Why do people abuse ketamine?

Why People Abuse Ketamine

People abuse ketamine primarily for its dissociative and psychedelic effects, which produce feelings of detachment, euphoria, hallucinations, and altered perceptions described as "floating," "being spaced out," and experiencing a sense of disconnection from reality. 1

Primary Psychoactive Effects Driving Abuse

The FDA drug label explicitly identifies the specific symptoms that make ketamine attractive for recreational use: 1

• Dissociative experiences including feelings of floating, detachment, and being "spaced out" 1
• Hallucinations and flashbacks that users seek for recreational purposes 1
• Altered mental states including disorientation that some find appealing 1
• Psychedelic properties that produce unique perceptual changes 2

Neurobiological Mechanisms of Abuse Potential

Ketamine's abuse liability stems from its complex pharmacological actions: 3

• NMDA receptor blockade on GABAergic neurons leads to disinhibition of dopaminergic neurons and increased dopamine release in reward pathways 3
• Mesolimbic system activation in brain regions that regulate natural and drug reward, creating reinforcing effects 4
• Rapid mood-altering properties that users find appealing, separate from therapeutic antidepressant effects 3

Addiction and Dependence Patterns

The FDA classifies ketamine as a Schedule III controlled substance due to documented abuse potential: 1

• Physical dependence develops with prolonged use, manifesting as withdrawal symptoms (craving, fatigue, poor appetite, anxiety) after discontinuation of frequent, high-dose use 1
• Tolerance occurs with repeated administration, requiring progressively higher doses to achieve the same psychoactive effects 1
• Individuals with prior substance use history face greater risk for ketamine abuse and misuse 1

Cognitive and Memory Impairment as a Consequence

• Recurrent high-dose ketamine abuse is associated with memory and attention impairment 1
• Disrupted learning and memory processing has been consistently linked with ketamine use 3
• Long-term neurocognitive toxicity remains a major concern with chronic abuse 5

Clinical Context and Paradox

A critical paradox exists: 4, 6

• Ketamine shows promise for treating other addictions (alcohol, heroin, cocaine) through mechanisms including disruption of drug-related memory reconsolidation 6
• However, repeated ketamine exposure for depression treatment could theoretically lead to substance use disorder, as depression and addiction share overlapping neural circuitry 4
• The transient nature of therapeutic effects requiring repeated dosing raises concerns about developing dependence in clinical settings 4

Common Pitfalls in Understanding Ketamine Abuse

• Do not assume therapeutic use eliminates abuse risk—the same dissociative properties that may contribute to antidepressant effects also drive recreational abuse 1, 3
• Recognize that short-term tolerability in clinical settings does not predict safety with chronic, high-dose recreational use 5
• The rapid onset of psychoactive effects (within minutes to hours) makes ketamine particularly attractive for abuse compared to traditional antidepressants 5