DRUGS

Is The Cost Of Legal Ketamine Driving People To Black Markets?

It's unclear whether ketamine helps with depression. But that hasn't stopped Josh from turning to the black market, desperate for a chance at relief.
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(Illustration: R. A. Di Ieso)
Feb 28, 2016 at 5:17 PM ET

Ketamine, a painkiller often known by its street name “Special K,” is being heralded as a potentially lifesaving treatment for the chronically depressed. But as clinics across the country begin to offer costly ketamine infusions to patients with treatment-resistant depression, some depressed individuals—desperate for relief but unable to shoulder the costs of legal infusions—are self-medicating with illegally purchased doses of the drug.

The illicit treatment has gotten Josh, a 28-year-old IT expert working in the San Francisco Bay area, out of his share of tough spots. “I’ve had some serious issues. I had legal issues; I was really stressed. I wasn’t suicidal, but at a point where I was feeling really bad and hopeless,” Josh, who declined to give his last name, told Vocativ in a phone interview. “I found it helpful, basically, to kind of get me up and functioning. The traditional medicine wouldn’t really help.”

Whether to combat illness or optimize performance, humans continually seek out new ways to “rewire” the brain. This impulse, and its implications, is explored in the sixth episode of DARK NET. The ground-breaking, new eight-part docuseries—developed and produced by Vocativ—airs Thursdays at 11 p.m. ET/PT on SHOWTIME.

The FDA first approved ketamine as an anesthetic in 1970, and categorized it as a Schedule III controlled substance, in the same family as anabolic steroids and Tylenol with codeine. But ketamine soon developed a reputation as something else entirely: a party drug, “Special K.” Ravers, among others, snort the substance so that they can party harder and longer, while waves of euphoria and an odd detachment wash over them and mix with the music. High doses can cause elaborate hallucinations.

“The traditional medicine wouldn’t really help.” — Josh

But recent evidence has shown that ketamine may also help with severe depression that does not respond to conventional treatments. Under a physician’s supervision, almost any prescription drug may be used “off label”—that is, for a legitimate application beyond its FDA-approved use. Off-label ketamine for depression is legal, and cautiously supported by some scientific evidence, including a slew of mouse studies. In one (admittedly small) human study conducted in 1999, seven subjects with severe depression showed marked improvement over a placebo group 24 hours after receiving ketamine infusions. More recently, a larger meta-analysis of seven separate trials found that ketamine produced an “antidepressant effect,” but only for a matter of hours or days. A much larger trial is currently recruiting participants.

Although the benefits and risks of off-label ketamine use will remain unclear until scientists complete large-scale clinical trials, physicians have already begun to open clinics across the country, offering small doses of the drug through sterile IVs.

Although one of the main complaints of ketamine researchers is that there is still not one defined course of treatment for the drug, one New York-based clinic advises a total of six infusions within a twelve-day period, followed by a so-called “maintenance program” that allows patients to return for a single booster infusion at any time they feel necessary, with most patients choosing to return for boosters within three to four weeks. Although the doses are seldom high enough to cause true hallucinations, patients often experience mild dissociations that stop within 15 minutes of ending the infusion.

“It was like being on a slow roller coaster in the dark, floating through space, and having abstract thought processes about life’s biggest questions.” — Justin

According to Dennis Hartman, founder of the Ketamine Advocacy Organization, the high cost of ketamine treatment isn’t due to the expense of the drug itself, which is readily available in generic form and “cheaper than a bottle Aquafina water,” but rather the cost of the doctor’s time (infusion treatments typically run two to three hours). Due to the expensive monitoring process, a single treatment can cost up to $1,000, and is not covered by insurance, likely because ketamine has not been FDA approved for treatment of depression.

Justin, 27, a freelance graphic designer diagnosed with clinical depression and anxiety, described his visit to a legal ketamine clinic in a Reddit conversation with Vocativ:

The infusion starts with a sedative, hits like a truck and makes the world spin a bit, but calms you down. After about 10 minutes the effects of the ketamine begin. I would close my eyes and put on ambient / atmospheric music and relax. It was quite an out of body experience, and very difficult to describe. It was like being on a slow roller coaster in the dark, floating through space, and having abstract thought processes about life’s biggest questions. No worry in the world during the infusions … I feel almost “reset” and have had more positive days than negative, and recovering from a low seems easier. It’s by no means a “miracle cure” but it has helped me.

On the street, a gram of Special K can cost as little as $10. Combine that with the far greater expense at clinics using the drug to treat severe depression, and there’s potential for disaster.”It’s expensive to get the treatment, so I did some research on it and basically dosed myself,” Josh says. “It wasn’t in a recreational context—I was curious to see if it would help.”

“When I finally acquired it, I think it was a dose of 250 or 500 milligrams, and I just put it in my gums and swallowed.” — Josh

Josh says that he attempted to manage his depression through legal means before turning to ketamine. “I’ve tried antidepressants, and they’re really not helpful, and some natural treatments like getting enough sleep, exercise, nutrition, meditation, those types of things,” he says. When Josh read about ketamine online, however, he resolved to try some of the controversial treatment himself. Unable to afford a trip to his local ketamine clinic, around three years ago Josh turned to the Dark Net and DeepDotWeb, a news site that reviews Dark Net markets, and managed to buy half a gram of Special K,which he says cost him barely $30.

From there, Josh scoured online forums, peer-reviewed studies and Erowid.org, a website that describes some of the science behind psychoactive substances. “When I finally acquired it, I think it was a dose of 250 or 500 milligrams, and I just put it in my gums and swallowed,” he says. Josh tried self-dosing around five times, he says. The experiment did not always go well. “I had some bad reactions sometimes,” Josh says. “But when the effects wear off, typically in an hour or so, you’re kind of more awake, and you feel a little bit better. And you notice improvement in the next couple of days—you’re able to deal with stress better.”

Scientists suspect that ketamine helps with depression by binding and blocking NMDA receptors in the brain. This likely sets off a cascade of events in the body, forming some proteins but stunting others, and ultimately increasing production of one protein called BDNF, which may play a role in managing depression. Most of these theories, however, have been gleaned from mouse studies and other small-scale research initiatives.

Of course, snorting or swallowing illegal rave drugs is not exactly safe, and illegal ketamine users like Josh are likely playing with fire. Physicians have warned that chronic, unsupervised ketamine use can cause permanent bladder damage—occasionally so serious that the bladder must be surgically removed and replaced with an external urine bag for the rest of the patient’s life—as well as cardiac problems. In doctor-facilitated ketamine infusions, the dosage is likely far below the threshold of bladder damage. And then there’s always a question of drug purity. When you buy Special K on the street, it’s difficult to ensure that the product will contain only ketamine and no adulterants, or even to ensure that it will contain ketamine at all.

Josh says that he is aware of the risks inherent in self-medicating with street drugs. But he maintains that even the temporary relief offered by ketamine makes it worthwhile, especially for those suffering from potentially life-threatening depression who cannot afford to pay for legal treatments.

“Depression is a pretty serious disease, and there aren’t really effective treatments for it,” he says. “I wouldn’t tell anyone to do anything, but I would say that, if they’re desperate, it’s useful and it works.”