Harm Reduction: Ketamine harm reduction

General aspects

Ketamine is a dissociative anesthetic that was first synthesized in 1962 and has since been widely used in both animals and humans. Its medical use is limited by the psychedelic side effects that appear in the recovery phase. Nevertheless, it is still an anesthetic used in pediatrics, geriatrics, obstetrics, and as an analgesic in pain management units. Additionally, it is one of the most widely used anesthetics in the world, especially in low- and middle-income countries and in emergencies due to disasters.

Ketamine (2-chlorophenyl-2-methylamine-cyclohexanone) is structurally related to phencyclidine and its analgesic and dissociative effects are produced by its antagonistic action on glutamatergic receptors (NMDA).

It expires between one and five years after its manufacture. It should be kept away from sunlight and preferably at a temperature between 4 and 25 degrees Celsius.

Dosage

Oral route:
• Low dose: 50-100 milligrams.
• Medium-high dose: 75-300 milligrams.
Nasal route (snorted):
• Low dose: 15-30 milligrams.
• Medium dose: 30-75 milligrams.
• High dose: starting from 75 milligrams.
Intramuscular route:
• Low dose: 15-30 mg
• Medium dose: 25-50 mg
• High dose: around 100 mg
Duration: Around 1-2 hours.

Common Adverse Effects

Ketamine is an anesthetic, so too high or too frequent doses can cause significant bodily impairment (loss of balance, reflexes, etc.) that can pose a significant risk of falls and accidents. To avoid this, it will be necessary to take care of the dosage and space out the doses sufficiently.

At the time of consumption, along with the desired effects, one may experience nausea, vomiting, dizziness, vertigo, sweating, headaches, confusion, and disorientation. It decreases the ability to pay attention, concentrate, and remember, and amnesia may occur. The day after, the person may feel somewhat tired, dizzy, and with a heavy head.

Toxic/Severe/Rare Effects

Continued use promotes the development of tolerance and dependence. Although withdrawal syndrome has not been described, some people develop compulsive consumption patterns similar to those of cocaine.

Physical (abdominal pain, eye problems, tremors, etc.) and psychological (anxiety, insomnia, psychosis, etc.) disorders may also appear.

Chronic use can damage the bladder and urinary system. The first symptoms (burning sensation when urinating, urgency, or blood in the urine) are usually reversible with complete abstinence. If consumption continues, the condition becomes chronic and progressive, leading to bladder destruction. The intranasal route and the use of large quantities or very frequent frequencies are associated with this problem. Daily consumption has a high risk and rarely appears in occasional consumption.

The psychedelic effects of ketamine are qualitatively distinct from those of LSD or mushrooms and have to do with the perception of one's own body. Occasionally, it is possible to reach a catatonic state in which the body can be seen from the outside or to develop Near-Death Experiences (NDEs): the sensation of leaving one's own body, passing through a tunnel, and merging into an eternity without time or space. This experience can be a "desired effect" (if sought by a trained psychonaut in an appropriate context) or a "psychological trauma" (if it occurs in a recreational environment and the person is not warned). Some people have difficulty integrating and making sense of this type of experience.