Ketamine Around the World: From Emergency Rooms to Dance Clubs

"Special K" is used as a dissociative in hospitals all over, so why is the legal status of this drug changing around the world?

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Ketamine, the powerful anesthetic also known as “Special K,” has a prominent place in modern medicine and emergency rooms across the world. Its widespread appeal can be attributed to the fact that users experience few side effects as doctors gradually administer small dosages of the drug, and although it is an induction agent (having the potential to fully sedate a patient)—ketamine is most commonly used for conscious-sedation procedures in lieu of painkillers.

Although hospitals administer the drug intravenously, patients may feel as though they have just inhaled laughing gas (or nitrous oxide) through a mask in the dental chair, or balloon at a concert, as ketamine and nitrous oxide are both dissociative drugs.

This means that they don’t block pain receptors like opiates and other painkillers do, but instead disassociate you from the pain while you get stitches or a root canal. For this reason, ketamine remains a useful battlefield anesthetic, and was first popularized in medicine during the Vietnam War.

Ketamine is also favored in medicine because it does not drop your blood pressure the way that opiates can, and is considered so safe that children in the hospital are routinely given the drug, and are actually less likely to experience mental discomfort than adult patients.

Like any pharmaceutical, however, ketamine does have its disadvantages—the main symptom being that the drug can likely provoke feelings of anxiety in patients unfamiliar with its "loopy" effects. This anxiety is usually felt while ketamine inspires vivid hallucinations: where time and space may zoom past your hospital bed as you try unsuccessfully to catch up to them, and you might emerge in an overwhelming haze of confusion.

As a patient’s mind races to make sense of what it claims to have seen, the face will appear tense and rigid, with eyes jolting back and forth—potentially disturbing concerned family members or nosy onlookers. But to address these concerns, and limit the amount of anxiety provoked, ketamine is often paired with a benzodiazepine (such as Xanax or Valium) in order to minimize a patient’s nervousness or disillusioned thoughts, with all patients being monitored carefully under the drug’s effect.

And while the chemical’s structure is not dissimilar from fellow animal tranquilizer and dissociative PCP, or “Angel Dust”—it is much safer than the latter—to the point of replacing PCP in both human and veterinary medicine.

Patients, human or otherwise, typically feel ketamine’s effect for a mere 30 minutes or so, and thankfully most do not find themselves in a K-hole: the (usually) anxious episode of being trapped in your own warped mind.

Many actually enjoy the high or emergence period directly afterwards, however, and report feelings of relaxation, rather than anxiety. Recently, ketamine has even been tested as an anti-depressant and results have been largely positive.

So why, then, is the legal status of this drug changing around the world: making its possession a criminal offense in more and more countries?

In the United States, for instance, ketamine is a Schedule III drug—like codeine and steroids—but has held this legal status since 1999.

Not all that much has changed regarding its usage since then, aside from the invention of a nasal spray for its anti-depressant debut, and rates of the drug’s abuse in America remain relatively low.

The U.S. Department of Health and Services report from 2009 cites ketamine as the illicit drug least likely to cause emergency hospital visits, and only 13 ketamine-related deaths nationwide are mentioned in the report.

Countries abroad, however, are not so lucky regarding ketamine’s potential for abuse, and as the U.S. fights its war on opiates, European and Asian countries are continuing to battle ketamine.

Although only being banned recreationally since 2006 and becoming a punishable offense to possess only as of last year, ketamine has been a problem in the United Kingdom for decades as part-time partiers become addicts and even occasional casualties.

Yet, the unique thing about ketamine abuse is that the negative effects can often take years to develop before it is too late, most notably after chronic abuse, which can lead to bladder or kidney failure and other life-threatening ailments. The recent death of Nancy Lee explains how the seemingly harmless drug can become lethal after years of abuse, and reinforces the claim that the U.K. is the “K Bladder” capital of Europe.

North America has not been spared, however, and recreational use and abuse of ketamine is on the rise in Canada—specifically Toronto—where “K” has re-entered the clubbing scene that it never really left.

There, and in club bathrooms worldwide, ketamine drips down the throats of those snorting the white powder, just as it drips into IV bags when distributed legally at the hospital.

It hits within about 30 seconds, giving users a psychedelic punch, often along with energy and euphoria, until the next "bump" is needed to maintain the high.

And despite the potential for the confusion and psychological tailspin of a "K-hole," many recreational users actually long for that state of mind, and keep ingesting "K" until they’ve mentally boxed themselves in.

Because overdoses on ketamine alone are uncommon, many clubbers limit their worries to that of their spending habits on the drug—a substance that is seemingly cheap and prevalent in almost every country.

Ketamine appears to be the least expensive in China, one of the leading manufacturers of the drug, and it has been engrained in Chinese club culture since its peak in the 1990s.

Hong Kong seems to have been the original ketamine capital, where many users combine the drug’s high with karaoke sessions in KTV (Karaoke TV) clubs– perfectly pairing the private TV rooms with all night “K” consumption.

But even decades after Hong Kong’s “K” epidemic was first reported, the trendiness of the drug, and those long karaoke nights, never really slowed down.

The Central Registry of Drug Abuse (CRDA) reports that ketamine use among illicit drug users in China under the age of 21 rose from 36.9% in the year 2000 to 84.3% in 2009.

Ketamine’s extreme popularity among Chinese youth can be attributed to the fact that the drug remains inexpensive and extremely easy to acquire there, as Superintendent of the Hong Kong Police Narcotics Bureau, Wilson Fok, describes in an interview for CNN.

“One gram of ketamine sells on the street here for $13 and is enough to be shared with two other people, while cocaine, for example, sells for $103 a gram… The drug is legal for medical use, but is trafficked into Hong Kong from other parts of Asia such as India and mainland China, and sold on the streets illegally.”

It is for this reason and more that China is considering a total ban on the drug, despite the fact that the World Health Organization (W.H.O) opposes such extreme measures.

The World Health Organization even considers ketamine to be a “core” medicine—putting it on a list of minimum medical needs for a basic healthcare system and documenting its importance.

In its 2006 “Critical Review” of the drug, the organization reported that:

“There is evidence that ketamine is abused, but looking at the figures one can hardly consider this to constitute a public health and social problem. Especially when comparing ketamine to the other cyclidines.”

The report also describes the necessity of the drug’s administration in Third World countries because of its ease of use—like the injectable solutions of ketamine hydrochloride in water that are packaged in small glass vials and used safely and effectively in medicine across the globe.

Ketamine is also not thought to be physically addictive, although a tolerance can quickly develop, and is rarely (if ever) prescribed.

For now, American officials remain far more concerned by prescription drug abuse than those snorting ketamine in dance clubs, but restrictions on the drug could still change, especially as the World Health Organization will discuss the drug in a Geneva committee meeting this month—partly as an answer to China’s ban request.

So while some continue to sing the drug’s praises, in karaoke sessions or official data reports, others are having to combat ketamine’s destruction of certain drug-addled populations and prove that, like anything abused every day—there are irreversible consequences.