What are the potential side effects of recreational ketamine use?

Side Effects of Recreational Ketamine Use

Recreational ketamine use can cause serious adverse effects including emergence reactions (hallucinations, delirium), urological damage (ketamine cystitis), hepatobiliary dysfunction, cognitive impairment, and potential for dependence and abuse. 1, 2

Acute Side Effects

Ketamine produces a range of immediate effects when used recreationally:

• Neuropsychiatric effects:

  • Dissociative state ("K-hole") with sensory distortion and detachment from reality 1
  • Emergence reactions (10-30% of adults) including:
    • Floating sensations, vivid dreams, hallucinations
    • Delirium and irrational behavior 1
  • Impaired memory and sensory recognition 1

• Cardiovascular effects:

  • Dose-dependent increases in heart rate, blood pressure, and cardiac output 1
  • Potentially dangerous for individuals with pre-existing cardiovascular conditions 1

• Other acute effects:

  • Nausea and vomiting 3
  • Excessive salivation (sialorrhea) 3
  • Laryngospasm (rare but serious) 3

Chronic Side Effects

Long-term or heavy recreational ketamine use can lead to several serious complications:

• Urological damage:

  • Ketamine-induced cystitis with symptoms including dysuria, increased frequency, urgency, and hematuria 2, 3
  • Reduced bladder capacity 2
  • Hydronephrosis in severe cases 2

• Hepatobiliary dysfunction:

  • Cholestatic pattern of liver injury 2
  • Biliary duct dilatation with or without obstruction 2, 3
  • Abnormal liver function tests 4
  • Choledochal cysts 4

• Cognitive and psychological effects:

  • Impaired verbal information processing 3
  • Persistent dissociative, depressive, and delusional thinking 4
  • Memory defects 1, 4

• Dependence and tolerance:

  • Physical dependence with withdrawal symptoms including craving, fatigue, poor appetite, and anxiety 2
  • Tolerance requiring higher doses to achieve the same effects 2

Special Concerns

• Abuse potential:

  • Ketamine is a Schedule III controlled substance with recognized abuse potential 2
  • Risk of abuse is higher in individuals with history of substance use disorders 2

• Date-rape drug risk:

  • Ketamine has been used as a "date-rape drug" due to its sedative and amnestic properties 1
  • Effects occur within 20 minutes and can last for less than 3 hours 1

• Polysubstance use:

  • Combining ketamine with other substances (especially CNS depressants) increases risk of respiratory depression, coma, and death 2
  • Alcohol co-ingestion is particularly dangerous 2

Risk Factors for Complications

• Frequency of use (regular users at higher risk) 5
• Cumulative dose (higher lifetime exposure increases risk) 5
• Pre-existing medical conditions (especially cardiovascular, hepatic, or urological) 1
• Polysubstance use 2

Recreational ketamine use carries significant risks that are distinct from its controlled medical applications. The most concerning long-term effects are the urological and hepatobiliary damage, which may persist even after cessation of use, though abstinence is considered the primary treatment approach for ketamine-related complications 3, 4.