Periodically, ketamine abuse is reported in news broadcasts or is the subject of TV dramas. Most of us have heard of the street name or slang terms for ketamine: Cat Valium, Jet K, Kit Kat, Special K, Super K, Vitamin K and a few others.

Although the drug is manufactured as the injectable liquid ketamine hydrochloride, the liquid is usually evaporated into a white powder for illicit use. Illegally, the drug is either snorted or swallowed.

Ketamine is tasteless and, although the drug is described as odorless, various reports indicate the drug has a mild dish detergent smell. At any rate, ketamine can easily be added to flavored drinks without detection. Ketamine is versatile. It is absorbed either via the intravenous, intramuscular, oral or topical routes and it easily dissolves in water, alcohol or lipid solutions.

Because the drug mixes well into liquids and induces amnesia, ketamine is listed as one of the “date rape” drugs. It is categorized as “a club drug” since ketamine often is used recreationally in nightclubs, discos and raves. Club drugs typically include stimulants, hallucinogenics and psychedelic drugs.

First developed in 1962, the medical uses of ketamine include starting and maintaining anesthesia and for post-operative pain management for both human and veterinary use. At sub-anesthetic doses, however, ketamine produces a dissociative state.

The dissociation can be mild with a dream-like state and hallucinations that include a pleasant feeling of floating above one’s immediate environment. Or the dissociative state can be more pronounced with a complete sense of detachment from one’s physical body and the immediate environment—this is called de-personalization and de-realization, respectively. Ketamine has been associated with intentional use to experience near-death sensations.

At sufficiently high doses, abusers of ketamine may experience the “K-hole”, a state of extreme dissociation with agitation along with visual and auditory hallucinations within 10 minutes of injected or oral use and which lasts for one to two hours.

Overdoses without medical management can produce symptoms that progress to delirium, blood pressure spikes, heart arrhythmias, loss of muscle control, increased intracranial pressure and fatal respiratory issues.

Ketamine flashbacks have been reported for up to several weeks after dosing and prolonged use may cause sustained agitation, depression, impaired attention and learning abilities, as well as memory loss and periodic amnesia.

Lethal overdoses of ketamine are rare, but several high-profile deaths have been reported. Death from Ketamine usually involves single doses of over 150mg or when ketamine is mixed with a cocktail of alcohol and/or other club drugs. The mystery writer might invent an interesting murder scenario using this effective and potentially deadly drug.

There is no known antidote for a ketamine overdose. Medical management primarily includes ventilating the patient to support respiratory and circulatory function. Treatment of the associated agitation with depressant therapies are not advised since these drugs further depress respiratory function and lengthen the effects of, and recovery from, a ketamine overdose.

Recently, several studies indicate that IV ketamine treatments may become a 21^st century breakthrough in antidepressant therapy, particularly for major depressive disorder and bipolar depression. Intravenous dosing of IV ketamine has been demonstrated to produce similar anti-depressive results in six hours as compared to six weeks of therapy with standard oral antidepressant medications, and there appears to be a profound reduction in suicidal thoughts.

Although it’s too early to confirm this attribute of ketamine, future medicinal psychiatric practice may well include ketamine as a standard anti-suicidal medication.

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