Ketamine - Overview

Ketamine is a hallucinogenic substance used in France in veterinary and human anaesthesia (hydrochloride). Low doses of ketamine cause a unique inebriation, high doses cause hallucinations and a feeling of loss of mental and physical unity.

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Flacon de Kétamine

Introduction/Background

Ketamine is a substance derived from phencyclidine (PCP), chemically produced and used as a veterinary and human anaesthetic. Since 2020, it has also been used to treat mood disorders, particularly treatment-resistant depression (Spravato®).

Ketamine, often referred to as “keta”, “ke”, “K”, or “Special K”, is part of the hallucinogen group. Diverted from its medical use to be used for recreational purposes, its main psychotropic effects, in moderation, are hallucinations and dissociative states, notably distorted visual and body perception. In very high doses, ketamine can cause out-of-body experiences (feeling as though you are leaving your body and observing it from the outside), or even loss of consciousness (known as a K-hole). It is ketamine’s S-enantiomer which is the most active, particularly due its affinity for the NMDA target receptor which is responsible for psychoactive effects.

Ketamine is presented as a colourless and odourless liquid. After evaporation, it may become very fine crystals or a white powder. It is predominantly snorted but may also be administered via intravenous or intramuscular injection.

There are also other hallucinogenic substances, such as LSD, hallucinogenic mushrooms, poppers, GHB-GBL, and nitrous oxide: for these substances, please see the dedicated pages.

Production/Supply

In France, hallucinogenic substances are not subject to organised or large-scale trafficking like other illicit substances.

Seizures

In France, the number of seizures and arrests for the simple use and trafficking, or use-resale, of hallucinogenic substances is very low due to the lack of structured trafficking. Therefore, the quantities seized, which see a fair share of random variation from one year to the next, are not truly representative of the presence of substances across the country. Moreover, these hallucinogenic substances are not detected by kits used during roadside checks.

At European level, seizures of ketamine have been reported by at least 16 EU countries, the total quantity seized estimated to be between 250 and 600 kilograms.

Supply

According to observations from the OFDT’s monitoring scheme for Emerging Trends and New Drugs (TREND) in 2022, depending on the area of purchase, the price of 1 gram of ketamine could vary between €20 and €50, with a current price of around €30-€40. When purchasing several grams, a sliding price scale is often proposed. A half gram is also sold for €20.

The OFDT’s National Identification System for Toxics and Substances (SINTES) monitors the mis-selling and atypical adulterations of substances. In 2022, it was often observed when the desired substance was ketamine, that analyses revealed 3-HO-PCP, 3-MMC combined with 4-MMC, MDMA, or pregabalin. Thus, there are often scams involving ketamine’s R-enantiomer, the effectiveness of which is much lower.

Since autumn 2022, TREND coordinating sites established in Île-de-France, Auvergne-Rhône-Alpes, Provence-Alpes-Côte d’Azur and Occitanie have gathered information on pink powders known by different names: “Tubici” or “pink cocaine”. Contrary to what these names suggest, these powders contain neither cocaine nor 2-CB, but a mix of existing substances. Following the preliminary analyses conducted by SINTES, law enforcement services, and harm reduction drug testing, ketamine is the dominant substance in this mixture (combined with MDMA in varying proportions).

Use in the adolescent population

In 2022, the Survey on Health and Drug Use on National Defence and Citizenship Day (ESCAPAD) observed that the use of ketamine affected 0.9% of 17-year-olds. At regional level, lifetime use of ketamine at 17 years old was somewhat more common in Brittany and Pays de la Loire (2% and 1.6% respectively), and less so in Île-de-France and Provence-Alpes-Côte d’Azur (0.6% and 0.3% respectively). As for use among high school students in general in 2022, 1.1% stated to have tried ketamine.

Use in the adult population

In France, the frequency of use of ketamine is unknown in the adult population.

At European level, ketamine is available but not monitored, which limits understanding of its use and its impact on public health. Recent estimates of the last year prevalence of use of ketamine among young adults varies from 0.4% in Denmark in 2021 (16-34 years old) to 0.8% in Romania in 2019. The Netherlands reported that the use of ketamine had increased among young people in nightlife settings.

Impacts

Risks associated with one-time use

It is after around 10-15 minutes that the effects are felt when the substance is inhaled, and around 30 minutes when it is ingested. It is used on its own or combined with other substances, most often stimulants (the name “Calvin Klein” denotes a mixture with cocaine, but combinations with MDMA and amphetamines are also observed).

The negative effects mentioned by users during one-time use are often “bad trips”, and “nightmare-like” discomfort, accompanied by anxiety, which generally occur when taken in a suboptimal context (individual is tired, for example). Lasting effects, often for several days (“glued” or “high” users), but also proven risks of accidents or reckless actions linked to delusions experienced, are also mentioned. The unintended side effects are also linked to fluctuations in the purity of the substances.

Trauma or injuries that users discover after a consumption sequence (due to its anaesthetic effect) also pose a risk associated with its use. Finally, taking into account a significant variation in effects between one individual and another, and a dose which is difficult to adapt, ketamine and GHB/GBL very easily lead to comas - sometimes sought by users - particularly in combination with alcohol (K-hole or G-hole).

Risks associated with chronic use

According to scientific literature, the chronic use of ketamine is linked to a major onset of cystitis characterised by incontinence, dysuria (irritation of the bladder/urethra), and haematuria (presence of blood in urine). It is also frequently associated with very strong abdominal pains, commonly known as “K-cramps”.

Usually, hallucinogens result in neither dependence nor tolerance, particularly due to the fact that they are used in relatively widely spaced sequences. However, a tolerance and dependence are observed among chronic ketamine users. Frequent users report an increase in doses over time, and other cases of addiction are identified in the literature.

Seeking treatment

In 2021, almost 300 people visited a specialised drug treatment centre (CSAPA) for a problematic use of ketamine.

Perceptions/Opinions

The substances and their patterns of use vary across party events in accordance with different elements: the profiles and habits of audiences present, the types of music played, the presence of resellers, the surroundings and layout of the space, the duration of the event, the police presence within it, the risk of police surveillance in its vicinity (certain substances such as ketamine and LSD, are not yet detectable in saliva tests, and are therefore favoured).

Legal framework and recent public guidelines

In international law, the Convention on psychotropic substances adopted in Vienna in 1971, classifies psilocin and psilocybin, contained in certain mushrooms, as narcotics. French law is much stricter, since all hallucinogenic mushrooms are classified as narcotics, regardless of their type. That equally applies to synthetic hallucinogens such as ketamine. In this respect, hallucinogens fall under the law of 31 December 1970 relating to health measures to fight against drug addiction and combat the trafficking and use of poisonous substances. Therefore, the purchase, possession, use, manufacture, transport, transfer (even free of charge) and sale of hallucinogens is banned by the Public Health Code and the penal code.

Depending on the severity of trafficking offences, sentences may extend to life imprisonment, and a fine of 7.5 million euros for participating in an organised trafficking network.

Ketamine used outside of the medical setting has been listed as a narcotic since 1997 (Legislative order of 8 August 1997 modifying legislative order of 22 February 1990 establishing the list of substances classified as narcotics).

Since 24 April 2017, injectable preparations of ketamine have followed regulations applicable to narcotics, namely, in addition to sections already applied, prescription on secure ordinance and the traceability of entries and exits on a special register (Legislative order of 19 January 2017 modifying legislative order of 22 February 1990 establishing the list of substances classified as narcotics, ANSM).