Is Ketamine Dangerous?

Today we’re going to be discussing a topic that is on a lot of hearts and minds after the recent holidays where we learned about a well-known “friend” in the media who died of various medical issues related to drug and alcohol abuse, and one of the causes of death was related to ketamine.

 Typically when we get curiosity calls into our office, they are about pricing, side effects, timing, whether or not people can drive after ketamine infusions, etc.  But more recently, people have been focused on the perceived dangerousness of the drug as the media has been more focused on this area since this person’s untimely death.

 This discussion is for public education and consumption only and should not be considered medical advice.  But it is important to understand how public perception and reality, while at times can be partially related, can also be two VERY DIFFERENT things.  First and foremost, you need to be following the advice of your own trusted medical professional in this regard.

 Ketamine is a drug that should only be administered BY a medical professional and UNDER their direct supervision.  What do I mean by this?  The obvious direction is: you should never use drugs you obtain illegally, or those you get on the street.  Secondly, and this is going to be by far a much more UNpopular opinion:  ketamine should NOT be administered AWAY from a medical office or hospital.  I’ll speak more about that momentarily….

 There has been a recent resurgence of interest in the field of psychedelics: the use of psilocybin, MDMA, ayahuasca, and ketamine in order to treat depression, anxiety, and PTSD, among other issues.  People are tired of the weeks or months it takes in order to feel better trying various oral antidepressants.  I get it.  Nobody wants to feel worse before feeling better, as a lot of oral antidepressants can cause weight gain, sexual difficulties, brain fog, and various GI upsets.  Even outside of the side effects you may or may not experience, there is also the cost involved:  not just of the medication itself but also the time lost to work while trialling some of these meds, or because of the side effects, or some folks even wind up in the hospital due to the severity of their symptoms or because the medications aren’t working yet and they start to self-harm or even become suicidal. 

 Some folks even believe there is a conspiracy amongst the medical community AGAINST psychedelics, or perhaps even big pharma.  While I myself am excited about the possibility of standardization of psilocybin in the near future (as there are already successful studies being run in the northeast), I am also concerned.  Not because of any conspiracy theories, but because of the risk associated with it.  Why is that?  I can’t tell you the number of people who have tried mushrooms in the past, or most recently who come to me and tell me (because they know my office is a judgment-free zone) that they are MICRODOSING mushrooms and feel so much better because of it. 

 I’m glad you’re feeling better, but they don’t even understand what microdosing means.  They believe they are just taking a “small dose” of the psychedelic that is being offered to them.  Here’s an example of why I’m so concerned:  let’s say you have two mushrooms side by side, harvested in different places.  One has a theoretical “TOTAL DOSE” of 100mg of psilocybin to make the math easy.  You are only taking 1/100th of the total mushroom, making for a rough dose of 1mg.  Ok.  Let’s look at the second mushroom.  Its “TOTAL DOSE” of psilocybin is 10,000mg.  You only take 1/100th of the total mushroom, so you’re still only “MICRODOSING” right?!?!?!  Except for the fact that you’re actually receiving 100mg which is 100X the dose you were getting in the first mushroom!!  Unless you have a seriously state-of-the-art lab in your basement, I’m gonna hazard a guess that you don’t have ANY IDEA how much actual active drug that you’re getting!  With no way to measure or test the dosage you’re actually receiving, the whole idea of microdosing means absolutely nothing in terms of knowing what you’re getting.  Which is why, until it is standardized by testing and clinical trials, I will consider it to be unsafe. 

Does psilocybin have fantastic and amazing potential?  For certain, many of the psychedelics do.  But it also comes with other risks as well.  For instance, because it acts like a serotonergic agent in your system, and most antidepressants (not all, but a majority of them) act on serotonin, you may have to have a 6-week washout period before even being able to try it without the risk of serotonin syndrome.  While this condition can be life-threatening in and of itself, this can also be potentially life-threatening if you were already depressed and suicidal on a multitude of agents, and now you’re washing out from all your psych meds while waiting on the possibility of this new agent working!  You see where I’m going with this.  Unless under close supervision, like being hospitalized (which I’m pretty sure nobody wants to do either time-wise or financially) you run the very real risk of hurting yourself in the meantime.  And that doesn’t even touch on the side effects while on the drug itself. 

 But I digress, back to ketamine.   Why do I think it should only be dosed and administered under the direct supervision of a medical professional?  So so so many reasons…

 Ketamine itself is a dissociative anesthetic, which means that it can take away pain while also causing you to psychically not be present in your body during the administration.  Most people describe a floaty or out-of-body feeling not dissimilar to being the observer in your own dream.  But it can cause scary side effects if not administered correctly, and even if it is!  Ketamine has the potential to elevate your blood pressure, cause laryngospasm, and can even prompt hallucinations in people who may be prone to psychosis.  These side effects CANNOT BE MEDICALLY MANAGED IN THE HOME! 

 Ketamine in small doses, administered and supervised by a medical professional is useful for a variety of mental health conditions.  In small doses, it doesn’t behave like an anesthetic.  In small doses, it doesn’t have the same side effects as it would if you received it in the ER to let them set your broken arm.  In small doses, you can frequently recover very quickly, as the medication is rapidly metabolized.  It is much safer in small doses, but it can still cause side effects.  Even water can be potentially hazardous at high intakes.  It’s all about the dosage.

 And as I’ve said before, if you’re obtaining the drug illegally, you literally have no idea what kind of dosing you’re receiving, and even if you’re receiving the actual drug itself!  For all you know, if could be fentanyl, or cut with cocaine.  Dealers haven’t been known to be exactly trustworthy and as far as I know they haven’t been required to pass pharmacology boards in order to administer drugs. :)

 Secondly, with the rise in public interest of psychedelics, there are companies (who shall remain nameless) who are now offering “the ketamine experience” at home.  Ummmm…..just no.  For several reasons.  First of all, ketamine is not as well-absorbed when used orally or sublingually as it is when it is in IV form which means they automatically have to increase the dose to get the same effects as you would when administering it through an IV.  Increased dosing means increased side effects and increased risk of adverse events, not to mention the increased potential for abuse.

 Thirdly, these programs frequently offer a lozenge that you are “guided” when to put it in your mouth and when to take it out.  Via some version of a HIPAA-compliant Zoom call.  Again, umm…just no.  I am sure there are a number of folks out there who are total rule-followers and would do just fine with it, but there are plenty of other people who say, “hey, I felt great with this, so what if I just use it longer, or more sounds better to me!”  What kind of oversight is there if a person uses more than the recommended dosage via teleprompter from a person who isn’t even in the same state as you?!?!  THERE IS NONE.  Hence, the difficulty in maintaining any sort of standardization or safety protocols.  What if your throat closes up or you have an allergic reaction?  Oh, no worries, Uncle John is in the background watching football, he can get me to the hospital or call 911.  You might be well-past their help by the time they get there.  It’s just not safe. 

 Again, I understand the desire to seek out new medications or forms of treatment when all other things have failed you.  But to do so while NOT under direct medical supervision may cost you more than side effects, it could cost you your life. 

 Spravato is the newest form of ketamine, its enantiomer or “mirror image” of ketamine called esketamine and is offered via nasal spray.  It’s primary indication is for the treatment of resistant major depression, but once again, it is only offered in the office under MEDICAL supervision.

 My understanding is that the friend who died in the media was undergoing IV ketamine therapy as well as oral therapy, as well as had other drugs and alcohol in his system at the time of death.  We can’t know what was on his mind, whether or not it was intentional, accidental, or being in the addicts’ mindset, “more is better.”  We may never know.  It breaks my heart how many years he suffered and how it affected his personal and professional life and my heart goes out to his friends and family who lost a truly kind and talented individual.

 What I can tell you is this:  don’t try ANYTHING unless you understand the ramifications of your actions while getting informed consent from a trusted medical professional.  Don’t let the cure be worse than the disease.  Because last I checked, there’s no cure for death.  Be safe out there, friends.  If you’re struggling, The Anderson Clinic is a judgment-free zone.

 So, if you found this information helpful, please like, subscribe, and follow us!  Tell your friends.  We’re @AndersonClinicCincy on Facebook, Instagram, and TikTok. And you can find our Psych Waves podcast on Apple and Spotify.  And if you happen to be in the Cincinnati area and are looking for assistance with treatment-resistant depression, anxiety, concussions, or PTSD, give us a call at (513) 321-1753.  Start feeling better faster.