Ketamine washed my thoughts away. It was quite a feat, really. Fifteen years living with post-traumatic stress disorder (PTSD), 10 of those addicted to heroin, had left my mind a chaos of unregulated, unwanted, constant noise. Anxiety and depression and memories. Translation: distress, distress, distress. And the storytelling. Everything is a story to a writer—and I mean everything.
Hornets and hummingbirds and other buzzy things with wings are energy movers, keeping the flow going. Cats are interdimensional travelers who bear secret messages of the multiverse if you learn how to listen. All those 20-something white boys who look and act alike were actually grown in a lab. Lady bluehair who glared me down on the bus that one time, the whole way to the Port Authority, just because I tripped on her shoe, she’s probably still sitting around thinking how much she loathes me. And that guy I like who didn’t text me back for three days… Wait, no; even then, I knew better than to go down the rabbit hole of that storyline.
Point being, forget New York; my mind was the city that never sleeps.
Until ketamine.
I wasn’t taking it for that purpose. I also wasn’t taking it just to get high, though I have in the past. On the particular occasion when ketamine first taught me how to quiet my thoughts, I was taking it to help me get off buprenorphine.
I didn’t have a bupe prescription and was winging it at home with a regimen of illicitly hoarded supply.
Buprenorphine, the main ingredient in Suboxone and Subutex, is a partial opioid agonist prescribed to mitigate withdrawal and reduce cravings in people who are addicted to opioids. Ketamine is a dissociative anesthetic with psychedelic properties that is commonly used in veterinary medicine. It has more recently begun to be prescribed for the treatment of various mental health conditions.
I’d been on and off buprenorphine for several years to treat what was then a recurring addiction to heroin and fentanyl. But at the time I first tried ketamine to help minimize withdrawal, I didn’t have a bupe prescription and was winging it at home with a regimen of illicitly hoarded supply.
The reason for that? The abysmal state of addiction care in the United States, overrun by abstinence-based modalities that rely on punishment as enforcement and an obsession with watching patients urinate, left me unwilling to ever set foot in a medical establishment again. As proof of my resolve, I still have part of a needle in my thigh that broke off when I was injecting three years ago.
When I decided to get off fentanyl in January 2021, I relied on buprenorphine I’d stashed from my last script. Which meant my supply was limited. Over the course of about eight months, I tapered myself down to a quarter-milligram of buprenorphine and jumped off from there. A therapeutic dose of buprenorphine ranges between 8 and 24 milligrams, so a quarter-milligram is low. But buprenorphine is a powerful chemical. There would still be withdrawal.
That’s where ketamine came in.
Even when I first began injecting heroin 10 years earlier, I’d heard from fellow users that ketamine could be used to dampen the symptoms of withdrawal, but it wasn’t something I’d ever much looked into. At the time, I was using opioids to put distance between myself and the PTSD, which I developed as the result of a physically and sexually abusive relationship when I was a teenager. I wanted to get away from the overwhelming feelings and memories. A psychedelic experience sounded like the last thing I needed.
Turns out, I was really wrong about that.
Ketamine is a Schedule III drug in the United States, which means it is considered to have “moderate to low potential for physical and psychological dependence” or “abuse,” and can be legally prescribed by licensed physicians. Currently, ketamine is FDA–approved for anesthesia, while Spravato (esketamine)—a ketamine-derived nasal spray formulation—is approved for treatment-resistant depression. But physicians are also able to prescribe ketamine for off-label uses. In some cases, that includes substance use disorders (SUD).
“I worked in conventional treatment models for eight years, I was the clinical director of a residential treatment center … [but] I got frustrated with relapse rates,” Craig Salerno, a psychotherapist with a practice in Boulder, Colorado, told Filter. He now provides counseling services for ketamine patients. “When I moved to private practice and started using psychedelics in the healing and recovery of addiction … it was super effective. I am seeing great results. It’s been pretty magical.”
In Salerno’s practice, oral ketamine lozenges are prescribed by a doctor and self-administered by the patient during a therapy session. This, according to Salerno, can help give patients perspective on their addiction and deeper understanding about issues they may be struggling with.
“[Clients use] the altered state and ketamine experience to do deep work and get new angles … Even if we don’t do therapy, ketamine tends to instigate spiritual experiences and shift perspectives,” Salerno said.
More commonly, ketamine is prescribed for treatment-resistant depression.
“Successful treatment is when people’s emotions become appropriate for the world around them. Nothing about ketamine makes you feel good when you wake up in the morning. It makes you feel ‘normal.’”
“Well over 90 percent of all medical research for ketamine has focused on depression, bipolar disorder or suicidal thinking,” Dr. Nicolas Grundmann, medical director of New York-based ketamine treatment provider Ember Health, told Filter. Ember Health gives patients with depressive disorders intravenous infusions of ketamine.
“What’s important to tease apart is that most people dealing with depression also deal with something else like trauma, substance use, etc, and those clients are perfectly appropriate to proceed with care,” Grundmann said. But he noted that the vast majority of research around ketamine for mental health has not focused on conditions like SUD or PTSD.
Studies have shown, he continued, that over a certain number of visits, IV ketamine “triggers a regrowth of neurons in the emotional reward system of the brain, and triggers what feels like a reset of the person’s emotional reward system.”
“Successful treatment is when people’s emotions become appropriate for the world around them,” Grundmann said. “Nothing about ketamine makes you feel good when you wake up in the morning. It makes you feel ‘normal.’”
Some studies have shown initial promise for ketamine as a substance use disorder treatment. More research would be welcome, but there appears at least to be a strong evidence base that ketamine is helpful for many of the issues faced by people with SUD, including myself.
Of course, I did not have access to a ketamine prescription. Even if I had sought one, I would have been unlikely to get it to aid in buprenorphine withdrawal—despite some evidence that ketamine is effective at reducing the intensity of opioid withdrawal. Even Salerno admitted that SUD patients typically have to detox in order to get their script, prior to coming to him for ketamine therapy.
My ketamine experience was therefore likely very different from those of Salerno and Grundmann’s patients. I had to use a non-medical-grade, illicit-market supply that I dosed out myself and put up my nose. Which, I gotta admit, was kinda fun.
Achieving that feeling was also quite the feat. There’s nothing fun about opioid withdrawal. Even withdrawing from a low dose of buprenorphine involves chills, restlessness, insomnia, anxiety and a general sense of ennui—still a considerably milder experience than withdrawal from heroin or fentanyl.
Without a prescription, prescriber, or any kind of guidebook besides the general street advice that “ketamine helps,” I didn’t know how often to dose, or how much. I basically just did a line whenever those symptoms started to get too uncomfortable.
And then, before long, the feeling that I wanted to crawl out of my skin was replaced by the sensation that I was a note in the song that was playing on my phone, a note in the song of my life, of the universe. My body felt numb and peaceful and undisturbed, but I could still feel myself. Which made me acutely aware that my “self” wasn’t my body. There was another part of me, a flowing, tingly energy that existed both within and beyond the opioid-dependent body laying in the bed. I felt my connection to everything, like my energy had become elastic, winding and stretching across my surroundings. I felt that I was someone powerful, whose place on this planet actually mattered. I hadn’t felt that in a long time. Maybe never.
Eventually, the stories stopped entirely. The visions, the background noise, that interminable negative storytelling, all of it.
The stories didn’t stop right away, but the ones that came to me were a lot of fun. I saw strange, brilliant flowers growing in stacks on a planet populated by humanoid cat people who communicated telepathically using gold crowns that hung over their foreheads. I saw a glowing carnival populated by blue-skinned magicians and many-armed dancers. At one point, the room around me dissolved into an electronic grid of symbols, like a scene from The Matrix, except that instead of binary, the symbols were some kind of intricate, alien language.
Several months later, a friend would describe having almost the exact same vision during an ayahuasca ceremony. Maybe that’s a real place. Maybe they all are.
Eventually, the stories stopped entirely. The visions, the background noise, that interminable negative storytelling, all of it. Leaving me with just peace.
That didn’t last forever, but the impacts on my life have continued ever since. Ketamine brought me from a place of pain and unease to a place of connection and calm. It gave me access to the space between my thoughts, and helped build a roadmap toward that place again—something I still use now, a year removed from buprenorphine and almost two years off IV opioids. It quieted the stories in my mind that tormented me, and opened doors to new stories.
It was certainly not a cure for any of the mental health issues that led to my addiction, but it opened something necessary within me, and helped get me through the pain of withdrawal without opioid cravings or returning to use.
I won’t credit ketamine with all the immense changes that have taken place within myself over the past two years, arguably the biggest of which is that I never experience opioid cravings. In the past when I had periods of sobriety, they were always heavy with the desire to use again at some point. I would have to use thought exercises like “playing through the tape,” reminding myself that opioids are unmanageable for me and eventually lead to chaos, addiction and withdrawal. Now, I just don’t want to feel the effects of heroin anymore.
There have been much bigger contributors to that than ketamine. But it was certainly a medicine that acted as a stepping stone. For that, I will be forever grateful.
Photograph by Ajay Karpur via Unsplash