Ketamine: Not Your Average “Special K”
Recently I had the honor to present at the joint meeting of the Southwestern and California Associations of Toxicologists on the use of ketamine in pediatric cases. Ketamine has a long history as a pharmaceutical agent for both human and veterinary medicine as an anesthetic agent in emergency medicine. It is also used in pediatric anesthesia, pain management and as a drug of abuse. Ketamine was derived from phencyclidine (PCP) in the 1960s for use as a dissociative anesthetic.Its anesthetic effect is achieved without respiratory depression by inhibiting the neuronal uptake of norepinephrine, dopamine, serotonin, and glutamate activation in the N-methyl-D-aspartate receptor channel.Ketamine use can result in unusual ideations as well as hallucinations resulting in its appeal to recreational drug users.
In the 1980’s an increase in ketamine abuse was seen and especially as a “club drug” and at “raves” which lead to its placement into Schedule III of the United States Controlled Substances Act (CSA) in 1999. Ketamine is difficult to synthesize outside a well-equipped laboratory; therefore, most of the illicit supply is diverted from human and veterinary anesthesia products. After its placement on the CSA, a decline in its popularity among high school students and young adults was observed.
However, we may see an increase in the use and abuse of ketamine. Currently, ketamine is being evaluated in clinical trails for use as a “rapid antidepressant” for individuals suffering from major depression. It has also been used in chronic-pain management, treatment-resistant unipolar depression, and bipolar disorder. Ketamine was evaluated as a potential aid in the treatment of alcohol as well as heroin addiction. Chronic pain affects more Americans than diabetes, heart disease and cancer combined with 100 million Americans suffering from its effects.9 With such a large population, the potential for ketamine being diverted for abuse is possible. Unfortunately, although many Americans will safely use their medications, there will be a percent that will become addicted to their pain medication and some of the prescribed medication finding its way into the hands of individuals who will abuse the compound.
- G Dolansky, A Shah, G Mosdossy2 and MJ Rieder “What is the evidence for the safety and efficacy of using ketamine in children?” Paediatr Child Health. 2008 April; 13(4): 307–308. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2529431/
- Evers A S et al. Chapter 13. General Anesthetics. Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 11e.
- Hocking G and Cousins M “Ketamine in Chronic Pain Management: An Evidence-Based Review” Anesth Analg 2003;97:1730–9
- Himmelseher S and Durieux M “Ketamine for Perioperative Pain Management” Anesthesiology 2005; 102:211–20
- Bergman S “Ketamine: Review of Its Pharmacology and Its Use in Pediatric Anesthesia” Anesth Prog 46:10-20 1999
- Blonk MI et al. Use of oral ketamine in chronic pain management: A review. Eur J Pain (2009), doi:10.1016/ j.ejpain.2009.09.005
- Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2013). Monitoring the Future national results on drug use: 2012 Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan.
- Johnston, L. D., O’Malley, P. M., Bachman, J. G., and Schulenberg, J. E., (2013). Monitoring the Future national survey results on drug use, 1975– 2012: Volume 2, College students and adults ages 19–50. Ann Arbor: Institute for Social Research, The University of Michigan.
- Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011. http://books.nap.edu/openbook.php?record_id=13172&page=1