Ketamine is both a legitimate medical drug and a recreational street drug. It was synthesized in 1962, approved by the FDA in 1970 as an anesthetic, and is classified as a Schedule III controlled substance in the United States. Its ability to produce intense dissociative effects, including feelings of detachment from reality and the body, made it popular as a club drug starting in the 1990s. Today it circulates under street names like Special K, Kit Kat, Cat Valium, Super Acid, Vitamin K, and Jet.
How Ketamine Works in Medicine
In hospitals, ketamine is FDA-approved as an injectable anesthetic. It’s used as the sole anesthetic for procedures that don’t require muscle relaxation, as a way to start anesthesia before other agents are given, or as a supplement to other anesthetics. It’s considered especially useful in pediatric care, emergency departments, patients with lung disease, and battlefield medicine because it doesn’t suppress breathing the way many other anesthetics do.
More recently, ketamine has gained attention for treating severe depression. Intravenous ketamine at low doses (typically 0.5 mg/kg of body weight, far below anesthetic levels) produces rapid but temporary antidepressant and anti-suicidal effects in people with treatment-resistant depression. In 2019, the FDA approved esketamine, a nasal spray version of a closely related compound, specifically for treatment-resistant major depressive disorder. This medical expansion has contributed to ketamine’s growing visibility and availability.
What Street Ketamine Looks Like
On the street, ketamine shows up as either a white powder or a clear liquid in small vials. The powder is made by evaporating the liquid from pharmaceutical ketamine. Most recreational users snort the powder in small lines called “bumps,” with a typical street dose around 100 milligrams. It can also be mixed into drinks, smoked in marijuana or tobacco cigarettes, or injected.
Unlike many other street drugs, ketamine doesn’t typically change hands through traditional street-level dealing. According to the DEA, distribution usually happens among friends and acquaintances at raves, nightclubs, and private parties. Open street sales are uncommon. Much of the illicit supply is diverted from legitimate sources: pharmaceutical companies, hospitals, and veterinary clinics rather than clandestine labs.
How Common Is Recreational Use
Ketamine use in the U.S. is rising, though it remains far less common than drugs like cannabis or cocaine. Among U.S. adults, overall ketamine use prevalence increased from 0.11% in 2015 to 0.20% in 2019, an 82% jump. After a brief dip during the pandemic, it climbed again from 0.20% in 2021 to 0.28% in 2022, a 40% increase in a single year. The growing availability of ketamine through telehealth prescriptions and clinical treatment programs has likely blurred the line between medical and non-medical use.
The Dissociative High and “K-Hole”
People use ketamine recreationally for its dissociative effects: a sense of floating, detachment from the body, distorted vision and sound, and altered perception of time. At lower doses, users describe a dreamy, mildly euphoric state. At higher doses, users can enter what’s called a “K-hole,” a profoundly disorienting experience where they feel completely disconnected from their body and surroundings, sometimes described as a near-death or out-of-body experience. The effects come on within minutes when snorted and last roughly 45 to 90 minutes.
Risks of Regular Use
The most distinctive long-term risk of frequent ketamine use is severe bladder damage, sometimes called ketamine bladder syndrome. Chronic users can develop an ulcerative inflammation of the bladder lining that causes intense pain, constant urgency to urinate, blood in the urine, and incontinence. In the largest study of this condition, 59 heavy users in Hong Kong developed ulcerative cystitis with shrunken, contracted bladders. The damage can extend beyond the bladder itself. Some users develop obstruction of the tubes connecting the kidneys to the bladder, tissue death in the kidneys, and eventually kidney failure.
People who use ketamine less frequently may notice milder symptoms that feel like a urinary tract infection, including burning and frequent urination. Many don’t connect these symptoms to their ketamine use, which means the damage can progress before they seek help.
Beyond the bladder, regular recreational use carries risks of psychological dependence, memory and cognitive problems, and dangerous sedation. Combining ketamine with alcohol or other depressants increases the chance of losing consciousness, vomiting while sedated, and breathing problems.
Purity and Contamination
Because most illicit ketamine is diverted from pharmaceutical sources rather than cooked in underground labs, it tends to be less adulterated than drugs like cocaine or heroin. Research on street ketamine has found relatively little cutting. One study of ketamine powder collected at London nightclub door amnesty programs found caffeine in five of nine samples, but serious contamination was uncommon. Interestingly, ketamine itself is more often used as an adulterant in other drugs: it’s frequently found mixed into pills sold as ecstasy or cut into methamphetamine.
That said, the illicit drug supply is unpredictable. Any powder purchased without pharmaceutical packaging carries some risk of contamination, and the consequences of unknowingly ingesting fentanyl or other potent substances in a mislabeled product can be fatal.
Legal Consequences
Ketamine sits on Schedule III of the Controlled Substances Act, which means it has accepted medical uses but also recognized potential for abuse. Schedule III is a lower tier than drugs like heroin (Schedule I) or fentanyl (Schedule II), but possessing or distributing it without a prescription is still a federal crime. Penalties vary by state, but federal civil penalties for distribution-related offenses can reach nearly $471,000 after recent inflation adjustments. Possession charges in most states can result in fines, probation, or jail time depending on the amount and local laws.