July 21, 2025 • 34 mins
Dr. Casey Grover explores the complexities of ketamine, examining its medical benefits, potential for addiction, and growing presence in both therapeutic and recreational settings.
• Originally developed as a dissociative anesthetic for surgery that doesn't suppress breathing
• Now recognized for treating treatment-resistant depression, PTSD, and suicidal ideation
• Can reduce suicidal thoughts as quickly as 90 minutes after administration
• Also effective for severe pain, alcohol withdrawal, and certain emergency situations
• Recreational use has increased dramatically with seizures up 350% between 2017-2022
• Creates a trance-like "K-hole" state that users seek for altered perception and relaxation
• Long-term use can cause "ketamine bladder" – potentially requiring surgical intervention
• No FDA-approved medications exist specifically for treating ketamine addiction
• For-profit ketamine clinics often charge $500-1,250 per treatment without comprehensive care
• Matthew Perry's death highlights the dangers of ketamine misuse, even under medical supervision
• Most patients with addiction histories should approach ketamine therapy with extreme caution
Thank you for tuning in to the Addiction Medicine Made Easy Podcast. Together we can improve how addiction is treated and save lives.
To contact Dr. Grover: ammadeeasy@fastmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
This episode is on ketamine, andketamine is complicated.
(00:45):
It can be a fantasticmedication, but it's also a club
drug and it can also lead toaddiction, which is known as
ketamine use disorder.
I have been meaning to do apodcast episode on ketamine for
almost two years and because Ihaven't taken care of a patient
with ketamine addiction myself,I haven't done it.
(01:06):
My colleagues locally inaddiction medicine that I
lecture to regularly asked forthis topic, so I went for it.
So with that, here we go Anoverview of ketamine, how it
helps as a medicine, how it canbe misused, how it can cause
addiction and when things getreally bad.
(01:33):
Okay, so today we're going tobe talking about ketamine the
good, the bad and the ugly and Ihave to say this lecture has
been on my bucket list for quitea while and I haven't gotten to
it because I personally havenot had a patient come to me for
ketamine addiction, so I can'tshare a lot of stories or
anecdotes about what I've seen.
(01:53):
But I think it's going to be abigger problem and so I'm glad
that we decided to pick ketamineaddiction and also the good
side of ketamine for us to talkabout.
And if anyone doesn't know,there is a very famous movie
called the Good, the Bad and theUgly starring our very own
Monterey County celebrity, clintEastwood, and it was one of my
(02:15):
dad's favorites.
So that's where the name comesfrom.
Okay, so what is ketamine?
Ketamine is an NMDA receptorantagonist, and that's a lot of
medical words.
Let me break it down.
So NMDA refers to a type ofreceptor for glutamate, and
(02:38):
glutamate is one of the brain'schemicals that turns it on, that
activates it.
One of the brain's chemicalsthat turns it on, that activates
it.
So by blocking the NMDAreceptor, ketamine has a downer
effect.
It turns out there's a littlebit more that ketamine does, and
this is the highest level,simple way to think about it.
(02:59):
But ketamine is a cousin of PCP.
We usually use it, as we'lltalk about, in anesthesia,
around procedures and surgery,but we're finding that it does a
lot more and, if you didn'tknow, it is a controlled
substance.
It's a Schedule III controlledsubstance in the United States.
So we're going to start withthe good side of ketamine.
(03:22):
Ketamine is an anesthetic,meaning it's used to help
facilitate surgery by takingaway pain, more or less, and
there's various types ofanesthesia.
So local anesthetic likeNovocaine or Lidocaine, is
injected into the tissue andmakes the nerve not feel pain.
(03:43):
General anesthesia is wherethey put you completely to sleep
and you're so out that youcan't feel anything and you stop
breathing.
So the anesthesiologist putsyou on a breathing machine.
Ketamine is interesting.
Ketamine is what's called adissociative anesthetic, meaning
that it puts people in atrance-like state and it does
(04:05):
not suppress their breathing.
We use it both in humans and inanimals and I have treated
patients myself with ketamine,using it as, again, a
dissociative anesthetic.
So let's say a child breaks anarm and they fall down and the
arm is really in a bad break.
We will sedate the child withketamine, reset the fracture and
(04:27):
then splint it.
Or let's say somebodydislocates their shoulder and
putting it back in is toopainful.
We'll use ketamine to put themin this trance-like state so we
can relocate the joint and it'svery useful in places where
there's not a lot of medicalcare.
So some of my co-residents atStanford went off to countries
(04:48):
with very poor medical systemsand they would actually give
people ketamine to allow thesurgeon to do a surgery.
It's a very useful medicationin the world of anesthesia.
Now it turns out that ketaminedoes other things and it's based
on the dose.
So let's say we give someone100 milligrams of ketamine, that
(05:11):
might put them in thetrance-like state so we can do a
procedure.
Let's say we give them 10 or 20milligrams it's not enough to
make them go into thattrance-like state, but it turns
out it can treat pain.
That trance-like state, but itturns out it can treat pain.
So this is a screenshot that isfrom a policy.
Actually I wrote for the ER atCommunity Hospital that we could
(05:33):
use ketamine to treat pain asan alternative to things like
morphine or fentanyl.
So it does work for pain.
Now you guys might rememberthat there's this website, open
Evidence, that allows me, as adoctor, to use AI to search the
National Library of Medicine.
We are finding that ketaminealso works for mental health
(05:56):
conditions.
So you can see on the screenhere.
I asked the question canketamine be used to treat
depression?
And the answer is yes, ketaminecan be used to treat depression
, specifically in patients withtreatment-resistant depression,
meaning the normalantidepressant medications are
not working Okay.
(06:16):
Along that same line, canketamine treat suicidal ideation
?
Yes, Ketamine can be used totreat suicidal ideation, and
this is pretty incredible.
If you look, single infusionsof ketamine can result in
significant reductions insuicidal ideation as early as 90
(06:39):
minutes after infusion, withmaximal effects at one to three
days.
And I've heard about this beingused that someone comes into
the emergency department.
They're suicidal, they get adose of ketamine and literally
(07:00):
within a few hours theirsuicidal thoughts go away, to
the point that they can go home.
I kept asking can ketaminetreat post-traumatic stress
disorder?
And the answer is yes, ketaminecan be used to treat
post-traumatic stress disorder.
And it turns out ketamine worksfor other things too.
In the hospital, we use it whenpeople are in really bad
(07:20):
alcohol withdrawal, likedelirium tremens.
It works for severe asthma, andwhen people are really agitated
and we have to restrain themfor their and the staff's safety
.
In the emergency department, wecan use ketamine too.
And so some physicians in themedical community are saying why
(07:42):
are we not giving ketamine toeveryone.
It works for mental healthconditions.
It reduces suicidal thoughts.
It can be used for pain.
It's a very useful medicine Nowaround.
Using ketamine in a hospitalusing it for anesthesia is very
(08:02):
well established.
Using it for alcohol withdrawalin severe cases and asthma
that's known.
Ketamine being used aroundmental health treatment is where
it's emerging and we're seeingnew uses for it.
So maybe about eight years agoI was the medical director of
the ER and they asked me to helpwrite up our policy in the
(08:23):
emergency department forketamine around depression and
suicidal ideation.
And I knew how to use ketaminefor sedating someone to do a
procedure, but I didn't know howto use it in mental health and
it can be done as an infusionlike an IV, and they've since
(08:46):
come up with a nasal spraycalled Spravato which can be
used to administer ketamine in anasal spray.
And so a buddy of mine fromresidency one of his good
friends was a ketaminepsychiatrist in San Jose,
meaning that her specialty as apsychiatrist was the use of
ketamine.
Now I love my patients withaddiction.
They are some of the nicestpeople but the way the brain
(09:09):
with addiction thinks is I justneed another substance.
And that's really whataddiction is right.
People have learned to use asubstance to try to
self-regulate until it begins tofall apart.
And so, as we're hearing aboutother things that might be able
to help with addiction, like LSDor magic mushrooms, my patients
(09:29):
say oh, dr Grover, it's great,you just do a bunch of mushrooms
and then you're sober.
It turns out.
That's really not how it works,and I know we're talking about
ketamine, but a little sidebarhere we are learning that some
of these hallucinogens can treataddiction, but it's probably
about a 10 to 1 ratio of talktherapy sessions to actually
(09:50):
getting the hallucinogen.
In other words, thehallucinogen makes the therapy
work better, and it turns outthat for mental health
conditions, that's how ketamineworks too.
So, according to thispsychiatrist, you don't just use
ketamine and you're magicallybetter.
What ketamine does is it makessymptoms of suicidal thoughts or
(10:13):
PTSD or depression better,faster than other treatments
better faster than othertreatments.
And then you use the ketamineto help the person feel better
while everything else starts towork.
So let's say somebody has ptsdand depression, they're starting
talk therapy, they're startinglexapro, they're just not
(10:34):
feeling good, they're stillsuicidal and maybe like three
months later it all starts towork and they're feeling better.
What a psychiatrist would dowould use ketamine in those
first few months to help theperson not feel so bad, while
everything else works.
And again it's the ketamineplus other psychiatric
treatments, and again you'regoing to do a decent amount of
(10:56):
therapy and then mix theketamine in.
So ketamine, while it has itsbenefit, ketamine is not the
magic bullet that makes thesemental health symptoms get
better.
Okay, so, as we've heard,ketamine is a very useful
medicine and we are learningthat it can be incredibly useful
for treating mental healthconditions.
Now, what's the bad side ofketamine?
(11:18):
Ketamine, it turns out, is anextremely popular recreational
drug and it's on the rise.
Some people use it as a clubdrug, and we'll talk about that.
Others are using it daily, andwe'll talk about that too.
But just as a testament to howmuch more illicit ketamine we're
(11:40):
seeing in the market in theUnited States, as you can see,
between 2017 and 2022, thenumber of seizures of ketamine
increased by 350% and the weightof the ketamine in those
seizures increased by over1,000%.
So ketamine is coming in to theillicit drug market like crazy.
(12:06):
Now I don't know how you all are, but I feel like American
politics is really politicized.
So I've been trying to get mynews from the international
media just because it's probablyless likely to be biased.
So I've been listening to theBBC a lot and this was a really
interesting podcast from, Ithink, just a week or two ago by
(12:27):
the BBC, called the KetamineTrail, and what they were doing
was actually tracking throughEurope how the ketamine gets
trafficked between the variouscountries and they are seizing
ketamine by the thousands ofpounds and they're seizing
ketamine in something like 50million euro quantities and they
(12:48):
are saying now that in Europeyou can make more money dealing
ketamine than other drugs, saycocaine for example.
So if anyone wants to listenagain, the BBC, it's called the
Documentary Podcast and theepisode is called the Ketamine
Trail.
Okay, how is ketamine used whenit's used in the illicit market?
It's very similar to how otherdrugs are used.
(13:11):
It can be injected, it can besnorted and it can be smoked.
You can eat it, but it's notreally that well absorbed.
You can eat it, but it's notreally that well absorbed.
The recreational dose is a lotless than the dose we use for
anesthesia and what people seemto like is where you take enough
(13:31):
that you start to dissociateand you go into a dreamlike
state where you feel relaxed andpeople call it the K-hole.
Now it turns out that ketaminewas never meant to be used
chronically.
It was meant to be used forshort periods of time and it was
never tested for long-term usebecause that's not how it was
(13:52):
developed medically.
So we are seeing as people aredaily regular users of ketamine.
It does have some significantside effects Impaired cognition
or our ability to think andprocess.
It disrupts our learning andmemory.
It can lead to hallucinations,it can increase our blood
pressure.
It's very damaging to theurinary tract, which I'll talk
(14:16):
about in just a sec, and then itcan damage the liver,
specifically the part of theliver called the bile ducts,
which is where the digestiveenzymes flow to the gallbladder
and then to the gut.
Now we are going to talk aboutketamine bladder.
This is really, to a geek likeme, fascinating and horrifying
at the same time.
(14:36):
So it turns out that ketaminedamages the urinary tract and
the urinary tract being thekidneys, the bladder and then
the tubes that connect thekidneys and the bladder called
the ureters.
And essentially what happens isketamine is toxic to those
tissues and damages them, mostspecifically the bladder, and
(14:59):
kind of like a UTI.
When the bladder's irritated,it spasms so you feel like you
have to pee all the time.
The bladder bleeds so you getblood in the urine and sometimes
you can't hold it in becausethe bladder's so irritated.
And when doctors actually lookinside the bladder with a camera
, that's a procedure called acystoscopy.
The bladder tissue's reallyirritated and inflamed.
(15:21):
If the person does not stopketamine you can get
irreversible damage.
So this is an article from theNew Zealand Medical Journal and
it's talking about cases ofyoung people using ketamine.
That leads to irreversibledamage.
And they're actually findingcases where people have to have
(15:43):
their bladders repaired,bypassed, meaning that a surgeon
has to find a way to divert theurine to the skin, to a bag,
because the bladder doesn't work, and some people even have to
have their bladders completelyremoved.
That's called a cystectomy.
So when anyone tells me ketamineis not addictive, my thought is
(16:07):
, if you're using a drug and youcan't stop and it's so bad that
they have to cut your bladderout, it's addictive.
That's a pretty seriousconsequence.
Now you heard, I try to avoidpolitics.
I try to get my news unbiased.
It turns out Elon Musk is auser of ketamine.
(16:28):
This is some reporting from Voxand there's actually been some
reporting that Elon Musk usesenough ketamine that he's
actually starting to have somebladder problems and you really
have to be a fairly heavy dailyuser of ketamine to get ketamine
bladder.
So, all politics aside, peoplecan have whatever opinion they
(16:52):
want of Elon Musk, but I bringthis up that this is starting to
bring ketamine a little bitmore to the public eye.
And again, if people arewondering, I wonder why the
ketamine is causing him bladderproblems, it's a known side
effect of chronic ketamine use.
Okay, why do people likeketamine?
Essentially it kind offunctions like a mild
(17:16):
hallucinogen.
I put this on here Maybe I'm alittle bit too off the cuff.
People like being in the K-hole.
It's an out-of-body experience.
They dissociate with theirsurroundings.
They feel like they're in thishappy, dream-like state.
It can change what they see interms of colors and the sense of
time.
It's fairly similar in terms ofthe experience of some other
(17:37):
drugs, like maybe ecstasy andhallucinogens.
It just works differently andyou can imagine why people want
to use it at a club or a rave.
It also turns out that ketamineacts on the other systems of
the brain besides that NMDAreceptor that it blocks.
(17:58):
So ketamine does cause arelease of dopamine in the
reward centers of the brain, soit causes pleasure and then it
also increases the levels ofother brain chemicals that
regulate mood, like serotonin.
So we talked a few months agoin our psych med lecture that a
lot of the antidepressants workby boosting serotonin levels.
(18:19):
That's probably why ketamineworks acutely for depression and
suicidal ideation is it affectsdopamine and serotonin to make
the person feel better.
I don't know exactly how thisworks yet, but apparently
ketamine is reported to enhancesexual encounters.
(18:40):
And then, on a sad and bad note, because we use ketamine as
doctors to put people in atrance-like state to do medical
procedures, ketamine has alsobeen reported to be used for
date rape to subdue a victim.
Can you get addicted to ketamine?
(19:01):
The answer is yes.
We have 11 criteria that we useto diagnose an addiction to any
substance Alcohol, cannabis,opioids and I listed all 11 of
them on the screen and you canlook this up if you need to.
It's called the DSM-5, whichrefers to the book, the
(19:22):
Diagnostic and StatisticalManual that lists these criteria
and it's very simple.
You use more than you want toand you try to cut down.
You have consequences becauseyou use it and then it causes
some changes in your body aroundtolerance and dependence.
And again, these are the same11 criteria that we use for
(19:44):
alcohol, for cannabis, foropiates.
So we would just apply these 11criteria to someone using
ketamine and if they met two ormore criteria, we would call it
a ketamine use disorder.
So on those 11 criteria, someof the last criteria are that
you get tolerance and you getdependence or withdrawal.
(20:06):
So tolerance, just a level set,is where you use a substance
and you need to use more of itover time to get the same
effects.
So does chronic ketamine useinduce tolerance?
We don't really know that wellbecause ketamine, again, was
really only meant to be used forshort indications in a medical
(20:28):
setting.
But there is some limitedevidence that you can get
tolerance to ketamine when youuse it chronically.
Next question Does ketaminehave a withdrawal syndrome?
Again, withdrawal being youtake a substance, you stop, your
brain and body are out ofbalance and you feel sick.
So again, we don't have a tonof data because ketamine was
(20:52):
never meant to be usedchronically, but there are some
reports of people feeling awithdrawal syndrome when they
stop ketamine.
Some of the symptoms that Ifound when I was reviewing this
topic chills, sweatiness,palpitations, restlessness,
nightmares, shaking,hallucinations and, as we heard,
ketamine helps people who aredepressed feel better faster.
(21:15):
So there's probably going to besome mood symptoms in ketamine
withdrawal as well, likedysphoria or low mood.
Next question can you overdoseon ketamine?
Very, very interesting question.
So, if you remember, Imentioned that when we use
ketamine to sedate people forsurgery, it preserves their
(21:38):
breathing and truly in aresource-limited setting, you
can put someone into thistrance-like state with ketamine
and do surgery on them and theirbreathing is sustained.
And most overdoses happen whena person takes a downer and
their breathing stops becausethey're so down.
So it's, I guess, possible thatyou could overdose on ketamine,
(22:04):
but it's pretty rare, given howit works, and it turns out that
in the UK between 1993 and 2006, they only had four deaths
where the only drug in aperson's system was ketamine.
Now, like hallucinogens, if youare under the influence of
magic mushrooms and you have noidea what's happening in your
(22:27):
hallucination and you run intotraffic and get hit by a car,
that's extremely dangerous.
We do have some cases wherepeople were under the influence
of ketamine and were seriouslyinjured or killed because of
accidents because they couldn'tunderstand what was happening in
their surroundings.
And then, like anything, onceyou start to mix multiple
substances together, the risk ofoverdose goes up from a
(22:49):
polydrug overdose.
Now, this is where I don't havea ton of experience.
How do you treat ketamineaddiction?
So I have not taken care of apatient myself with ketamine
addiction and unfortunatelythere are no FDA-approved
medications to treat ketamineaddiction.
(23:10):
There is no ketamaboxone, ifyou will.
Essentially what we have iscounseling and therapy, mutual
support groups, and then we'regoing to treat whatever comorbid
mental health condition thatthey have.
So let's say somebody hasreally bad PTSD and depression
(23:31):
and they're trying toself-regulate with ketamine.
As they come off of it, we'regoing to want to put them on
medications that are standardfor the treatment of PTSD and
depression and then get theminto counseling and therapy and
then, obviously, if theaddiction's severe, then we're
going to want to up theintensity of services IOP, php
and then residential if needed.
(23:53):
Okay, the ugly this is the partthat I think really hurts me as
a doctor is that there'sabsolutely a for-profit ketamine
industry that is a littlepredatory.
So my family likes to traveland one of the places that we
(24:15):
like to go.
There's a clinic thatadvertises itself as a ketamine
clinic and we've driven past itso many times that I went huh, I
wonder what that's all about.
So I went onto their websiteand take a look at the pricing.
Iv ketamine psychotherapy is$500 a dose, so these are not
(24:37):
getting billed to insurance.
These are usually cash pay.
Iv ketamine for pain is $900 atreatment.
Iv ketamine for complex pain is$1,150 a treatment.
I mentioned.
Ketamine can be taken orally.
It doesn't absorb that great.
(24:58):
Sometimes it's given as anunder-the-tongue lozenge $325 a
session.
And then the nasal ketamine is$1,250 a treatment.
Now, if you remember when wetalked about how do you actually
use ketamine to treat mentalhealth conditions?
(25:19):
Ketamine is meant to be thebridge right.
Ketamine is meant to make aperson feel better while other
psychiatric treatments start towork.
Now, if you zoom in on thisclinic's IV ketamine
psychotherapy protocol, theygive you a personalized ketamine
(25:41):
protocol.
I'm not quite sure what that is.
They give you a treatment guideand workbook and it's a
one-hour treatment.
They give you a treatment guideand workbook and it's a
one-hour treatment.
It's a 45-minute infusion witha 20-minute recovery time.
That's the whole hour.
They're not actually doing anycounseling, from what I can tell
, essentially they're trying toget people to pay cash for these
(26:09):
expensive ketamine treatments,but they don't actually seem to
offer the psychotherapy and theother medications to actually
help the person get betterlong-term.
And it's unfortunate that weare seeing some of these.
I don't want to use the termpredator, that seems pretty
wrong but they're basicallytrying to cater to people who
want a quick fix.
They're basically trying tocater to people who want a quick
fix but, as we've talked about,ketamine really isn't a
(26:32):
destination therapy, it's abridge.
Now the saddest and mosthigh-profile example of this is
the actor Matthew Perry, andMatthew Perry wrote a recent
memoir about his addiction.
He was very open about his useof alcohol.
(26:52):
It seemed to me his drug ofchoice was opiates and he'd been
in and out of too manytreatment programs to count, and
unfortunately he died in a hottub and the cause of death was
thought to be ketamineintoxication.
So what I think happened fromwhat I can tell because ketamine
preserves the breathingreflexes is they were increasing
(27:15):
and increasing and increasinghis dose of ketamine and they
got him to a high enough dosethat they put it in the medical
range of dosing that we use tosedate people to do medical
procedures and in that state theperson's body is basically limp
.
So he got enough ketamine thatthey basically administered
(27:37):
anesthesia and he slipped underthe water of the hot tub and
drowned.
And unfortunately, the doctorsthat were treating him have some
not so altruistic motives intreating him Apparently.
One of the doctors that wastreating him had some text
(27:58):
messages that were saved andsubmitted to the investigation
that basically was mockingMatthew Perry as somebody who
was not very intelligent and hadmore money than he knew what to
do with, and it felt like thedoctor was really just
interested in making money offthis celebrity who was in a very
bad place.
I don't know if we've had allthe hearings and charges to
(28:19):
actually know what happened, butthat's some of what I've heard
from some of the reports aboutthis.
Now you might be wondering whothe woman on the right side of
the screen is.
That's Jasveen Sangha, and sheis the so-called ketamine queen.
Jasveen Sangha was a socialitein Southern California who was a
(28:43):
major supplier of ketamine toboth the illicit market and to
people who were getting ketaminepsychotherapy, and she has also
been involved in theinvestigation of Matthew Perry's
death.
And fun fact about JasveenSangha.
That's what she looked like inhigh school, because one of my
(29:04):
family members actually went tohigh school with her.
I remember when this all hitthe news and they mentioned what
high school she went to, I wenthuh.
So I texted my family memberand I got this picture back.
So, anyways, there's theketamine queen in high school.
Okay, what do I recommend to mypatients who I am treating for
addiction?
What do I recommend for themaround ketamine?
(29:25):
And let me just give you myjourney here.
So I personally wrote ouremergency department's protocol
on how to use low-dose ketaminefor pain.
We were trying to come up withways to treat pain without
needing opiates.
I was the medical director ofthe emergency department in our
emergency department as we werestarting to roll out protocols
(29:49):
to use ketamine for depressionand suicidal ideation and I was
initially all on board.
I was using ketamine in mypractice to treat pain in the
emergency department and we weregetting people into psychiatry
to use ketamine for theirdepression, suicidal ideation
and PTSD and other mental healthconditions.
(30:10):
And then we had someinteresting behaviors from some
of our patients.
We had one patient try to hackan IV pump to try to get the
ketamine to go in faster.
Not once, multiple times thispatient tried to get the
ketamine to go in faster.
Another patient who was in theemergency department for pain
(30:35):
while he was receiving theketamine infusion he reached
into his backpack and took outsome of his opioid pain meds and
told the nurse he needed totake them to make the ketamine
high better.
And then one of our otherpatients told one of our nurses
how much he loved the ketaminehigh as she was administering it
(30:55):
to him.
And I've had enough experienceslike that that I've really had a
lot of hesitation aboutrecommending ketamine because it
is potentially addictive.
I want to be very clear.
Ketamine is a very usefulmedication for people with
mental health.
If it's used correctly andthey're the right patient for it
(31:17):
, it can be life-changing.
But I just kept seeing moreproblems with it than I was
seeing it really help patients.
So do I recommend ketamine tomy patients with addiction?
It depends.
The answer is for most of mypatients.
When they ask me, should I tryketamine for X mental health
(31:38):
condition, I usually say no.
And many of my patients usemultiple substances and we all
know that patients with a kindof a polysubstance use disorder
really will go to any substancethey can get.
And those people I tell themyou are just not a good
candidate for ketamine.
We do not need to add aketamine addiction to your
(31:59):
problem list.
For a couple of my patients Iwill consider it if they've
sought out a mental health carepractitioner and they're working
with that mental health carepractitioner and they're working
with that mental health carepractitioner and the health care
practitioner says hey, let'sconsider ketamine.
And that's usually somebody whohas significant mental health
issues and they tend to have onedrug of choice.
(32:21):
Like, let's say it's somebodywho's got PTSD and alcohol use
disorder.
They've never used illicitsubstances, alcohol was only
their thing.
My suspicion that they're goingto get addicted to ketamine is
much lower, given theirsubstance use history.
And they're really saying I'vegot to get my depression better
so I can quit drinking.
But I'm not an expert in usingketamine for mental health
(32:45):
services.
So if somebody comes in andthey want to talk to me about it
and they're like I think thispatient will be a great
candidate and I think it couldbe okay, I will let them do
their thing and if it helps thepatient I'm all for it, okay.
So that is the end of theslides that I prepared.
I have my references, buthopefully that's a good overview
(33:07):
of the good, the bad, bad andthe ugly side of ketamine.
So I think I will stop there.
We can discuss and we'll takesome questions before we wrap up
.
A huge thank you to the montagehealth foundation for backing
my mission to create fun,engaging education on addiction,
and a shout out to thenonprofit Central Coast Overdose
(33:29):
Prevention for teaming up withme on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
(33:50):
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
You.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
This episode is on ketamine, andketamine is complicated.
(00:45):
It can be a fantasticmedication, but it's also a club
drug and it can also lead toaddiction, which is known as
ketamine use disorder.
I have been meaning to do apodcast episode on ketamine for
almost two years and because Ihaven't taken care of a patient
with ketamine addiction myself,I haven't done it.
(01:06):
My colleagues locally inaddiction medicine that I
lecture to regularly asked forthis topic, so I went for it.
So with that, here we go Anoverview of ketamine, how it
helps as a medicine, how it canbe misused, how it can cause
addiction and when things getreally bad.
(01:33):
Okay, so today we're going tobe talking about ketamine the
good, the bad and the ugly and Ihave to say this lecture has
been on my bucket list for quitea while and I haven't gotten to
it because I personally havenot had a patient come to me for
ketamine addiction, so I can'tshare a lot of stories or
anecdotes about what I've seen.
(01:53):
But I think it's going to be abigger problem and so I'm glad
that we decided to pick ketamineaddiction and also the good
side of ketamine for us to talkabout.
And if anyone doesn't know,there is a very famous movie
called the Good, the Bad and theUgly starring our very own
Monterey County celebrity, clintEastwood, and it was one of my
(02:15):
dad's favorites.
So that's where the name comesfrom.
Okay, so what is ketamine?
Ketamine is an NMDA receptorantagonist, and that's a lot of
medical words.
Let me break it down.
So NMDA refers to a type ofreceptor for glutamate, and
(02:38):
glutamate is one of the brain'schemicals that turns it on, that
activates it.
One of the brain's chemicalsthat turns it on, that activates
it.
So by blocking the NMDAreceptor, ketamine has a downer
effect.
It turns out there's a littlebit more that ketamine does, and
this is the highest level,simple way to think about it.
(02:59):
But ketamine is a cousin of PCP.
We usually use it, as we'lltalk about, in anesthesia,
around procedures and surgery,but we're finding that it does a
lot more and, if you didn'tknow, it is a controlled
substance.
It's a Schedule III controlledsubstance in the United States.
So we're going to start withthe good side of ketamine.
(03:22):
Ketamine is an anesthetic,meaning it's used to help
facilitate surgery by takingaway pain, more or less, and
there's various types ofanesthesia.
So local anesthetic likeNovocaine or Lidocaine, is
injected into the tissue andmakes the nerve not feel pain.
(03:43):
General anesthesia is wherethey put you completely to sleep
and you're so out that youcan't feel anything and you stop
breathing.
So the anesthesiologist putsyou on a breathing machine.
Ketamine is interesting.
Ketamine is what's called adissociative anesthetic, meaning
that it puts people in atrance-like state and it does
(04:05):
not suppress their breathing.
We use it both in humans and inanimals and I have treated
patients myself with ketamine,using it as, again, a
dissociative anesthetic.
So let's say a child breaks anarm and they fall down and the
arm is really in a bad break.
We will sedate the child withketamine, reset the fracture and
(04:27):
then splint it.
Or let's say somebodydislocates their shoulder and
putting it back in is toopainful.
We'll use ketamine to put themin this trance-like state so we
can relocate the joint and it'svery useful in places where
there's not a lot of medicalcare.
So some of my co-residents atStanford went off to countries
(04:48):
with very poor medical systemsand they would actually give
people ketamine to allow thesurgeon to do a surgery.
It's a very useful medicationin the world of anesthesia.
Now it turns out that ketaminedoes other things and it's based
on the dose.
So let's say we give someone100 milligrams of ketamine, that
(05:11):
might put them in thetrance-like state so we can do a
procedure.
Let's say we give them 10 or 20milligrams it's not enough to
make them go into thattrance-like state, but it turns
out it can treat pain.
That trance-like state, but itturns out it can treat pain.
So this is a screenshot that isfrom a policy.
Actually I wrote for the ER atCommunity Hospital that we could
(05:33):
use ketamine to treat pain asan alternative to things like
morphine or fentanyl.
So it does work for pain.
Now you guys might rememberthat there's this website, open
Evidence, that allows me, as adoctor, to use AI to search the
National Library of Medicine.
We are finding that ketaminealso works for mental health
(05:56):
conditions.
So you can see on the screenhere.
I asked the question canketamine be used to treat
depression?
And the answer is yes, ketaminecan be used to treat depression
, specifically in patients withtreatment-resistant depression,
meaning the normalantidepressant medications are
not working Okay.
(06:16):
Along that same line, canketamine treat suicidal ideation
?
Yes, Ketamine can be used totreat suicidal ideation, and
this is pretty incredible.
If you look, single infusionsof ketamine can result in
significant reductions insuicidal ideation as early as 90
(06:39):
minutes after infusion, withmaximal effects at one to three
days.
And I've heard about this beingused that someone comes into
the emergency department.
They're suicidal, they get adose of ketamine and literally
(07:00):
within a few hours theirsuicidal thoughts go away, to
the point that they can go home.
I kept asking can ketaminetreat post-traumatic stress
disorder?
And the answer is yes, ketaminecan be used to treat
post-traumatic stress disorder.
And it turns out ketamine worksfor other things too.
In the hospital, we use it whenpeople are in really bad
(07:20):
alcohol withdrawal, likedelirium tremens.
It works for severe asthma, andwhen people are really agitated
and we have to restrain themfor their and the staff's safety
.
In the emergency department, wecan use ketamine too.
And so some physicians in themedical community are saying why
(07:42):
are we not giving ketamine toeveryone.
It works for mental healthconditions.
It reduces suicidal thoughts.
It can be used for pain.
It's a very useful medicine Nowaround.
Using ketamine in a hospitalusing it for anesthesia is very
(08:02):
well established.
Using it for alcohol withdrawalin severe cases and asthma
that's known.
Ketamine being used aroundmental health treatment is where
it's emerging and we're seeingnew uses for it.
So maybe about eight years agoI was the medical director of
the ER and they asked me to helpwrite up our policy in the
(08:23):
emergency department forketamine around depression and
suicidal ideation.
And I knew how to use ketaminefor sedating someone to do a
procedure, but I didn't know howto use it in mental health and
it can be done as an infusionlike an IV, and they've since
(08:46):
come up with a nasal spraycalled Spravato which can be
used to administer ketamine in anasal spray.
And so a buddy of mine fromresidency one of his good
friends was a ketaminepsychiatrist in San Jose,
meaning that her specialty as apsychiatrist was the use of
ketamine.
Now I love my patients withaddiction.
They are some of the nicestpeople but the way the brain
(09:09):
with addiction thinks is I justneed another substance.
And that's really whataddiction is right.
People have learned to use asubstance to try to
self-regulate until it begins tofall apart.
And so, as we're hearing aboutother things that might be able
to help with addiction, like LSDor magic mushrooms, my patients
(09:29):
say oh, dr Grover, it's great,you just do a bunch of mushrooms
and then you're sober.
It turns out.
That's really not how it works,and I know we're talking about
ketamine, but a little sidebarhere we are learning that some
of these hallucinogens can treataddiction, but it's probably
about a 10 to 1 ratio of talktherapy sessions to actually
(09:50):
getting the hallucinogen.
In other words, thehallucinogen makes the therapy
work better, and it turns outthat for mental health
conditions, that's how ketamineworks too.
So, according to thispsychiatrist, you don't just use
ketamine and you're magicallybetter.
What ketamine does is it makessymptoms of suicidal thoughts or
(10:13):
PTSD or depression better,faster than other treatments
better faster than othertreatments.
And then you use the ketamineto help the person feel better
while everything else starts towork.
So let's say somebody has ptsdand depression, they're starting
talk therapy, they're startinglexapro, they're just not
(10:34):
feeling good, they're stillsuicidal and maybe like three
months later it all starts towork and they're feeling better.
What a psychiatrist would dowould use ketamine in those
first few months to help theperson not feel so bad, while
everything else works.
And again it's the ketamineplus other psychiatric
treatments, and again you'regoing to do a decent amount of
(10:56):
therapy and then mix theketamine in.
So ketamine, while it has itsbenefit, ketamine is not the
magic bullet that makes thesemental health symptoms get
better.
Okay, so, as we've heard,ketamine is a very useful
medicine and we are learningthat it can be incredibly useful
for treating mental healthconditions.
Now, what's the bad side ofketamine?
(11:18):
Ketamine, it turns out, is anextremely popular recreational
drug and it's on the rise.
Some people use it as a clubdrug, and we'll talk about that.
Others are using it daily, andwe'll talk about that too.
But just as a testament to howmuch more illicit ketamine we're
(11:40):
seeing in the market in theUnited States, as you can see,
between 2017 and 2022, thenumber of seizures of ketamine
increased by 350% and the weightof the ketamine in those
seizures increased by over1,000%.
So ketamine is coming in to theillicit drug market like crazy.
(12:06):
Now I don't know how you all are, but I feel like American
politics is really politicized.
So I've been trying to get mynews from the international
media just because it's probablyless likely to be biased.
So I've been listening to theBBC a lot and this was a really
interesting podcast from, Ithink, just a week or two ago by
(12:27):
the BBC, called the KetamineTrail, and what they were doing
was actually tracking throughEurope how the ketamine gets
trafficked between the variouscountries and they are seizing
ketamine by the thousands ofpounds and they're seizing
ketamine in something like 50million euro quantities and they
(12:48):
are saying now that in Europeyou can make more money dealing
ketamine than other drugs, saycocaine for example.
So if anyone wants to listenagain, the BBC, it's called the
Documentary Podcast and theepisode is called the Ketamine
Trail.
Okay, how is ketamine used whenit's used in the illicit market?
It's very similar to how otherdrugs are used.
(13:11):
It can be injected, it can besnorted and it can be smoked.
You can eat it, but it's notreally that well absorbed.
You can eat it, but it's notreally that well absorbed.
The recreational dose is a lotless than the dose we use for
anesthesia and what people seemto like is where you take enough
(13:31):
that you start to dissociateand you go into a dreamlike
state where you feel relaxed andpeople call it the K-hole.
Now it turns out that ketaminewas never meant to be used
chronically.
It was meant to be used forshort periods of time and it was
never tested for long-term usebecause that's not how it was
(13:52):
developed medically.
So we are seeing as people aredaily regular users of ketamine.
It does have some significantside effects Impaired cognition
or our ability to think andprocess.
It disrupts our learning andmemory.
It can lead to hallucinations,it can increase our blood
pressure.
It's very damaging to theurinary tract, which I'll talk
(14:16):
about in just a sec, and then itcan damage the liver,
specifically the part of theliver called the bile ducts,
which is where the digestiveenzymes flow to the gallbladder
and then to the gut.
Now we are going to talk aboutketamine bladder.
This is really, to a geek likeme, fascinating and horrifying
at the same time.
(14:36):
So it turns out that ketaminedamages the urinary tract and
the urinary tract being thekidneys, the bladder and then
the tubes that connect thekidneys and the bladder called
the ureters.
And essentially what happens isketamine is toxic to those
tissues and damages them, mostspecifically the bladder, and
(14:59):
kind of like a UTI.
When the bladder's irritated,it spasms so you feel like you
have to pee all the time.
The bladder bleeds so you getblood in the urine and sometimes
you can't hold it in becausethe bladder's so irritated.
And when doctors actually lookinside the bladder with a camera
, that's a procedure called acystoscopy.
The bladder tissue's reallyirritated and inflamed.
(15:21):
If the person does not stopketamine you can get
irreversible damage.
So this is an article from theNew Zealand Medical Journal and
it's talking about cases ofyoung people using ketamine.
That leads to irreversibledamage.
And they're actually findingcases where people have to have
(15:43):
their bladders repaired,bypassed, meaning that a surgeon
has to find a way to divert theurine to the skin, to a bag,
because the bladder doesn't work, and some people even have to
have their bladders completelyremoved.
That's called a cystectomy.
So when anyone tells me ketamineis not addictive, my thought is
(16:07):
, if you're using a drug and youcan't stop and it's so bad that
they have to cut your bladderout, it's addictive.
That's a pretty seriousconsequence.
Now you heard, I try to avoidpolitics.
I try to get my news unbiased.
It turns out Elon Musk is auser of ketamine.
(16:28):
This is some reporting from Voxand there's actually been some
reporting that Elon Musk usesenough ketamine that he's
actually starting to have somebladder problems and you really
have to be a fairly heavy dailyuser of ketamine to get ketamine
bladder.
So, all politics aside, peoplecan have whatever opinion they
(16:52):
want of Elon Musk, but I bringthis up that this is starting to
bring ketamine a little bitmore to the public eye.
And again, if people arewondering, I wonder why the
ketamine is causing him bladderproblems, it's a known side
effect of chronic ketamine use.
Okay, why do people likeketamine?
Essentially it kind offunctions like a mild
(17:16):
hallucinogen.
I put this on here Maybe I'm alittle bit too off the cuff.
People like being in the K-hole.
It's an out-of-body experience.
They dissociate with theirsurroundings.
They feel like they're in thishappy, dream-like state.
It can change what they see interms of colors and the sense of
time.
It's fairly similar in terms ofthe experience of some other
(17:37):
drugs, like maybe ecstasy andhallucinogens.
It just works differently andyou can imagine why people want
to use it at a club or a rave.
It also turns out that ketamineacts on the other systems of
the brain besides that NMDAreceptor that it blocks.
(17:58):
So ketamine does cause arelease of dopamine in the
reward centers of the brain, soit causes pleasure and then it
also increases the levels ofother brain chemicals that
regulate mood, like serotonin.
So we talked a few months agoin our psych med lecture that a
lot of the antidepressants workby boosting serotonin levels.
(18:19):
That's probably why ketamineworks acutely for depression and
suicidal ideation is it affectsdopamine and serotonin to make
the person feel better.
I don't know exactly how thisworks yet, but apparently
ketamine is reported to enhancesexual encounters.
(18:40):
And then, on a sad and bad note, because we use ketamine as
doctors to put people in atrance-like state to do medical
procedures, ketamine has alsobeen reported to be used for
date rape to subdue a victim.
Can you get addicted to ketamine?
(19:01):
The answer is yes.
We have 11 criteria that we useto diagnose an addiction to any
substance Alcohol, cannabis,opioids and I listed all 11 of
them on the screen and you canlook this up if you need to.
It's called the DSM-5, whichrefers to the book, the
(19:22):
Diagnostic and StatisticalManual that lists these criteria
and it's very simple.
You use more than you want toand you try to cut down.
You have consequences becauseyou use it and then it causes
some changes in your body aroundtolerance and dependence.
And again, these are the same11 criteria that we use for
(19:44):
alcohol, for cannabis, foropiates.
So we would just apply these 11criteria to someone using
ketamine and if they met two ormore criteria, we would call it
a ketamine use disorder.
So on those 11 criteria, someof the last criteria are that
you get tolerance and you getdependence or withdrawal.
(20:06):
So tolerance, just a level set,is where you use a substance
and you need to use more of itover time to get the same
effects.
So does chronic ketamine useinduce tolerance?
We don't really know that wellbecause ketamine, again, was
really only meant to be used forshort indications in a medical
(20:28):
setting.
But there is some limitedevidence that you can get
tolerance to ketamine when youuse it chronically.
Next question Does ketaminehave a withdrawal syndrome?
Again, withdrawal being youtake a substance, you stop, your
brain and body are out ofbalance and you feel sick.
So again, we don't have a tonof data because ketamine was
(20:52):
never meant to be usedchronically, but there are some
reports of people feeling awithdrawal syndrome when they
stop ketamine.
Some of the symptoms that Ifound when I was reviewing this
topic chills, sweatiness,palpitations, restlessness,
nightmares, shaking,hallucinations and, as we heard,
ketamine helps people who aredepressed feel better faster.
(21:15):
So there's probably going to besome mood symptoms in ketamine
withdrawal as well, likedysphoria or low mood.
Next question can you overdoseon ketamine?
Very, very interesting question.
So, if you remember, Imentioned that when we use
ketamine to sedate people forsurgery, it preserves their
(21:38):
breathing and truly in aresource-limited setting, you
can put someone into thistrance-like state with ketamine
and do surgery on them and theirbreathing is sustained.
And most overdoses happen whena person takes a downer and
their breathing stops becausethey're so down.
So it's, I guess, possible thatyou could overdose on ketamine,
(22:04):
but it's pretty rare, given howit works, and it turns out that
in the UK between 1993 and 2006, they only had four deaths
where the only drug in aperson's system was ketamine.
Now, like hallucinogens, if youare under the influence of
magic mushrooms and you have noidea what's happening in your
(22:27):
hallucination and you run intotraffic and get hit by a car,
that's extremely dangerous.
We do have some cases wherepeople were under the influence
of ketamine and were seriouslyinjured or killed because of
accidents because they couldn'tunderstand what was happening in
their surroundings.
And then, like anything, onceyou start to mix multiple
substances together, the risk ofoverdose goes up from a
(22:49):
polydrug overdose.
Now, this is where I don't havea ton of experience.
How do you treat ketamineaddiction?
So I have not taken care of apatient myself with ketamine
addiction and unfortunatelythere are no FDA-approved
medications to treat ketamineaddiction.
(23:10):
There is no ketamaboxone, ifyou will.
Essentially what we have iscounseling and therapy, mutual
support groups, and then we'regoing to treat whatever comorbid
mental health condition thatthey have.
So let's say somebody hasreally bad PTSD and depression
(23:31):
and they're trying toself-regulate with ketamine.
As they come off of it, we'regoing to want to put them on
medications that are standardfor the treatment of PTSD and
depression and then get theminto counseling and therapy and
then, obviously, if theaddiction's severe, then we're
going to want to up theintensity of services IOP, php
and then residential if needed.
(23:53):
Okay, the ugly this is the partthat I think really hurts me as
a doctor is that there'sabsolutely a for-profit ketamine
industry that is a littlepredatory.
So my family likes to traveland one of the places that we
(24:15):
like to go.
There's a clinic thatadvertises itself as a ketamine
clinic and we've driven past itso many times that I went huh, I
wonder what that's all about.
So I went onto their websiteand take a look at the pricing.
Iv ketamine psychotherapy is$500 a dose, so these are not
(24:37):
getting billed to insurance.
These are usually cash pay.
Iv ketamine for pain is $900 atreatment.
Iv ketamine for complex pain is$1,150 a treatment.
I mentioned.
Ketamine can be taken orally.
It doesn't absorb that great.
(24:58):
Sometimes it's given as anunder-the-tongue lozenge $325 a
session.
And then the nasal ketamine is$1,250 a treatment.
Now, if you remember when wetalked about how do you actually
use ketamine to treat mentalhealth conditions?
(25:19):
Ketamine is meant to be thebridge right.
Ketamine is meant to make aperson feel better while other
psychiatric treatments start towork.
Now, if you zoom in on thisclinic's IV ketamine
psychotherapy protocol, theygive you a personalized ketamine
(25:41):
protocol.
I'm not quite sure what that is.
They give you a treatment guideand workbook and it's a
one-hour treatment.
They give you a treatment guideand workbook and it's a
one-hour treatment.
It's a 45-minute infusion witha 20-minute recovery time.
That's the whole hour.
They're not actually doing anycounseling, from what I can tell
, essentially they're trying toget people to pay cash for these
(26:09):
expensive ketamine treatments,but they don't actually seem to
offer the psychotherapy and theother medications to actually
help the person get betterlong-term.
And it's unfortunate that weare seeing some of these.
I don't want to use the termpredator, that seems pretty
wrong but they're basicallytrying to cater to people who
want a quick fix.
They're basically trying tocater to people who want a quick
fix but, as we've talked about,ketamine really isn't a
(26:32):
destination therapy, it's abridge.
Now the saddest and mosthigh-profile example of this is
the actor Matthew Perry, andMatthew Perry wrote a recent
memoir about his addiction.
He was very open about his useof alcohol.
(26:52):
It seemed to me his drug ofchoice was opiates and he'd been
in and out of too manytreatment programs to count, and
unfortunately he died in a hottub and the cause of death was
thought to be ketamineintoxication.
So what I think happened fromwhat I can tell because ketamine
preserves the breathingreflexes is they were increasing
(27:15):
and increasing and increasinghis dose of ketamine and they
got him to a high enough dosethat they put it in the medical
range of dosing that we use tosedate people to do medical
procedures and in that state theperson's body is basically limp
.
So he got enough ketamine thatthey basically administered
(27:37):
anesthesia and he slipped underthe water of the hot tub and
drowned.
And unfortunately, the doctorsthat were treating him have some
not so altruistic motives intreating him Apparently.
One of the doctors that wastreating him had some text
(27:58):
messages that were saved andsubmitted to the investigation
that basically was mockingMatthew Perry as somebody who
was not very intelligent and hadmore money than he knew what to
do with, and it felt like thedoctor was really just
interested in making money offthis celebrity who was in a very
bad place.
I don't know if we've had allthe hearings and charges to
(28:19):
actually know what happened, butthat's some of what I've heard
from some of the reports aboutthis.
Now you might be wondering whothe woman on the right side of
the screen is.
That's Jasveen Sangha, and sheis the so-called ketamine queen.
Jasveen Sangha was a socialitein Southern California who was a
(28:43):
major supplier of ketamine toboth the illicit market and to
people who were getting ketaminepsychotherapy, and she has also
been involved in theinvestigation of Matthew Perry's
death.
And fun fact about JasveenSangha.
That's what she looked like inhigh school, because one of my
(29:04):
family members actually went tohigh school with her.
I remember when this all hitthe news and they mentioned what
high school she went to, I wenthuh.
So I texted my family memberand I got this picture back.
So, anyways, there's theketamine queen in high school.
Okay, what do I recommend to mypatients who I am treating for
addiction?
What do I recommend for themaround ketamine?
(29:25):
And let me just give you myjourney here.
So I personally wrote ouremergency department's protocol
on how to use low-dose ketaminefor pain.
We were trying to come up withways to treat pain without
needing opiates.
I was the medical director ofthe emergency department in our
emergency department as we werestarting to roll out protocols
(29:49):
to use ketamine for depressionand suicidal ideation and I was
initially all on board.
I was using ketamine in mypractice to treat pain in the
emergency department and we weregetting people into psychiatry
to use ketamine for theirdepression, suicidal ideation
and PTSD and other mental healthconditions.
(30:10):
And then we had someinteresting behaviors from some
of our patients.
We had one patient try to hackan IV pump to try to get the
ketamine to go in faster.
Not once, multiple times thispatient tried to get the
ketamine to go in faster.
Another patient who was in theemergency department for pain
(30:35):
while he was receiving theketamine infusion he reached
into his backpack and took outsome of his opioid pain meds and
told the nurse he needed totake them to make the ketamine
high better.
And then one of our otherpatients told one of our nurses
how much he loved the ketaminehigh as she was administering it
(30:55):
to him.
And I've had enough experienceslike that that I've really had a
lot of hesitation aboutrecommending ketamine because it
is potentially addictive.
I want to be very clear.
Ketamine is a very usefulmedication for people with
mental health.
If it's used correctly andthey're the right patient for it
(31:17):
, it can be life-changing.
But I just kept seeing moreproblems with it than I was
seeing it really help patients.
So do I recommend ketamine tomy patients with addiction?
It depends.
The answer is for most of mypatients.
When they ask me, should I tryketamine for X mental health
(31:38):
condition, I usually say no.
And many of my patients usemultiple substances and we all
know that patients with a kindof a polysubstance use disorder
really will go to any substancethey can get.
And those people I tell themyou are just not a good
candidate for ketamine.
We do not need to add aketamine addiction to your
(31:59):
problem list.
For a couple of my patients Iwill consider it if they've
sought out a mental health carepractitioner and they're working
with that mental health carepractitioner and they're working
with that mental health carepractitioner and the health care
practitioner says hey, let'sconsider ketamine.
And that's usually somebody whohas significant mental health
issues and they tend to have onedrug of choice.
(32:21):
Like, let's say it's somebodywho's got PTSD and alcohol use
disorder.
They've never used illicitsubstances, alcohol was only
their thing.
My suspicion that they're goingto get addicted to ketamine is
much lower, given theirsubstance use history.
And they're really saying I'vegot to get my depression better
so I can quit drinking.
But I'm not an expert in usingketamine for mental health
(32:45):
services.
So if somebody comes in andthey want to talk to me about it
and they're like I think thispatient will be a great
candidate and I think it couldbe okay, I will let them do
their thing and if it helps thepatient I'm all for it, okay.
So that is the end of theslides that I prepared.
I have my references, buthopefully that's a good overview
(33:07):
of the good, the bad, bad andthe ugly side of ketamine.
So I think I will stop there.
We can discuss and we'll takesome questions before we wrap up
.
A huge thank you to the montagehealth foundation for backing
my mission to create fun,engaging education on addiction,
and a shout out to thenonprofit Central Coast Overdose
(33:29):
Prevention for teaming up withme on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
(33:50):
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
You.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Cardiac Cowboys
The heart was always off-limits to surgeons. Cutting into it spelled instant death for the patient. That is, until a ragtag group of doctors scattered across the Midwest and Texas decided to throw out the rule book. Working in makeshift laboratories and home garages, using medical devices made from scavenged machine parts and beer tubes, these men and women invented the field of open heart surgery. Odds are, someone you know is alive because of them. So why has history left them behind? Presented by Chris Pine, CARDIAC COWBOYS tells the gripping true story behind the birth of heart surgery, and the young, Greatest Generation doctors who made it happen. For years, they competed and feuded, racing to be the first, the best, and the most prolific. Some appeared on the cover of Time Magazine, operated on kings and advised presidents. Others ended up disgraced, penniless, and convicted of felonies. Together, they ignited a revolution in medicine, and changed the world.