Karl Jansen

Department of Liaison Psychiatry, South London & Maudsley NHS Trust, St. Thomas’ Hospital, Lambeth Palace Road, London, UK. E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

I have been interested in the non-medical use, users and consequences of ketamine for quite a few years. The general knowledge of ketamine is still quite sketchy and there are still a lot of misconceptions about it, so we are not quite ready to present research findings at the moment. I am hoping that in another year it will be meaningful and useful to start talking about this research but at the moment there are so many misunderstandings that we need to be speaking in a general sense.

What is ketamine?

The information provided to users about ketamine is often wrong, although well-intentioned. I know of one health project that has produced a card about ketamine which says that ketamine is a ‘downer’. Ketamine is actually quite a powerful stimulant, not a downer. Ketamine makes your heart race and it wakes people up. One of the other things is the issue of overdose. Ketamine is a disassociative anaesthetic with quite a good safety record in human medicine in the last thirty years. It was invented in 1962 by a man called Calvin Stevens working for Parke Davis. It has psychedelic effects and can create some insights into the nature of reality, personality and sense of sacredness. In sub-anaesthetic doses it does not usually lower breathing and heart rates. That is the whole point about using ketamine in anaesthesia; it can be given to children and the elderly who may be a little physically impaired. It can cause a near-death experience but this does not mean that that person is physically near-death. Ketamine does not stop the heart. It is nothing like a ‘flatliner’.

The Ketamine experience

The perception that people have of ketamine depends very much on the set and setting. The people who take ketamine outside of nightclubs are often involved in alternative spirituality. They are often looking for some sort of religious experience. Rather than using the words near-death experience, this experience could be called a K-trip. People who have taken high doses of ketamine have reported experiences such as hearing sounds; the idea of travelling by tunnel into ‘the light’ at high speed with the conviction of having died; seeing God; out of body experiences and other realities. It can be a re-experience of memories, life reviews, a sense of everything being clear (which is different from confusion), a border between realms, hovering and so on. The experience can be like lucid dreaming; this is where people are aware that they are dreaming, rather like virtual reality games. There are quite a few scenes in the film ‘Contact’ and ‘2001’ which are like ketamine.

A lot of people have been given ketamine in studies, especially anaesthetic studies, and a lot of the research has been done by anaesthetists. There are 6,300 papers about ketamine in the Medline database. There are only a few hundred about ecstasy, for example, and about 3000 about LSD, so a lot is known about ketamine. More is actually known about ketamine than about most other drugs on the dance floor as it is a very heavily researched substance. So it is not that great a mystery in terms of what it does and it is not really that new. What is new is its use in a dance context.

Risks

The number one danger is not that it is a downer or that you could overdose on it, it is the fact that you are quite helpless when you are on ketamine. You are not in charge of your body. An anaesthetic is not a very good thing to take in a nightclub, because you cannot walk, talk or look after yourself. The effects begin about 30 seconds after an intravenous injection, 2 to 4 minutes after an intra-muscular injection, 5 to 10 minutes after snorting or intra nasal use and about 20 minutes after an oral dose on an empty stomach. That is very fast, and most drugs that you swallow are not this fast. So if someone swallows some and thinks it is not working they could swallow a whole lot more, or think they can drive somewhere. That would be a very serious mistake. The effect comes on very quickly so there is not an hour or so to drive to a nightclub after you have dosed up on ketamine. I have talked to people who have had very serious accidents.

A user of ketamine told me: "I use pure ketamine in the club scene to be beyond words and in touch with god and other dimensions of reality". Therefore, people do have these sort of spiritual experiences in nightclubs as well. This is quite interesting because the effects of ketamine are only partly dependent on the set and setting. There are quite a few things which happen which do not seem to matter where you are. It is such a powerful drug that it seems to take you out of wherever you are, into somewhere else altogether. There are people who have even tried to establish a very favourable setting for themselves and do everything perfectly, and yet have had extremely frightening experiences which they did not expect to have. So the idea that you will have a good time if you do it at home is not necessarily true, although you may be safer, unless you are in the bath-tub, or fall down the stairs.

In an account from someone who did a very large dose of ketamine and had been doing so for years at home in their bedroom which seemed reasonably safe, the person said, "I went to hell instead and it was not really much fun; it was a sense of eternity". This is particularly interesting because there are a lot of ideas being put forward about the contribution of quantum physics to the basis of the inner mind, and whether that is based on quantum mechanical principals. The sort of language that people use, the absence of time for example, is quite consistent with quantum mechanical principals, so it is interesting to record those sorts of experiences.

Psychedelic effects of ketamine

Quite common psychological effects of ketamine are the sense of merging with other people and becoming inanimate matter, which is quite a distinctive ketamine effect and not as common with LSD. People think they are merging with the wall or the carpet. Other effects are ‘out of body trips’, transcendence of time, experience of evolution, extension of awareness, and symbols. This is really what we mean when we say "psychedelic". The word hallucinogen does not really cover these sorts of things. When people have schizophrenia they can hear voices, telling them to kill themselves for example, but all these sorts of things (experiences of past lives, going to other universes) are not really what we mean when we talk about hallucination. Psychedelic means to reveal the mind, and we learn a lot more about the inner depths of the mind from psychedelics, and that word is still used in anaesthetic literature as well. The psychedelic effects of ketamine have been linked to blood levels in anaesthetic journals so it is not necessarily a term tied up with the 1960s and art, it is still a medical term.

Some near-death experiences and ketamine experiences may be a re-experiencing of birth. For that I prefer to use the term ‘near-birth experience’. Stanislav Grof, a psychiatrist in the United States, said that you go back to the amniotic universe when you are floating inside your mother with no boundaries and there is a sort of symbolical representation: a symbolic re-experiencing. You can see the galaxy, the ocean and experience a sense of coming home or returning from exile. This is how he tries to explain a number of psychedelic experiences with both ketamine and LSD. The next stage is when the uterus is contracting but the cervix is closed. This is where the "no exit hell" idea comes from. According to Stanislav Grof, when you have a psychedelic experience where you think you are in hell, this is a symbolic re-experiencing of one of your deepest earliest memories in which one moment you are floating and the next you are being compressed. This has not happened to you before and it is very unpleasant, and then a child is born from the darkness into light. He thought that that might be where the idea of the light comes from; it is self-reuniting with source. You do not have to go through this sequentially and any stage can be repeated many times. That probably does explain some experiences that people have but obviously not all of them.

There is quite a lot of new data that suggests that the foetus does hear and remember sounds, at least as far back as 20 weeks. There is some data to suggest that near-death experiences can be therapeutic. This has raised the question of whether ketamine can be used in therapy, as it is in Russia for treating alcohol dependence and other conditions. Ketamine trips can be quite harmful as they can set off a whole range of mental health problems. It does not actually cause those problems but it can trigger them. This is because it creates pretty big holes between your conscious and your unconscious and a lot of undealt with material can come through those holes. This can start going around and around and you can develop a neurosis. This is the same with ecstasy actually. Any drug that brings unconscious material up can trigger a neurosis. Of course, that does not mean that you have got brain damage, but it does mean that your psychological defences have been impaired.

Doses and effects

Ketamine has got a tremendous capacity for creating psychological dependence and people have died as a result of that. The most famous of these people was Marcia Moore, who wrote the book called ‘Journeys into the Bright World’. She went out into the forest one night and injected herself with a huge amount of ketamine and died of hypothermia. In fact, there are effects of ketamine which are similar to being very drunk, such as trouble with talking, helplessness and death through exposure. There is some work by John Krystal which shows that some of the effects of ketamine go through the same brain systems as alcohol. Ketamine blocks the action of glutamate, which plays a crucial role in thinking, memory, motion, language, sensation and perception. Ketamine isolates the brain and "wipes the stage of the usual players", and as a result things come up from the depths of your mind, and also from what we can call the ‘transpersonal realms’.

Ketamine blocks NMDA receptors which are crucially involved in memory and thinking, amongst other things. That is why so little of the ketamine experience is remembered. People only remember a tiny fraction. One of the ideas I put forward is that the same mechanism is involved in the failure to recall dreams, caused by a natural blocker, as there are at least 3 or 4 substances in the brain which have similar actions to ketamine. The mental firewall not only blocks out your own personal disturbing material but also obliterates awareness of other realities incompatible with ordinary reality. This raises the matter of psychosis. If you take a lot of ketamine these different realities can start to interfere with your function in this one, and you can become very unwell from the point of view of what John Lilly called ‘the social consensus reality’. Psychedelic doses which are considerably less than anaesthetic doses of ketamine act more like a stimulant than a sedative and usually increase the heart rate. The higher brain is usually very switched on rather than shut down. Imaging the brain has shown that the whole higher brain is red hot on ketamine.

There have been very few deaths by pure overdose with ketamine. Anaesthetists occasionally, accidentally inject people with 10 or 20 times the amount they intended, but those people have usually been fine. One of the few deaths known about from pure overdose (Marcia Moore did not die of an overdose but from freezing) is that of a woman whom I will call Ariel, aged 49, almost exactly the same age as Marsha Moore who died when she was 50. Ariel was American and a co-owner of a New Age food supplements business. She started taking ketamine when she was about 48. She took ketamine everyday for seven months and developed the belief that she had an angel lover on the "other side" called Gabriel, who sent her messages and formed clouds into heart shapes. She had always been very thin and had strange ideas about things, but there was no pre-existing history of any formal psychiatric problem. One day she put on her best clothes and all of her best jewels and lay down on her bed and went "to join Gabriel". She did actually manage to die too. The post-mortem noted that she weighed six stone and she had a minimum of 600 milligrams of ketamine per litre of blood. Her death certificate is one of very few to simply read "ketamine poisoning".

Psychedelic doses are usually not much more than 10% of anaesthetic doses, unless you are particularly foolish. If you take more than that you just knock yourself out. The real physical dangers arise mainly from the setting: balance, numbness and muscle weakness can result in falls which can be lethal if they are over the edge of a building. This has actually happened.

Further Reading:

Bergman SA (1999) Ketamine: review of its phamocology and its use in paediatric anaesthesia. Anaesthesia Progress 46 (1) 10-20.

Crysell A (1998) Lost in the K-hole. Muzik 40, September, p45-48. ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Green SM, Clem KJ, Rothrock SG (1996) Ketamine safety profile in the developing world: survey of practitioners. Acad. Emergency Medicine 3 (6) 598-604.

Hansen G et al. (1998) The psychotropic effects of ketamine. Journal of Psychoactive Drugs 20, 419-425.

Jansen KLR (1990b) Ketamine: can chronic use impair memory? International Journal of Addictions 25, 133-139.

Jansen KLR (1993) Non-medical use of ketamine. British Medical Journal 306, 601-602.

Jansen KLR (1996a) Neuroscience, ketamine and the near-death experience: the role of glutamate and the NMDA receptor. In The Near-Death Experience: A Reader (Ed.s. Bailey LJ, Yates J) New York, Routledge, p265-282.

Jansen KLR (1996b) Using ketamine to induce the near-death experience: mechanism of action and the therapeutic potential. Yearbook for Ethnomedicine and the study of Consciousness (Jahrbuch furr Ethnomedizin and Bewusstseinsforschung) 4, 1995 (Ed.s. ratsch C, Baker JR), Berlin, VWB, 55-81.

Jansen KLR (1999d) Ketamine, Near-death and Near-birth Experiences. On line only, at:

Jansen KLR (2000) Anaesthetic apocalypse – ketamine part 1: hits and myths. Druglink (Institute for the Study of Drug Dependence, ISDD, London) 15 (1) 8-12 ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Jansen KLR (2000) What’s special about special K? Part 2: an addictive psychedelic drug. Druglink (Institute for the Study of Drug Dependence, ISDD, London) (in press) ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Knet J (1996) The Ketamine Konundrum. ()

Lily JC (1978) The Scientist: A Novel Autobiography. New York, Bantam Books/ J.B. Lippincott (now published in updated form by Ronin Publishing).

Moore M, Alltounian H (1978) Journeys Into The Bright World. Massachussetts, Para Research.

Stafford P (1992) Psychedelics Encyclopedia. 3^rd Ed., Ronin Publishing, Berkeley, Ca.

Turner DM (1994) The Essential Guide to Psychedelics. Panther Press, USA. (out of print but may be found at

(http://www.geocites.com/Hotsprings/Spa/4558/)

Vollenweider FX, Leenders KL, Oye I, Hell D, Angst J (1997) Differential pschopathology and patterns of cerebral glucose utilization produced by (S)- and (R) – ketamine in healthy volunteers using positron emission tomography (PET). European Neuropsychopharmocology 7, 25-38.