Some Issues With Ketamine

Burned septums, "Bristol Bladder," lethal overdoses, and more

Clockwise from top left: David Cutler, Elijah McClain, Hunter Barr, Max Johnson, Jamie Britt, Jerica LaCour, Willard Truckenmiller, and Daniel Taylor.

The following is an excerpt from p. 212-217 of Chapter 4, “Mystical Medicine, Wicked Weapon: A Both/And Approach to Ketamine” from my new book, Drugism (2022):

[Note: This piece is lovingly dedicated to the memories of Elijah McClain, David Cutler, Willard Truckenmiller, Jerica LaCour, Jamie Britt, Hunter Barr, Max Johnson, and Daniel Taylor, all of whom lost their lives at the hands of the state by non-consensually administered ketamine overdose.]

In Chapter Three, we discussed D. M. Turner, who wrote The Essential Psychedelic Guide. Here we return to his story, for it tragically illustrates what can go wrong in the course of habitual ketamine use.

The Essential Psychedelic Guide was published in 1994. But Turner did not live to see the book become an underground classic. In January, 1997, he was found dead, submerged in water in his bathtub. A vial of ketamine sat next to him.^[i]

It is generally thought that Turner embarked on a New Year’s Eve ketamine trip on the final night of 1996. In his tub (perhaps hoping to mimic the effects of an isolation tank) he, it is believed, either settled too far into the water or somehow fell and drowned, presumably while high on ketamine. And based on the pharmacology of the drug, we can deduce a couple other possibilities: respiratory depression or cardiac arrest as a result of ketamine overdose.

Ketamine overdose can produce severe respiratory depression and/or cardiac arrest, both of which can be fatal.

Of all the effects which ketamine has been known to produce, probably the scariest are its ability to greatly reduce or stop altogether our breathing mechanisms and its ability to induce cardiac arrest. It seems quite possible that one of these played a role in Turner’s death, but we may never know for sure. We do know that Turner, like Marcia Moore and John Lilly before him, had developed an intense love of ketamine that drew him back to the drug repeatedly.

Unlike Moore or Lilly, however, Turner developed this love for ketamine while also maintaining a similar love of DMT. In the forward to a posthumous edition of The Essential Psychedelic Guide, there is an interesting comment from a friend of Turner’s. This anonymous friend explained that Turner, on multiple DMT trips, had received messages urging him to stop his ketamine use. Despite these prods from the DMT, he was unable to give up ketamine.^[ii]

Like anything else, drug or otherwise, ketamine can become an object of habitual use. This is clearly evident from the lives of John Lilly, Marcia Moore, and D. M. Turner. This is not an effect of ketamine per se but of life on Earth. However, there are a handful of adverse effects which are, most certainly, attributable to ketamine. What are they?

Adverse effects of ketamine:

• Even a moderate dose of ketamine can increase blood pressure and produce nausea and/or vomiting.^[iii] And because it is an anesthetic, if someone using it for recreational purposes takes just a bit too much, they can become temporarily paralyzed (as I can attest from personal experience; see start of chapter).

• Ketamine’s acidity can irritate and damage skin and cartilage in the nasal passages when insufflated. If it is snorted frequently for an extended period, the drug can burn a hole in of one’s septum, similar to cocaine.^[iv]

• Ketamine has been known to produce a specific kind of pain in the abdomen, dubbed “K cramps” by its victims.^[v]

• Excessive use can damage the kidneys.^[vi] (This is the case with many drugs.)

• Ketamine can also damage the bladder when used excessively. A particularly harrowing effect, it has in multiple cases necessitated bladder replacement and, due to its prevalence in UK drug scenes, has been dubbed “Bristol Bladder.”^[vii]

• Although ketamine has been used to treat seizures, it has also caused them.^[viii]

• As mentioned above, ketamine can induce respiratory depression and even stop the breathing mechanism altogether, particularly in high doses and when injected too quickly.

• Similarly, an overdose of ketamine may induce cardiac arrest.^[ix]

A brilliant harm reduction activist by the name of Mat Southwell devised a strategy that enables ketamine users to effectively mitigate these harmful effects which he calls the “K Check.” The K Check is wonderful for people who consume ketamine willingly, of their own accord.^[x] In recent years, however, cases of ketamine-induced respiratory depression and death have occurred increasingly in people who have not used the drug willingly, but have instead been given it against their will during encounters with law enforcement and emergency medical personnel.

State-sanctioned murder with ketamine

One study, published in July, 2021, examined more than eleven thousand cases in which ketamine was administered to people by emergency personnel outside hospital settings, all from the year 2019 alone.^[xi] (The actual number of people who received ketamine in such circumstances that year is likely even higher. The study does not claim to be comprehensive in this regard.) Its findings are disturbing, despite its authors’ attempt to downplay the issues which their own data reveals.

For example, the study found that 23% of the people given the drug experienced respiratory complications as a result. A similar study from Colorado which also examined cases of ketamine administration in 2019 found a comparable rate, 24%, of complications from the drug.^[xii]

In the first-mentioned study, 128 deaths were recorded following the administration of ketamine. Given the total number of cases studied, this represents a rate of slightly more than 1%. For every 88 people administered the drug, 1 died.

In the US, ketamine was administered by force to more than eleven thousand people by emergency personnel and police outside hospital settings in 2019 alone.

And yet the study’s authors work their magic with the numbers and conclude that the ketamine itself was actually only responsible for a mere 8 of the 128 recorded deaths, or 0.07%.  Based on this figure, they insist that patient mortality as a result of ketamine administration is “rare.”^[xiii]

But this 0.07% figure is misleading, as the actual rate of death following ketamine administration was 1.13%. So, what gives? Why does the study seem to minimize both the actual rate and the gravity of death as a result of ketamine administration? If we look, for a moment, at who wrote and published the study, the quagmire reveals itself.

The study was published in Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, or ACEP. Despite the name, ACEP is not a college, but a lobbying group that advocates for the interests of emergency physicians. Of the seven authors of the study, nearly all of them are current or former emergency physicians. Two of the study’s authors work at the University of North Carolina at Chapel Hill, the same campus where the Defense Advanced Research Projects Agency (DARPA) funds research on novel synthetic drugs for use in the military and general population.^[xiv]

For every 88 people administered the drug, 1 died.

The study is not unlike a report released by a police department who, accused of wrongdoing, investigates itself and finds itself innocent. Instead of police officers standing accused and “investigating,” it is emergency physicians. Now, don’t get me wrong—I have absolutely nothing against emergency physicians; quite the opposite. We desperately need them. However, we also need a third party, such as analysts or scholars who have no stake in the issue, to review the data at hand if we are to have serious, objective answers in this situation. More simply, we need accountability.

One of the many people who died in 2019 as a result of ketamine administration was Elijah McClain. It was McClain’s tragic story that propelled the issue into the headlines a year later when his case received media attention in the wake of nationwide protests against police brutality. Well-known and easily available, I will not repeat the heartbreaking details of McClain’s death here, out of respect for his memory and the wellbeing of his family.

Suffice it to say that it involved 500 milligrams of ketamine injected rapidly into the young and entirely innocent McClain.^[xv] A 500 milligram dose is more than three times what is required to fully anesthetize a 150-pound person.^[xvi] We also learned that when injected too quickly, ketamine is more likely to cause respiratory depression or cardiac arrest. And yet, such large, rapid doses are quite common when the drug is administered during arrests.

McClain was just one of many, many people who have been injected with ketamine during a police encounter. This state-sanctioned crime occurs across the US, from Colorado to Minnesota to South Carolina to Florida.^[xvii] If the above-mentioned studies are accurate, nearly one in four of the people who receive the drug experience respiratory complications as a result. And death is not, despite the American College of Emergency Physicians’ assurance, a rare occurrence.

Deaths from administration of ketamine in arrest scenarios occurred years before McClain and have continued to occur afterward. Even an off-duty deputy police officer has died as a result of ketamine administration during arrest. His name was Willard Truckenmiller, and in May, 2016, he was celebrating his 32^nd birthday at a bar in Fort Myers, Florida when he became unruly and was subsequently arrested and given 500 milligrams of ketamine. He suffered two heart attacks and died as a result.^[xviii]

In January, 2018, police in Colorado Springs, Colorado, encountered a woman named Jerica Lacour who appeared to be drunk and distressed. They used ketamine to chemically restrain her while verbally taunting her. Lacour, who already had alcohol in her system, experienced respiratory arrest and died shortly thereafter. She was 29 years old, and a mother of five.^[xix]

In October, 2019, the drug was administered to a man in Mount Pleasant, South Carolina named Jamie Britt who was changing his tire at the time. He had reportedly been seen urinating, a crime which evidently is severe enough to warrant death by lethal injection. Police and paramedics arrived and gave him a 500 milligram dose. Britt subsequently experienced respiratory complications and died shortly thereafter.^[xx]

In September, 2020, also in Colorado Springs, police administered a fatal dose of ketamine to a young man whose parents had called for emergency medical help. Hunter Barr was his name, and he was in the midst of an adverse reaction to a combination of LSD and cough syrup he had taken earlier. He was 26.^[xxi]

Earlier that year, in July, a woman in Minneapolis, Minnesota called 911 because her boyfriend was having a diabetic seizure. Paramedics arrived and administered glucagon (which, as we learned in Chapter Two, is a hormone that, along with insulin, regulates our glucose levels). They also called police. When the officers arrived, the man was injected with 500 milligrams of ketamine and 20 milligrams of Versed, the brand name for a benzodiazepine also known as midazolam. He had a heart attack, was hospitalized, and later died. His name was Max Johnson.^[xxii]

While the 500 milligram doses given to McClain, Truckenmiller, Britt, Johnson, and others were disturbingly high, paramedics have given even more than that to others. Just four days before McClain met his death, another young man named Elijah was given ketamine during an arrest, also in Colorado. But on this occasion, the man, Elijah McKnight, was given 750 milligrams over the course of multiple injections, just minutes apart, after being tackled and tasered several times.^[xxiii]

His crime? He was asleep at a bus stop. Miraculously, McKnight survived, although he did suffer a 3-day long coma in a hospital immediately following his arrest.

In many cases, ketamine has been used under the pretense that the arrestee suffered from something called “excited delirium.” Purportedly a condition in which people become uncontrollably wild and gain “superhuman strength,” “excited delirium” is, frankly, bullshit. It is not recognized by the American Psychiatric Association, who publish the Diagnostic and Statistical Manual of Mental Disorders which lists every diagnosable mental condition. “Excited delirium” is nothing more than a pseudoscientific excuse for cops to terrorize people.

In July, 2021, the state of Colorado halted the use of ketamine in arrests.^[xxiv] Two months later, the cops and paramedics who collectively murdered McClain were charged with homicide and manslaughter, among other charges.^[xxv] As of the time of this writing, the case is still ongoing.

Some of the victims and their families have received settlements for these injuries and deaths.^[xxvi] But no amount of money will bring any of them back to life, or undo the trauma they and their families have experienced. We should recognize these actions for what they are: state-sponsored crimes. The use of ketamine in arrest scenarios is a flagrant abuse of power, and has most likely occurred at least once as you have read this chapter.

Unfortunately, such instances are not the only times ketamine has been administered by those in positions of power with grave results. The drug has also been used by doctors to manipulate and abuse patients. The most notorious example is probably Keith Ablow.

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Endnotes

^[i] Jansen, 89.

^[ii] See “Foreword to the PDF Edition” by Forbidden Donut in Turner, The Essential Psychedelic...

^[iii] Kelly, The Little Book…, 36.

^[iv] Wright, “Ketamine: why not…” and 18:30-18:45 in Southwell, “K-Check.”

^[v] Jansen, 271.

^[vi] Wolfson and Hartelius, eds., 343.

^[vii] See 19:40 in Southwell; also Hatton.

The bladder issue seems to have been virtually unknown to the first generation or two of ketamine users. Marcia Moore makes no mention of it in her 1978 book, nor does the pseudonymous Kit Kelly in 1999’s The Little Book of Ketamine, nor does Jansen in Ketamine: Dreams and Realities, first published in 2000. Perhaps the bladder issue did not exist in earlier years; perhaps it relates instead to something about the way ketamine has been produced in recent decades.

To my knowledge, advanced chemical testing of street ketamine compared to pharmaceutical ketamine has not been done. If it has, it has certainly not been well publicized.  Do some batches of ketamine, perhaps those produced in uncontrolled settings (such as those of the Boshe cartel or the illicit labs in Myanmar and Pakistan) have a lower pH, making them more acidic and therefore more damaging to organs? Or perhaps they are made with chemical processes with leave trace residues of unknown contaminants which then irritate the body?

Interestingly, Mindbloom lists bladder issues as possible side effects of frequent ketamine use. See “Important FDA Safety Information,” a sidebar on https://www.mindbloom.com/the-medicine.

^[viii] Jansen, 271; Kim, et al, “Ketamine-induced generalized…”

^[ix] Kelly, The Little Book…, 36.

^[x] Southwell.

^[xi] Fernandez, et al, “Out-of-Hospital…”

^[xii] Gliha, “Sedated: The Problem…”

^[xiii] Fernandez, et al.

^[xiv] Information about ACEP was obtained from the following sources:

“About ACEP” at https://www.acep.org/who-we-are/about-us/

“American College Emergency Physicians: Annual Lobbying Totals: 1998-2022” at https://www.opensecrets.org/orgs/american-college-of-emergency-physicians/lobbying?id=D000000293

Information about the study’s authors was obtained from the following sources:

“Kenneth A. Scheppke, MD appointed as Florida’s State EMS Medical Director” at https://floridastrokecollaboration.org/wp-content/uploads/2019/05/Schepple-Florida-EMS-Director.pdf

“40 Under 40: Remle P. Crowe, PhD (ESO – Austin, TX)” at https://ambulance.org/2020/02/14/2020-40-under-40-remle-crowe-texas/

“Meet the Eagles” at http://useagles.org/meet-the-eagles-eagles/

“Antonio R. Fernandez, PhD, NREMT-P” at https://www.med.unc.edu/emergmed/directory/antonio-fernandez/

“J. Brent Myers, MD” at https://www.jems.com/author/j-brent-myers-md/ 

Information about DARPA-funded research at UNC Chapel Hill is from Eanes, “Why a UNC…”

^[xv] Hernandez, “Aurora police critically…”

^[xvi] Erowid, “Ketamine Dosage.”

^[xvii] Mannix, “At urging of…”; “Episode 13: Ketamine”; Nieberg, “Ketamine that’s injected…”

^[xviii] Cardona, “Lee deputy died…”

^[xix] Gliha; “Jerica Marie LaCour.”

^[xx] “Editorial: Public deserves...”

^[xxi] Gliha.

^[xxii] “After Encounter With...”

^[xxiii] Whitehead, “Man injected with…”

^[xxiv] Verlee, “From Bond Hearings…”

^[xxv] Sherry, “What The Indictiment…”

^[xxvi] Whitehead, “Man injected with…” and Franklin, “Aurora, Colo., will…”

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Sources

“After Encounter With Boyfriend Led To Administration Of Ketamine, Minneapolis Woman Accuses Hennepin Healthcare EMS And MPD of Racism.” CBS Minnesota WCCO, Aug 2, 2020.

Cardona, Alexi C. “Lee deputy died of brain injury after ketamine treatment for alcohol-induced delirium.” Naples Daily News, Dec 14, 2016.

“Editorial: Public deserves more answers on ketamine.” The Post and Courier, Dec 29, 2020.

“Episode 13: Ketamine.” Lethal Dose Podcast, Sep 29, 2021. https://www.youtube.com/watch?v=OIMtExYVC4s

Erowid. “Ketamine Dosage.” Feb 14, 2020. Online. https://www.erowid.org/chemicals/ketamine/ketamine_dose.shtml

Fernandez, Antonio R., Scott S. Bourn, Remle P. Crowe, E. Stein Bronsky, Kenneth A Scheppke, Peter Antevy, J Brent Myers. “Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality.” Annals of Emergency Medicine, 78(1):123-131. Jul 2021.

Franklin, Jonathan. “Aurora, Colo., will pay a $15 million settlement over the death of Elijah McClain.” NPR, Nov 18, 2021.

Gliha, Lori Jane. “Sedated: The Problem Solvers investigate the new ketamine bill, new research, and another death.” FOX31 Denver KDVR, Jun 30, 2021.

Hatton, Celia. “The Ketamine Connection.” BBC, July 10, 2015.

Hernandez, Esteban L. “Aurora police critically mishandled encounter with Elijah McClain before his death, independent report finds.” Denverite, Feb 22, 2021.

Jansen, Karl. Ketamine: Dreams and Realities. Multidisciplinary Association for Psychedelic Studies, Sarasota, FL. 2004.

“Jerica Marie LaCour.” Tribute Archive. https://www.tributearchive.com/obituaries/2869505/Jerica-Marie-LaCour

Kelly, Kit. The Little Book of Ketamine. Ronin Publishing, Inc., Berkeley, CA.  1999.

Mannix, Andy. “At urging of Minneapolis police, Hennepin EMS workers subdued dozens with a powerful sedative.” Star Tribune, Jun 15, 2018.

Nieberg, Patty. “Ketamine that’s injected during arrests draws new scrutiny.” The Associated Press, Aug 22, 2020.

Sherry, Allison. “What The Indictment In The Elijah McClain Case Reveals About His Deadly Encounter With Aurora Police.” Colorado Public Radio, Sep 1, 2021.

Southwell, Mat. “K-Check.” HIT Hot Topics 2012, Sep 20, 2012. https://www.youtube.com/watch?v=9ICkZjgw-fM

Turner, D. M. The Essential Psychedelic Guide. Panther Press, San Francisco, CA. 1994.

Verlee, Megan. “From Bond Hearings, Court Fees To Ketamine—Colorado Has A Lot Of New Criminal Justice Laws.” Colorado Public Radio, Jul 7, 2021.

Whitehead, Darren. “Man injected with ketamine reaches $115,000 settlement.” 9News, Nov 20, 2021.

Wolfson, Phil and Glenn Hartelius, eds. The Ketamine Papers: Science, Therapy, and Transformation. Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA. 2016.

Wright, Rachel. “Ketamine: why not everyone wants a ban.” BBC, Mar 13, 2015.

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