To many people, ketamine is something of a super drug. It’s a powerful anesthetic. It’s a rapid-acting antidepressant. It can be a wonderfully good time. But as its medical and recreational use continue to surge, many of us share the same concern: Is ketamine addictive?
“Like many psychoactive drugs, ketamine’s immense potential for depression treatment comes with a risk of abuse,” says Ben Spielberg, a neuroscientist and CEO of TMS & Brain Health, clinics that offer ketamine infusions. Evan Haines, co-founder of Oro House Recovery Centers, adds that the world’s leading expert on ketamine, Dr. Karl Jansen, believes that mainstream accounts of the drug’s addictiveness are overblown. “He puts the figure at around 15 percent, which isn’t as high as others might put it, but it’s not insignificant either,” Haines tells me.
Nonetheless, Lawrence Weinstein, chief medical officer of the American Addiction Centers, explains that ketamine is a chemically addictive substance. “Phencyclidine piperidine, or PCP, from which ketamine is derived, is widely known to be addictive, and this same property exists in its descendent,” he says. “It’s been said that dopamine is a significant cause of compulsive behaviors, and just like with other drugs, ketamine rapidly increases the release of dopamine and activates the reward pathway in the brain.”
Weinstein adds that the excess dopamine affects a molecule called glutamate, which nerve cells use to communicate: “The disturbance of glutamate transmission combined with the abundance of dopamine affects an area of the brain called the nucleus accumbens, which is believed to contribute to the development of mental disorders and addictive behaviors.”
That said, Philip Wolfson, CEO of the Ketamine Research Foundation and author of The Ketamine Papers, says the danger of abuse that could lead to addiction is dramatically reduced in a controlled, psychotherapeutic framework. For example, ketamine lozenges (as opposed to IVs) are frequently used as a means of preventing overuse during ketamine therapy. “You can only put so many in your face,” he explains.
Furthermore, a good ketamine therapist will ensure that you’re dosed appropriately, and they’ll reduce that amount over time, too. “Ketamine therapy conducted in a clinical environment effectively treats depression at very small, sub-anesthetic doses on a dosage schedule that tapers off in frequency,” Spielberg explains.
Still, Wolfson acknowledges that there are bad actors in the clinical ketamine scene who engage in a “promiscuous sending out of psychedelic agents” and there are recreational users who abuse the drug to the point of developing a dependency. In addition to potentially becoming addicted, people who use multiple grams of ketamine daily may experience bladder problems and kidney dysfunction, not to mention brain damage.
“I failed my exams but didn’t tell my parents until later,” one compulsive ketamine user writes on an online forum. “First came ket. At this point I was using up to seven grams a day and the bladder pains were excruciating (leading to one hospital trip). An hour of having your stomach being fucked raw by a red hot poker is how I’d describe the most intense pains. And still, I kept going back for more. Because ket just kills thinking. It kills my ability to be anxious.”
This numbing of negative thoughts tends to be what many who suffer from addiction are seeking, which points to a complexity of the condition that goes far beyond just drugs. “Oftentimes, substance abuse is precipitated by an underlying mental health disorder, such as depression, anxiety and/or PTSD,” says Spielberg.
Or as Haines tells me, “As [leading addiction expert] Dr. Gabor Maté astutely points out, no drug in and of itself is addictive: It’s the person who suffered adverse childhood experiences or other chronic stress that makes them more susceptible to the soothing quality that a particular drug provides for them that’s the cause of addiction.”
In other words, sure, ketamine can be addictive, but so can any substance that helps a person forget their troubles. It’s certainly something to be aware of, but rather than blaming ketamine (or other drugs) for causing addiction, prevention begins by providing adequate mental health care and safe spaces for using these powerful substances. If we can manage that, there may be more to gain than lose from ketamine.
“As we’re seeing with many other drugs that have been stigmatized for decades, such as cannabis and psilocybin, it’s detrimental to ignore the potential of drugs that can actually help more than they might harm,” Spielberg says. “Ketamine, like numerous other drugs used by the medical community, is an effective therapy with low risk of harm in a controlled clinical environment.”
Yeah, what he said.