On March 6, 2019, the U.S. Food and Drug Administration (FDA) announced that it had approved a medication that contains ketamine for use in the treatment of depression.
Prior to this announcement, ketamine may have been most widely known among the general public as a dangerous recreational substance, one that is often included in the informal category of club drugs.
What is Ketamine?
Ketamine is a dissociative anesthetic. This means that the drug’s effects can include feelings of euphoric relaxation, a diminished ability to feel pain, the sense of being disconnected from your mind or body, impaired motor functions, hallucinations, and memory loss. The chemical structure of ketamine is similar to that of phencyclidine (PCP), an illegal drug that is also referred to as angel dust.
As is the case with several other powerful substances, the possible benefits and potential harm of ketamine can vary considerably depending on the circumstances in which the drug is used.
Medical Uses of Ketamine
The FDA’s March 6 announcement was not the first time that the agency had approved ketamine for medical use. In 1970, the drug earned approval for use in the United States as an anesthetic.
In the 1970s, ketamine gained widespread acceptance among U.S. military medical personnel, who used it as battlefield and surgical anesthetic when treating service members who had suffered combat-related injuries in Vietnam.
When used appropriately by qualified healthcare providers, ketamine is a safe medication. Unlike other common anesthetics, it does not typically suppress respiration or lower blood pressure. These features, combined with the relatively low cost of producing the drug, have made ketamine a popular choice among medical professionals throughout the world.
In 1985, the World Health Organization (WHO) added ketamine to its list of essential medicines. A WHO fact sheet about ketamine describes the substance as “a versatile medicine and possibly the most widely used anesthetic in the world.”
Illicit Use & Recreational Abuse of Ketamine
Although ketamine is a safe and beneficial medication when used by experienced professionals for legitimate medical purposes, this does not mean that the drug is harmless.
Ketamine’s effects have made it unfortunately popular among individuals who are seeking a recreational high, as well as those who wish to surreptitiously disorient or disable potential victims prior to assaulting them.
According to the University of Maryland’s Center for Substance Abuse Research (CESAR), ketamine abuse was first noted in the 1970s. It expanded during the 1980s in conjunction with the increased popularity of all-night dance parties, or raves.
Ketamine is most commonly abused by inhaling it in powder form, dissolving it into a liquid and drinking it, or swallowing it in pill form. It is also sometimes injected. When it is dissolved into a liquid, ketamine can be virtually undetectable by smell or taste, which has contributed to its use as a date-rape drug.
Understanding Ketamine’s Negative Effects
The National Institute on Drug Abuse (NIDA) has reported that high doses of ketamine can cause several negative effects, including delirium, amnesia, impaired motor functioning, and breathing problems. Long-term ketamine abuse can lead to ulcers, pain in the stomach and bladder, kidney damage, and depression.
When ketamine is abused in combination with alcohol or other drugs, as is often the case, the risk of negative outcomes increases significantly.
Continuing to abuse ketamine can cause a person to develop a tolerance, which means they will need to use the drug more frequently or in greater amounts to achieve the desired effect. This can increase their risk for harm. Ketamine overdose can be fatal.
Ketamine’s negative effects may be particularly harmful to individuals who ingest the drug without their knowledge or consent. While under the influence of ketamine, a person may be incapable of differentiating between reality and hallucinations. They may also not be able to fight back or escape from a person who is attempting to inflict harm upon them.
Ketamine’s impact on memory can also make it difficult for a person who has been assaulted to remember exactly what happened or identify the perpetrator.
Potential Benefits of Ketamine for Behavioral Health Clients
Ketamine’s successful decades-long use as an anesthetic, combined with its place on WHO’s list of essential medications, is clear evidence that the drug offers significant benefits when used appropriately by qualified healthcare providers. And the FDA’s recent approval of ketamine for use in the treatment of depression demonstrates that the full extent of the drug’s medical applications may not yet be completely understood.
According to the news release that announced the FDA’s decision, studies suggest that the newly approved drug, a nasal spray that is being marketed under the brand name Spravato, has the potential to quickly and dramatically improve the quality of life of individuals who have been suffering from treatment-resistant depression.
“In one of the short-term studies, Spravato nasal spray demonstrated statistically significant effect compared to placebo on the severity of depression,” the release noted, “and some effect was seen within two days.”
Due to safety concerns, the FDA is limiting access to this medication. Spravato may only be used by individuals who have treatment-resistant major depressive disorder, and it must be used in combination with an oral antidepressant. Also, the nasal spray can only be administered in a certified medical office under the supervision of an approved physician. Patients may not take the medication home with them for future use.
Continued ketamine research will involve documenting its effectiveness in depression treatment, exploring possible additional medical uses, and noting its limitations, side effects, and potential dangers. This ongoing evaluation process will ensure that governmental agencies, medical professionals, and members of the public have the best available information to guide their decisions and actions.