What Does Ketamine Do?
Ketamine is ordinarily used as an anesthetic. Doctors may use ketamine to put a patient “under” to perform procedures that do not require muscle relaxation. Ketamine also causes dissociative effects for the user. It is considered a hallucinogen because it can distort the user’s perception of sight and sound.
However, recent studies have shown alternative uses for the drug. Low doses of ketamine can have positive results when prescribed for chronic pain, depression, anxiety, and more. Many people have found success when treating refractory depression, which is a form of depression that persists after two or more trials of antidepressants (SSRIs). However, ketamine must be used with caution in order to avoid a detrimental addiction.
Ketamine Forms and Bioavailability
Bioavailability refers to the drug amount that is actually absorbed by the body. The method of intake for a drug will determine how much is used to influence the body. Below are the bioavailability levels for different forms of ketamine:
- Intravenous – 100%
- Nasal Spray – 25% to 50%
- Troche/Sublingual – 30% to 40%
- Oral/ingested – 0%
Of course, injecting a drug will lead to 100% of it being absorbed. Nasal sprays and sublingual options allow for a portion to be absorbed into the bloodstream. Ingesting ketamine, however, subjects it to the digestive system and will destroy the drug before it is absorbed by the body.
Addiction and Ketamine
Like any drug, ketamine has the potential for addiction. It is vitally important to follow your practitioner’s instructions when taking any prescribed medicine. Abuse of the drug can lead to psychological addiction.
Psychological Addiction
Ketamine users are more at risk of psychological addiction than physical addiction. The dissociative state ketamine induces may create a euphoric experience for the user. Of course, this needs to be mediated in order to eliminate overuse or misuse of the drug.
Neurological Addiction
Users of ketamine, however, are not at risk of neurological addiction. Neurological addiction occurs when the brain relies on an outside source (usually a drug) for certain neurotransmitters (dopamine, serotonin, etc.). The brain stops producing these neurotransmitters due to its dependence on the outside source. Because of this, a user may experience physical repercussions such as withdrawal, muscle pain, fatigue, and even seizures if completely cutting off the drug. Ketamine does not work in this way and cannot create a neurological addiction. Unlike oxycontin, morphine, and similar drugs, it is possible to abruptly stop taking ketamine without suffering from negative physical side effects.
Laws About Ketamine
Drugs are classified into 5 levels of dependency potential. Schedule 1 is the strongest potential for dependency and schedule 5 is the lowest. Ketamine is a DEA schedule 3 drug. This means that it has a low to moderate potential for dependence. Other drugs in this category include codeine (90mg or less), anabolic steroids, and testosterone. This classification makes it illegal for recreational use and will require a prescription from a medical professional.
FDA-approved ketamine is required to be taken in an office under the supervision of a medical practitioner. This helps protect against the potential for abuse. Taking it in the office allows doctors to monitor for cardiac effects and respiratory issues, as well as supervise any dissociative event that may occur.
Compounded ketamine, however, leaves it to the discretion of the provider. Often at smaller doses supervision is not required, and patients are allowed to take their medication in the comfort of their own homes.
Signs of Ketamine Addiction
Ketamine can cause psychological dependence if used incorrectly. Signs of addiction or misuse include:
- Insomnia
- Irritability
- Anxiousness
- Impatience
- Clumsy or uncoordinated
- Mumbled speech
- Agitated behavior
While we may see some physical symptoms such as skin redness in the patient, signs of addiction mostly include behavioral changes. As pharmacists, we look out for how often the patient is requesting refills and if they are requesting refills earlier than prescribed.
How to Prevent Ketamine Addiction
Medical professionals can do a variety of things to help prevent ketamine addiction. Limiting the number of doses patients can fill at a time is a must. Prescribe ketamine for no more than 30 days. This way the patient will need to re-evaluate their prescription with their doctor once a month. Our pharmacy is always tentative if a patient requests an early refill. Our policy is to contact the doctor for any early refill request.
If a patient understands the benefits of ketamine but fears developing an addiction, they may delegate a trusted individual to monitor their medication. Taking ketamine under the supervision of their doctor is a great strategy. Additionally, limiting access to ketamine by having someone else administer the drug will create more safety assurances for the patient.
Rachel Burns, PharmD
Lead Pharmacist, ClearSpring Pharmacy
