Ketamine, used everywhere, shows the potential of legal psychedelic drugs
Psychedelics like LSD and mushrooms are illegal because they're said to have "no accepted medical use and a high potential for abuse," according to the small group of well-dressed Washingtonians who decide these things.
But this isn't true. And if you want to see just how many uses psychedelics might be good for — medical and otherwise — consider how many varied, weird, and contradictory uses there are for the only legal hallucinogenic drug: ketamine.
In the public imagination, Special K was the worthless club drug that put users in a K-hole, disassociated from their bodies and floating above it all, serene, happy, calm. It was laughed at by South Park as part of the "stupid spoiled whore" playset. It was dismissed as a horse tranquilizer. "Just say Neigh," said the t-shirts.
Today, everything has changed. It's in Oprah's world as "Hope in a Hallucinogen." In Scientific American as "the biggest thing to happen to psychiatry in 50 years." On VICE as "the best drug on Earth." And even on the cover of Time magazine.
Most of this hype focuses on the antidepressant properties of K, which are crazy effective. Studies show that 60 to 70 percent of people with treatment-resistant depression respond to ketamine. That's a big deal. Depression affects 7 percent of U.S. adults; suicide is at a 30 year high; 12 percent of Americans take antidepressants (a $15 billion industry). There are hundreds of ketamine clinics across the country where people can use a drug that was once taboo. They often pay thousands of dollars for treatments. It's so well accepted that many insurance companies now cover it.
But that's not all. It is perhaps more versatile than any other drug. Period.
It's in ambulances. Doctors’ offices. Emergency departments. Not to mention, of course, EDM shows and hippie jam band festivals still. And not hidden in those places, as something shameful. But celebrated, as a cure.
The more people try ketamine for different things, they more they find it works for: alcoholism, social anxiety disorder, arthritis and lyme disease. It can improve electroshock therapy, and it can reduce pain so much that it helps the lame to walk.
"It's a miracle," said Jacob Tobey, president of the Psychedelic Club of Denver. "Because it's schedule III, you can be using it right now legally. You can't really do that with mushrooms or LSD."
There are huge downsides, incuding disorientation that can lead to accidents, damage to the bladder and serious addiction.
But the feeling among the psychedelic community is that what is true of ketamine is also true of other psychedelic drugs. That, once you legalize them, you'll find dozens of application that few people have so far thought of.
The proliferation of ketamine into the culture has people excited — and scared — about a future with psychedelic drugs.
DOCTORS' LITTLE HELPER
"It's not voodoo medicine, it's not fringe science, it's a paradigm-shifting revolution," said Dr. Wade Grindle of Boulder Mind Care, a ketamine clinic on the tourist-heavy Pearl Street Mall. Ketamine clinics have popped up on the Front Range in the past few years. Grindle's informational sessions are full of depressed folks suddenly excited by a novel treatment.
Grindle's office is simple. There's a comfortable chair with an IV infusion pump sitting next to it. The client picks out music for the trip. Grindle's staff starts an IV and pumps a steady stream of low-dose ketamine into the patient. (Other docs give the drug as a pill under the tongue.)
Some patients do ketamine therapy every six months or so. Some microdose it, every other day or every third day, said Dr. Richard Suddath, a psychiatrist in Boulder.
Docs don't know exactly how ketamine works. It doesn't act on the same receptors as most other psychoactive drugs — the serotonin, norepinephrine, dopamine, opioid, or cannabinoid receptors. It stops a receptor called NMDA from working, but that doesn't explain all its different effects. Some researchers think it turns the brain more plastic, letting it reshape itself. Two recent papers suggest that it changes the pattern of neuron firing in the lateral habenula, a part of the brain associated with feeling happy by enjoying rewards, calming a "bursting" bunch of neurons that are overactive in depression.
None of this science explains why it has such wide-ranging effects, which "remain mysterious," scientists say. In fact, what seems to change people's lives is the bizarre experiences people have on the drug.
"Weird" is the word you hear more than any other when people describe ketamine.
It "takes you out of your body." Ketamine is a "dissociative." You float behind and above yourself. The mind's monkey chatter turns off. And so the body still feels pain and sadness, but you get a new perspective on it. Somehow, that's enough to change a life.
"There's a component of awe," said Grindle. "It's an epiphany moment."
And because it's so easy to handle, so unlikely to give you a difficult trip, K is the psychedelic drug with the most addictive properties, the most "potential for abuse."
Take "Lee." He loved K at concerts, because it made him "a little wobbly, a little fun, music sounds a little bit better, makes me a little bit more social." There's no hangover. And it's short-acting. "You can take a bump and be back to baseline in 40 minutes to an hour — you can drive yourself home," Lee said. "If you take LSD, it takes 12 hours before you're sober gain."
Lee started doing it every other week on the weekends. "It's the only substance I've ever felt a craving for," Lee said. "I probably was addicted."
This is common. Treatment centers offer help for ketamine addicts, including residential treatment.
However, because K is less addictive than the drugs eating through the veins of middle America — opioids like heroin and fentanyl — you're more likely to hear of K these days as a treatment for addiction than a cause of it. It can re-jigger the way you think about alcohol, and a VA doctor says it could be key in knocking out addiction to opioids.
In ketamine is a light, a guide to thousands of patients.
Boulder's Lilo Fishbein used ketamine as a teen as a party drug, before realizing it was helping her in her life. "After a night of ketamine I realized I needed to apply to graduate school,'" she said. She trained to become a psychotherapist, and hopes to someday treat clients with K. "K can give me the insight that my mind has been too cluttered to find."
"Pine" is a cryptocurrency multi-multi-millionaire, and so he should've been happy. But his life wasn't worth living, he said in an email. He has Borderline Personality Disorder — a missing sense of self-identity, intense emotional swings, little purpose or motivation. Emptiness. He blames feelings of abandonment as a child.
There's currently no specific medical treatment for borderline personality disorder. Right now, researchers are at Yale and in Melbourne are doing clinical trials on whether ketamine can help borderline. It might become an approved drug soon.
But Pine didn't want to wait for that.
He traveled across the country to one of the few ketamine clinics willing to try it for borderline, even though they had little experience. Over six sessions, his life changed. He could feel his symptoms fully on ketamine. "However, since I'm dissociated and somewhat 'sedated' with ketamine, I could confront those emotions and experiences, and push them to the past and replace them with more logical and mature thought processes and reactions," Pine wrote us.
Since then, the chronic emptiness is less. The mood swings are muted.
"It almost feels magical," Pine emailed.
While on ketamine, feeling freer than he had in a long time, Pine had a revelation. "I want to make a difference in the world," he thought to himself. He already had millions more than he could ever use. "So why not donate it to charity?"
That day, his foundation, the Pineapple Fund, was created. He pledged 5,057 bitcoin, worth $86 million when he announced it (and $55 million today), to clean water, civil rights, and medical research. One of his biggest donations went to the psychedelic research organization MAPS.
MAPS is on track to have MDMA therapy for PTSD approved by 2022. But once MDMA — molly, ecstasy — is legal, it can be prescribed "off-label" for anything. So how many uses will doctors find for MDMA? As many as ketamine? Uses no one's thought of yet? How big can ecstasy be?
IN THE AMBULANCE
Ketamine has been used for surgical anesthesia in emergency rooms. Increasingly, it's finding its way into ambulances.
I'm an EMT. I respond to 911 calls in Boulder, Colorado. Last month, our ambulances got ketamine. For patients with "agitated delirium" — that is, so amped on bath salts or psychosis that they're out of control — injecting a small amount of ketamine into the muscle, the dude quickly calms down.
It's also an amazing drug because — unlike fentanyl — it kills pain without depressing the respiratory drive. When medics give fent, we EMTs have to watch the patient like nervous grandmothers to make sure they don't stop breathing. No matter how zonked patients are on ket, by contrast, the patients breathe like racehorses. And so we EMTs can breathe easier, too.
"We are constantly given a narrative that something has no medicinal value, and we keep finding out that they do have medicinal value," said Tobey, president of the Psychedelic Club of Denver.
Mushrooms for long-distance runs; ayahuasca for cancer; ibogaine for porn addiction; 2c-b for couples; LSD for flow. Not to mention the usually unmentioned: psychedelics give folks purpose in their lives; they suggest to some that we're more than just our chemicals; they are thrillingly dangerous; friendships and communities are based on them. These things you cannot get from fentanyl, Tylenol, Prozac, or Buprenorphine.
Like with ketamine, you might one day be able to trip — and have your insurance cover it.
This might scare folks who bought into the mindless fear-mongering language of D.A.R.E., or who saw friends get weird after a too-strong mushroom trip.
But, says Tobey, since the world is such a mess, why not try something new? We might be able to get ourselves out of this hole we're in — one K-hole at a time.