Ketamine Misuse and Addiction: Signs, Effects, and Treatment

Ketamine is an anesthetic approved by the U.S. Food and Drug Administration (FDA) for use in humans and animals, and an alternate form of the drug, called esketamine, is approved for treatment-resistant depression.¹ Outside of medical settings, ketamine is also made illegally and misused recreationally for its pleasurable dissociative effects.¹

Ketamine misuse can lead to a range of short- and long-term health effects, and regular use is associated with several hallmark symptoms of addiction seen with other substance use disorders.¹

If you or someone you care about is struggling with ketamine misuse, you should know that professional treatment is available and can help you improve your overall health and wellbeing.

What Is Ketamine?

Ketamine is a chemical compound originally developed for use as an anesthetic in humans and animals.¹ It was created as a safer alternative to phencyclidine (PCP), an earlier anesthetic associated with more severe side effects.¹

Today, a special formulation of ketamine of ketamine called esketamine (Spravato) is FDA-approved to treat adults with treatment-resistant depression.¹ You may also come across ketamine-assisted therapy for mental health and substance use disorders, which uses ketamine under medical supervision to support recovery from certain types of addiction.

Outside of these medical settings, ketamine is also produced and sold illegally. Illicitly manufactured ketamine is commonly sold as a white powder, liquid, or pill and is known by street names like Special K, Super K, Vitamin K, or simply K.¹

Effects of Ketamine

Ketamine blocks N-methyl-D-aspartate (NMDA) receptors and partially activates mu-opioid receptors.² Though the precise mechanism isn't entirely understood, these neurochemical actions are thought to contribute to its sedating, dissociative, pain perception-altering, and potential antidepressant effects.^2,3

At lower doses, ketamine can produce feelings of happiness or a dream-like state. Other short-term effects may include:¹

• Headache.
• Dizziness.
• Sleepiness.
• Difficulty speaking.
• Numbness.
• Blurred vision.
• Nausea.
• Changes in blood pressure and heart rate.

At higher doses, ketamine can cause an intense feeling of detachment from the body and reality. This state is commonly referred to as a “k-hole.”¹

Why Do People Misuse Ketamine?

People misuse ketamine recreationally, often at clubs, festivals, or parties because it's relatively inexpensive, takes effect quickly, and produces a powerful dissociative high.⁴ Others may misuse ketamine in an attempt to self-medicate for anxiety, depression, and other mental health conditions, especially as ketamine's reputation as a mental health treatment has grown.

How Is Ketamine Misused?

Misuse can involve using illicitly manufactured ketamine or using prescription ketamine differently than directed, including taking larger doses or using it more often than prescribed.

Illicitly manufactured ketamine is most commonly misused by snorting it as a powder, though it may also be swallowed as a pill or, less commonly, injected in liquid form.⁴

When snorted, ketamine reaches the brain quickly, and the effects are short-lasting (around 1.5 hours).⁴ When taken by mouth, its effects begin relatively more slowly because much of the drug is metabolized by the liver before entering the bloodstream.⁴ Ketamine is also frequently mixed with other substances, like alcohol or cocaine, which increases the risk of experiencing negative health consequences.⁴

Because illicit ketamine isn't regulated, it can be impossible to know its exact strength or whether it has been mixed with other substances, increasing the risk of dangerous reactions (oversedation, respiratory depression, multi-substance overdose).

Is Ketamine Addictive?

Yes, studies show that ketamine can result in changes in the brain similar to those of drugs with more well-established addictive potential.¹ Regular ketamine use is associated with symptoms of addiction, including using more than intended, spending a lot of time obtaining or using ketamine, continuing to use it despite knowing it's causing problems, and tolerance, which means needing more of the drug to feel the same effects.¹

Ketamine's addictive potential appears to work in two ways: the dissociative high itself is reinforcing, and ketamine's effect on dopamine, while more limited than with other drugs, adds an extra layer of reward that encourages repeated use.⁴

Unlike alcohol or opioids, ketamine hasn't historically been associated with a well-defined physical withdrawal syndrome. However, some people have reported intense cravings, anxiety, poor appetite, fatigue, and physical discomfort when they stop using the drug. Withdrawal may be more likely when ketamine is abruptly stopped after a period of frequent use, large dose use, or use for long periods of time, such as might occur over the course of regular misuse.^3,4

In one large international survey of people who use ketamine, 8.55% of past-year users met clinical criteria for ketamine dependence, showing that while not everyone who tries ketamine becomes dependent, the risk is real for people who use it regularly.⁵

Signs of Ketamine Addiction

Only a qualified healthcare or mental health professional can diagnose a substance use disorder (SUD). However, recognizing the signs of problematic ketamine use can help determine whether it may be time to seek an evaluation or treatment.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not outline separate diagnostic criteria for ketamine use disorder. However, because of many overlapping drug effects and shared diagnostic features, a ketamine addiction may be diagnosed using the criteria for phencyclidine (PCP) use disorder.⁶

A diagnosis requires at least two of the following symptoms occurring within a 12-month period:⁶

• Using ketamine in larger amounts or for longer than intended.
• Wanting to cut down or stop using ketamine but being unable to.
• Spending a lot of time getting, using, or recovering from ketamine.
• Experiencing cravings or a strong urge to use ketamine.
• Failing to meet responsibilities at work, school, or home because of ketamine use.
• Continuing to use ketamine despite ongoing relationship problems it causes or worsens.
• Giving up important social, work, or recreational activities because of ketamine use.
• Using ketamine in situations where it is physically dangerous to do so.
• Continuing to use ketamine even after it causes or worsens physical or mental health problems.
• Needing more ketamine to achieve the same effects (tolerance).

Unlike alcohol or opioids, at the time of publication, the DSM-5 didn't formally recognize a withdrawal syndrome for ketamine or other phencyclidine-type substances, and excluded withdrawal from the diagnostic criteria.⁶ That said, some people do report cravings and physical symptoms after stopping.⁴

Health Effects of Ketamine Misuse

Repeated ketamine misuse can lead to various health consequences. Ketamine's effect on dopamine reward pathways can make it increasingly difficult to cut back the longer misuse continues.⁴ Additionally, long-term use can build physical dependence. As tolerance grows, patterns of misuse may continue to worsen.^1,4 Fear of any associated withdrawal symptoms may also make continued use more likely.

Long-term ketamine misuse can lead to a bladder condition known as ulcerative cystitis, which can cause pain, urgency, and blood in your urine.⁴ Long-term misuse is also linked to gastrointestinal problems, including abdominal pain sometimes referred to as “K-cramps.”^1,4

Long-term ketamine misuse is associated with anxiety, depression, and memory problems.¹ At high doses, ketamine can cause psychosis, a break from reality that can include delusions lasting up to a month after a person stops using.¹

Overdose deaths involving ketamine nearly doubled between mid-2019 and mid-2023. About 82% involved other drugs, including illegally manufactured fentanyl, methamphetamine, or cocaine, per the CDC.⁷

Ketamine overdose is also a risk, especially when it’s combined with other substances. According to data from the Centers for Disease Control (CDC), ketamine was involved in fewer than 1% of U.S. drug overdose deaths between mid-2019 and mid-2023.⁷ However, overdose deaths involving ketamine nearly doubled during that period, and about 82% involved other drugs, including illegally manufactured fentanyl, methamphetamine, or cocaine.⁷

Treatment for Ketamine Misuse and Addiction

If ketamine misuse or another substance use disorder (SUD) is negatively affecting you, know that professional treatment is available and can help you live a healthier life.⁸

Treatment can take place in a variety of settings depending on the level of support a person needs.8 Some people benefit from medical detox to manage withdrawal from certain substances, followed by inpatient or residential treatment.⁸

Others receive care through outpatient treatment programs, or ongoing aftercare services. As a person progresses through treatment, they may “step up” or “step down” between different levels of care.⁸

Behavioral therapies, such as cognitive behavioral therapy (CBT) and motivational interviewing, are a key part of treatment and can help people change behaviors and patterns related to substance use, develop healthier coping skills, and build motivation for recovery.⁸

Treatment may also address co-occurring mental health conditions, such as anxiety or depression, which can improve overall outcomes. Many people also benefit from peer support groups as part of their long-term recovery.⁸

How to Help Someone Struggling With Ketamine Misuse

If someone you care about is misusing ketamine, your support can make a real difference in whether they seek help. Family members are often the first to notice when a loved one’s behavior or mood changes.⁹

Here are some things to keep in mind when you start the conversation:v

• Choose the right time and place. Find a private, quiet setting with few distractions where you can talk without feeling rushed.
• Be honest and direct. Share the specific changes you've noticed and explain why you're concerned using calm, nonjudgmental language.
• Listen without judgment. Give them space to share how they're feeling, acknowledge their emotions, and avoid interrupting or criticizing.
• Offer support, not pressure. Reassure them that substance use disorders are treatable and offer to help them find treatment or make an appointment.
• Be patient and keep checking in. One conversation may not lead to immediate change. Continue offering support and let them know you're there when they're ready.

It can also help to learn about ketamine misuse and substance use treatment ahead of time so you feel more prepared. Support groups and family therapy may help you process your own emotions while supporting someone else, since caring for a loved one through addiction can take a toll.

For more guidance, including how to start the conversation, our guide on how to help someone with an addiction walks through the process step by step.

Find Treatment for Ketamine Addiction

Ketamine misuse and addiction can feel isolating, but effective treatment is available, and recovery is possible with the right support. Whether you're looking for yourself or a loved one, connecting with a qualified provider is an important step. You can find ketamine addiction treatment with Recovery.com. Filter by location, insurance, and more to get started.