From Bushwick warehouses to the vet’s office: What is Ketamine?

Ketamine isn’t exactly a celebrity of the narcotic world.

It doesn’t have the widespread acceptance of marijuana, the pop culture cachet of cocaine or the terror-inducing headlines of the opioid epidemic.

It’s a familiar sight, however, at warehouse parties in Bushwick, within the cabinets of veterinarian’s offices and in most hospitals around the world.

Usage rates are ticking upward — both recreationally and medicinally — and while it’s not anywhere near crisis level, some information can be useful for both demystifying its uses and protecting against abuse.

What is ketamine?

The substance, normally found in a powder or liquid form, is traditionally used as a sedative for animals, hence its many nicknames relating to felines: Kitty, Cat Valium and Kit Kat.

A 2017 survey from the Substance Abuse and Mental Health Services Administration revealed that 1.3 percent of Americans 12 and older had tried ketamine at least once in their lifetime, with the highest usage rate among 18 to 25 year olds. That’s been steadily increasing each year from 1.1 in 2015, the first year the drug was included in the survey.

Of nine hallucinogens listed in the report, ketamine had the second lowest usage rate only behind DMT. Other drugs like cocaine and ecstasy had 14.9 and 7 percent use rates respectively, while marijuana came in at 45.2 percent.

In the medical field, ketamine is used every day for millions of people as an anesthetic in burn units and physical trauma situations. More recently, the drug has been used to treat those with depression.

The FDA recently approved esketamine, a nasal-spray ketamine antidepressant — the first new option for depression treatment in 60 years.

Club drug

Though ketamine’s use among Americans is relatively low compared to other drugs, it has seeped its way into Brooklyn’s party scene, becoming as prevalent in clubs, according to users, as cocaine and MDMA (commonly known as ecstasy).

Effects may include euphoria, mental and body highs, spiritual experiences, increased sense of connection, reduced or eliminated acute pain, and hallucinations, according to Erowid, a nonprofit that provides information on psychoactive drugs.

Several recreational users told the Brooklyn Eagle that the drug, which is sold for roughly $80 a gram on the street, also enhances music, makes them feel more present and helps them forget their daily problems.

For Nick, a habitual user and Brooklyn resident who asked that only his first name be used, the drug provides a mental escape and relief from the pressures of life.

“It’s a mix of euphoria,” he said. “There’s a lot of pain relief, both physical and emotional. You could have a stressful day and you just do K and forget about everything that’s going on. It’s just you and your little black space.”

He said that what initially started as a recreational habit slowly evolved into an everyday one.

“It turned into a religious thing,” he told the Eagle. “I was doing it for spiritual enlightenment, assisting in astral projection. After a while, I needed a little bump here or there before I could go and do anything.”

Nick said his nostrils were constantly in pain from being scraped dry, and they would routinely bleed. He also said his septum was thinned out and his short-term memory reduced. As for his long-term memory, he said it was pretty much gone. “I’ll be in a room to witness something happen,” he said, “and I won’t remember it at all.”

He became so dependent on ketamine, often going through one to two grams in a sitting, that he said he’s currently taking a break.

Willa — another Brooklyn resident who spoke to the Eagle under an alias — said she uses the drug sparingly and only in social settings.

“I’m not waking up and using it or coming home from work and using it like I would with smoking a joint,” she said. “I use it only when I’m out going to see live music and wanting to get in a party-mode.”

Willa estimates that as many as 40 percent of people at the parties she attends in Brooklyn are using it. Nick said he thought that number was closer to 15 percent.

Continued use of ketamine can create a psychological dependence and will require more of the drug to reach the same effects, according to Addiction Center. Telltale signs that someone is using ketamine include slurred speech, irritability, antsy behavior and depression, among other symptoms.

The ‘buddy drug’

Dr. Steven Levine, a board-certified psychiatrist and founder of Actify Neurotherapies, a ketamine treatment facility, praises the drug as an effective antidepressant, especially for those with treatment-resistant depression.

The drug is particularly successful, he said, in reducing suicidal tendencies, an area that conventional antidepressants like Prozac and other SSRIs do not address.

While some people abuse ketamine recreationally, according to Levine, “in a controlled medical setting with a very different intention, the risk of abuse or addiction is really quite small,” he told the Eagle.

The stigma surrounding ketamine as both a club drug and animal tranquilizer has created a negative image for a substance that has had a tremendous positive impact in the medical community, according to Levine.

“It’s sexier to say cat tranquilizer, or club drug ketamine or Special K,” Levine said. “It’s always going to be the grabbier headline so that’s what gets perpetuated … [But there should be] more attention on it as an antidepressant.”

For Vincent M., a 40-year-old South Slope resident and 9/11 survivor suffering from PTSD, depression and suicidal thoughts, effective treatment options were scarce. “I really ran the gamut of what was able to help me,” he said. “I was going downhill.”

Vincent was hospitalized 10 times, had “tried every medication in the book,” and received 17 treatments of electroshock therapy without any significant improvement. His doctor suggested he look into ketamine treatment, and he visited Levine.

“I would definitely be back in the hospital if it weren’t for ketamine,” he told the Eagle. “It really snapped me out of any suicidal tendencies. I was cutting myself all the time, and then it just kind of stopped. It really helped stabilize me.”

Levine emphasized that the drug is on the World Health Organization’s list of essential medicines, and that it must be readily available in any medical setting across the globe.

Ketamine is also widely used in the military to treat injuries.

“Really the proving ground for ketamine was during the Vietnam War on the battleground,” Levine said. “It was known as the ‘buddy drug’ because it was considered so safe as an anesthetic that it could be delivered by your untrained buddy on the battlefield.”

Levine typically implements ketamine intravenously, but he now offers it through nasal spray following the FDA’s approval. Levine said he treated someone as old as 93.

“With depression, there’s a tendency to feel hopeless, and that is what can lead to suicide,” Levine said. “That gets compounded when people have tried a number of medicines and they realize there’s really nothing new out there and they give up. What this shows us is that we’re not done yet.”

Question marks

While ketamine is praised for quickly treating depression, there is still a lot of uncertainty surrounding the drug.

Dr. J. John Mann, director of molecular imaging and neuropathology at Columbia University, stresses that while there are clear short-term benefits to ketamine, there are still some unknowns, including the drug’s long-term effects, its abuse potential and the optimal number of treatments a patient should receive.

Columbia has conducted the only two large-scale ketamine clinical control trials funded by the National Institute of Health.

“There are concerns, but we don’t know all of the answers,” Mann told the Eagle. “We have followed people for months after they’ve gotten the treatment to try and detect anybody that might begin abusing the ketamine, and although our sample size is not enormous — maybe a couple hundred people — we don’t see any evidence of that at this stage.”

Mann said that the abuse potential would become clearer now that the FDA has approved esketamine. He added that the drug must also be administered in a medically certified setting, so “it’s not like people are going off home with this nasal spray and starting to use it whenever they want to.”

The side effects of ketamine infusions are “fairly predictable,” according to Mann. People experience an out-of-body feeling directly after it’s given, and some users may experience a slight increase in blood pressure or nausea during administration.

Anyone with psychotic symptoms, Mann said, should avoid ketamine because of the “otherworldly” feeling, though he predicts that similar drugs will sprout up in the future that do not have such effects.

Within 24 hours, Mann said, 40 percent of patients being treated for depression have a robust response. A study released by Columbia showed that if the patients’ other medications were optimized with ketamine, after six weeks, they were as well as after 24 hours.

At Columbia, ketamine is part of a more integrated treatment program that employs other types of antidepressant treatments to supplement the ketamine infusions.

“There should be a psychiatrist involved whose job it is to determine, does this person warrant getting ketamine? How many treatments should they get? And what other treatments should be given in addition to ketamine?” Mann said. “Those three elements are essential.

“People are better off getting it where the person making the clinical judgements is not a person whose necessarily good at giving IVs, but an experienced psychiatrist who knows a lot about depression and how to treat it.”

Follow reporter Scott Enman on Twitter.