Ketamine clinics have grown from fewer than 100 nationwide in 2015 to more than 1,500 by 2024, part of a market estimated at roughly $3.4 billion to $3.8 billion.
The drug is a dissociative anesthetic that distorts perceptions of sight and sound and leaves users feeling disconnected, according to the DEA’s ketamine drug fact sheet.
Here are five things to know:
1. It’s a medical anesthetic that’s also abused recreationally. Ketamine is an injectable, short-acting anesthetic used in both humans and animals, sometimes called a “dissociative anesthetic” because it makes patients feel detached from their pain and environment, per the DEA. It can induce sedation, immobility, pain relief and amnesia.
Since the 1970s it has been legally marketed in the U.S., and in 1999 it became a Schedule III non-narcotic substance under the Controlled Substances Act — a category for drugs with accepted medical uses and a potential for moderate-to-low physical dependence or high psychological dependence.
In 2019, the FDA separately approved an esketamine nasal spray, known as Spravato, for treatment-resistant depression, available only through a certified doctor’s office or clinic. Abused for its ability to produce dissociative sensations and hallucinations, ketamine has also been used to facilitate assault.
2. Most of the supply is diverted or smuggled, not sold on the street. Ketamine is produced commercially in several countries, including the U.S., but most of what’s illegally distributed domestically is diverted or stolen from legitimate sources — particularly veterinary clinics — or smuggled in from Mexico, according to the DEA. Street sales are rare; distribution typically happens among friends and acquaintances at raves, nightclubs and private parties. It comes as a clear liquid or a whitish powder, and pharmaceutical liquid is sometimes evaporated into crystals and ground into powder.
Powdered ketamine is snorted in “bumps” or smoked, often mixed into marijuana or tobacco cigarettes, while the liquid form is injected or mixed into drinks. It’s often combined with MDMA, amphetamine, methamphetamine or cocaine. Common street names include Special K, Cat Valium, Kit Kat, Vitamin K and Jet K.
3. Effects hit fast and hard, both mentally and physically. Onset is rapid, often within a few minutes, though it’s slightly slower when taken orally. A “Special K” trip is shorter than an LSD or PCP trip — roughly 30 to 60 minutes — but can include hallucinations and a sense of being out of one’s body.
Ketamine can also cause agitation, depression, cognitive difficulties, unconsciousness and amnesia, and Hallucinogen Persisting Perception Disorder — a recurrence of drug-like effects weeks later — has been reported.
Physically, users may see a spike in heart rate and blood pressure that gradually eases over 10 to 20 minutes, along with involuntary rapid eye movement, dilated pupils, salivation, tear secretion, muscle stiffening and nausea.
4. An overdose is dangerous, and other drugs can mimic ketamine’s effects. An overdose can cause unconsciousness and dangerously slowed breathing, according to the DEA fact sheet. Other hallucinogens such as LSD, PCP and mescaline produce similar effects, while depressants like GHB and Rohypnol are misused for similar amnesiac or sedative properties — including, like ketamine, to facilitate sexual assault, the DEA said.
5. Leaders support stronger oversight. Earlier this year, the American Society of Anesthesiologists called for stronger oversight of ketamine prescribing and administration as use of the drug expands for depression, post-traumatic stress disorder and other mental health conditions.