Ketamine

What is ketamine?

Ketamine (Special K, Vitamin K, or Ket) is a dissociative drug with hallucinogenic properties. 


Effects

The effect a substance will have depends on the characteristics of the substance, but also on the set and setting of the user. This section describes the effects of ketamine in general.

Ketamine is a dissociative hallucinogen. Dissociation is another word for separation: during ketamine use you can experience a separation between your mind and body. At a dose of up to 50mgs you will experience a clouded, “vague” mental state. At a dose above 50mgs, the effects can become more intense and psychedelic in nature. The higher your dosage is, the stronger and longer the effects will last.

Positive effects (negative) Side effects

Dissociative effects

Dissociation describes the separation of body and mind.

This can present with the following effects:

  • The feeling that your hands no longer belong to your body
  • Your sense of touch is altered, with skin feeling as if it were made of wood, rubber or plastic.
  • Body parts feel much bigger or smaller than they actually are
  • Losing sense of where your limbs are
  • The density of your body decreases, feeling as if it ‘dissolves’ in your environment
  • No longer being able to differentiate between whether a limb is your own or someone else’s
  • Feeling like the mind is in a different dimension than the body
  • Out-of-body experience
  • Visual hallucinations (especially with eyes closed) and altered perception of time, insights into the cosmos, existence and being are also frequently mentioned by users.

K-hole

A k-hole is a very strong ketamine experience. During this, you are often unable to move or talk. Contact with the outside world is no longer possible. It is difficult to differentiate between what is real and what is only in your mind. It can be a very interesting or informative experience, but it could also be very frightening. Make sure you have the opportunity to lie down if you plan on taking a lot of ketamine. In summary, it could be either a positive or negative experience for you.

Altered sensory perception

How you perceive your environment changes, this can affect all of your senses. Sometimes, this could make it seem as if your surroundings differ from reality. More information about tripping and hallucinations can be found here.

Nausea/vomiting

An uneasy and tense feeling in the abdomen, which may cause discomfort. Nausea often precedes vomiting.

Changes in perception of time

The passage of time could feel altered during ketamine use. Some parts of the evening fly by, while some parts feel a lot slower. When you are feeling comfortable, it can be nice that the feeling does not seem to stop. But if you feel uncomfortable, this can be a bothersome experience. So this effect can work both ways.

Impaired coordination

Drug use can negatively affect the coordination of your body parts.

Changes in thought patterns

You more quickly form logical and illogical associations, but your thoughts may also become more chaotic and confused. For the user, this could be either a positive or negative experience.

Confusion

You can get confused. Logical thinking is then difficult. It is also possible that you do not remember what you just did.

Insightful experiences

Some experiences from substances may give you new insights. Because your brain activity is altered, different thoughts may arise and you might gain new perspectives.

Brain damage

Brain damage

Relaxation

Reduction of stress, uneasiness, sadness, panic, and feelings of depression.

Impaired short-term memory

Short-term memory does not work properly after taking some drugs. This makes you remember things less well. For example, it often happens that during a conversation you forget what you were talking about, or that you forget the reason you walked somewhere. The next day you often don’t know very well what happened the night before.

Paranoia and delusions

Anxiety, paranoia and delusions (e.g. the idea that people are talking about you).

Double vision

Not being able to focus your eyes properly.


Dose and mode of use

Ketamine is often insufflated.
It can also be found in liquid form, which can be injected into muscle tissue for a very intense experience. The liquid can also be boiled off, leaving a crystalline powder. Ketamine is rarely taken orally (for example, in pill form). When taken orally, a higher dose is needed to feel the same effect as other methods. The liver will metabolize quite a lot of ketamine from the intestines before it can reach the brain.

The vast majority of ketamine that is used recreationally is produced by the pharmaceutical industry and subsequently ends up in the illegal circuit.

Determining a dosage can be difficult. How high the dose is at which you achieve the desired effect, depends on the experience you are looking for. Do you just want to feel a little vague and clouded, fall into a k-hole, or somewhere in-between? Additionally, your experience is dependent on many other factors besides intake dose.

One of these factors is the relatively quick tolerance for the ‘psychedelic effect’ of ketamine. As a result, you will need increasingly higher doses to achieve the same effect. If you have not used ketamine for a longer period after previous frequent use, make sure to start with a lower dosage when you decide to take ketamine.

Snorting dose
Light 10 – 30 mg
Medium 30 – 70 mg
High 70+ mg

At a dose of 50mg or more, sitting or lying down is recommended.
Ketamine in powder or crystalline form may be adulterated, make sure to always have your ketamine tested.


Duration

If you snort ketamine you will feel the first effects within 3-10 minutes. The experience lasts approximately 1-1.5 hours in total. (Note: ketamine is more potent than, for example, cocaine. This means that for the same dose, ketamine will have a more profound effect).

After injecting ketamine you will start to feel the effects after 3-5 minutes, with the experience lasting between 30-45 minutes.


Risks

Short-term risks of use

  • Confusion and difficulty coordinating movements. This creates a risk of falling and tripping, which could lead to accidents.
  • Ketamine dulls your senses, meaning you are less aware of pain and you can injure yourself without noticing.

Choking on vomit

When someone loses consciousness (e.g. passing out or a k-hole), there is a chance that they will choke on their own vomit.

In such an event, make sure to put that person in a recovery position: the vomit will then be able to flow freely out of the mouth. When they are free from immediate danger, call 112 (emergency services) for help.

Triggering a drug-induced psychosis

Frequent and high-dosage ketamine use can increase susceptibility to developing psychosis. During a psychosis, you may suffer from delusions, hallucinations, losing your grip on reality, and you could become very anxious. It becomes difficult to differentiate between reality and your thoughts. Your behaviour and thought patterns are often erratic and chaotic.

It is still unclear whether this can only be triggered in people who are already predisposed to psychosis, or whether regular drug use and an unhealthy lifestyle (e.g. little sleep) by itself can induce psychosis.

Using ketamine consecutively for days without sleeping, resting and eating exhausts your body, and therefore increases the risks of psychosis. Does someone in your environment react erratic and anxious? You can help that person by removing distractions (music, TV off for a while) and finding another environment where that person can get some rest. Speak calmly, be understanding and, if necessary, go outside together. Do not deny or confirm any delusions and if it does not get better, call a general practice centre. Medical staff are there to help you and can, if necessary, arrange a consult, write a prescription or provide care in another way.

Read more about psychosis in this article.

Experiencing a bad trip

You may be overwhelmed by the intensity of your ketamine experience. Such an experience can certainly be frightening for inexperienced users, and is called a ‘bad trip’. A bad trip, for example, manifests itself in confusion as a result of a dose that was too high. However, it can also arise because someone no longer has his/her thoughts under control.

In such a situation, it is important to put the person’s mind at ease. Explain to them that the situation they are in is a result of the drug and that things will be well again in a short time.

Give the person in question as much rest as possible, preferably in a familiar environment. Accepting the situation is often the first step a person needs to take to sit out the trip in calmer waters. Using hallucinogens when you are not feeling well or in an unfamiliar/busy environment increases the chance of unpleasant experiences during the trip and is therefore not recommended.

Read more.

Long-term risks of use

Kidney & bladder problems

The kidneys, along with the liver, are the great ‘cleaners’ of your body. The kidneys work hard to get rid of (harmful) substances, like drugs, and in some cases, this may lead to bladder and kidney problems.

For example, having to urinate more frequently because the capacity of the bladder is reduced.

Click here for a detailed explanation of ketamine and bladder problems.

Psychological dependency

When someone has a psychological dependency, they are convinced that they cannot function without using the substance.

However, there is no physical change in body chemistry that would produce bodily side effects from quitting the substance.


Interactions

Combining different types of drugs can be risky and unpredictable. When you combine drugs you can have a higher risk of health problems. In the following paragraphs you can read about the effects and the risks of a number of combinations that occur frequently and also a about few that are extra hazardous. Also check our theme combining drugs.

Ketamine and alcohol

Ketamine and alcohol are both downers. They cause less activity in your brain. They reinforce each other’s effect. Some people like a low dose of both. At higher doses, the chance of unpleasant effects is considerably greater. Many people report feeling nauseous and vomiting. They are also more likely to become disoriented. They no longer understand what is happening and how to react to it.

Especially after a lot of alcohol it is not recommended to take ketamine. The chance of throwing up is high. If you first take ketamine and then drink alcohol, you are better able to control how you feel. But then still it is possible you’ll feel nauseous.

You can pass out of the combination. If you also feel nauseous and have to vomit, you could choke on your own vomit because you can’t control your body anymore. So always avoid passing out. Passing out is not ‘taking a nap’. It requires medical care. If someone has passed out of alcohol and ketamine, it is important to see whether someone responds to painful stimuli. If someone does not respond, call the ambulance immediately or take someone to the emergency room. If someone still responds to painful stimuli, keep a close eye on that person. And continue to administer pain stimuli until the person is awake again. Lay the person on their side so that vomit does not block the airway.

Alcohol reduces how deeply and how often you breathe. Combining alcohol with ketamine enhances that effect. Especially if you take even more downers (eg GHB or benzodiazepines, sleeping pills) then the chance of respiratory depression is greater. You then get too little oxygen, which can lead to a coma and in extreme cases you can die.

Ketamine and cannabis

Combining cannabis and ketamine increases the risk of nausea and vomiting. If you then have trouble moving because of the ketamine, in the worst case you can choke on your own vomit if you lie on your back. Cannabis can also make the effect of ketamine even more vague. Which is not always positive.

Ketamine and GHB

Ketamine and GHB are both downers. They cause less activity in your brain. They reinforce each other’s effect. Some people like a low dose of both. The combination increases the chance of unpleasant effects, especially at higher doses. Many people report feeling nauseous and vomiting.

You can pass out of the combination. If you also feel nauseous and have to vomit, you could choke on your own vomit because you no longer have control over your body. So always avoid passing out. Passing out is not ‘taking a nap’. It requires medical care. If someone has passed out of GHB and ketamine, it is important to see whether someone responds to painful stimuli. If someone does not respond, call the ambulance immediately or take someone to the emergency room. If someone still responds to painful stimuli, keep a close eye on that person. And continue to administer pain stimuli until the person is awake and awake again. Put the person on their side so that vomit does not block the airway.

With both drugs, people often suffer from memory problems when they are under the influence. You can no longer remember names, for example. Or you don’t remember what you just did. The combination enhances that effect. Writing down when you took something can prevent you from accidentally overdosing.

If you choose to combine, take less of both drugs. Or wait until one of the two has significantly decreased in strength. If you have no experience with GHB or ketamine, make sure you first have experience with both drugs separately.

There is a chance that the combination will make you more impulsive. Something stupid or dangerous seems like a good idea. A sober tripsitter can keep you from doing weird things.

Ketamine and ecstasy/MDMA

It changes the XTC/MDMA experience. After using MDMA, many people indicate that they already have some hallucinations (crash barriers, bar tables, sunglasses, etc.). Ketamine increases the risk of hallucinations. This can be fun, but also scary. The experience becomes much more vague. Some take ketamine after the MDMA to take the sharp edges off the end.

With both drugs, people often suffer from memory problems when they are under the influence. You can no longer come up with names, for example. Or you don’t remember what you just did. The combination enhances that effect. Writing down when you took something can prevent you from accidentally overdosing.

There is a chance that the combination will make you more impulsive. Something stupid or dangerous seems like a good idea. A sober tripsitter can keep you from doing risky things.

If you choose to combine, take less of both drugs. Or wait until one of the two has significantly decreased in strength. If you have no experience with MDMA or ketamine, make sure you have experience with both drugs separately.

Both ketamine and MDMA increase heart rate. This can put an extra burden on your heart and blood vessels. If you have heart problems, the combination is not recommended.


Unity tips

Using hallucinogens is inherently risky because of the chance of a bad trip occurring and because of intensifying psychological problems. If you do intend to use hallucinogens, you can limit the risks by:

  • Carefully dosing ketamine, because the effective dose of ketamine is much lower than that of other insufflated drugs.
  • Be careful with ketamine at parties, you may become disoriented and unstable, dancing is often no longer possible, and you may trip or fall on the dance floor. Think about whether or not you wish to experience this on the dancefloor.
  • If you’re using ketamine for the first time, make sure to take it in a controlled/safe environment (not at a party), start with a low dose and make sure there’s someone around who has experience with ketamine.
  • You often get nauseous when using ketamine. To prevent this, it is best not to eat for at least 3 hours beforehand.
  • If you end up having a bad experience with ketamine, keep in mind that you will feel fairly normal within an hour or so. This time may seem to last very long to you because the passage of time seems altered by the drug.
  • Stop taking ketamine when you notice bladder problems after use.
  • Do not combine using ketamine together with nervous system depressants, such as alcohol or GHB, this increases your chances of losing consciousness.
  • If you have insufflated ketamine, make sure to clean your nose before going to sleep. You can do this by removing the remains that are still in your nose with a damp cotton swab, a nasal douche, spraying with saline water, or using your fingers while in the shower.
  • If you inject ketamine into the muscles, expect an intense experience. Make sure you are able to lie down and use only sterile materials!

Unity tips for using drugs

  • When using a drug for the first time, take only a small dose to see how your body reacts to the substance
  • Only use drugs when you are feeling well
  • Use drugs recreationally, not to combat psychological issues like fatigue
  • Avoid using drugs if you have (had) psychological afflictions or if you have a family history of psychological diseases (such as depression) in your family
  • Test your drugs before use at a drugs-testing service
  • Make sure to prepare a good set and setting for drug use
  • Only use drugs sparingly. Keep track of your use over time.
  • Decide in advance how much you are planning to use over the evening, and stick to that. 
  • Do not combine drugs with other substances or medicines
  • Do not participate in traffic after drug use
  • Prevent infectious diseases; Use your own snorter/sniffer and do not share paraphernalia with others
  • After insufflating, rinse your nose well with lukewarm saline water (for example, by using a nasal spray or nasal douche)
  • Are you, or one of your friends not feeling well? Keep an eye out for one another, take care of each other and visit the first aid (if one is available)
  • Call 112 in a life-threatening situation
  • Eat healthy before and after drug use. In particular, foods with lots of antioxidants and vitamins (blueberries, raspberries, blackberries, grapes, raisins, oranges, kiwi, broccoli). This is perhaps the most important tip! It can be difficult to eat during and after drug use, but make sure to try to eat something anyway. Eating well is a great way to reduce the hangover! If you can’t hold in solid foods, try juices, breakfast drinks, and smoothies.

Unity tips for using psychedelics

  • When taking a psychedelic for the first time, try to have your experience in nature or at home
  • Do you want to trip at a party or festival? Adjust your dose to be smaller than what you are used to.
  • Prevent nausea by eating something easily digestible at least 2 hours before taking your drugs
  • Make sure to always have a sober person (a trip sitter) around when tripping.
  • Pay close attention to the effects you experience: if you feel that they are too strong or unpleasant, ingesting vitamin C, dextrose or sweet drinks may help to alleviate this.
  • Do not fight any unpleasant feelings during the trip, but let yourself float on the flow of the trip
  • Do not combine psychedelics with other drugs (including alcohol) and medications. Cannabis in particular can greatly intensify and prolong the effect of psychedelics.
  • Make sure you are free from responsibilities the day after using, take some time to process the experience
  • Do not use psychedelics if you suffer from epilepsy or have a cardiovascular disease.

Unity tips for using sedatives

  • Do not use sedatives (downers) in combination with other sedatives (alcohol, GHB, sleeping pills, opiates) or ketamine. This is dangerous because you can fall unconscious and suffocate on your vomit.
  • Write down the time of intake and your dose, text the dose and time to each other or put it in your phone to keep track of it yourself.
  • If you feel that you are getting falling asleep, you can try to keep moving to avoid falling asleep. But beware; if moving takes a lot of effort, there is a chance that you may fall or trip, so be careful.
  • An overdose is more likely on an empty stomach, a full stomach increases the chance of vomiting.
  • Less is more; taking a small, extra dose later because you did not feel anything after your first dose is better than taking too much and having an overdose.
  • Ensure that the people around you are aware of what you are going to use and have been using.

FAQ

What is ketamine cut with?

The testing service regularly tests ketamine that contains contamination from other substances such as levamisole or caffeine. You can find the most recent information about cuttings in the DIMS annual report.
To avoid unnecessary risks, it is always good to have your ketamine tested. You can do this at various places in the Netherlands, often for free! Check drugs-test.nl for a location near you.

What to do if someone has a bad trip?

Always make sure that you are and remain safe yourself. If you are in danger, you cannot help the person in need.
Find a quiet place with the one who is having a hard time. Don’t try to deny that he/she is having a bad trip. Try to reassure him/her: he/she has taken drugs and the effects and thus the bad trip always wear off. Ask the person about what they are experiencing and try to talk the trip on a positive side without downplaying it. For example, by giving a positive meaning to the things he/she sees. Try to do things that make him/her feel comfortable, such as moving or singing. See if it makes sense to talk about pleasant things. Distraction can also help, for example by drawing. Let your voice sound calm and reassuring.
Make sure that the user does not end up in dangerous situations such as traffic. Call emergency services if it becomes unsafe for the user or his environment or if the bad trip is too intense to solve it yourself.

What if I have medical complaints after the use of partydrugs?

Some complaints after using drugs can last longer, A medical explanation or even treatment may then be necessary. The Brijder has set up a national consultancy for party drugs related medical complaints. If you have medical complaints after the use of party drugs, you can call the consultancy: 088 – 358 29 40. This service is only available in the Netherlands.

 

Someone close to me uses this substance almost every weekend. Should I worry?

When someone close to you uses a substance often it is normal to worry. There are risks: to physical health; that he/she will gradually use more and more and become dependent. When only using it on weekends, there is the possibility that he/she is able anymore to go out without using. It can then be useful to have a conversation with each other in an open, non-judgmental way. Mention the impact the use has on you as a person, for example that you are worried. If you would like tips or advice for this, please contact the addiction care institution in your region.

What about the different versions of ketamine?

There are several versions of the ketamine molecule. There is a left-handed (L), a right-handed (R) version and the combination of both versions. We call the latter racemate or a racemic version (left and right 50-50). The levorotatory ketamine is called esketamine. The dextrorotatory ketamine is called arketamine. The atoms on the molecule are exactly the same but they are mirrored. Just like your hands are exactly the same, yet not: they are each other’s mirror image.
The appearance of the ketamine does not tell you anything about which one you have. Ketamine can be crystallized in rods, spheres, sugar, needles, etc. So what it looks like does not provide information about which ketamine you have.

It is difficult to determine exactly which version is on the Dutch drug market, but it seems that ketamine is racemic on the recreational drug market. Half left-handed and half right-handed. This is apparent from information that we have received via the DIMS (Dutch test service, Trimbos Institute). Research in Austria also shows that 99% of the Austrian market is racemic. It is very expensive to investigate which version you have (left, racemic or right), which is why the DIMS does not analyse it. Only if you have real pharmaceutical grade ketamine in liquid form do you know which form you have: left-handed ketamine. But that liquid ketamine is very rare.

What are the effects of ketamine on your bladder?

Ketamine makes the bladder wall more easily inflamed. If you snort ketamine often, your bladder wall may be constantly inflamed. The pain this causes is also known as k-cramp. Because of the pain, people tend to use more, which in turn causes more physical problems.
The constant inflammation can make your bladder wall less flexible due to scar tissue. You have to urinate more often. The inflammation can get so bad that the bladder is permanently destroyed and you need a stoma.

What are the acute risks of ketamine?

There are not that many acute risks for ketamine. Most accidents happen because someone trips over something or bumps into something. Ketamine can make it more difficult for you to move and you’ll feel disoriented. For example, using ketamine at a party can make dancing more difficult.
Ketamine also has an anesthetic effect, so you may hit yourself and hardly feel anything. Therefore, make sure that you sit or lie down when using ketamine to prevent you from falling or tripping.

Why is ketamine used medically?

Ketamine is one of the few downers that hardly affects breathing. This makes it very suitable for use as an anesthetic. Ketamine for medical applications is called ‘esketamine’ and is only available medically. Ketamine has an inhibitory effect on the nervous system. Pain stimuli are not (properly) passed on. As a patient you no longer feel pain. The doctor can then anesthetize you or perform short-term operations without too many risks. It is mainly used in the anesthesia of the elderly and children because breathing is extra important to monitor during the operation.
If you want to start using ketamine, it is important to realize that it affects your orientation and the functioning/movement of your body. Dancing or partying is often no longer there and you can easily trip or fall on the dance floor. So using ketamine at a party may not give you the effects you’re looking for. Knowing more? Check: unity.nl/nl/drug/ketamine for more information!

Can you become addicted to ketamine?

You can’t become physically addicted to ketamine, although the frequent use of ketamine does have adverse effects. When you stop using there are no physical withdrawal symptoms. With regular use of ketamine, you run a high risk of becoming mentally addicted though. Tolerance will soon set in. This means you have to take a higher dose to achieve the same effect.

The temptation to take ketamine increases when you want to escape reality. The drug takes control of your life. Frequent use makes you lose sight of reality and can cause fear, panic and delusions if you don’t use. It is therefore difficult to stop independently. If you are concerned about your own use, discuss this with friends or with your doctor.

What happens when you are k-holing?

A k-hole is a very strong ketamine experience. K-holing is often compared to a near-death experience: out-of-body experience and going through a tunnel towards a light. You can’t move and you can’t talk.
We think it’s because multiple areas in the brain can no longer communicate with each other due to the blockage of NMDA receptors. For example, because the area that controls your muscles does not transmit information to those muscles, you can’t move and you can’t talk.
It can be a very interesting or educational experience, but also very scary. Therefore, make sure you can lie down if you plan to take a lot of ketamine. It is good to know that ketamine is a powerful drug. You need much less of it compared to other substances that are snorted. So pay attention to how much you take and think carefully about this in advance!

How much ketamine do you need to feel anything?

It differs per person how much you need and how quickly you will feel the effects. Therefore, it is difficult to answer this question. But with ketamine you will become a bit vague at a dose of 5 to 50 mg. At doses above 50 mg, the effects can become more psychedelic and very intense. The more you take, the stronger and longer the effects last. Ketamine is a strong drug and you need less of it compared to other drugs that are snorted. So pay attention to how much you take and think carefully about this in advance!

 


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