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Ketamine: Medical Uses, Misuse Risks and Treatment

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Ketamine is a dissociative anesthetic that the FDA has approved for use in medical settings since 1970. Outside medical care, it is misused for its dissociative effects. Misuse can cause dangerously slow breathing, especially when ketamine is mixed with other drugs, and long-term use is linked to bladder damage, memory problems, depression and addiction.

What Ketamine Is (and Its Approved Medical Uses)

Ketamine was developed as a less toxic alternative to phencyclidine (PCP). Since the 1970s it has been marketed in the United States as an injectable, short-acting anesthetic for use in people and animals. In medical settings it produces sedation, immobility, pain relief and memory loss for the procedure.

Ketamine made or diverted for misuse is sold as a liquid or an off-white powder. Street names include Special K, K, Kit Kat, Cat Valium and Vitamin K.

Esketamine (Spravato) and depression

Esketamine is one of the two mirror-image forms of the ketamine molecule. In March 2019 the FDA approved esketamine nasal spray, sold as Spravato, for adults with treatment-resistant depression. Its current label also covers depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior, used along with an oral antidepressant.

Spravato is tightly controlled. It is available only through a restricted FDA program, and it is given in certified health care settings under a provider’s supervision. Patients are monitored for at least two hours after each dose. Its label carries a boxed warning for sedation, dissociation, slowed breathing, abuse and misuse, and suicidal thoughts and behaviors. Patients are told not to drive or operate machinery until the next day after a restful sleep.

Ketamine itself is not FDA-approved for any mental health or substance use disorder. Some clinics offer ketamine for depression, anxiety and other conditions, but that is off-label use. If you are struggling with depression, talk with a licensed doctor or psychiatrist about FDA-approved options and their risks. Using ketamine on your own, outside medical supervision, carries the serious risks described below.

How Ketamine Affects the Brain and Body

Ketamine blocks NMDA receptors, which disrupts the brain chemical glutamate. It also acts on other receptors in the brain. Its misuse effects include:

  • Distorted sight and sound
  • Feeling detached from your body and surroundings, and not in control
  • A dreamlike state or a feeling of floating outside the body
  • At higher amounts, extreme detachment from the body and reality, sometimes called a “k-hole”

The DEA reports that these effects last about 30 to 60 minutes, much shorter than LSD or PCP. Short-term side effects can include headache, dizziness, sleepiness, trouble speaking, numbness, blurred vision, nausea, stomach pain, a rapid heartbeat and changes in blood pressure.

Short- and Long-Term Risks

Short-term risks

  • Injury. Because ketamine distorts perception and makes it hard to move or respond, people can be hurt or put themselves in dangerous situations.
  • Psychosis. Ketamine can cause short-term psychosis.
  • Slowed breathing. Unsupervised use can cause respiratory depression, which is dangerously slow and shallow breathing.
  • Mixed or contaminated drugs. The DEA notes ketamine has been found combined with MDMA, methamphetamine, cocaine and other drugs, and NIDA warns that illicit dissociative drug products may be contaminated with fentanyl or other dangerous substances.
  • Drink spiking. Ketamine is one of the club drugs that MedlinePlus says are sometimes used as “date rape” drugs: someone may slip it into a drink to make sexual assault easier. Don’t leave your drink unattended or accept drinks from people you don’t know well.

Long-term risks

  • Bladder damage. Long-term misuse can cause ketamine-induced uropathy, a treatable but potentially serious condition. Symptoms can resemble a urinary tract infection, such as pain and needing to urinate often or urgently.
  • Memory and mood. Heavy or regular use is linked to memory loss, depression and anxiety.
  • Delusions. Frequent use can cause delusions that last up to a month after stopping, and ketamine can worsen symptoms in people with schizophrenia.
  • Stomach pain. Long-term use may cause abdominal pain sometimes called “k-cramps.”

Overdose: Signs and What to Do

Ketamine can be dangerous at high doses and in combination with other drugs. NIDA reports that among health problems linked to ketamine, the most serious, some life-threatening, involved mixing it with other drugs, especially opioids or GHB. Alcohol and other depressants add to the risk.

Call 911 right away if someone:

  • Cannot be woken or does not respond
  • Is breathing very slowly, shallowly or not at all
  • Has chest pain, a racing heart or a seizure
  • Is extremely agitated, confused or seeing things that aren’t there

Stay with the person and tell responders what was taken. If opioids may be involved, give naloxone (Narcan) if you have it. Naloxone reverses opioid overdoses; it does not reverse ketamine, so it never replaces calling 911.

Is Ketamine Addictive? Dependence and Withdrawal

Ketamine has addictive potential, although researchers are still measuring how strong it is. Laboratory studies show that ketamine causes brain changes typical of drugs that can be addictive. In people, regular use outside a clinic is linked to signs of a substance use disorder, including:

  • Tolerance, or needing more to get the same effect
  • Using more than intended
  • Cravings
  • Continuing to use despite problems
  • Withdrawal symptoms when stopping

If you notice you are using more, using more often, or can’t stop, talk with a doctor. A doctor can also check for bladder problems and mental health effects.

Ketamine and the Law

Ketamine is a Schedule III controlled substance under the federal Controlled Substances Act. Florida law also lists ketamine in Schedule III (Florida Statutes s. 893.03). Spravato is also a Schedule III drug. Possessing ketamine without a valid prescription, or selling it, can lead to criminal charges.

Treatment for Ketamine Use in Florida

There is no FDA-approved medication to treat ketamine addiction, so treatment centers on counseling and behavioral therapy. A good program will also make sure you get medical care for any bladder or stomach problems and treatment for depression, anxiety or other mental health symptoms.

Many people start with outpatient rehab in Florida, which lets you keep up with work and family while attending therapy. If you also live with depression, anxiety or psychosis, dual diagnosis treatment treats both conditions with one care team. People who need more structure may choose intensive outpatient or residential care.

You can search licensed Florida programs by location and level of care in our free rehab directory, or call the SAMHSA National Helpline for a referral.

Choosing a Treatment Program in Florida

Not every program is the right fit for ketamine use. When you call a program, it’s fine to ask direct questions before you commit. Useful questions include:

  • Is the program licensed in Florida?
  • Does the program have experience treating ketamine and other dissociative drug use?
  • Can it coordinate care with a doctor for bladder, stomach or mental health problems?
  • What levels of care does it offer, and how does it decide which one is right for me?
  • Does it accept my insurance, and what will I owe out of pocket?
  • What support does it offer after the program ends?

For a step-by-step checklist, read our guide on how to choose a rehab in Florida.

Getting Help Now

  • SAMHSA National Helpline: 1-800-662-4357. Free, confidential treatment referrals, 24/7, in English and Spanish.
  • Call or text 988 if you or someone you know is in crisis or thinking about suicide.
  • Call 911 for a possible overdose or any medical emergency.

Sources

Frequently Asked Questions About Ketamine: Medical Uses, Misuse Risks and Treatment

What is ketamine?

Ketamine is a dissociative anesthetic that has been used in the United States since the 1970s for surgery in people and animals. It is a Schedule III controlled substance. Outside of medical care it is misused for its dissociative effects, usually snorted as a powder, mixed into drinks, smoked or injected. Street names include Special K, K and Kit Kat.

Is ketamine FDA-approved for depression?

Ketamine itself is FDA-approved as an anesthetic, not for depression. A related drug, esketamine (Spravato), was approved by the FDA in 2019 for treatment-resistant depression in adults and is given in certified medical settings. Clinics that offer ketamine infusions for depression or anxiety are using it off-label. Using ketamine without medical supervision carries serious health risks.

What are the effects of ketamine misuse?

Ketamine distorts sight and sound and makes people feel detached from their body and surroundings and not in control. At higher doses, people describe extreme detachment, called a "k-hole." The DEA reports that these effects last about 30 to 60 minutes. Short-term side effects include headache, dizziness, nausea, blurred vision, and changes in heart rate and blood pressure.

Can ketamine damage your bladder?

Yes, long-term ketamine misuse can damage the bladder and urinary tract, a condition called ketamine-induced uropathy. Symptoms can feel like a urinary tract infection, such as pain and needing to urinate often or urgently. NIDA describes it as treatable but potentially serious. Long-term misuse is also linked to memory problems, depression, anxiety and stomach pain sometimes called "k-cramps."

Is ketamine addictive?

Ketamine has addictive potential, though researchers are still measuring how strong it is. Laboratory studies show it causes brain changes typical of addictive drugs, and people who use it regularly outside a clinic report tolerance, cravings and withdrawal symptoms. If you notice you are using more, more often, or can't stop, a doctor or treatment program can help.

Can you overdose on ketamine?

Yes, ketamine can be dangerous in high doses or in combination with other drugs. Unsupervised use can cause respiratory depression, which is dangerously slow and shallow breathing. NIDA reports that the most serious problems involved mixing ketamine with opioids or GHB, and alcohol adds to the risk. Call 911 if someone is unresponsive or breathing poorly; give naloxone (Narcan) if opioids may be involved.

Where can I get treatment for ketamine addiction in Florida?

You can find licensed Florida programs that treat ketamine and other dissociative drug use through our free directory or the SAMHSA National Helpline at 1-800-662-4357. There is no FDA-approved medication for ketamine addiction, so treatment centers on counseling and support, along with care for any bladder or mental health effects. Many people start with outpatient rehab in Florida.