Ketamine is a widely used medication with applications in anaesthesia, pain management, and, more recently, psychiatric treatment. However, myths about ketamine regarding its safety, legality, and effects persist. The purpose of this article is to clarify common myths with scientific evidence.
Page last updated:
Wednesday, 26 March 2025
Contrary to popular belief – ketamine is a legally approved medication. In the United States, it has been FDA-approved as an anesthetic since 1970 (Domino, 2010). It’s classified as a Schedule III controlled substance, meaning it has recognised medical uses but also potential for misuse (DEA, 2020).
In the UK, while it was reclassified in 2014 from a Class C to a Class B drug due to concerns about recreational use, it remains legally available for medical purposes (Home Office, 2014). Plus, its off-label use in treating psychiatric conditions, such as treatment-resistant depression, is gaining widespread recognition (McIntyre et al., 2021; Duman et al., 2019).
Ketamine is, in fact, used on a daily basis in hospitals around the world. It’s an essential anesthetic, especially in emergency medicine and pediatric surgeries, thanks to its safety profile and its ability to maintain airway reflexes (Sinner & Graf, 2020). Ketamine infusions are also becoming a go-to treatment for individuals battling treatment-resistant depression and acute suicidal thoughts (Zarate et al., 2019).
Fact: Ketamine dosing is far from one-size-fits-all. Factors like body weight, metabolism, and the condition being treated all play a role. For anaesthesia, a typical intravenous dose ranges from 1-2 mg/kg. However, for psychiatric treatments, much lower doses are used—around 0.5 mg/kg over 40 minutes for depression (Sanacora et al., 2017).
Fact: The way ketamine is administered matters. Different methods of administration—like intravenous (IV), intranasal, intramuscular, and oral—result in different levels of absorption. IV administration gives near 100% bioavailability, while other forms, like the FDA-approved esketamine nasal spray for depression (Spravato), have a bioavailability of about 48% (Daly et al., 2018). So, not all forms are equal in how they affect the body (Morgan et al., 2018).
Fact: While ketamine’s use in psychiatry is a hot topic these days, it’s far from a new drug. Originally synthesised in 1962 (Domino, 2010), its antidepressant effects were first noted in the early 2000s (Berman et al., 2000). Over the years, studies have shown ketamine’s rapid-acting benefits for depression (Wilkinson et al., 2017), making it a promising tool in treating mental health conditions.
Fact: Ketamine is well known in the veterinary world, but it’s also widely used in human medicine. Though the formulation and dosing might differ between humans and animals, the drug’s dissociative and analgesic properties are leveraged in both settings (Wax et al., 2022).
Fact: This couldn’t be further from the truth. Illicit ketamine is often contaminated with other unknown substances, which can increase the risks of adverse health effects. Studies have found that street ketamine often contains harmful impurities (Sindicich et al., 2019). On the other hand, medical-grade ketamine is manufactured under strict pharmaceutical regulations, ensuring its purity and consistency.
Fact (but Needs Context): Ketamine can be misused – but it’s not as addictive as opioids or benzodiazepines. Unlike those substances, ketamine doesn’t impact the brain’s dopamine or GABA systems in the same way, which lowers its potential for physical dependence (Morgan & Curran, 2017). However, psychological dependence can develop, especially with frequent recreational use (Schak et al., 2016). Additionally, high doses used for recreation have been linked to ketamine bladder syndrome, a painful condition that can cause long-term urinary damage (Wood et al., 2020).
Ketamine is an essential medical tool with a growing list of uses in anaesthesia, pain management, and psychiatric treatments. While many myths persist, scientific research continues to shed light on its safety, efficacy, and proper use. As ketamine-assisted therapies become more mainstream, it’s important to clear up these misconceptions to reduce stigma and promote informed decision-making.
By understanding the truth about ketamine, we can better navigate the complex landscape of this drug, appreciating both its medical potential and the need for proper oversight.
