the United States, ketamine is a Schedule III drug, meaning that it is legal when prescribed for medical use as an anesthetic. It can also be prescribed legally for off-label use, like for the treatment of depression. In 2019, the FDA approved Spravato, delivered as a nasal spray made from esketamine, half of the mirror image of ketamine, for use in treating treatment-resistant depression or TRD. Because it is under patent, the price of Spravato can be hundreds of times the price of generic ketamine.
Licensed providers can legally offer ketamine-assisted therapy.