What ketamine is

Ketamine is a dissociative anesthetic used medically for anesthesia and pain management. Recreational use carries risks involving consciousness, coordination, bladder health, and mental stability.

Before anything: key safety principles

• If you have a history of psychosis, schizophrenia, severe anxiety, or heart conditions, ketamine use can be particularly risky.
• Never use alone. Have a sober sitter.
• Avoid using if you’re in an unsafe environment.
• Avoid mixing with alcohol, opioids, or other depressants due to increased risk of respiratory problems and accidents.

About purity and quality (non‑facilitating guidance)

You cannot reliably judge purity by appearance alone. Safer approaches include:

• Use a drug‑checking service if one exists in your region.
• Use reagent tests that can detect some adulterants, although they cannot confirm purity or complete safety.
• Be cautious with unusually potent or weak effects, unusual odors, or colors—these can indicate contamination.

First‑time harm‑reduction guidance (non‑specific)

• Have a sober sitter who stays with you the whole time.
• Start with the lowest possible amount and wait at least an hour to understand how you react. Everyone’s sensitivity varies widely.
• Sit or lie down when the effects begin—coordination and balance may collapse suddenly.
• Do not use near water, balconies, traffic, stairs, or anything that could be dangerous if you dissociate or fall.
• Keep hydration normal but avoid excessive drinking.

What to expect

• Dissociation, altered body perception, visual distortion, and changes in time sense.
• Slowed physical movement and reduced pain perception (which increases accident risk).
• Possible nausea and vomiting.
• After‑effects like dizziness, fatigue, or cognitive fog.

Bladder and long‑term risks

Repeated or heavy use can cause:

• Severe bladder irritation
• Urgency and pain
• Difficulty urinating
• Long‑term damage that can become permanent

Reducing frequency and avoiding binges lowers risk.

Red flags when you should seek medical help

• Chest pain or persistent rapid heartbeat
• Inability to stay conscious
• Seizures
• Confusion that lasts more than a few hours
• Severe abdominal or bladder pain

Safer‑environment checklist (harm reduction)

• Choose a calm, familiar indoor space with soft lighting.
• Remove hazards such as candles, sharp objects, clutter, or things that can be tripped over.
• Have water available, but avoid over‑hydration.
• Keep a fully sober sitter present for the whole duration.
• Ensure phones are charged and emergency numbers are accessible.
• Prepare a comfortable spot to lie or sit (pillows, blankets).
• Avoid balconies, stairs, traffic, bathtubs, and bodies of water.
• Agree in advance on boundaries, communication signals, and what the sitter should or should not do.
• Plan the rest of the day and next morning to avoid responsibilities while under after‑effects.
• Avoid mixing with alcohol, opioids, or other depressants.

How to care for someone using ketamine (non‑facilitating, safety‑only)

General supportive care

• Stay calm, quiet, and reassuring. Sudden noises or fast movements can be disorienting.
• Speak slowly and softly; people may have difficulty processing speech.
• Help them stay seated or lying down to avoid falls.
• Offer water occasionally but do not pressure them to drink.
• Keep the environment dim and low‑stimulus.
• Respect their space unless they are unsafe.
• If they want to change position or go somewhere, help them move safely.

If they become anxious or confused

• Ground them gently: mention where they are and that they’re safe.
• Use simple, short sentences.
• Encourage slow breathing by breathing calmly yourself.
• Avoid arguing with or challenging unusual perceptions.

If nausea or vomiting occurs

• Turn them onto their side to reduce choking risk.
• Keep a bowl or towel nearby.
• Do not leave them unattended until they are fully responsive.

Warning signs requiring medical help

• They cannot be awakened or are barely responsive.
• Rapid, irregular heartbeat or chest pain.
• Severe confusion that does not improve.
• Seizures.
• Continuous vomiting or signs of dehydration.
• Severe bladder or abdominal pain