Is ketamine legal in some places

The Charité researches ketamine

Friday evening. Five people in their twenties are sitting in the shared kitchen of an old building in Prenzlauer Berg. Later they will stagger together through the Berlin night until they are unable to move. One of them, Mara *, a student, athletic type, puts fine lines of white powder on a mirror with a big grin on her lips. The start of the evening: with ketamine. Mara draws one of the lines through her nose.

Mara first used ketamine when she was 17. Suddenly it tingled everywhere. The result was a fit of laughter. A knife tip of the powder was sufficient for this condition. Today she needs more. “There are phases when I take Keta every weekend because it's a real challenge. When you dance, your body is pulled back and you have to fight it, ”she says. Mara now takes half a gram per weekend. The body quickly develops tolerance to the substance. The trips often do not even last an hour, then Mara has to refill. After all, the ebb of the intoxication is more pleasant than with other party drugs.

The anesthetic, synthesized for the first time in 1962, which can put both animals and humans into a kind of comatose sleep, is firmly anchored in Berlin's nightlife. Many take it in small doses after partying to counteract the stimulating effects of other drugs. Others are primarily looking for the dissociative effect of the substance. Because it separates body from mind, the world seems unreal, out-of-body experiences are possible. K-Hole is the name given to the condition shortly before fainting: similar to a near-death experience. Now the drug is to be given a new purpose in Germany: as a miracle cure for depression.

30 Berliners get ketamine legally

As early as 2006, 18 severely depressed people were injected with ketamine at the Institute of Mental Health in the USA, the world's largest research center for mental disorders. After a short time, the symptoms subsided. Ketamine blocks the NMDA receptors in the central nervous system, which could be a binding site for glutamate. Glutamate dysregulation plays a role in depression, that much is known. The exact reasons for the potency of the drug in depressed people have not yet been clarified.

Malek Bajbouj from the Center for Neurology, Neurosurgery and Psychiatry at the Berlin Charité wants to change that. He has been working with ketamine for several years. There are currently 30 subjects in treatment. How often and in how high a dose the drug is administered to them remains a secret. "In a third of the patients the effect starts immediately, in a third with a delay, and the remaining patients feel nothing," he describes his observations. Not a bad quota for an antidepressant.

Love of life for potential suicides

The study will expire at the end of this year, and the next one will start in September. So far, Baibouj has been optimistic: "If it is administered in a suitable setting, it definitely has a future in the treatment of depression." In the USA there are already around 20 centers in which mental illnesses are treated with ketamine.

The first ketamine practice opened in Germany a year ago. Frank Mathers is the name of the doctor who began in Cologne as the first in Germany to treat people with severe depression with ketamine. Today he is speaking in a Wilmersdorf conference room. The stocky man with an American accent is an anesthetist and teaches dentists how to use nitrous oxide. He has now administered ketamine as an antidepressant to around 50 patients between the ages of 24 and 80. "People come to me who have already been treated as inpatients, who have attempted suicide and who do not work with conventional antidepressants," he explains. “After consultation with the treating psychiatrist and a detailed anamnesis, the therapy begins.” But not everyone is suitable for treatment with ketamine: In people with anxiety disorders, psychoses or schizophrenia, the drug can intensify existing symptoms.

More drugs that are medication

Marijuana:
In Germany there are around 270 sick people who can get weed with a special permit from the pharmacy. It helps against pain, epilepsy, asthma, Tourette and some other diseases.

Nitrous oxide:
Like ketamine, nitrous oxide is used as an anesthetic. Inhaling the gas results in a brief, euphoric high that lasts for up to two minutes.

Codeine:
The cough suppressant, an opiate like heroin, has been abused as a drug in the US rap scene and gang culture for years because of its relaxing effect. The wave has now also spilled over to Germany.

Ritalin:
Children with AD (H) D disease are often treated with Ritalin. But students and partiers also use the drug to stay awake or focused. In high doses, Ritalin has a psychedelic effect, but at the same time it can lead to circulatory collapse and respiratory paralysis.

Mara has not yet had any negative experiences, but knows some people who were undoed by ketamine. They had psychoses, became paranoid, isolated themselves from society and often ended in withdrawal. "I think keta should only be used by people with a solid personality," recommends Mara. Then her face darkens: “The worst thing I find is when guys give too much ketamine to little girls with no drug experience. They don't get along anymore. ”In the worst case scenario, they end up in the hospital.

Despite their years of experience with ketamine, pioneers like Mathers are breaking new ground. He injects the patient about 0.5 milligrams of the active ingredient per kilogram of body weight. If the medication does not work after the second session, it is not advisable to continue therapy. Otherwise, it will continue as needed. Distances and exact dosages vary from type to type - according to gut instinct. But what exactly changes with ketamine therapy? “A successful businessman came to me once, depressed for a long time, stuck in everyday life. After a session, he suddenly had the thought of meeting his son again. Later he also wanted to see his son's girlfriend. So it kept developing. Ketamine pulls depressives out of their routine and gives them new ideas, maybe even solutions. "

180 euros per intoxication

These solutions cost 150 to 180 euros for patients per session. The registers don't pay. That is why Mathers does not see ketamine as an alternative to conventional antidepressants: "It would be more important to develop a pill that, like ketamine, blocks the NDMA receptors, but does not allow the patient to fall halfway into a coma." Many psychotherapists are afraid of using the drug to work “because they are not familiar with it and fear respiratory depression or fainting. In case of doubt, you should always involve an anesthetist with experience who has all the necessary equipment ready. "

According to Mathers, ketamine will not be the new savior for those who are depressed. Research with the drug could be a way to find effective alternatives. The recreational consumers will still use the original. How worrisome is it to use ketamine as a drug? Mathers grins. "I'd rather not say anything about that."

* Name changed