The health and psycho-social consequences of ketamine use

Ketamine is a non-competitive NMDA receptor antagonist that acts as a dissociative anaesthetic with analgesic and amnestic properties. Ketamine has broad areas of application and is a rapidly acting, relatively safe analgesic and anaesthetic agent, particularly for children and is widely used in veterinary practice. Ketamine can induce schizophrenic-like symptoms in healthy adults and schizophrenic patients. It has a wide margin of safety and there are very few cases of pure ketamine overdose recorded, with the majority of deaths due to the dangerous activities or contexts of its use. Information on ketamine is not routinely collected in population surveys and morbidity and mortality data collections. Levels of use in the general population, however, appear to be very low with higher levels in groups with access to the drug, medical and veterinarian professionals, and party drug users. There are a number of potential ketamine effects that may be seen as adverse or harmful, with growing evidence of the physical and psychological symptoms of ketamine dependence among recreational ketamine users. A withdrawal syndrome, including psychotic features, is beginning to be described. The use of ketamine with other neurotoxic drugs, such as alcohol, should be avoided. Increased rates of high risk sexual and injecting behaviours in association with ketamine use, however, have been reported by gay men and marginalised youth in the US. In conclusion, ketamine does not appear to currently pose a significant public health risk, however, at the individual level the usual harm minimisation strategies should be observed. (c) 2005 Elsevier B.V. All rights reserved.