1. Ketamine - Effects and Treatment How Much Do You Know?
Michael Bird

2. Introduction
Ketamine is a drug used in human and veterinary medicine developed by the pharmaceutical company Parke-Davis (today a part of Pfizer) in 1962.
Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar.
Pharmacologically, Ketamine is classified as an *NMDA receptor antagonist, and at high, fully anesthetic level doses, Ketamine has also been found to bind to opioid receptors and sigma receptors.
The drug was first given to American soldiers during the Vietnam War.
* NB not associated with MDMA

3. Group Exercise
I would like you to get into groups of no more than 5, use the title ‘How much do we know about Ketamine’
For instance, you may wish to look at both it’s illicit and legitimate usages
What is the ‘willing’ user of Ketamine trying to achieve?
What are the positive/negative effects of using Ketamine?
What treatment have you found to be useful, or have you researched any successful treatment methods?
How would you currently work with someone that is using Ketamine? What would be the care plan/referral pathway?
How would you define success with a Ketamine user?

4. So what are the Effects of Ketamine?
Like other drugs of this class such as phencyclidine (PCP), Ketamine induces a state referred to as *“Dissociative Anesthesia” and is used as a recreational drug
Ketamine has a wide range of effects in humans, including:
Anesthesia - ‘blocking sensations’ inc. pain
Analgesia - specific painkiller
Hallucinations - distorted sensory experiences
Bronchodilation - drug used to facilitate airflow
Elevated blood pressure
* Slide on the term ‘Dissociative’ to follow

5. Medical Use
Ketamine is still used in human medicine as an anesthetic and can be used in minor surgery
Used in treatment for complex regional pain syndrome (CRPS)
Continued research into its effectiveness in treating depression
Research into a combination of controlled Ketamine use, Psychotherapy and Group Therapy as part of a treatment program for Alcohol addiction.
Used in the treatment of Schizophrenia

6. What is Dissociative Substance?
A Dissociative is a drug which reduces (or blocks) signals to the conscious mind from other parts of the brain, typically, but not necessarily, limited to the senses.
Dissociation is a partial or complete disruption of the normal integration of a person’s conscious or psychological functioning
Such a state of ‘sensory deprivation’ or dissociation can facilitate self-exploration, hallucinations and/or dreamlike states of mind.
The risks and benefits of each dissociative experience, as with most substances, are markedly different from user to user.

7. Random Facts
Unlike other well known Dissociatives, i.e.PCP, the effects of Ketamine are relatively short lasting - 15min/hour dependant on amount and administration
Slang terms include Special K and being in a ‘K-hole’
As well as Most of the world's illicit Ketamine comes from Asia-based pharmaceutical manufacturers, many ounces or even kilos of pharmaceutical Ketamine are sold and shipped in each transaction by legitimate Asian producers
100mg is usually enough to enter a K-hole
The price of Ketamine varies from £10 to £20 a gram.

8. Ketamine Treatment
Importance of a thorough assessment with a focus on:
Poly-drug use
Method of administration
Past successful treatments
Specific reason for this drug of choice and focusing on the associated dangers of use
Assertive outreach may be needed for this hard to engage client group
Set up specific groups - Meditation and Art/Music Therapy Groups
Alternative therapies inc Auricular Acupuncture
Long term engagement the most proven method for success

9. Final Questions
Can you identify any difficulties that you have currently that may make things difficult for this client group? If so is there anything that can be done to improve things?
Following the short discussion today, can you identify any more effective ways of working with this particularly difficult client group?
How can your team/group/agency improve the services that you deliver to Ketamine users?
Is there anything further than I can do to help Ketamine users?

10. Finally - Thank You for your participation Enjoy the rest of your day….