We report a patient with chronic ketamine abuse who presented with severe cachexia, upper gastrointestinal involvement, hepatobiliary dysfunction, and acute kidney injury. Most studies of ketamine’s effects on the brain to-date have looked at the effects of acute exposure—how one dose affects the brain in the immediate term. For this study, researchers examined repeated daily exposure over the course of up to ten days. Statistically significant alterations to the brain’s dopamine makeup were only measurably detectable after ten days of daily ketamine use.
Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, and it blocks HCN1 receptors. However, at higher doses it may also bind to the opioid mu and sigma receptors. Glutamate is involved with learning, memory, emotion, and pain recognition. It can exhibit sympathomimetic activity which can lead to rapid heart rate and elevated blood pressure. More research on how ketamine affects addiction is needed, but it may change how your brain deals with cravings, motivation to quit a drug, and controlling behavioral reactions.
The included studies described structural gray matter and white matter differences, differences in brain functionality and differences in neurotransmitter receptor binding. All retrieved studies were retrospective cohort studies, level IV on the Sackett scale or level 2b on the Oxford CEBM levels of evidence scale (Sackett, 1989; Howick et al., 2018). To date, the safety of prolonged ketamine administration has sparsely been investigated in humans in a prospective manner. The studies that have been done, have been conducted in clinical setting, with a much lower dose than the doses that are used recreationally. However, given the scarcity of research on the topic, these findings are worth mentioning.
Associated Data
While users report feeling complete bliss on ketamine, consuming high amounts of this drug can produce effects similar to a near-death experience. While ketamine isn’t the most fatal of substances when used alone, developing an addiction to this drug use screening tests drug can greatly affect quality of life. The patient was further managed with oral and intravenous hydration, a multivitamin supplement, and omeprazole. The acute kidney injury and the liver function abnormalities improved gradually (Table 1).
- A possible mechanism for the white matter changes identified in the reviewed recreational ketamine studies could be AMPA-receptor mediated excitotoxicity.
- For those who abuse ketamine via insufflation (“snorting”) adverse reactions may be less serious, but still present.
- Therefore, we also analyzed the results after excluding four of these five studies.
- In 16 ketamine users averaging 2.4 grams/day for 7.3 years, a lower level of axial diffusivity was found compared to 16 polydrug controls, especially in the frontal part of the right hemisphere (Edward Roberts et al., 2014).
- The higher ReHo in the left precentral frontal gyrus was negatively correlated with estimated total lifetime ketamine consumption and ketamine craving (Liao et al., 2012).
Gray matter volumes in rOFC, rMPFC and rNAC were negatively correlated with ketamine dependence severity and gray matter volumes of the rOFC, rmPF, lCN, lGP, lH, and rNAC negatively correlated with cognitive performance (Liu et al., 2016; Tang et al., 2016). Different from other studies, this study also found higher gray matter volume in ketamine users compared to controls, i.e., in the left caudate nucleus. Many of the observed changes were correlated with the amount and duration of ketamine consumption, suggesting a possible dose dependent effect of prolonged ketamine on brain structure and function. Although the identified lower gray and white matter volumes or integrity could suggest direct neurotoxic effects of ketamine, the observed higher structural and functional connectivity and dopamine binding may suggest indirect compensatory effects. Together, these findings suggest that long-term intensive ketamine use may affect the structure and function of cortical gray and white matter, especially in frontoparietal regions. Within the ketamine users group, adolescent onset users were compared to adult-onset users.
Ketamine Slang Terms
Ketamine treatment might also make behavioral therapy more effective, which is a big part of overcoming addiction. In a medical setting, doctors give low doses of ketamine over a longer period of time. Ketamine was approved by the FDA in 2019 for the treatment of depression, “but its usefulness alcoholism and anger management is limited by its potential for abuse because of its psychiatric side effects,” said Fangyun Tian. Addiction can negatively impact quality of life, physical health, mental well-being, and relationships. If you think you may have a ketamine addiction, reaching out for help is not a weakness.
For those who abuse ketamine via insufflation (“snorting”) adverse reactions may be less serious, but still present. Fast heart rate, high blood pressure, hallucinations, and impaired consciousness upon presentation to the emergency department may be most common effects with “snorting”. When abused, it is typically insufflated (“snorted” up the nose) in social situations. It is also injected, consumed orally as a liquid (mixed into drinks), or smoked in marijuana or tobacco. It is frequently abused in combination with other substances, such as cocaine, MDMA or amphetamines.
Of all remaining articles, full-texts and one congress abstract were read. Finally, we found our complete dataset consisting of 16 studies (see Figure 1) for the inclusion flowchart. It needs to be considered however, that there may be a U-shaped dose-effect relation between ketamine and cognitive changes. In rats, different 5–7-days dosing regimens of ketamine yielded opposite effects on cognitive tasks in which the rats had to detect novel objects, or novel placement of objects.
Ketamine for Addiction: What to Know
Whereas, low ketamine enhanced novelty detection compared to controls, higher doses impaired novelty detection (Schumacher et al., 2016). In conclusion, these animal studies may provide important clues for the potential neurotoxic effects of prolonged ketamine use. Prolonged ketamine may either up- or downregulate important regulatory neuronal proteins, potentially resulting in impaired neuronal functioning and cognitive performance. “This study gives us a deeper brain-wide perspective of how ketamine functions that we hope will contribute to improved uses of this highly promising drug in various clinical settings as well as help minimize its recreational abuse.
In 2020, 1.3% of 12th graders were found to have misused the drug for recreational purposes—this number was at 0.7% only a year prior. The patient was initially managed with intravenous hydration, thiamine, and continuous urinary drainage through an indwelling catheter. Esophagogastroduodenoscopy showed grade 3 esophagitis and mild gastritis. The histology from the esophageal mucosa revealed only chronic inflammatory changes.
Fourth, most of the included subjects were of Asian ethnicity, which might have influenced outcomes for instance through genetic differences in drug metabolism. However, it has been shown that frequencies of cytochrome P450 variants responsible for ketamine metabolism do not vary significantly between people with Asian 52 ways to identify a covert narcissist or Caucasian ancestry (Mizutani, 2003; Peltoniemi et al., 2016). In addition to its legal, medical uses, ketamine and synthesized analogs have become drugs of abuse with hallucinogenic properties. In both studies, the researchers concluded that ketamine lowered the chances of restarting or relapsing into addiction.
Axial diffusivity is thought to be a measure of axonal density and radial diffusivity is thought to be related to the degree of myelination (Liao et al., 2010). In 16 ketamine users averaging 2.4 grams/day for 7.3 years, a lower level of axial diffusivity was found compared to 16 polydrug controls, especially in the frontal part of the right hemisphere (Edward Roberts et al., 2014). Axial diffusivity was significantly lower in eight white matter clusters in the right hemisphere in the ketamine group compared to the control group, the three largest being located in the frontal cortex (Edward Roberts et al., 2014).
Likewise, snorting and injecting ketamine are common ways to consume ketamine, so this permits quick entry into the bloodstream. Because ketamine is consumed in liquid and powder form, or mixed in these forms with other stimulants—there is a high chance that a person using this drug has little to no idea of how much is being consumed. Because of its addictive nature, this drug is more commonly used in veterinary clinics to sedate animals. Ketamine is available as an injectable liquid but is also abused in powder form. Ketamine is a drug gaining fast notoriety with America’s young population.
For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The risk of HIV, hepatitis, and other blood-borne infectious diseases exists for those who share needles when drugs are used recreationally. Binge use, where the user indulges in the drug in excess amounts in a short period of time has been reported, as well. High doses may dangerously reduce breathing, lead to muscle spasms or weakness, dizziness, balance difficulty, impaired vision, slurred speech, nausea and vomiting, and severe confusion.