Jansen, K. L. R. (2001) A review of the non-medical use of ketamine: part 1: use, users and consequences. Journal of Psychoactive Drugs (in press)
A Review of the non-medical use of Ketamine: Part 1: Use, Users and Consequences
2. KETAMINE AND THE DANCE CULTURE
Until the mid-1980's, non-medical use of ketamine was often identified with 'mind explorers' and alternative spirituality (the New Age), and was linked to those with access to the drug, such as medical and bioscience professionals (Weil & Rosen 1983). Most case studies of ketamine dependence are still drawn from this pool of home-setting self-injectors (Ahmed & Petchkovsky 1980; Hurt & Ritchie 1994; Jansen 1990b; Kamaya & Krishna 1987; Moore & Bostwick 1999; Soyka, Krupitski & Volki 1993). However, since the mid-1980's there has been increased ketamine use linked with the growth of the 'dance culture' ( techno clubs/parties/ 'raves') (Curran & Morgan 2000; Dotson et al. 1995; Jansen 1993; Skovmand 1996; Weiner et al. 2000). Ketamine is a stimulant at low doses (White & Ryan 1996) and some users can still dance while affected by it, especially when the drug is combined with other stimulants that reduce dissociation. The dance culture began in American night-clubs around 1980 and spread to the beach parties of Goa (India) and Ibiza. European DJ's returned home with new drugs such as ecstasy (MDMA, methylenedioxy-methamphetamine) and ketamine (bought over-the-counter in Goa) to stage free parties in warehouses, barns and fields. By 1993, the dance culture had became so large that it reduced profits in the liquor industry as 'ravers' drank water and avoided alcohol. Alarmed lobbyists, amongst others, encouraged the U.K. Government to write a section into The Criminal Justice and Public Order Act (1994), outlawing unlicensed parties where techno music was played. The Act required that parties be licensed, forcing them into venues where alcohol was sold. By banning the free parties from barns and paddocks, the law helped to push the use of all the 'dance drugs' into the mainstream of society, as the approved venues were also used by mainstream people. With the profits of all sides assured, the dance culture grew even faster and was then re-exported to many other countries (e.g. Topp et al. 1998).
The figures for non-medical ketamine use are largely unknown as it has yet to be included in statistically valid surveys, but rising use has been noted in both fashion and dance magazines (e.g. Jansen 1997c, Crysell 1998) and the mainstream media which reacted with articles such as 'Party Craze for Cat's Drug' (Reuter 1996), 'Is Your Kid on K?' (Cloud 1997), 'Drug Users Adopt Bad Trip Anaesthetic' (Hall and Cassidy 1992) and 'Sedate Rape' (Cosmopolitan 1997). A survey was conducted in 1996, involving interviews at 18 venues throughout the South-East of England. Respondents were selected on an anonymous, randomised basis. Of the 496 participants (70% aged between 19 and 24), 31% had used ketamine and 85% had used ecstasy (Release 1997). Ketamine-induced disorders were included for the first time in books such the Handbook of Psychiatric Emergencies (Slaby 1994), and 1994 was also the year that the Australian Illicit Drug Report included ketamine for the first time (Australian Bureau of Criminal Intelligence 1995). The DEA website and related sources warned that 'ketamine abuse' was rising (DEA 1997; Anon 1997; Brown 1995). Ketamine featured in an X-Files episode in 1997, where it was used to recover lost memories, and was mentioned in the film Armageddon (1998). It was not mentioned in the film Altered States, a popular myth, and did not inspire the record 'K' by Kula Shaker, although the drug has had an effect on music (e.g. The Chemical Brothers' Lost in the K-hole, Mrs Wood's K-Street Detour, The Higher Intelligence Agency's Ketamine Entity, and music by the techno DJ Danny Tenaglia).
In the U.K., many (but certainly not all) party/club-goers first took ketamine accidentally in a pill that was sold to them as 'ecstasy'. The results of this 'surprise attack' were often unpleasant, and ketamine acquired a bad reputation. When swallowed, the drug is absorbed into blood which goes to the liver first, where most of it is changed into norketamine before reaching the brain (Grant 1981). Norketamine has more numbing and sedating effects and lasts longer (Humphries et al. 1997). Ketamine was also taken in its own right by a faction of the 'free party'/ 'crusty'/ 'traveller' subculture from the outset, because the Indian imports were then cheap while ecstasy was expensive. Some of those who took ketamine with alcohol would then bump into others and behave without regard for the social mores, increasing ketamine's bad reputation. In contrast, in the USA and Australia ketamine has usually been a relatively expensive drug taken by affluent students and professionals (Topp et al. 1998; Jansen 2000). The European situation changed as more users took ketamine by the intra-nasal route, increasing its popularity (Dalgarno & Shewan 1996).
Medical staff have now injected ketamine into millions of people, mostly in developing countries as an anesthetist is not essential (Ketcham 1990), although Parke-Davis (1999-2000) now state that ketamine should only be given by a specialist in a hospital, with resuscitation equipment to hand. In developed countries, ketamine is still widely used (e.g. Green et al. 1998) but increasingly controversial (Sobel et al. 1999). The usual media description 'horse/cat/elephant tranquilliser' is thus misleading. Ketamine still has an accepted place in modern human medicine. In August 1999, ketamine became a schedule 3 drug at the federal level in the USA, and controls are increasing elsewhere. For example, in 1999 in the state of Victoria, Australia, ketamine was listed in Schedule II as a drug of dependence requiring a stricter enforcement regime and specific offences were introduced for using, possessing and trafficking in ketamine (Australian Bureau of Criminal Intelligence 2000). In Europe, ketamine could still be ordered legally from chemical companies in October 2000. It was also stolen from animal hospitals, laboratories and hospitals, and smuggled from other countries. In the U.K., ketamine is not controlled by the Misuse of Drugs Act, but sale is restricted by the Medicines Act. In practice, the U.K. police ignore ketamine and prosecutions are rare, except for 'conspiracy to offer to supply a class A drug (MDMA)' for 'fake ecstasy' pills. This may have lead to a false impression amongst those who rely on arrest and conviction reports as to the real extent of non-medical ketamine use.
All brands are not identical. Ketalar contains a preservative (benzthonium chloride) which may have mental effects (Durieux & Nietgen 1997). Other brands (e.g. German brand Astrapin) contain chlorobutanol which is toxic in some animal models (Malinovsky et al. 1993; Borgbjerg et al. 1994). One brand contains only S(+)ketamine rather than the Ketalar/Ketaset equal mixtures of S(+) and R(-)ketamine (different molecular shapes). S(+)ketamine causes faster loss of consciousness, is more likely to suppress breathing, and has a faster recovery time (Engelhardt 1997). S(+)ketamine is a more potent psychedelic drug than R(-)ketamine. The rumour that 'it's a new ketamine without the psychedelic part' is incorrect (Vollenweider et al. 1997a).