Ketamine

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One day course on Ketamine Hydrochloride

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Ketamine

  1. 1. KetamineKetamine Tony D’AgostinoTony D’Agostino
  2. 2. Ketamine:Ketamine: Level 2Level 2
  3. 3. Course outlineCourse outline • Medical and recreational historyMedical and recreational history • Different formsDifferent forms • How it WorksHow it Works • Health / psychiatric issuesHealth / psychiatric issues • Harm reduction & treatmentHarm reduction & treatment • ResearchResearch
  4. 4. Current UK Snapshot • AmphetamineAmphetamine • Cocaine PowderCocaine Powder Number 1 Class A drugNumber 1 Class A drug • EcstasyEcstasy • CannabisCannabis decreasing?decreasing? • MethamphetamineMethamphetamine starting to appear?starting to appear? • KetamineKetamine • Legal Highs – Methoxetamine / M-ket (insights)Legal Highs – Methoxetamine / M-ket (insights)
  5. 5. KetamineKetamine General Knowledge QuizGeneral Knowledge Quiz
  6. 6. Ketamine is a short acting drug? True or False?
  7. 7. Ketamine is a short acting drug? True or False?
  8. 8. Ketamine is used in the NHS? True or False?
  9. 9. Ketamine is used in the NHS? True or False?
  10. 10. Ketamine is an hallucinogen? True or False?
  11. 11. Ketamine is an hallucinogen? True or False?
  12. 12. A ‘K Hole’ refers to leaving your body on Ketamine? True or False?
  13. 13. A ‘K Hole’ refers to leaving your body on Ketamine? True or False?
  14. 14. Ketamine is a horse tranquilizer? True or False?
  15. 15. Ketamine is a horse tranquilizer? True or False?
  16. 16. Ketalar is a brand name for ketamine? True or False?
  17. 17. Ketalar is a brand name for ketamine? True or False?
  18. 18. ‘Ereska’ is a brand name for a new intranasal Ketamine? True or False?
  19. 19. ‘Ereska’ is a brand name for a new intranasal Ketamine? True or False?
  20. 20. Ketamine was invented by the Americans? True or False?
  21. 21. Ketamine was invented by the Americans? True or False?
  22. 22. The term ‘Candyflipping’ refers to a combination of Ketamine and cocaine? True or False?
  23. 23. The term ‘Candyflipping’ refers to a combination of Ketamine and cocaine? True or False?
  24. 24. Ketamine can lower your tolerance to heroin? True or False?
  25. 25. Ketamine can lower your tolerance to heroin? True or False?
  26. 26. Ketamine depresses the CNS? True or False?
  27. 27. Ketamine depresses the CNS? True or False?
  28. 28. Ketamine is a Class C drug? True or False?
  29. 29. Ketamine is a Class C drug? True or False?
  30. 30. You can inject Ketamine? True or False?
  31. 31. You can inject Ketamine? True or False?
  32. 32. The US army tested Ketamine on humans in the 1950’s to see if it acted as a truth serum? True or False?
  33. 33. The US army tested Ketamine on humans in the 1950’s to see if it acted as a truth serum? True or False?
  34. 34. Ketamine can give you ‘K cramps’? True or False?
  35. 35. Ketamine can give you ‘K cramps’? True or False?
  36. 36. There is a dependency issue with Ketamine? True or False?
  37. 37. There is a dependency issue with Ketamine? True or False?
  38. 38. Ketamine is physically addictive? True or False?
  39. 39. Ketamine is physically addictive? True or False?
  40. 40. End of QuizEnd of Quiz
  41. 41. HistoryHistory
  42. 42. Historical Background • Ancient Greece -“Cave Sniffing” • 1775 – Joseph Priestley: Nitrous oxide • 1790s – Humphrey Davy tested gas on himself including Coleridge. • 19th Century - England and America Ether, chloroform and nitrous oxide “sniffing parties” and “ether frolics”
  43. 43. • 1880s Parke-Davis added dried peyote cactus to list • 1952 PCP patented – though used post- WW1 as anaesthetic • 1962 Calvin Stevens invented CI 581 - Ketamine. • 1964 Ketamine given to a human for first time by Dr Domino, his wife coins the phrase “dissociative anaesthesia” - replacement for PCP had been found.
  44. 44. • 1966 Ket was patented by Parke-Davis (late) - used in Vietnam War - ‘buddy drug’ • Late 1960s Ketamine sold illegally “mean green” and “rockmesc” Hospital staff divert to street • 1970 FDA approved ketamine for use in children and the elderly • 1970s Argentina “ketamina” - therapy • 1978 Marcia Moore and John Lilly Psychonauts
  45. 45. • 1989 – 1992 ‘Dud pills’ Ecstasy cut with Ketamine • 1994 Criminal Justice Act • 1995 Ketamine enters mainstream dance culture. Popular has dance drug ‘Ketamine House’ • Late 1990s Berlin party scene - sniffing ketamine for its stimulant properties • Late 1990s IV injection of ket is the method preferred by Muscovite teenagers • 1999 Time Out “Ketamine is the new E”
  46. 46. • 2003 – 5 MixMag reports shows steady increase in Ketamine use year after year. Also Drugscope. • 2005 – UK anecdotal reports on bladder problems. Media reports no mention • 2006 – Ketamine Class C drug in UK • 2007 – Hong Kong - First clinical reports of serious bladder and kidney problems • 2008 – Isolated reports of serious bladder problems with users (BDP, Notts, Norwich) • 2011 – Ketamine use doubled
  47. 47. Different formsDifferent forms
  48. 48. Dissociative anaestheticsDissociative anaesthetics • Nitrous oxideNitrous oxide • DXM (dextro-methorphan)DXM (dextro-methorphan) • Fly agaric (muscimol)Fly agaric (muscimol) • Salvia divinorumSalvia divinorum • PCP Phencyclidine ‘angel dust’PCP Phencyclidine ‘angel dust’ • MethoxetamineMethoxetamine • KetamineKetamine
  49. 49. Nitrous OxideNitrous Oxide
  50. 50. DXMDXM (Dextro-methorphan)(Dextro-methorphan) Sprite, cough syrup with codeineSprite, cough syrup with codeine ""purple drankpurple drank" or "" or "SizzurpSizzurp",",
  51. 51. Fly agaricFly agaric (muscimol)(muscimol)
  52. 52. Salvia divinorumSalvia divinorum
  53. 53. PCPPCP PhencyclidinePhencyclidine
  54. 54. MethoxetamineMethoxetamine
  55. 55. Drug Research 1. Where does it come from? (e.g. plant? Laboratory?) 2. How much does it cost? 3. How can it be taken? 4. Which ways are taking it are safer? 5. How does taking this drug make you feel? 6. Are there any health problems with this drug?
  56. 56. Structure of KetamineStructure of Ketamine • ““Ketamine’s dualKetamine’s dual anaesthetic/hallucinogenianaesthetic/hallucinogeni c naturec nature • S-Ketamine producesS-Ketamine produces anesthetic effectsanesthetic effects • R-Ketamine produces theR-Ketamine produces the hallucinogenic effects.hallucinogenic effects.
  57. 57. KetamineKetamine (K, Special K)(K, Special K) • DissociativeDissociative anestheticanesthetic
  58. 58. Ketalar Ketmex KetnestKetalar Ketmex Ketnest Ketaset & ImalgenKetaset & Imalgen Ketamine brandsKetamine brands
  59. 59. Ketamine combinationsKetamine combinations • Space basingSpace basing • CK1CK1 • HeroinHeroin • EcstasyEcstasy • AlcoholAlcohol • AmphetamineAmphetamine
  60. 60. Legal HighsLegal Highs • BZPBZP • SpiceSpice • MephedroneMephedrone -- Meow M-catMeow M-cat • MethyloneMethylone M1M1
  61. 61. How it worksHow it works
  62. 62. Effects on Humans Wide range of effects in humans including; • Analgesia • Anaesthesia • Hallucinations • Raised blood pressure • Stimulates CNS • Bronchodilation Ketamine is detectable in urine for approximately 1-2 days.Ketamine is detectable in urine for approximately 1-2 days.
  63. 63. Ketamine Doses • Low – 10-50mg Bump Stimulates CNS • Medium – 60-100mg Dissociation • Large – 100-250mg K hole • Mega – 250mg + Unconscious • Surgical – 500mg + 10X accidental dose Varies with route administration. Tolerance builds quickly. The more you take it the less you K hole
  64. 64. Mechanism of ActionMechanism of Action • GlutamateGlutamate • NoradrenalineNoradrenaline • Dopamine & SerotoninDopamine & Serotonin • Opioid receptorsOpioid receptors • Cannabiniod receptorsCannabiniod receptors • Sigma receptors?Sigma receptors? Increased doses effects more receptorsIncreased doses effects more receptors
  65. 65. Ketamine and the brainKetamine and the brain • Ketamine plays on the cortex which involvesKetamine plays on the cortex which involves cognition and perceptioncognition and perception • Dreams, ket experiences, NDEDreams, ket experiences, NDE • Mystical ‘entheogen’ – Sigma receptors?Mystical ‘entheogen’ – Sigma receptors? • Olney’s lesions (brain damage?)Olney’s lesions (brain damage?)
  66. 66. HealthHealth
  67. 67. Ketamine and PCP OverdoseKetamine and PCP Overdose • Ketamine:Ketamine: – wide margin of safety (some ODwide margin of safety (some OD cases)cases) – respiratory depression possible, withrespiratory depression possible, with complete recoverycomplete recovery • PCP:PCP: – convulsions, coma, death.convulsions, coma, death.
  68. 68. BenefitsBenefits • Palliative CarePalliative Care • AntidepressantsAntidepressants • Alcohol and substance abuse clinicsAlcohol and substance abuse clinics • Reversing tolerance of morphine in cancerReversing tolerance of morphine in cancer patientspatients • Treatment of stroke victimsTreatment of stroke victims • Alleviation of phantom painsAlleviation of phantom pains • Management of Complex Regional PainManagement of Complex Regional Pain Syndrome (medically induced coma)Syndrome (medically induced coma)
  69. 69. Lower urinary tract?Lower urinary tract? • Medically unknown at present: LiverMedically unknown at present: Liver /kidneys – bladder ulcers / fibrosis/kidneys – bladder ulcers / fibrosis • Dismissed as psycho-somaticDismissed as psycho-somatic • Hong Kong Clinical trials (establishes link)Hong Kong Clinical trials (establishes link) • Bath & Lancaster researchBath & Lancaster research • Urological Depts?Urological Depts? • Stabiliser in Ketamine? Nor-KetamineStabiliser in Ketamine? Nor-Ketamine
  70. 70. Mental HealthMental Health
  71. 71. Mental healthMental health • Psychosis (Mimics)Psychosis (Mimics) • DepressionDepression • Anxiety, Panic attacksAnxiety, Panic attacks • Flashbacks? PTSD?Flashbacks? PTSD? • Shuts down activity in pre frontal cortexShuts down activity in pre frontal cortex ((depression?depression?))
  72. 72. Real-time fMRI ManchesterReal-time fMRI Manchester
  73. 73. Harm reductionHarm reduction
  74. 74. ExerciseExercise Harm reduction advice on Ketamine?Harm reduction advice on Ketamine? • SnortingSnorting • SmokingSmoking • InjectingInjecting • OralOral
  75. 75. • If you sit in the bath to soothe the pain there is aIf you sit in the bath to soothe the pain there is a risk of unconsciousness and drowning.risk of unconsciousness and drowning. • If you have a panic or anxiety attack stay withIf you have a panic or anxiety attack stay with your friends.your friends. • If you experience urination problemsIf you experience urination problems symptoms willsymptoms will not respond to cystitisnot respond to cystitis treatmentstreatments • Snorting damages lining of nose – impairs smell,Snorting damages lining of nose – impairs smell, don’t share strawsdon’t share straws • Pills come on quite fast 10-15mins on emptyPills come on quite fast 10-15mins on empty • Oral doses can take 1hr to workOral doses can take 1hr to work
  76. 76. • Give yourself breaksGive yourself breaks • Injecting ketamine brings the additional risksInjecting ketamine brings the additional risks of damaging your veins, skinof damaging your veins, skin infections andinfections and contracting blood borne viruses such ascontracting blood borne viruses such as Hepatitis or HIV.Hepatitis or HIV.
  77. 77. Ketamine detox?Ketamine detox? • Encourage a slow reductionEncourage a slow reduction • Librium can alleviate anxiety. Complementary therapies canLibrium can alleviate anxiety. Complementary therapies can also be useful.also be useful. • Difficulty sleeping initially or may need a considerable amountDifficulty sleeping initially or may need a considerable amount of sleep, serotonin and dopamine levels will be depleted.of sleep, serotonin and dopamine levels will be depleted. • Encourage users to eat and drink regularly and healthily, andEncourage users to eat and drink regularly and healthily, and to avoid isolation.to avoid isolation. • Engaging in a social support network can help to continueEngaging in a social support network can help to continue reduction and abstinence.reduction and abstinence.
  78. 78. Treatment?Treatment? What treatment is available?What treatment is available? • CBT, MI etcCBT, MI etc • Psychotherapy, hypnosisPsychotherapy, hypnosis • Complimentary therapiesComplimentary therapies • Rehab, support groupsRehab, support groups • Biocom 2000 laser system???Biocom 2000 laser system???
  79. 79. Treatment?Treatment? What treatment is available?What treatment is available? • Ketamine Bladder Syndrome.comKetamine Bladder Syndrome.com • ICN Interstitial Cystitis Network (dietsICN Interstitial Cystitis Network (diets & support)& support) • Canadian Research ElmironCanadian Research Elmiron (Pentosan Polysulfate)(Pentosan Polysulfate)
  80. 80. ResearchResearch • KPTKPT (Ketamine assisted(Ketamine assisted psycho-therapypsycho-therapy • Krupitsky:Krupitsky: HypnodelicHypnodelic Psycholytic therapyPsycholytic therapy • LancetLancet (OCD) Psilocybin(OCD) Psilocybin • AMAAMA (PTSD) Ecstasy(PTSD) Ecstasy

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