Club Drugs and Their Treatment

Ketamine was first manufactured in 1965, as the result of a search for an anesthetic that would not compromise respiration nor cause the same negative side effects as phencyclidine (PCP), specifically psychosis and violence, after administration. Veterinarians and pediatric surgeons still legally manufacture it, primarily for therapeutic use; recent crackdowns on the illegal distribution of ketamine(Drug information on ketamine) from these sources have led to the increased smuggling of it from foreign sources. Special K, Super K, Vitamin K, or just plain K, are all names for the nonanalgesic anesthetic.

Ketamine is classified as a dissociative anesthetic. As this classification implies, the drug causes a dose-dependent dissociative episode with feelings of fragmentation, detachment and what one user has described as "psychic/physical/spiritual scatter." Use of ketamine imparts a disconnection from awareness of stimuli from the general environment. These stimuli include, but are not limited to, pain.

Ketamine is a close chemical cousin of PCP, also known as angel dust. Ketamine produces minimal cardiac and respiratory effects, and its anesthetic and behavioral effects remit soon after administration (Moretti et al., 1984; Pandit et al., 1980). In addition, ketamine does not cause the same type of behavioral problems associated with PCP. The medication continues to have therapeutic usefulness, principally with children and animals.

Ketamine is a noncompetitive N-methyl-D-asparate (NMDA) antagonist (Curran and Monaghan, 2001). It substantially disrupts both attention and learning. In human research subjects, ketamine affects the ability to modify behavior, to learn new tasks and to remember (Curran and Monaghan, 2001; Krystal et al., 1994). Overdose from ketamine is very rare. A single dose of ketamine creates a "trip" that lasts about one hour (Dalgarno and Shewan, 1996); larger doses last longer and have a more intense effect (Malhotra et al., 1996). The user feels physical tingling, followed by a feeling of removal from the outside sensory world. Tolerance develops rapidly, and dependence, though rare, is well documented. Flashbacks have been reported, and their incidence may be higher than with many other hallucinogens (Siegel, 1984). Mild doses induce an autistic stare and a diminishment of thought. Higher doses result in the phenomena of the "K-hole," which is characterized by social withdrawal, autistic behavior and an inability to maintain a cognitive set. Individuals experiencing such conditions may be described as zombie-like (Gay Men's Health Crisis, 1997).

The most dangerous effects of ketamine are behavioral. Individuals may become withdrawn, paranoid and physically awkward. An individual who is intoxicated on ketamine should be placed in a part of the clinic or emergency department with the least amount of light and stimulation--the less stimulation the better. If necessary, the patient may be given benzodiazepines to control the associated anxiety (Graeme, 2000); however, antipsychotics should be avoided because their side-effect profile may cause discomfort, which could possibly exacerbate the patient's agitated state.

Ketamine is an addictive drug. Numerous reports exist of individuals becoming dependent on the drug and using it daily (Galloway et al., 1997; Jansen and Darracot-Cankovic, 2001). Such dependence should be treated in the manner of any other chemical dependency. Treatments such as group therapy or manualized relapse prevention are recommended.

Gamma-hydroxybutyrate (GHB) is a largely tasteless, clear liquid. Individuals taking it describe feelings similar to intoxication from alcohol(Drug information on alcohol), but with increased stimulation. The effects are dose dependent with small doses (about a teaspoon) resulting in mild disinhibition and larger doses resulting in even higher levels of disinhibition. Even larger doses, but still quite small amounts (not much more than a tablespoon), may result in somnolence, unresponsiveness, respiratory depression, coma and death.

First synthesized in the mid-1970s (Vickers, 1969), GHB was popular with bodybuilders and readily available in health food stores during the 1980s. It came to the attention of authorities in the late 1980s as a drug of abuse, and the U.S. Food and Drug Administration banned it in 1990, after reports of several poisonings (Chin et al., 1992). In the past decade, it has become more widely known as a drug of abuse associated with nightclubs and raves. In addition, it has achieved notoriety as a "date-rape drug."