WE REALLY NEED to talk about Ketamine. Why? Well, good reasons include the recent spate of tragic fatalities caused by the drug (including a lengthening list of much-loved celebrities) and an even longer list of ordinary people who need to attend urological clinics with grotesque damage to their urinary tracts.

Also, and perhaps the most politically persuasive of arguments, because there is now evidence (in addition to anecdotes and subjective surveys) that the number of people using Ketamine intermittently or regularly has grown exponentially over the past decade, in Ireland and the United Kingdom.

So, firstly, what exactly is Ketamine? Ketamine is a synthetic (man-made) anaesthetic and sedative drug first developed in the early 1960s (and derived from a now-notorious precursor, Phencyclidine, also known as ‘PCP or Angel Dust’).

Initially licensed by the FDA in 1970, Ketamine quickly gained popularity among military surgeons dealing with wounded soldiers in the Vietnam War, as a simple injectable anaesthetic that produced a short-lived trance-like state of ‘dissociation’ (in which recipients felt detached from their bodies, and unable to feel pain).

Crucially – and unlike most other anaesthetic drugs – it didn’t cause patients’ blood pressure to plunge. It actually ‘protected’ their airway and, in places and times of scarce resources, it allowed non-anaesthetists to create a kind of ‘general anaesthesia’ during which urgent life – and limb-saving surgery could be undertaken.

Horst Fass, Pulitzer Prize winning combat photographer in Vietnam. During that war, Ketamine was widely used as a medical anaesthetic. Alamy Stock Photo Alamy Stock Photo

The same qualities meant that it became a drug of choice for treating distressed children in emergency departments, as well as one of the most widely used anaesthetic agents in veterinary practice worldwide, affording sedation and pain relief in both contexts, with an intramuscular injection. And the analgesic effect has been invaluable in the care of (human) patients with chronic pain (e.g. complex regional pain syndrome after injury), albeit with ‘sub-anaesthetic’ doses. 

The same applies to so-called ‘treatment resistant depression’ in which patients with disabling mood disorders that have failed to respond to conventional anti-depressant medications have been successfully, and often dramatically, helped with relatively low-dose Ketamine infusions (and, more recently, with a nasal spray).

The drug has also been used, with close monitoring in specialist settings, to help people combat drug and alcohol addiction. So Ketamine is clearly a medically attractive drug, with many useful applications, and it is included on the World Health Organization’s ‘List of Essential Medicines for Anaesthesia and Pain Management’. 

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But why do people use Ketamine ‘recreationally’? As with so many medicines, Ketamine has proven hugely popular among non-medical users, like clubbers, party- and festival-goers, and so-called ‘psychonauts’ (who employ........

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