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Dr Chris Luke It's high time we talked about Ketamine

The retired emergency medicine specialist discusses the controversial, man-made medical drug that was developed in clinical settings, but has now evolved into a dangerous recreational drug.

WE REALLY NEED to talk about Ketamine. Why? Well, good reasons include the recent spate of tragic fatalities caused by the drug (including a lengthening list of much-loved celebrities) and an even longer list of ordinary people who need to attend urological clinics with grotesque damage to their urinary tracts.

Also, and perhaps the most politically persuasive of arguments, because there is now evidence (in addition to anecdotes and subjective surveys) that the number of people using Ketamine intermittently or regularly has grown exponentially over the past decade, in Ireland and the United Kingdom.

So, firstly, what exactly is Ketamine? Ketamine is a synthetic (man-made) anaesthetic and sedative drug first developed in the early 1960s (and derived from a now-notorious precursor, Phencyclidine, also known as ‘PCP or Angel Dust’).

Initially licensed by the FDA in 1970, Ketamine quickly gained popularity among military surgeons dealing with wounded soldiers in the Vietnam War, as a simple injectable anaesthetic that produced a short-lived trance-like state of ‘dissociation’ (in which recipients felt detached from their bodies, and unable to feel pain).

Crucially – and unlike most other anaesthetic drugs – it didn’t cause patients’ blood pressure to plunge. It actually ‘protected’ their airway and, in places and times of scarce resources, it allowed non-anaesthetists to create a kind of ‘general anaesthesia’ during which urgent life – and limb-saving surgery could be undertaken.

horst-fass-pulitzer-prize-winning-combat-photographer-for-the-associated-press-shown-in-a-1965-file-photo-was-wounded-in-both-legs-by-shell-fragments-on-december-6-while-covering-the-embattled-bu-do Horst Fass, Pulitzer Prize winning combat photographer in Vietnam. During that war, Ketamine was widely used as a medical anaesthetic. Alamy Stock Photo Alamy Stock Photo

The same qualities meant that it became a drug of choice for treating distressed children in emergency departments, as well as one of the most widely used anaesthetic agents in veterinary practice worldwide, affording sedation and pain relief in both contexts, with an intramuscular injection. And the analgesic effect has been invaluable in the care of (human) patients with chronic pain (e.g. complex regional pain syndrome after injury), albeit with ‘sub-anaesthetic’ doses. 

The same applies to so-called ‘treatment resistant depression’ in which patients with disabling mood disorders that have failed to respond to conventional anti-depressant medications have been successfully, and often dramatically, helped with relatively low-dose Ketamine infusions (and, more recently, with a nasal spray).

The drug has also been used, with close monitoring in specialist settings, to help people combat drug and alcohol addiction. So Ketamine is clearly a medically attractive drug, with many useful applications, and it is included on the World Health Organization’s ‘List of Essential Medicines for Anaesthesia and Pain Management’. 

Recreational use

But why do people use Ketamine ‘recreationally’? As with so many medicines, Ketamine has proven hugely popular among non-medical users, like clubbers, party- and festival-goers, and so-called ‘psychonauts’ (who employ mind-altering chemicals or other techniques to explore the deepest reaches of the ‘psyche’).

It is relatively cheap, quickly available (from online dealers), and it can be taken in a variety of ways (snorted, swallowed, smoked, or – rarely – injected). The drug is primarily taken for its ‘mind-altering’ effects, and it belongs to a ‘family’ of such drugs, including MDMA, Mescaline, PCP and LSD, that have been popular for decades among (especially young) people who want to experiment with – or enjoy again – a mind-bending blend of auditory and visual hallucinations, detachment from reality, sedation, blissful inertia or ‘peace’, or ‘profoundly spiritual’ experiences.

powdered-amphetamine-drugs When used recreationally, Ketamine is often snorted in powder form. Alamy Stock Photo Alamy Stock Photo

And one ‘benefit’ of Ketamine (which may be called ‘Special K’ and many other street names) over its hallucinogenic cousins is that the altered mental state tends to last just an hour or two, unlike that following use of the other drugs and, afterwards, there is often amnesia for the drug-induced state and what happened during it. That said, most users combine their use of Ketamine with a wide range of other drugs (like Cannabis, Cocaine and MDMA [‘Ecstasy’]), so the picture is complicated. 

The dangers

What are the ‘downsides’ of Ketamine use? Not all users find the ‘bliss’ that enthusiasts report. And of course, it is the persistent – often ‘dependent’ – consumers who eventually demonstrate the dangers of excessive use of the drug. The ‘mechanism’ of the harm is often predictable from the state of the user as perceived by others: users may be apparently ‘drunk’, agitated and confused, paranoid, fearful, unsteady on their feet, not able to control their muscles or understand what is said to them (or the risks around them), and often unable to remember where they are or what has just happened.

Such ‘visible’ effects were the basis of recent fevered speculation (in The Atlantic and Wall Street Journal) about the behaviour of Elon Musk, who has publicly acknowledged that he relies on Ketamine for his recurrent depression.

file-tesla-facilities-face-wave-of-attacks-as-elon-musk-delves-into-politics-miracle-mile-los-angeles-california-usa-april-13-chief-executive-officer-ceo-and-product-architect-of-tesla-inc Elon Musk Alamy Stock Photo Alamy Stock Photo

However, it is the fatalities that are most worrying. One of the first publicised cases was that of ‘D.M. Turner’, a renowned psychedelic researcher who died in 1996, after injecting an unknown quantity of Ketamine, and drowning in a bathtub, while seemingly incapacitated by the effects of the drug.

Sadly, a near ‘copycat’ case was that of Matthew Perry, the 54-year-old star of the 1990s TV hit series, ‘Friends’, who was found ‘floating face-down in a hot tub at his Pacific Palisades home’ in 2023 due to a combination of Ketamine toxicity and drowning.

matthew-perry-attends-an-nbc-all-star-party-in-pasadena-picture-uk-press Actor Matthew Perry, who had battled addiction for many years, died from Ketamin toxicity and drowning. Alamy Stock Photo Alamy Stock Photo

He had allegedly been given huge amounts of the drug by two doctors to ‘treat’ his longstanding addictions to opioids and alcohol. And UK Ketamine deaths reported in the past 18 months have included that of ‘RuPaul’s Drag Race’ star, The Vivienne, a 32-year-old, who reportedly suffered a Ketamine-induced cardiac arrest in the bathroom of their home; Rian Rogers, a 26-year-old ‘rising star of the car industry’ who was found dead in his shower after a cardiac arrest, due to the Ketamine he kept taking to ease the pain caused by his shrivelled ‘Ket bladder’; and 20-year-old Sophie Russell, who weighed just six stone when she died following a two-year history of Ketamine use. Sophie first tried the drug in school, while Rian experimented with it first at a festival.

Even more shocking among recent Ketamine-related deaths was the murder-suicide in February 2025 by a Wyoming woman, Tranyelle Harshman, a 32-year-old with post-partum depression, who shot her four daughters and then herself, and was found to have ‘large amounts of Ketamine’ in her bloodstream.

All of these deaths seem to be potentially related to one or more of the complications of heavy Ketamine misuse. These include physical and mental dependence on the drug, with constant cravings for more, despite the increasingly obvious dangers of its use.

Aside from transient nausea, weakness and memory loss (which is why Ketamine is used as a ‘date-rape’ drug), short and long-term effects include cognitive or ‘mental’ decline, memory failure, anxiety, depression, self-harm while ‘detached’ from reality and unable to feel pain, recurrent hallucinations (sometimes – as in getting into a so-called ‘K-hole’ – these can be terrifying) and, most infamously, prostrating abdominal pain due to a combination of bile duct and urinary bladder damage.

The latter can be devastating, with painful bloody ulceration of the bladder lining and ureters, an insatiable need to urinate (up to 50 times a day), and a relentless shrivelling of the bladder that may require ‘ostomy’ bags for urine drainage or even surgical ‘reconstruction’. The abdominal pain often drives users to take a hot bath or shower, and even more of the Ketamine for pain relief, in a fatally ‘vicious circle’ that may only be apparent post-mortem.

Ketamine in Ireland

What evidence is there of a substantial problem with Ketamine in Ireland? Official data typically takes a year or two to be published, but figures from the National Drug-Related Deaths Index in Ireland reveal eight poisoning deaths where Ketamine was ‘implicated’ between 2011 and 2020. Annual Ketamine-linked admissions to Irish drug-treatment facilities have approached 100 of late, although just 17 admissions were ‘primarily’ driven by Ketamine misuse (which is typically combined with use of other ‘recreational’ drugs).

The UK’s Office for National Statistics reports that nearly 4% of 16-24-year-olds used Ketamine in 2023 but, in Ireland, HSE Addiction Experts are still speculating about the scale of an ‘emerging trend’ of Ketamine use, especially at music festivals. Almost two-thirds of responders to a festival-goer survey had used the drug in the previous year, while EU and UCC surveys of drug users found that Ketamine was the fourth most popular drug among Irish university-level students (of whom 16% had used the drug at least once).

Finally – and most strikingly – in 2023, the Irish Revenue service seized 41.2 kg of Ketamine, valued at €2.47mn, while in 2024 an EU Drugs Agency study involving analysis of municipal wastewater placed Dublin in the top 20 of 128 European cities for levels of Cocaine, Ketamine and MDMA and 15th for the levels of Ketamine. These latter ‘concrete numbers’ probably give us the best available indication of the scale of Ketamine use in Ireland at the moment and, while they should be monitored frequently, and augmented with hospital and autopsy records, they offer a rough guide to the (considerable) level of medical need likely to be created by Ketamine in the next few years.

The Take-Home Message? Notwithstanding the unceasing challenges of legislation, regulation and education, the fact is that Ketamine is now an established ‘major drug’ of misuse in Ireland, and its potentially disastrous impact on users’ brains, bladders and behaviour need to be widely and urgently appreciated, especially by paramedics, emergency physicians, and the staff in every pub, club and festival venue.

Dr Chris Luke is a retired Consultant in Emergency Medicine, co-founder of the Club Cork Drugs and Alcohol Awareness course in 2003 and host of the Irish Medical Lives podcast.

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    Mute Buster Lawless
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    May 4th 2025, 7:35 AM

    Ketamine? Just say NEIGHHHH

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    Mute Larry Betts
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    May 4th 2025, 8:23 AM

    @Buster Lawless: Get off your high horse

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    Mute Ckeego
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    May 4th 2025, 6:52 PM

    @Buster Lawless: Psychonauts? Now, that’s a new one. Fuchtards, more like…

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    Mute Buster Lawless
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    May 4th 2025, 7:36 AM

    Great pun in the headline in fairness

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    Mute 2q6v4IEp
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    May 4th 2025, 8:41 AM

    Human beings’ advanced cognitive function is an extremely mixed blessing. A majority of people will search for ways to relieve the stress of simply being cognizant in a world where almost everyone has limited power, limited avenues for ‘success’ and is invariably a component of systems of power that exploit and consume the individual: it is this desire for escape that is the means through which human bodies are most often exploited. Under pressure we seek a quick fix when the path to conscientious distraction, enjoyment or enlightenment involves more investment of time and energy. We also like the feel of something dirty or naughty: the texture of our shadow. Those who can combine conscientiousness with their shadow become the light: they turn their suffering into wisdom and generosity.

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    Mute Thesaltyurchin
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    May 4th 2025, 3:06 PM

    @2q6v4IEp: It is also, mostly good fun, which we generally see as a ‘problem’ these days. Unfortunately, society focuses on the lowest amount and legislates the majority accordingly. Ketamine has been around for 20+ years here, certainly anything one gets ‘addicted to’ is a problem. 8 deaths since 2011 isn’t even a percentage, it’s unfortunate, (wonder what else was mixed into those substances), perhaps if we were serious and tested these things for radicals, maybe they could have been prevented.

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    Mute Gary Kearney
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    Thu 1:55 PM

    @Thesaltyurchin: Ketamine is a nasty drug and death is not the only way to measure the negative effects it has!

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    Mute slippy clip
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    May 4th 2025, 8:32 AM

    I think people should send me the numbers of these bold dealers so I can block each and every one of them! >:(

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    Mute Lothario Jim
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    May 4th 2025, 7:53 AM

    Enjoy yourself

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    Mute Pól Pot
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    May 4th 2025, 9:10 AM

    Depressed? Turn yourself into a cryptocurrency.

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    Mute Pól Pot
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    May 4th 2025, 9:15 AM

    Just lay back in the chair and disappear. Beats decades of antidepressant apathy or soul devouring alcoholism.

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    Mute Thesaltyurchin
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    May 4th 2025, 3:07 PM

    @Pól Pot: Chillguy doing nicely.

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    Mute Ckeego
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    May 4th 2025, 6:51 PM

    Well, if it turns you into Elon Musk, you are welcome to it….

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    Mute Dominic Leleu
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    May 4th 2025, 11:29 AM

    they died using drugs ? ah well
    moving on

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    Mute Nick Vasilakis
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    May 4th 2025, 1:21 PM

    We should be monitoring opioid levels in sewage treatment stations. To establish a baseline, so that we can better judge trends, and to measure what we are discharging into the sea.

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    Mute Troll Hunter
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    May 6th 2025, 12:52 AM

    Ahem

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