Drug tolerance is defined by the National Institute on Drug Abuse (NIDA) as the point at which a person no longer obtains any effect from a drug and requires a higher dose for the desired outcomes. Tolerance is often the result of a chemical reaction in the brain caused by the drug’s repeated interaction on its chemical levels.
For instance, when a mind-altering drug is taken, it changes the way the brain sends it chemical messengers. Neurotransmitters that signal feelings of pleasure, such as dopamine and serotonin, are often affected. Levels of these chemical messengers will rise either through stimulation of their production, changes in the way they are transmitted, or blockages in their reabsorption due to the mechanism of a certain drug. When the drug processes out of the brain, chemical levels in the brain are changed again.
Regular interaction of a psychoactive drug on brain chemistry can cause the brain to anticipate and get used to the effects. The drug will then no longer be effective in regular doses. Higher doses will be needed to override the brain and get the full effect of the drug. Per NIDA, ketamine is a dissociative anesthetic drug that can lead to drug tolerance with repeated use.
Ketamine is mostly used in veterinary medicine as an anesthetic, though it does have some licit use in humans as a short-acting injectable anesthetic medication. The U.S. Drug Enforcement Administration (DEA) reports that ketamine is used recreationally. It can be snorted, smoked, ingested in drinks, or injected as a dissociative hallucinogenic structurally similar to phencyclidine (PCP).
In low doses, it can be mellowing and cause colorful hallucinations and sensory distortions, called “K-land.” In slightly higher doses, the trip is likened to a near-death, out-of-body experience, called a “K-hole.” In even larger doses, it can cause a person to revert to an infantile state and become immobile, called “baby food.” At the highest doses, ketamine intoxication is likened to a spiritual experience, called “God.”
Ketamine is considered a club drug, and it is most commonly used recreationally by teens and young adults per the DEA. The drug affects brain chemistry, causing auditory and visual hallucinations that begin within a few minutes of taking the drug and last about 30-60 minutes.
Ketamine can cause users to feel disconnected from themselves and their environment. A “Special K” trip is often more desirable than that associated with many other hallucinogenic drugs since the effects are generally much shorter. A typical dissociative hallucinogen like PCP can have effects that continue for hours. Ketamine also acts as a stimulant and raises blood pressure and heart rate.
Taking ketamine repeatedly can lead to drug tolerance. The Indian Journal of Psychological Medicine reports that extreme tolerance can form with the regular and cyclical use of ketamine. Routine use can also cause the brain to become dependent on the drug, which will make it hard to feel normal without taking it. Intense cravings for ketamine can occur when it processes out of the body, making the user want to take it again and again.
Some ways to recognize if you are tolerant to, and potentially dependent on ketamine include:
If you recognize that ketamine tolerance is, in fact, a possibility, the next steps involve deciding how to reduce your use. Continuing to escalate the dosage can be highly dangerous as it is possible to overdose on the drug. Breathing problems and unconsciousness are possible signifiers of a ketamine overdose. Extremely high doses of ketamine can also depression, amnesia, delirium, cognitive impairment, dangerously high blood pressure, difficulties with balance, coordination, and motor functions, and can even cause fatal respiratory distress, NIDA warns.
Since it is a hallucinogenic drug, a ketamine trip can be unpredictable and have undesirable consequences and side effects. The more ketamine you take at a time, the more likely you are going to experience an adverse reaction to the drug.
It is also possible to experience flashbacks months or even years after taking ketamine, which can occur randomly and at unexpected times. A flashback is a re-experiencing of a hallucinogenic trip, and it can be decidedly unpleasant as there is no way to control when or where it might occur. Taking large doses of ketamine, especially regularly, can increase the risk of experiencing flashbacks later in life.
Tolerance can be reduced by minimizing use. If you take the drug regularly, you should try to slow down how often and how much you take. By reducing the dosage amount, you can reset tolerance levels. That being said, continuing to take ketamine regularly will just build the tolerance back up again. Drug cravings are also likely to occur when dropping doses of ketamine or trying to space them out.
Recreational use of ketamine is problematic and classified as drug abuse. Nearly 1.5 million people in the United States older than age 11 were considered to be currently using a hallucinogenic drug at the time of the 2016 National Survey on Drug Use and Health (NSDUH). Drug tolerance and potential dependence can be managed through specialized treatment programs.
A medical detox program can help to manage drug cravings while detoxing from ketamine. Detox programs use supportive and medical methods to control drug cravings while the drug processes safely out of the body. After a few days of abstaining from ketamine, you can enter a drug abuse and addiction treatment program that can teach you how to control cravings on a long-term basis and to manage potential triggers for drug use.
Behavioral therapies and counseling sessions provide resources and tools that can retrain the brain by teaching coping mechanisms and healthy habits. Some patterns of thinking are self-destructive, for example, and can lead you to feel like you need ketamine to escape or feel better. Behavioral therapies can help you to recognize that these thoughts lead to negative and detrimental behaviors. In group and individual sessions, you can explore what may have been the cause of your ketamine use in the first place and come up with healthier ways of thinking and, therefore, acting in the future.
Support groups can be helpful. It feels good to be surrounded by other people who understand where you are coming from and can offer meaningful encouragement and tips for minimizing relapse, or a return to ketamine use. These groups are made up of others who have similar goals and understand your struggles. It is empowering to have strong peer support in recovery.
Ultimately, ketamine is largely considered an illegal recreational drug in the United States with limited medical use. Use of this drug for nonmedical purposes is abuse and can have lasting repercussions. A specialized drug abuse program can help to manage ketamine abuse and support recovery.
(January 2007). Neurobiology of Drug Addiction. 6. Definition of Tolerance. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance
(December 2014). Club Drugs (GHB, Ketamine, and Rohypnol). National Institute on Drug Abuse. from https://www.drugabuse.gov/sites/default/files/drugfacts_clubdrugs_12_2014.pdf
(August 2013). Ketamine. Drug Enforcement Administration. from https://www.deadiversion.usdoj.gov/drug_chem_info/ketamine.pdf
Drugs of Abuse A DEA Resource Guide 2017 Edition. Drug Enforcement Administration. from https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=51
(July-September 2014). Ketamine Dependence in an Anesthesiologist: An Occupational Hazard? Indian Journal of Psychological Medicine. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100428/
NIDA Community Drug Alert Bulletin- Club Drugs: Ketamine. National Institute on Drug Abuse. from https://archives.drugabuse.gov/publications/nida-community-drug-alert-bulletin-club-drugs/ketamine
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm