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Ketamine's Split Personality: Risky Club Drug, Effective Anesthetic

These glass capsules contain the drug ketamine.
Nicolas Asfouri
AFP/Getty Images
These glass capsules contain the drug ketamine.

Special K. K-land. Or even "baby food," because users sink into "a blissful, infantile inertia," the Drug Enforcement Agency says — ketamine is best known as a club drug here in the U.S.

Most recently, ketamine played an integral role in HBO's summer murder mystery The Night Of — Andrea and Naz took some and hooked up. He blacked out and awoke to find her stabbed to death in her bed. And he doesn't remember whether he did it.

But in many countries around the world, the hallucinogen has another purpose: It's the only drug available to sedate people during surgeries or to help with pain after operations.

"Ketamine is a safe, simple and cheap anesthetic," says Dr. Jannicke Mellin-Olsen, an anesthesiologist at Baerum Hospital in Oslo, Norway. "It is vital to global health."

And she is trying to keep it that way.

Mellin-Olsen was just elected as one of two presidents of the . At the group's annual meeting in Hong Kong last week, she called on the U.N. to keep ketamine free of global trade restrictions and not to treat the drug as a controlled narcotic, like heroin and cocaine.

"The experience with restricting other medicines, like morphine, is that governments put so strict procedures for acquiring it, that it in effect, it becomes unavailable," Mellin-Olsen says.

"That would be catastrophic for millions of people," says Miguel Trelles, an anesthesia adviser for Doctors Without Borders, who coordinates its surgery and emergency medicine unit. "I'm not saying ketamine is a panacea," he says, "but it saves lives."

When you have surgery in the U.S., doctors give you a cocktail of drugs to knock you unconscious. Some of these drugs lower your blood pressure and suppress your cough reflex — which keeps you from choking on your own vomit. Doctors put a tube in your throat to make sure your airway is always open. They also have to monitor your blood pressure and breathing throughout the operation.

But with ketamine, these fancy monitoring machines and procedures aren't necessary, Trelles says. Health workers don't need electricity, an IV or much training to use it. And ketamine doesn't interfere with your cough reflex, he says. So doctors don't have to put a tube in a patient's throat.

All these properties mean that hospitals in poor countries can still use ketamine for sedation and pain relief, even if they don't have trained anesthesiologists on staff. At Doctors Without Borders clinics around the world, doctors and nurses use ketamine in about 90 percent of C-sections and 95 percent of trauma surgeries in war zones, after earthquakes and in ERs.

But ketamine can have some serious side effects, such as flashbacks, amnesia, impaired motor function, loss of touch with reality and panic attacks.

When people take ketamine recreationally, they can build up a tolerance. Some people end up taking large quantities. Over time, the drug can permanently damage the kidneys and bladder, causing severe cramps, bloody urine and painful urination.

But chronic use of ketamine was never what its creator had in mind.

In the 1960s, Calvin Stevens was a chemist at Parke-Davis pharmaceutical company. He was trying to create for an anesthetic to replace PCP, which had some bad side effects.

Eventually, Stevens synthesized ketamine. And he struck gold.

The drug could sedate someone in minutes and wore off after only an hour or so. By 1970, the Food and Drug Administration approved the drug as a fast-acting, short-lasting anesthetic. A few years later, military doctors and nurses were using it on soldiers in the Vietnam War.

But over time, better anesthetics and analgesics slowly replaced ketamine in Western operating rooms, except for pediatric and veterinary surgeries. Recreational drug users discovered the drug's trance-like properties. Eventually, abuse of ketamine started to overshadow its medicinal use.

The biggest problems with ketamine abuse have arisen in southern Asia, especially China.

"Ketamine is the most popular of all recreational drugs taken in South China, which is arguably the epicenter of global ketamine consumption and production," Vice's Motherboard wrote a few years ago in a feature about the drug. "Here, in the heart of China's longtime manufacturing base, the drug is snorted and swallowed on a level unheard of in the West."

One study found the number of ketamine abusers more than tripled in Hong Kong from about 1,600 people in 2000 to more than 5,000 in 2009.

And the ketamine problem has continued to spread throughout East Asia and Australia, according to the U.N. Office of Drugs and Crime. "But because ketamine is a legal substance — and therefore not controlled — the true extent of its use is unclear and probably underestimated."

Right now, the U.N. recommends no restrictions on the trade and distribution of ketamine. It's up to individual countries to regulate it.

But China wants that to change. The country has petitioned to the U.N., four times since 2006, to designate ketamine as a controlled narcotic. The U.N. rejected its latest petition this past May, after the World Health Organization recommended against regulating the drug.

"The medical benefits of ketamine far outweigh potential harm from recreational use," Marie-Paule Kieny of WHO said in December. "Controlling ketamine internationally could limit access to essential and emergency surgery, which would constitute a public health crisis in countries where no affordable alternatives exist."

Copyright 2020 NPR. To see more, visit https://www.npr.org.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.