Whenever a doctor prescribes a new medication, it is nearly reflexive to wonder whether it might be addictive. After all, we’ve seen the news stories about the opioid crisis and it’s natural to be wary of medicine that you’ve never tried before.
The answer is simple, but it requires some understanding of the different types of addiction. Most people are more concerned about physical addiction. Ketamine is not usually physically addicting when used under medical supervision. The National Institute on Drug Abuse within the United States’ National Institute of Health (NIH) designates that presence of any ketamine withdrawal syndrome is “unknown”. It’s worth noting that ketamine has been used around the world as one of a safer anesthetics for adults, children, and animals.
However ketamine, like any drug, has the possibility of becoming psychologically addicting. Risk factors for psychological addiction are completely different from physical addiction and have little to do with the medication in question. Continue reading for more information about psychological addiction and how to differentiate it from physical addiction.
It’s important to begin by addressing the two types of addiction: psychological and physical. By understanding the difference between the two, you will have a better idea of what it means to say that ketamine can be psychologically addicting at the prescribed dose, but not physically addicting at the dosages a doctor would prescribe.
The pharmacology of drugs can create physical addiction in patients and as a result, some drugs have a higher risk of addiction than others. The chemical makeup of a drug decides how it influences your brain. Some drugs, like Ibuprofen, affects your body by suppressing pain signals and lowering your fever. Other drugs, like cocaine, cause a large amount of dopamine to flood certain parts of your brain, resulting in a high and making you feel elated.
The elevated level of dopamine eventually leads to addiction because your body comes to rely on the large presence of the neurotransmitter, and in turn decreases the number of receptors which the dopamine activates. When you aren’t under the influence of the cocaine or elevated dopamine levels, your brain receptors are “starved” for stimulation and as result you crave more.
Ketamine works by blocking a type of receptor in the brain called the NMDA receptor, which leads to the release of certain chemicals that produce its effects. Over time, the brain can adapt to the presence of ketamine and become tolerant to its effects, which can theoretically lead to physical dependence. The physical addiction potential of ketamine has been discussed based largely on one case of a single patient who developed these symptoms after 2 years of using 4–7 g of ketamine daily, and two psychotic patients with ketamine dependence admitted to a psychiatric unit. Those scenarios are very different from how ketamine is used undermedical supervision for mental health treatment.
Keep in mind that recreational ketamine can be physically addicting. This is because unregulated, large doses for the purpose of hallucinating acts more dramatically on your body. That is why ketamine is labelled as a Schedule III controlled substance and is not legal to take outside of the purview of a licensed medical professional.
As a recreational drug, ketamine may be known as Special K, Kit Kat, or Vitamin K. There have been many cases where frequent dosings of high dose ketamine developed into ketamine addiction. If you’re taking it to chase a high, you will soon need to take larger and larger doses to recreate the feelings.
When you take it as part of a prescription, however, you begin at a much lower dose. This is known as a subdissociative dose because it is low enough that most patients do not hallucinate or dissociate. Additionally, your goal in a medical context is to feel the regenerative effects of ketamine after your session as your mind forms new and better pathways. When you aren’t trying to ‘get high’ and your doctor is monitoring your medicinal intake, there is much lower risk of becoming physically addicted to ketamine.
Psychological addiction is very different from physical addiction, although they both lead to the same drug-seeking behaviors. Physical addiction, as noted above, is when your body becomes dependent on a drug to feel normal. Your body has trouble functioning normally without a baseline amount of the drug in your body and you need an increasingly larger amount of drugs to achieve a high. Physical addiction will lead to withdrawal symptoms when you stop taking it.
Psychological addiction is an imagined dependence on a drug. You may feel like you can’t accomplish basic tasks without consuming more of the drug, even though your body isn’t physically dependent on it. Knowing that a specific drug makes you feel good, or that you will feel poorly without it, can cause a strong psychological addiction.
Psychological addiction can be just as powerful of a condition as physical addiction. Ketamine, like all drugs, is designed to impact your body. People can become psychologically addicted to any drug including ketamine. Of note, fewer than 15 cases of human ketamine dependence have been described in the literature over the past 20 years
Even drugs that low risk for physical dependence can cause mental dependence. However, ISHA’s trained professionals are there to ensure that you take a consistent amount of ketamine on a prescribed schedule and to help you work through any possible ensuing issues.
Research on ketamine therapy pharmacology has revealed that many of the effects seen in higher doses are mostly absent in lower doses. Experiences regarding dissociation, or the feeling of being completely detached from reality, and hallucinations are rare in subdissociative doses.
Another aspect that separates medically prescribed ketamine from recreational ketamine is the frequency of doses. Recreational ketamine users may self-dose multiple times per day or for many days on end without taking a break. The combination of high doses taken at a high frequency make ketamine have a high risk of physical and psychological addiction.
Under your ISHA’s supervision, you will ingest a predetermined, consistent amount of ketamine on a controlled schedule with constant monitoring. We will walk you through the process from start to finish and continuing watching you through our telehealth system to ensure that you have as positive of an experience as possible.
Lumanauw DD, Youn S, Horeczko T, Yadav K, Tanen DA. Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain. Acad Emerg Med. 2019 Sep;26(9):1044-1051. doi: 10.1111/acem.13755. Epub 2019 Apr 29. PMID: 30901130.