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Europol–EMCDDA progress report on ketamine in accordance with Article 3 of the joint action of 16 June 1997 concerning the information exchange, risk assessment and the control of new synthetic drugs PDF Print E-mail
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Reports - EMCDDA Report on the risk assessment of Ketamine
Written by Richard Dennis   

Introduction

The Horizontal Working Party on Drugs, at its meeting of 22 September
1999, asked the EMCDDA and Europol for preliminary information on the
substance ketamine under Article 3 of the joint action. Europol national units
and Reitox national focal points were subsequently requested to provide
information on ketamine. The EMCDDA and Europol also conducted
enquiries. No reporting took place using the ‘Europol–EMCDDA reporting
form on new synthetic drugs’.

Ketamine is subject to control in five Member States: Belgium (Royal Decree
31.5.1976), Greece (Law 1729/87); France (Decree 8.8.1997); Ireland (to be
scheduled under the Misuse of Drugs Act); and Luxembourg (Grand-Ducal
Decree 4.3.1974). It is controlled through means of medicinal legislation in
Germany, Spain, the Netherlands, Austria, Sweden and the United Kingdom.
In the United Kingdom, the Advisory Council for the Misuse of Drugs
recommended monitoring of ketamine.

Available information on ketamine

Chemical and physical description, including the name
by which ketamine is known

The chemical name for ketamine is 2-(2-chlorophenyl)-2-(methylamino)-
cyclohexanone.

Figure 1: Structural formula of ketamine

ketamine01

It is a dissociative anaesthetic drug used as a licensed product in veterinary
medicine (i.e. Vetalar and Imalgene) and to a lesser extent by the medical
profession, mainly for emergency care (i.e. Ketalar). Ketamine is freely soluble
in water or alcohol and usually comes from the pharmaceutical industry in
liquid form in ampoules for intramuscular or intravenous injections.

Ketamine is known in Member States by the street names: K, special K,
vitamine K, ket, super K, liquid E and others (5).

In the United Kingdom, ketamine appears in the form of well-made tablets,
visually similar to and often sold as ‘ecstasy’ tablets. It is rarely found alone
in tablets but is usually mixed with a stimulant drug (e.g. amphetamine or
MDMA, ephedrine and/or caffeine). Typical impressions on the tablets are
the same as those found on ‘ecstasy’ tablets, such as a bird, clover/club,
heart, etc.

Ketamine is also found on the ‘illicit recreational’ drug market as liquid,
powder and capsules, where it is snorted or swallowed. It has also been used
as a cutting agent for drugs such as cocaine, amphetamine and heroin.

Ketamine does not react with commonly used field-test kits (e.g. Marquis
reagent) although other drugs present may produce a positive reaction.

The typical nasal dose is around 200 mg, thus one dose at this price is less
than EUR 3. With ease of access, at relatively low prices, it is unlikely that
illicit tablet manufacturers would contemplate the synthesis of ketamine,
which is probably too difficult for most clandestine chemists.

Information on the frequency, circumstances and/or quantities in which
ketamine is encountered

In Austria, although there have been no reported seizures or hospital treatment
episodes attributed to ketamine, there is some anecdotal evidence of
use among very small, closed groups.

In Belgium, 89 kg of ketamine were seized in September 1999. In January
2000, another seizure of 3 kg took place. Both seizures contained pure
ketamine in powder form. In addition, there have been a few seizures of
ketamine in tablets, mixed with MDMA or amphetamine. Ketamine is not
free for trade in Belgium.

In Finland, there were 14 seizures of ketamine in 1998, totalling 614 tablets.
In 1999, five seizures occurred, totalling 49 tablets with the ‘propeller’ logo.

In France, two seizures of tablets with an ecstasy-type logo containing ketamine
and amphetamine were reported in 1998 and 1999. A survey of young
people who were regular attendees at techno party events found that 15 %
reported that they had taken ketamine. Among a matched control group of
young people who did not go to such events, consumption of ketamine was
non-existent, indicating that use is not widespread.

In Germany, six people were arrested in May 1999 in relation to the seizure
of an illicit synthetic drug laboratory. A large amount of laboratory equipment
was seized, as were chemicals and end products. These included 182 g
of ketamine hydrochloride in tablet form (700 tablets with blue colour) and
0.9 g of ketamine powder. Another 2 000 yellow tablets were seized containing
methamphetamine hydrochloride and ketamine hydrochloride.

In Greece, treatment staff and helplines reported three instances of ketamine
use in 1999 in the same recreational drug scene as ecstasy and cocaine.
There are reports of ketamine liquid being boiled to obtain powder that is
sniffed.

In Ireland, from 1 January 1998 to 15 October 1999, there have been 43 incidents
of ketamine seizures. In 40 of these cases, ketamine and ephedrine were present
in tablet form (number of tablets 4 500); one case was of 27 000 tablets with
ketamine only or ketamine with caffeine, one case of 26 tablets which contained
only ketamine and one case of 0.23 g of ketamine powder. The vast
majority of ketamine seized in Ireland emanates from the Netherlands.
Organised crime groups or Irish nationals are responsible for the importation
and distribution of ketamine. There are no indications that Ireland is a transit
or export point.

In Spain, a combination of ketamine and cocaine is known as ‘special CK’ (6).
Early seizures took place in 1995 in the Balearic Islands and in 1996 a submission
of ketamine mixed with manitol was found in Barcelona. There have
been a series of small seizures throughout 1996 to 1999. Between 1995 and
1996, a British police team visited the Balearic Islands to investigate the origin
of ketamine tablets that had been seized in discotheques and bars and were
suspected to have been manufactured in the United Kingdom. The seizures
were mainly from foreign tourists and none have occurred in Madrid and
other major cities. This, together with the absence of deaths, indicates a lack
of widespread popularity in Spain.

In Sweden, ketamine is an integral ingredient in four different medicinal
products and some years ago stolen ketamine products from the legal pharmaceutical
trade appeared on the illegal market. Misuse is a minor concern
at present. There have been occasional and minor seizures of ketamine on
the domestic user market.

In the United Kingdom, seizures climbed rapidly in the early 1990s. In 1995,
almost 100 000 tablets containing ketamine and ephedrine and carrying a
logo commonly found on ecstasy tablets were seized. During 1995 and
1996, a number of hospitalisation cases were reported. Ketamine seizures
peaked in 1997 and over the past two years have stabilised at around 200
submissions per year. There have been few significant customs seizures, suggesting
that most, if not all, tablets consumed in the United Kingdom are produced
there. It is believed that ketamine raw material is imported in bulk
from legitimate suppliers in Europe. Ketamine appears to be distributed
through illicit drug distribution networks. Small quantities can be obtained
by mail order from chemical catalogues at around EUR 64 for 5 g. A number
of ketamine tablet manufacturers have been successfully prosecuted for
conspiracy to supply, or attempt to supply, a controlled drug and some dealers
have been prosecuted for conspiracy to defraud contrary to common law.

Recently, in the north-west of England and in London, it has been reported
that, among some circles of ‘early adopters’ and ‘media types’, ketamine is
being sought out as a drug experience in its own right. In a targeted survey
of 200 regular techno dance clubbers in London in 1998, 40 % said that
they had experimented with ketamine and 10 % were planning to use it that
evening. The survey placed ketamine in fourth place after cannabis, amphetamine
and ecstasy. More recently, some outreach workers have expressed
scepticism about the existence of a significant trend in ketamine use.
However, considering the perceived influence of the media on patterns of
drug consumption, it is too early to dismiss the development of ketamine use
as a new trend.

A first indication of the possible risks associated with ketamine

Ketamine is not strictly hallucinogenic, but in small doses users feel
detached from their immediate environment. It also causes catalepsis (muscle
rigidity) and reduces reaction to pain. Overdose is rare, but adverse effects
include hypertension, tachycardia, headache, nausea, vomiting, slurring of
speech, numbness and, in more severe reactions, temporary unconsciousness,
respiratory collapse or heart failure. It can also provoke panic or acute
anguish or anxiety, particularly when taken unknowingly or without prior
knowledge of its possible effects. There is also some evidence that the effects
of ketamine are considerably diminished in someone with tolerance.
However, the sudden anaesthetic effects of ketamine create high risk for
accidents and makes driving following consumption dangerous.

Two deaths linked with the use of ketamine were reported for 1996 in
Ireland. Both persons who died had a history of ecstasy use. In one death,
ketamine was found in combination with opiates. In the other it was found
in combination with ephedrine and pseudoephedrine.

During 1995 and 1996, in the United Kingdom, a number of hospitalisation
cases occurred of users suffering anxiety attacks who had taken large doses
of ketamine believing it to be ecstasy. Since 1996, no deaths have been
recorded but there is growing documentation showing similarity to phencyclidine,
associated with foetal malformation (mainly cephalic size reduction)
in pregnant women and effects on neonates.

A study of 346 young people attending raves in Vienna found that young
people who were regularly taking ecstasy and amphetamine considered the
psychological risks attached to taking drugs such as ketamine very high.

Information on chemical precursors

The precursors mainly used for illicit production of ketamine are cyclohexanone,
methylamine and chlorobenzene.

Information on the mode and scope of established or expected use
of ketamine as a psychotropic substance

Ketamine is often sold in a form which is indistinguishable from ecstasy,
although there are also reports of ampoules, liquid, powder and capsules.
The dose varies depending on the pattern of use and route of administration.
For example, at low doses ketamine is a stimulant, especially if it is sniffed
with amphetamine and/or cocaine or taken with drugs in the ‘illicit recreational’
drug scene. It may also be administered in intramuscular doses for a specific
ketamine experience.

A study of 100 ketamine users conducted by the Australian National Drug
and Alcohol Research Centre in the mid-1990s reported that there appeared
to be four primary user groups:

injecting heroin users;

members of the gay scene;

regular drug users in the ‘dance’ scene; and

‘self-exploratory’ people.

There have been no prevalence studies on ketamine use in Europe but there
is little evidence that it is abused on a wide scale. The anaesthetic properties
and unpredictable effects make it an unsuitable drug for widespread ‘going
out’ recreational purposes. These effects distinguish ketamine from MDMA
and are likely to prevent widespread dissemination of illicit ketamine use.

Numerous books and journal articles have been written concerning ketamine.
Information about its effects, supply and health risks are provided on the Internet.

Information on other use of ketamine and the extent of such use

The role of ketamine in producing psychotherapeutic effects, particularly in
relation to ‘near-death experiences’, is widely documented.

Drafted by Europol and the EMCDDA
17 March 2000

(5) However, as occurs with logos, drug users and suppliers in different countries may apply the
same synonym to different drugs, either mistakenly or deliberately. For example, in Australia, ‘liquid
ecstasy’ has been reported to be a synonym for ketamine, whilst in the United Kingdom it is a
synonym for GHB. In the absence of facilities for chemical analysis at user level, the significance
of a logo or a synonym is uncertain with regard to drug content. ‘K hole’ is a term used by conscious
consumers of ketamine to describe and locate the effects of the drug.

(6) Referring to Calvin Klein, the popular American designer.

 

Our valuable member Richard Dennis has been with us since Monday, 20 February 2012.

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