Ketamine - Ketamine - Effects and TreatmentEffects and Treatment

How Much Do You How Much Do You Know?Know?

Michael BirdMichael Bird

IntroductionIntroduction Ketamine is a drug used in human and Ketamine is a drug used in human and

veterinary medicine developed by the veterinary medicine developed by the pharmaceutical company Parke-Davis (today a pharmaceutical company Parke-Davis (today a part of Pfizer) in 1962.part of Pfizer) in 1962.

Its hydrochloride salt is sold as Ketanest, Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Ketaset, and Ketalar.

Pharmacologically, Ketamine is classified as Pharmacologically, Ketamine is classified as an *NMDA receptor antagonist, and at high, an *NMDA receptor antagonist, and at high, fully anesthetic level doses, Ketamine has also fully anesthetic level doses, Ketamine has also been found to bind to opioid receptors and been found to bind to opioid receptors and sigma receptors.sigma receptors.

The drug was first given to American soldiers The drug was first given to American soldiers during the Vietnam War.during the Vietnam War.

* NB not associated with MDMA* NB not associated with MDMA

Group ExerciseGroup Exercise I would like you to get into groups of no more than 5, I would like you to get into groups of no more than 5,

use the title ‘How much do we know about Ketamine’use the title ‘How much do we know about Ketamine’ For instance, you may wish to look at both it’s illicit For instance, you may wish to look at both it’s illicit

and legitimate usages and legitimate usages What is the ‘willing’ user of Ketamine trying to What is the ‘willing’ user of Ketamine trying to

achieve?achieve? What are the positive/negative effects of using What are the positive/negative effects of using

Ketamine?Ketamine? What treatment have What treatment have youyou found to be useful, or have found to be useful, or have

you researched any successful treatment methods?you researched any successful treatment methods? How would you currently work with someone that is How would you currently work with someone that is

using Ketamine? What would be the care plan/referral using Ketamine? What would be the care plan/referral pathway?pathway?

How would you define success with a Ketamine user? How would you define success with a Ketamine user?

So what are the Effects of So what are the Effects of Ketamine?Ketamine?

Like other drugs of this class such as Like other drugs of this class such as phencyclidine (PCP), Ketamine induces a state phencyclidine (PCP), Ketamine induces a state referred to as *“Dissociative Anesthesia” and is referred to as *“Dissociative Anesthesia” and is used as a recreational drugused as a recreational drug

Ketamine has a wide range of effects in Ketamine has a wide range of effects in humans, including:humans, including:

Anesthesia - ‘blocking sensations’ inc. painAnesthesia - ‘blocking sensations’ inc. pain Analgesia - specific painkillerAnalgesia - specific painkiller Hallucinations - distorted sensory experiencesHallucinations - distorted sensory experiences Bronchodilation - drug used to facilitate airflowBronchodilation - drug used to facilitate airflow Elevated blood pressureElevated blood pressure* Slide on the term ‘Dissociative’ to follow* Slide on the term ‘Dissociative’ to follow

Medical UseMedical Use Ketamine is still used in human medicine as Ketamine is still used in human medicine as

an anesthetic and can be used in minor an anesthetic and can be used in minor surgerysurgery

Used in treatment for complex regional pain Used in treatment for complex regional pain syndrome (CRPS)syndrome (CRPS)

Continued research into its effectiveness in Continued research into its effectiveness in treating depressiontreating depression

Research into a combination of controlled Research into a combination of controlled Ketamine use, Psychotherapy and Group Ketamine use, Psychotherapy and Group Therapy as part of a treatment program for Therapy as part of a treatment program for Alcohol addiction.Alcohol addiction.

Used in the treatment of SchizophreniaUsed in the treatment of Schizophrenia

What isWhat is Dissociative Substance?Dissociative Substance? A A DissociativeDissociative is a drug which reduces (or is a drug which reduces (or

blocks) signals to the conscious mind from blocks) signals to the conscious mind from other parts of the brain, typically, but not other parts of the brain, typically, but not necessarily, limited to the senses.necessarily, limited to the senses.

DissociationDissociation is a partial or complete is a partial or complete disruption of the normal integration of a disruption of the normal integration of a personperson’’ss conscious or psychological functioning conscious or psychological functioning

Such a state of ‘sensory deprivation’ or Such a state of ‘sensory deprivation’ or dissociation can facilitate self-exploration, dissociation can facilitate self-exploration, hallucinations and/or dreamlike states of mind.hallucinations and/or dreamlike states of mind.

The risks and benefits of each dissociative The risks and benefits of each dissociative experience, as with most substances, are experience, as with most substances, are markedly different from user to user.markedly different from user to user.

Random FactsRandom Facts Unlike other well known Dissociatives, i.e.PCP, the Unlike other well known Dissociatives, i.e.PCP, the

effects of Ketamine are relatively short lasting - effects of Ketamine are relatively short lasting - 15min/hour dependant on amount and 15min/hour dependant on amount and administrationadministration

Slang terms include Special K and being in a ‘K-hole’Slang terms include Special K and being in a ‘K-hole’ As well as Most of the world's illicit Ketamine comes As well as Most of the world's illicit Ketamine comes

from Asia-based pharmaceutical from Asia-based pharmaceutical manufacturers, many ounces or even kilos of manufacturers, many ounces or even kilos of pharmaceutical Ketamine are sold and shipped in pharmaceutical Ketamine are sold and shipped in each transaction by legitimate Asian producerseach transaction by legitimate Asian producers

100mg is usually enough to enter a K-hole100mg is usually enough to enter a K-hole The price of The price of KetamineKetamine varies from varies from ££110 to 0 to ££220 a 0 a

gram.gram.

Ketamine TreatmentKetamine Treatment

Importance of a thorough assessment with a focus on:Importance of a thorough assessment with a focus on:

Poly-drug usePoly-drug use Method of administrationMethod of administration Past successful treatmentsPast successful treatments Specific reason for this drug of choice and focusing Specific reason for this drug of choice and focusing

on the associated dangers of useon the associated dangers of use Assertive outreach may be needed for this hard to Assertive outreach may be needed for this hard to

engage client groupengage client group Set up specific groups - Meditation and Art/Music Set up specific groups - Meditation and Art/Music

Therapy GroupsTherapy Groups Alternative therapies inc Auricular AcupunctureAlternative therapies inc Auricular Acupuncture Long term engagement the most proven method for Long term engagement the most proven method for

successsuccess

Final QuestionsFinal Questions

Can you identify any difficulties that you have Can you identify any difficulties that you have currently that may make things difficult for currently that may make things difficult for this client group? If so is there anything that this client group? If so is there anything that can be done to improve things?can be done to improve things?

Following the short discussion today, can you Following the short discussion today, can you identify any more effective ways of working identify any more effective ways of working with this particularly difficult client group?with this particularly difficult client group?

How can your team/group/agency improve the How can your team/group/agency improve the services that you deliver to Ketamine users?services that you deliver to Ketamine users?

Is there anything further than I can do to help Is there anything further than I can do to help Ketamine users?Ketamine users?

Finally - Finally - Thank You for your Thank You for your

participationparticipation

Enjoy the rest of your day…. Enjoy the rest of your day….