Ketamine Harm Reduction Strategies - Dr. Katzman
Our goal in providing this information is not to promote such use, but to assist you in doing so with the least risk and most benefit, should you choose to do so. Please see Dr. Katzman's Harm Reduction blog for more information about reducing risk and enhancing habit change.
So: if your party scene involves Special K, what do you need to know to keep everyone safe as possible? (Here's one top tip: try your best not to combine it with alcohol!)
Borrowing heavily from Karl Jansen’s excellent book Ketamine: Dreams and Realities (2001), let’s approach specifics for safer use of ketamine through the lens of drug, set, and setting.
Ketamine’s short-term safety record in medical settings is significant; Parke-Davis notes that patients have been given 10 times the anesthetic dose without serious problems, and that there are few directly harmful effects of the drug on the body.
Most notably, there is a temporary rise in blood pressure, so those with cardiovascular issues, uncontrolled hypertension, stroke risk factors, or glaucoma would be well-advised to avoid or minimize use.
Transient side effects such as drowsiness and sedation, blurred vision, nausea, and headache tend to resolve within a few hours. (Nausea and risk of vomiting is greatly reduced by using on an empty stomach and by staying relatively still.)
Long-term chronic use can cause a thickening of the bladder and urinary tract, and is associated with developing ulcerative cystitis. Some long-term heavy users (i.e. a gram/day over years) have experienced recurring pelvic pain and had their bladders removed as a result.
To reduce the potential harm on the bladder:
There are also some specific cautions around each route of administration:
Since most ketamine-related fatalities are related to combining it with another drug, there are some very important interactions with other substances to consider:
Given these interactions, the best strategy may be to deliberately designate different drugs for each occasion and set some limits around this (e.g. “no cocktails on Special K night”), and make sure other drugs are not readily available when you are high.
(On a benefit maximization note, medical practitioners report that using alcohol 48 hours before/after ketamine can wipe out the potential mood-elevating and antidepressant effects. So why not get the very most out of your party drug by using it a little more strategically?)
The final issue around the drug itself is the question of its purity and the reliability of your source:
If you buy substances in recreational settings, it might be wise to purchase a reliable test kit and test anything before you take it.
Another crucial factor is your general and historical mental health. Ketamine can trigger psychotic symptoms in those with psychotic disorders, and its mood-elevating properties can induce a manic episode for those with bipolar disorder not controlled by a prescribed mood stabilizer.
Depersonalization and dissociative symptoms can also occur, especially for those with a dissociative reaction to trauma, so any history with these experiences might mean that this is not the party drug for you.
(Additionally, as previously mentioned, nausea is limited by being still.)
Difficulty with walking and balance means that in recreational settings, ketamine’s primary physical danger is the risk of falling over and sustaining injury.(Bathrooms are particularly treacherous, given the hard, angular surfaces and risk of drowning.)
Much like with alcohol, this loss of motor control means that you should not drive or operate any heavy equipment. It is similarly dangerous to have anything (such as a cigarette) burning, as this could ignite clothing or bedding while you are dissociated.
Involving your community--especially sober sitters--is protective; most recreational use deaths happened when the person was alone (i.e in the bathtub, up in a tree). The increased vulnerability of the ketamine state also creates a real risk for sexual assault and other harm, which underscores the importance of involving only those that you trust.
Additionally, since ketamine, like other psychedelics, can induce a state of high suggestibility, it is important to carefully consider your choice of music, companions, and environment. Adverse ideas may be implanted and program the dissociated mind in a harmful way.
TOLERANCE AND DEPENDENCE
Unlike other psychedelics, ketamine does not lose its efficacy immediately following use, which can then tempt the user into the “repeated use trap” (so named by infamous psychonaut and ketamine enthusiast John Lilly).
Tolerance builds with frequency, and many feel that much of the drug’s magic is lost with compulsive, uncontrolled use. (Be cautious here; once your relationship with this substance becomes compulsive, it seems impossible to return to that original feeling of magic.) Withdrawal symptoms are primarily psychological, as the urges for ketamine can primarily become about escape from this reality and disconnection from the self.
The treatment of ketamine dependence lies outside the scope of this post, but I would like to close with a particularly potent quote from Jansen’s book about the protective nature of community and ritual:
Psychedelic drugs played an important part in some pre-industrial societies. However, these cultures did not have “drug problems” with psychedelics because the drugs were treated with reverence, and taken in a ritualized, sacred, and socially approved or socially demanded manner, usually under the guidance of a shaman who was both priest and doctor.
The loss of ritual, which includes basic safety procedures, may be an indicator of problem use... A possible harm minimization step is this to re-establish safety rituals where they have been eroded, if there is no intention of stopping use completely.
Summing it up: what would OPTIMAL recreational use of ketamine look like?
It would be a special occasion with trusted friends, while you are feeling physically and psychologically well, and without any medical contraindications.
Ideally you wouldn't eat or drink anything for a few hours beforehand, drink lots of water and eat light food after you've come down, and hydrate well on the days before and after.
You would test your drugs ahead of time, use clean snorting straws/needles, and not combine it with other substances (especially alcohol).
You would have a comfortable place to recline and enjoy the experience, with appropriate lighting and evocative, beautiful music, and not move around much till the effects have passed. You might also ask someone you trust to stay sober and watch over you.
Thank you so much for reading this post, and we welcome your questions and comments!
Dr. Jessica Katzman, Clinical Psychologist at Healing Realms
Disclaimer: Using ketamine outside a medical setting is prohibited, and this site does not recommend the activities described here. This information is provided for educational purposes only, and to assist those who have already decided to use substances to do so in the safest and most beneficial manner possible. It is your responsibility to assume the risks associated with these activities. Please consult with a medical professional beforehand, especially if you have a preexisting physical or mental/emotional concerns, or are on medication.