Constructive ways to discuss ketamine in the news

Three steps for a better dialog

It’s easy for proponents of anything exciting—let alone a promising treatment like ketamine therapy—to focus on just the positive. Some well-meaning proponents may even become dismissive of or hostile towards contrary views. What might have been an opportunity for enlightenment calcifies into resentment.

Don’t let this happen to you.

The next time you find yourself in a conversation discussing ketamine or ketamine therapy in the news, try the steps below.

1. See different vantage points

Ketamine is a widely-available drug with many different uses. So while someone may say that they understand ketamine, it may be just one perspective as illustrated in the parable about the blind men and the elephant. Here are some examples:

• Emergency and veterinary medicine: Ketamine produces an altered state of consciousness which some describe as feeling disconnected from physical sensations. For this reason, hospitals and medics use ketamine to relieve acute pain and suffering.
• Mental and behavioral health practitioners: Ketamine’s dissociative effects seem to relieve depressive symptoms. While the underlying mechanisms may not be fully understood, many people with mood disorders are finding significant relief using various forms of ketamine therapy. A growing number in this field have seen these benefits whereas others may have only encountered ketamine as a substance use disorder.
• Scientific community: Researchers like Gül Dölen suggest that related to their ability to create an altered state of consciousness, psychedelics (including ketamine) may reopen critical learning periods. These are temporary opportunities whereby new memories and behaviors can be formed. Ketamine is also an active area of brain research because it may boost levels of Brain Derived Neurotropic Factor or BDNF which is a protein associated with neurogenesis and synaptic plasticity.
• Recreational drug users: Ketamine may be best known as a party drug. Many people, especially in the UK and southeast Asia (and increasingly here in the US), seek ketamine for its profound dissociative experience. Some are also turning to ketamine for spiritual enlightenment and self-improvement.
• Law enforcement: Like all controlled substances, there is demand for an unregulated supply of ketamine. Unfortunately, the illegal drug trade is a constant threat to public safety and those sworn to protect it.
• Friends and family: Many people have learned about ketamine from a close friend or family member. They may have witnessed their partner undergo a significant transformation with ketamine therapy. Or they may have participated in an intervention with their son who developed a ketamine use disorder.

People are complex and may hold two or more perspectives simultaneously. And experiences, beliefs, and attitudes change constantly. Regardless, try and determine who you’re speaking with early in your conversation.

2. Listen to understand

Knowing whether your patient candidate is married to a DEA agent or ER doc is helpful but insufficient. This is because these perspectives are only heuristics: imperfect clues about someone’s actual knowledge, experiences, and beliefs.

The next step in having a meaningful conversation about ketamine or ketamine therapy in the news is to listen. Ask questions like the following in a non-judgmental way:

1. What do you know or believe to be true? Why?
2. What has been your experience with ketamine or ketamine therapy?
3. Why are you so passionate about this issue? And why now? (Assuming they hold a strong opinion and it’s not obvious why.)

People often rate the best conversations as ones where the other person was simply an active listener. That is, “good conversationalists” show interest with verbal and non-verbal cues, regularly confirm their understanding by restating key points, and attempt to make an emotional connection with the speaker.

3. Offer to share your perspective

Read the room. Sometimes people just want to be heard and are not actually interested in what you have to say. In fact, just being heard and not interrupted or lectured by someone—who they expected to—can be more influential than any facts and testimonials.

Otherwise, you may want to offer to share your viewpoint. Be subtle if you could be perceived as preachy. For example, “I read a similar article about ketamine misuse. For this reason, I believe anyone offering ketamine therapy should adhere to six common sense safety precautions.”

If explicitly asked to share your thoughts:

• Be humble and qualify your statements, eg, “From my experience, ketamine is safe and effective when….”
• Avoid extremes like always, never, and every.
• Don’t dismiss that ketamine can cause real harm, sometimes with deadly consequences, no matter how rare.
• If you must address a questionable point from earlier, avoid the urge to set the record straight. Instead, try one of the techniques below.

How to address specific events

Many headlines with ketamine are sensational. Unfortunately for reputable practitioners of ketamine therapy, the headlines are memorable too. Because of this, you may find it useful to respond to specific examples.

Let’s revisit some of the headlines from above.

Pete Davidson Has Been Using Ketamine to Cure Depression

Does Ketamine Therapy Get You High? The Miracle Drug

Headlines like these are cruel because they set unrealistic expectations for those who are the most desperate for relief. This can lead to disastrous outcomes when someone falsely believes ketamine therapy is their last resort.

Everyone is different and results can never be guaranteed for any treatment. Use this opportunity to emphasize the importance of setting realistic expectations and discussing alternative treatments when obtaining patient informed consent.

Mail order ketamine companies growing in California

‘Special K’ for breakfast: Ketamine infusion clinics for depression treatment

These headlines imply that ketamine is too easily accessible. Ketamine is a controlled substance. This means that it can only be administered or prescribed by a licensed medical professional who follows strict rules enforced by the DEA and some state agencies. Refocus this conversation to the complex challenge of providing access to psychedelic medicines.

Ketamine therapy for mental health a 'Wild West' for doctors and patients

Ketamine is in the spotlight thanks to Elon Musk — but is it the right treatment for depression?

Readers here might believe that ketamine therapy is an unproven fad promoted by tech-bro culture. While different forms of ketamine therapy are evolving all the time (which is a good thing), they all build upon a growing body of scientific research which demonstrates ketamine’s antidepressant effects. Invite skeptical interlocutors to search PubMed for “ketamine” or simply start with this list of citations.

Pilot in deadly hot air balloon crash had ketamine in system

This was a tragic accident made worse when several news outlets profited from foolhardy reporting. Initial crash investigation reports stated that the pilot had high levels of ketamine in his blood at the time of the crash which killed four and critically injured one.

A few days later—but after the vitriol washed across social media—it was found that the ketamine was administered after the incident. This may be a time to highlight ketamine’s use as an anesthetic and decade’s long appearance on the World Health Organization’s most essential drugs list.

Matthew Perry died of 'acute effects of ketamine'

Interest in ketamine surged when the coroner’s report implicated ketamine in this sad event. Also in the report but less surprising: coronary artery disease, buprenorphine, and water.

I’m no doctor but am certain that ketamine should not be combined with opiates (or any sedatives) or activities which require judgement or coordination. It cannot be overstated that psychoactive substances do not mix well with other substances or physical activities.

Ketamine: An alternative to police force or a silent killer

Practitioners all over the world, but especially in Colorado, were shocked to learn that an extremely high dose (possibly as high as 400-500mg) of ketamine was used by paramedics to subdue Elijah McClain. This was shortly after he was strangled using a technique called a carotid hold. Discuss: Was this an appropriate use of ketamine? If not, what changes should be made that protect first responders and the people they must help?

Ketamine Is Destroying Young People's Bladders

How ketamine became the UK's hidden campus killer

It’s no secret that when misused or abused, ketamine may cause lasting damage to livers, bladders, and brains. Illustrate safety precautions for ketamine therapy as well as illicit ketamine use. It may also be helpful to add the following context.

1. One government institute estimates that 1,519 college students suffer alcohol-related deaths each year in the US alone. Further, an astounding 500,000 students are unintentionally injured because of drinking. An additional 696,000 students are assaulted by another student who had been drinking each year based on data from 1998 to 2001.
2. The CDC states that 80,411 people died from opioid overdoses in 2021. That’s over 220 people every day. This shocking rate amounts to more than 1,000,000 opioid-related deaths since 1999.
3. For comparison, a 2023 analysis of 34 medical articles from around the world found 138 deaths from ketamine and its analogs. Only nine were attributed exclusively to ketamine or its analogs. The researchers also noted that one or more substances in addition to ketamine were found in 53% of the cases. Importantly, no overdoses or deaths were reported related to the use of ketamine as an antidepressant in a therapeutic setting.

Conclusion

Ketamine therapy practitioners and researchers are best situated to serve as the counterweight to sensational reporting. Whether speaking with prospective patients, friends and family, or members of the public, those with relevant qualifications and practical experience should listen to understand, acknowledge the potential for misuse and abuse, and offer to share nuanced perspectives.

Ketamine is just one kind of psychedelic that has shown promise for its ability to help people with debilitating mood and pain disorders. While we are seeing more and more interest in the healing potential of these substances, any misstep or change in public sentiment can reverse the trend like what happened in the 1970s.

And unlike with opiates—which have undeniable medical value despite their tragic consequences when abused—ketamine and other psychedelic medicines are unlikely to produce the significant financial incentives needed to support an army of well-fed lobbyists who can influence public policy.

Therefore, practitioners and researchers should serve as thoughtful advocates of ketamine, ketamine therapy, and psychedelic medicine in conversations big and small.

If you or someone you know is misusing ketamine or other substances, get informed and seek help near you. Call or text 9-8-8 (or visit Suicide & Crisis Lifeline website) if you are experiencing a mental health crisis.