At moderate to higher subanesthetic doses, ketamine typically produces dissociative or psychedelic effects, ranging in expression and intensity depending on individual sensitivity. Ketamine does not usually induce psychedelic effects at extremely low doses, and psychedelic dose ranges are still below higher quantities used for anesthetic purposes.
Research suggests that doses that produce a psychedelic effect more consistently lead to more effective mental health treatments when administered in clinical settings. A lethal dose of ketamine1 is approximately 600mg, whereas the typical therapeutic dose is .5 mg, or 1/1,200 of the lethal dose.
There are multiple ways to ingest ketamine. Ketamine can be consumed through insufflation, or sniffed through the nose, either in powder form or in a nasal spray. In ketamine-assisted therapy, it can be administered intravenously through an IV drip. It can also be administered by therapists intramuscularly, or via injection. Licensed practitioners may also administer ketamine in the form of sublingual lozenges that dissolve under the tongue. Several derivatives of ketamine are available as pharmaceutical products , including S-Ketamine (or esketamine), R,S-Ketamine, and R-Ketamine.
Ketamine Risks
Things to Know
- Ketamine can be ingested by insufflation, nasal spray, intravenously, or intramuscularly
- There are multiple types of ketamine packaged as pharmaceutical products
- Ketamine sold on the black market does not meet FDA standards unless it is diverted from prescription use, and can contain potentially deadly adulterants
- Ketamine purchased on the black market should be tested to ensure that it not contain adulterants or is a counterfeit substance
- Esketamine is a form of ketamine packaged as a pharmaceutical product and given FDA-approval for various types of depression
Ketamine Dosage
In recreational contexts, ketamine primarily comes in a loose powder. The other formats of ketamine – nasal spray, IV, Intramuscular, and lozenge – are only available via prescription or under the supervision of a mental health clinician.
When ingesting ketamine for personal use in a nonclinical environment, it is often more comfortable to start with a low dose, especially if you have little experience with this substance. Many people prefer to start with 5mg to 10mg, and give themselves at least 10 minutes to register the effects. To help prevent taking more than intended, it is often best to use a scale that measures in milligrams to ensure you’re taking an accurately measured dose. If you don’t have a scale, start with a tiny “bump,” a small allotment of a powder drug, which is roughly 10mg. The effects of a low dosage of ketamine generally last for 15-20 minutes.
Therapeutic or medicinal doses of ketamine are often around 25mg and above. Some ketamine-assisted therapy treatment centers administer 35mg of ketamine in the first session and increase the dose in following sessions, sometimes surpassing 70mg of ketamine.
Taking higher doses of ketamine increases the likelihood of experiencing an extended and more intense state of dissociation. High dose ketamine experiences often last around one hour.
Ketamine Is Technically an Anesthetic
Ketamine is not a traditional psychedelic. It’s a dissociative anesthetic that is commonly used in surgical and medical procedures. It has been used since the 1970s in dentistry and pediatric medicine. There are multiple medical uses2 for ketamine. It’s also used in veterinary medicine to treat cats3 , dogs4 , and other animals5 .
Different Types of Ketamine
R,S-Ketamine6 refers to a racemic mixture of two enantiomers of ketamine: R-ketamine and S-ketamine. “Enantiomers” are mirror image isomers of a molecule that differ in their spatial arrangement but have the same chemical formula. R,S-Ketamine has been used for over 50 years of medical use for anesthesia and pain relief. This form of ketamine is used in most human clinical trials, including as an intervention for various mental health and substance use disorders. Most of the studies have predominantly focused on intravenous (IV) R,S-Ketamine infusion.
S-Ketamine7 , or Esketamine8 , is a Schedule III drug and was FDA-approved for Treatment-Resistant Depression in 2019, making it the first mental health application of ketamine to meet FDA requirements for safety and efficacy. It is manufactured by Janssen Pharmaceuticals, Inc., a subsidiary company of Johnson & Johnson, and is available as a prescription medication under the brand name Spravato. It was later approved as a treatment9 for Major Depressive Disorder with acute suicidality in 2020. The FDA says Esketamine is different than ketamine10 .
R-Ketamine11 does not have FDA approval as an antidepressant. This type of ketamine is said to produce fewer hallucinogenic and dissociative effects than S-Ketamine. It also produces less dopaminergic activity, which may translate to a lower potential for abuse. Research shows12 that R-Ketamine may stimulate the formation of new neural connections. Finally, R-Ketamine may be more potent and longer-lasting, and produce fewer side effects than S-Ketamine. However, there is almost no controlled human data yet on this type of ketamine, so more research is required.
Ketamine Infusions
Ketamine infusions can refer to two different types of administration methods: Intravenous (IV) infusions, an IV drip; or intramuscular (IM) infusion, an injection of ketamine into the muscle tissue of your arm or leg.
Intramuscular infusion13 allows ketamine to be absorbed quickly into the bloodstream. IM injection also has the benefit of bypassing the first-pass metabolism system, which means the medication is less likely to cause side effects such as nausea because it bypasses the gastrointestinal system.
Intravenous infusions, or an IV drip, deliver medication directly into the vein using a needle or catheter, and offer the ability to carefully control the flow rate of medication over time. IV administration slowly administers precise amounts of medication14 .
Ketamine Sublingual Lozenges
Ketamine lozenges15 are dissolvable tablets and are the most common ketamine format administered via telemedicine services and intended to be used by patients in home settings. These tablets dissolve under the tongue and are delivered directly into the bloodstream through a network of blood vessels located in the mouth.
Ketamine Nasal Spray
S-Ketamine is recognized for rapid and lasting action in reducing depression and suicidal ideation. However, the cost of branded Spravato for bi-weekly treatments could run as high as $6,785 per month16 , which is far beyond the cost of generic IV R,S-Ketamine treatments. It could potentially be less expensive at the patient level with the help of insurance. Due to the stigma that still exists around ketamine, however, it can be hard to find an insurer willing to cover the cost of Esketamine products. Ketamine nasal sprays are also available on the black market for personal use purposes, but they are not held to the same testing or dosing standards as pharmaceutical products.
Ketamine Powder
Ketamine powder is generally how people consume ketamine recreationally. It’s sniffed up the nose and is popular in party and music festival scenes17 .
Drug Checking
It’s highly recommended to check ketamine18 and other substances acquired on the black market to determine if they have been adulterated with other more dangerous drugs, such as fentanyl. Counterfeit substances are also sometimes sold as ketamine.
Effects of Ketamine
At low doses, ketamine can produce dreamy, trance-like effects, giving the user a subtle floating sensation. At moderate to high doses, users may begin to feel dissociated from their physical body, making it hard to move around. Having a safe space to sit or lie still is important when taking moderate to high doses. At high doses, ketamine can have hallucinogenic effects, producing intense and vivid closed eye visuals. High doses may also lead to warped perceptions of time and space, as well as out-of-body experiences.
Ketamine is relatively short acting, usually lasting anywhere from 30 minutes to an hour.
K-Hole
Strong doses of ketamine may lead to what’s known as a K-Hole or a state of intense dissociation in which users often feel teleported out of their body to other worlds or realities. The effects of a K-hole has been compared to near death experiences19 . While some users intentionally seek to experience K-holes, finding them profound and mystical, others consider them frightening and unpleasant. For those curious about K-holes, it is recommended to start slow and gradually increase dosage amounts in order to develop familiarity with ketamine’s dissociative effects. It can be easy to slip into a K-hole without intending to if too much is ingested too quickly.
