Talk:Ketamine/Archive 2

Out of Body..........
I would say that the out of body experience description is accurate in that when I was a novice user in my teens I had originally thought that Ketamine would put me to sleep. After having insufflated (snorted) a dose of approximately 0.5 grams of very pure substance (Ketaset), I and my companion experienced an intense experience where the room appeared to take the shape of a bowl which consisted of a maze of circuitry in which we were embedded, and left outside ourselves to view the two of us in this condition.


 * I have used the ketamine drug intensively and have found most of the experiences described here to be true. Playing video games (quite difficult) and watching TV also brings about interesting effects from the drug. An increased empathy/identification with the characters and a looser dividing line between real/illusion respresented/tangible seem to result from moderate doses. I was once watching Jonathon Ross (comic UK celebrity interviewer/film reviewer) interview Ringo star and i actually thought i was participating in the conversation to some degree; it was like i was sitting on the couch along side them while being aware that i wasnt (like i said it was moderate dose). I think it relates in some way to narrative as making up rather distorted stories from incoming situational information seems to be a reliable feature of any K session (for example, i once thought i was director of broadcasting while i was at a warehouse rave and that i was responsible for all the ppl being in the right place and making sure the set was right).

-I'd have to agree with this person. Though I didn't use it recreationally, I was on it intravenously while recovering from a grade 3 compound fracture (eventually the limb was removed). Point is, one evening I believed I was participating in a live action video game and everytime I opened my eyes I had to start the "level" over but I kept opening them because there was something that was scaring my pants off. Apparently I tried to climb out of bed several times and started speaking to the nurses in a variety of accents (so I'm told). During the day I entertained myself with a mirror, a comb, and my heart monitor.-

12:00, 1 July 2005 (UTC)

Common Names Again
What's the point in putting 'wonk' as a common name? I've never heard it used in any context at all. You might aswell put another random bloody word in there too!!!!!86.1.183.223 02:01, 6 September 2007}}

Naaah mate! Wonk's The Word! Thats The Word I Hear All Over Stroud Mate!, kempeee

12:00, 7 September 2007 (UTC)

More safety info needed
While Ketamine is a relatively safe drug (physically speaking anyway), as mentioned this article could do with some safety information. In particular, ketamine's (and other selected dissociative's) neuroprotective effects are worth mentioning briefly. These are NMDA receptor glutamate-block mediated, and it would appear (check Medline) that these neuroprotective features may assist in reducing stroke and CVA glutamate excitatory damage to neural tissues. There is considerable research in this area.

12:00, 1 January 2013 (UTC)

Smoked?
I hadn't heard of this particular method of use before, and I'm not sure it's common, or even feasable. Perhaps the (original?) author had confused Ketamine with its dissociative cousin PCP? Since this doesn't seem to be a common use, maybe it should be removed. Overand 05:01, 10 July 2005 (UTC)
 * "or smoked in combination with marijuana"


 * It is not common, and unfeasable as described. It might be possible to do it with special equipment, but ketamine burns up too quickly and does not become a vapor to be inhaled when lit normally. A myth linked to PCP. --Tarnas 07:24, 1 August 2005 (UTC)


 * i have never seen it taken in this way, and i have spent a year sqautting around east london where was very commonly used recreationally.


 * I've experienced this on two occasions, and had mixed results. I found it very wasteful and the vapour burnt my lungs and throat. Possible, but IMO, pointless.

It is wasteful, but it most certainly can be done.

I have smoked it, but did not experience any effect. it tasted like burning plastic, and so smoking should probably not be mentioned, as i am relatively sure what we are inhaling when we burn ketamine is quite unhealthy indeed.


 * If there's no reputable source for citation then it should probably be not mentioned.

As with most pharmaceutical compounds, you wouldn't want to burn the HCl salt, but you could vaporize the freebase oil. In theory, you should be able to burn the HCl salt with another smoking medium and get some effect, but you would be mostly burning the molecule, as the boiling point is too close to the temperature that it burns at.

As with similar articles, this should not be listed as a valid method of ingestion.

I have smoked it and know at least one other who has smoked it, I mixed it with another medium as described above I will not describe more details as I do not want that information to be easily available. My experience was as follows; it tastes disgusting (burning plastic as above) and there was an extreme psychoactive effect which was impossible to describe and deeply unpleasant. I don't know of any relevant sources for this I will keep an eye out and make an edit if I find one. Dayliterobbery (talk) 04:22, 10 October 2013 (UTC)

DrBurningBunny (talk) 14:11, 6 February 2012 (UTC)

intravenous use
I'd like to have clarification on the statement in the article that ``Intravenous self-injection of ketamine is very dangerous.'' Asking here because a request for clarification on this unqualified, subjectively worded, and not necessairily self-evident claim with a tag was summarily deleted. 213.93.230.146 (talk) 08:21, 18 June 2009 (UTC)

What are you talking about ketamine is very safe to inject thats why they use it on car crash victims with no medical history. Psychonaught (talk)

You're missing the point; "IV self-injection". NB the SELF portion of the administration. Recreational IV drug abuse is universally accepted as dangerous, particularly for centrally-acting, highly addictive substances that lower accurate perception. IV administration is the preferred method of hospital dosing as it allows accurate monitoring of blood levels, and in this setting is considered safe.Corymichael780 (talk) 14:44, 25 March 2010 (UTC)

From what I've read here and other places it seems ketamine is surprisingly safe in itself. People seem to be confused about this sometimes, citing instances where a person on ketamine has died or been injured. That is caused by the behavioral effects of the drug, causing someone to walk in front of a bus, etc. Drugs like PCP, "Bath Salts", Bromo-Dragonfly, however have definite lethal dose levels. — Preceding unsigned comment added by 66.68.207.144 (talk) 18:29, 31 May 2012 (UTC)

Intravenous ketamine which is self administered is in fact dangerous. This is due to the rapidness of ketamine's onset. Dissociation occurs very quickly with IV ketamine, and often times the body has produced a profound analgesic effect, especially at the site of the injection. The danger inlies when an individual becomes dissociated with the syringe still in their vein, perhaps with only a portion of the solution injected. A combination of poor coordination and high analgesia produce a scenario in which the individual could easily hurt themselves, and worse yet they may pass out before they are able to seek help. If platelets clog the syringe partway through the injection, then the likelihood of becoming dissociated before the syringe is removed increases dramatically. The danger is not like heroin, where one could inject too much and overdose ultimately leading to O2 deprivation and death. If a recreational user is determined to use ketamine intravenously, it would be safer to have a third party administer the drug. Alternatively intramuscular injection might replace intravenous injection if safety is a concern. Excessive doses of ketamine will cause a deficit in cognitive functioning, but is actually neuroprotective and quite safe so long as the individual isn't operating machinery.

Also if the ketamine is prepared from a liquid prescription, then one may wish to dilute the ketamine before intravenous use. Studies have shown that undiluted ketamine hydrochloride in solution can kill live bladder cells when directly applied. This was likely due to the solution being kept at such a low pH[3.7 if not mistaken] to increase potency, and dilution should prevent any type of damage. No studies have yet to use diluted ketamine solution in bladder cell testing, an experiment which could provide some clarity on the issue of possible bladder damage. Without this diversity the current studies still hold bias.

KetaminePanda (talk) 02:12, 19 October 2012 (UTC)

Self injection is always dangerous of any drug, especially IV Dayliterobbery (talk) 04:29, 10 October 2013 (UTC)

Dangers
Is ketamine as safe as this article makes it sound? There is no mention of any negative effects beyond the few hours of the trip. Maybe there are none. Could someone more knowledgeable clarify? Agentsoo 2 July 2005 10:45 (UTC)

there are dangers; perhaps i will edit them in:

http://www.erowid.org/chemicals/ketamine/ketamine_health.shtml

Lockeownzj00

I'm currently undergoing IV ketamine treatment for relief of pain from Reflex Sympathetic Dystrophy (RSD), which is due to wind-up or sensitization of the central nervous system, although the exact mechanisms responsible are still not understood. The first treatment was 40 mg/hr for 5 days in the intensive care unit on a neurology ward. Booster treatments are 10 mg/hr for 4 hrs on 2 consecutive days. Patients have to have a full cardiac work-up prior to, and are hooked up to a heart monitor during treatment because ketamine can cause extra stress on the heart. It also causes anxiety, which raises blood pressure and there is definitely decreased coordination. At 40 mg/hr they draw blood every day to monitor liver function as well.

Another type of danger :) The Dr had the hospital remove phones from these patient rooms, as some were making banking decisions or purchases from QVC while "under the influence" - could make for some unpleasant surprises!

Nervis Breakdown 05:42, 5 November 2005 (UTC)

The fact that it's in the same family as PCP should show evident dangers of it. But yes, from what I know, it's addictive and dangerous. Tolerance + addiction = bad. 4.234.51.29 21:50, 25 January 2007 (UTC)

It would hardly be used to treat addiction if it were very addictive. — While this does make sense logically, some drugs used to treat addiction are chemically similar to the drug of addiction or otherwise have similarly addictive properties. However, due to the different context or circumstance in which it is taken, these drugs might differ in their addictive dynamics - for example taking heroin to kill time or pain vs. taking buprenorphine to remove the negative effects of heroin withdrawal. It depends upon the associations one makes between a drug and a stimulus/what triggers the desire for it. — Preceding unsigned comment added by 75.158.98.81 (talk) 09:06, 29 January 2012 (UTC)

As an anaesthetic, its about the safest there is. Yes, it has drawbacks (addiction the only really common one...) but when you look at it in comparison with, for example, thiopental, or even propofol, its incredibly safe! Of course, in some ways that makes it worse if its abused - users don't display the physical breakdown that may allow diagnosis of addiction to other drugs. (Dlh-stablelights 20:31, 8 June 2007 (UTC))

It is extremely dangerous if used daily in high doses and on a daily/almost daily basis including physical pain ("cramps"), urinary problems from cystitis like symptoms to bladder removal, mood swings, psychotic episodes and more some of which aren't even mentioned in this article or the recreational use article I have sources to make a lot of relevant edits and will have a look for more to prove what I already know from a decade of addiction but do not have sources to hand but I do not know which article to start in if anyone could help I would much appreciate it Dayliterobbery (talk) 04:43, 10 October 2013 (UTC)

History
The history section I just added needs some attention, and I think the article could stand to have the history more unified, leaving the other sections free of background information. Sorry it's so half-baked, I've just got to run to work right now and wanted to get the ball rolling. Overand 22:56, 10 July 2005 (UTC) The exact cause to why ketamine became a schedule 3 drug http://www.clerk.co.montgomery.oh.us/pro/ David J Day 8/27/1974 arrest date August 11 1999 the next day they made a emergency ruling to make it a scheduled 3 drug Also you can go to http://www.daytondailynews.com/news/archive/ Search Aug 1 1999 to Sept 1 1999 headline COPS NAB COUPLE IN DRUG CASE this is what you get.
 * Made a first go at this, could use more about its creator, its history in psychology/psychiatry/academia, and the course of its becoming illegal. --Tarnas 07:27, 1 August 2005 (UTC)

COPS NAB COUPLE IN DRUG CASE
 * Local and federal agencies say they worked 3 months on the investigation

Moraine police on Tuesday arrested a Miami Twp. couple on several charges involving the designer "party" drug Ecstasy and LSD, a hallucinogenic.

The arrests of David Jason Day, 24, and his wife, Tonya Inez Henson Day, 22, of 4869 Delba Drive, capped a three-month investigation by Moraine police and the Food and Drug Administration into those drugs, along with Ketamine, a powerful mind-altering anesthetic, chemically similar to PCP. Moraine Police Detective Sgt. Tracy Harpster said Ketamine isn't federally scheduled at this time so Day wasn't charged with possession of the drug. However, he could be charged in New York, where he allegedly picked up the vials, and where possession of the drug without a prescription is illegal.

Day was charged with conspiracy to traffic in Ecstasy, two counts of corrupting another with drugs, and trafficking in LSD. One count of corrupting stems from the sale of LSD to a juvenile. Day's wife was charged with felony permitting drug abuse; she is accused of taking part in drug deals with her 17-month-old son present.

Both were arraigned Wednesday before Montgomery County Common Pleas Judge David Gowdown and released on bond.

Day helps operate the Reptile House, which has a store at 121 N. Springboro Pike and a warehouse at 2311 Dryden Road. Police confiscated items from the warehouse and searched the couple's home, seizing money, drugs and the couple's car, Harpster said.

Ecstasy (MDMA) is a synthetic drug with both hallucinogenic and amphetamine-like properties.

Ketamine is known on the street as "K" or "Special K" or "KitKat." Street value of the Ketamine was $30,000, Harpster said. The drug is manufactured in liquid form primarily as a veterinary tranquilizer, but is sold on the street in pill or crystalline powder form.

Use of the drug locally seems rare. "We aren't familiar with it," said Bill Wharton, administrative assistant, Montgomery County Combined Health District. "No one has mentioned using it," said Sharon Taylor, who sits on the screening panel of Project Cure, a drug treatment center. — Preceding unsigned comment added by 107.9.9.161 (talk) 00:23, 18 October 2013 (UTC)

Inducing vs Starting
I disagree with your reversion of this change. Starting is slightly simpler but it doesn't fit nearly as well and IMHO everyone reading technical english will be fine with inducing. What do you think? Testem (talk) 13:24, 24 April 2014 (UTC)
 * We can use "inducing" in the body of the text but should really try to make the lead simplier. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:26, 24 April 2014 (UTC)
 * But do you think this really offers enough simplification to justify the technical inaccuracy? One doesn't really "start" anaesthesia. Testem (talk) 14:20, 24 April 2014 (UTC)
 * Inducing anesthesia is the start. I do not really see this as a technical inaccuracy Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:24, 24 April 2014 (UTC)
 * Mmm it is semantics to an extent but I don't think they are really interchangeable. I wouldn't "start" a current in a coil, for example. Testem (talk) 12:04, 25 April 2014 (UTC)

I would start a current in a circuit. We could ask for further opinions at WT:MED if you wish Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:16, 25 April 2014 (UTC)
 * I would like that :) Testem (talk) 13:11, 25 April 2014 (UTC)

Orphaned references in Ketamine
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Ketamine's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "emcdda": From Drug liberalization: Illicit drug use in the EU: legislative approaches, EMCDDA thematic papers, Lisbon 2005 From Mephedrone:  From Methoxetamine:  

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 04:37, 4 July 2014 (UTC)

None of these fit. I have messaged the user that added these to ask them to provide the full detail. Testem (talk) 09:17, 4 July 2014 (UTC)

Is this MEDRS compliant?
The article contains,

"A review article in 2013 concluded that "despite limitations in the breadth and depth of data available, there is evidence that ketamine may be a viable option for treatment-refractory cancer pain".[17]"

The source (Breedlau et al. 2013) is a good one, it is a systematic review and synthesis of literature, recent and in a decent journal. I just don't know if in the "Use" section (as opposed to "Research") WP should be talking about what "may be a viable option". I don't have access to the full text but I note they included 5 RCT's, and 6 uncontrolled studies. I also note that the 2012 Cochrane review found only 2 RCT's that met criteria and using higher standards didn't include any uncontrolled studies. The conclusion of the Cochrane review was,

"Current evidence is insufficient to assess the benefits and harms of ketamine as an adjuvant to opioids for the relief of cancer pain."

This seems more appropriate for WP and is a higher level of MEDRS.

- - MrBill3 (talk) 09:25, 27 July 2014 (UTC)

This also,

"The combination of ketamine with an opioid may be useful for pain caused by cancer, as suggested in animal models.[16]"

Animal models? In the "Use" section? Animal studies at all? - - MrBill3 (talk) 11:39, 27 July 2014 (UTC)

Suggested reference
The following chapter is recent and quite reputably published.

It seems to cover most of the information in the article and it is a secondary, third-party reliable source. - - MrBill3 (talk) 12:06, 27 July 2014 (UTC)

References and archiving
I am in the process of Boldly formatting the references uniformly. I also propose archiving this talk page. Please raise any objections. - - MrBill3 (talk) 01:52, 27 July 2014 (UTC)
 * Judging from the dates of the posts I think once a year would be a reasonable setting for the archive bot. Roger (Dodger67) (talk) 07:07, 27 July 2014 (UTC)
 * Archiving is usually done between a few and 90 days. Usually to maintain the page at 75 KB or 10 main topics per talk page guideline. I don't have a problem setting the parameter to a fairly lengthy period but a year seems to defeat the purpose. I may just set it at a year and wait for further comments/consensus. - - MrBill3 (talk) 08:35, 27 July 2014 (UTC)


 * With the exception of the recent/current flurry of activity, this page only has about 7 or 8 topics per year, so I think we should let the bot do an initial run and then we can revisit the issue later, if the activity level remains higher going forward. Roger (Dodger67) (talk) 21:45, 27 July 2014 (UTC)
 * I have set the bot to archive anything over 360 days. Do you think I should disable (remark out) the bot after an initial run or leave it set to autoarchive at one year old? I'm fine with either, as long as the bulk of old stuff is archived to make this page workable. Thanks for your input. - - MrBill3 (talk) 22:05, 27 July 2014 (UTC)

Should lead have more on recreational use?
The lead currently contains a single sentence on recreational use, "Recreational use has led to high-profile deaths.[7]" This does not seem an adequate summary of the content. Granted there is a stand alone article Recreational use of ketamine but this article contains enough information on recreational use to support a second sentence summarizing recreational use as due. Something like, "Ketamine has been used as a recreational drug since the 1970s, increasingly so to the end of the 20th century and as a result it's use has been restricted in many (some, several?) countries." The existing sources and content certainly support at least that. Due/Undue, appropriate? Input from medical editors appreciated as I am not extensively experienced in editing articles about drugs with medical and recreational use. - - MrBill3 (talk) 08:47, 27 July 2014 (UTC)

More, no. Better, yes. If you put recreational use in the context of medicinal benefit, then yes. If the impression left on the reader is "horse tranquilizer and drug of abuse", that is not a factual representation of this drug. If 99.5% of the medication produced is used in medical settings, what is the agenda behind emphasizing the aspects of abuse?

I would support a full paragraph on abuse, were it to put abuse in the proper perspective. Abuse is a problem now, it is only going to get worse as people recognize it as a possible treatment for their emotional ills. Self-medication with ketamine is a sure path to abuse, and I would support factual and documented entries to help the reader make good judgments.

I do know more about this medication than the average bear - please give me the opportunity to share:

1. Ketamine is a very unique substance in that its LD 50 is estimated to be 450 times its therapeutic dose. The practical effect of this is that people abuse it at such high doses that the effects they experience are not relevant to the effects at lower dosages. The abuse dosage of ketamine is roughly 100 times the medicinal dose. 12 times the normal "dose" of water will kill you. Ketamine is pretty unique. Every reference to effect or side effect needs to reference the dose of the observation or it is a very misleading entry, for this drug.

2. The recreational deaths in the citing in the first paragraph are not due to overdose. They are due to unsupervised use of an anesthetic - guess what, that is not a good idea in any circumstance. Pointing out that people die when they self administer an anesthetic is like pointing out people die when they jump off a cliff. I am pretty sure as it stands this does not belong in wiki. But as said elsewhere, I am content leaving the community to judge.

3. This is a generic medication competing against existing and promised patented products. There is a huge financial benefit to some players for ketamine to be seen unfavorably. I would suggest that all contributions include a full COI, as I have done. I notice nothing from you, MRBill3, despite all of the hours you have clearly spent recently editing the page. Either you are the most saintly person on earth, or perhaps you have something more to share? Geraldwgaines (talk) 03:28, 28 July 2014 (UTC)
 * Thank you for your response. I think the article contains a fairly adequate discussion of recreational use in the body and provides a link to a stand alone article on the subject. What I am proposing is an additional sentence in the lead to summarize the content in the article (see WP:LEAD). Note my proposed text above. Balance is provided per due in the article, but if you have specific sourced suggestions for content you think would provide a perspective that reflects the mainstream academic consensus on ketamine, please create a section here for each suggestion and provide the reference. I am not sure if the best summary of the content on recreational abuse is a one sentence mention of high profile deaths. That is why I opened this discussion. Feel free to critique my suggested content and propose and alternative. Please keep in mind that WP and this talk page are not a soapbox or forum for discussing the merits of ketamine, the unjustness of the lack of study etc.
 * Note that personal attacks are strictly against policy. Your assertions that I have a COI or "something more to share" are not appropriate. I have stated more than once, I have no COI in relation to editing on WP. That closes the issue further assertions will be considered tendentious or personal attacks neither of which I have much patience for. I can assure you I am not "the most saintly person on earth" but I am an editor who has devoted considerable time and effort improving the encyclopedia. That doesn't entitle me to anything more than the civility and assumption of good faith that should be extended to every editor. Sarcasm, personal attacks and battleground mentality lower the reputation and credibility of an editor so I suggest some moderation in your approach. That said carry on, contribute to improving the encyclopedia. - - MrBill3 (talk) 04:17, 28 July 2014 (UTC)

Failed verification
I removed,

"Indeed, a review published in 2009 found no evidence of ketamine-induced neuron death in humans.

The article actually discusses the FDA call to investigate the possibility discussing problems with extrapolating animal studies to humans and stating in it's summary,

"Although it is beyond dispute that ketamine can induce neuronal death in rodents and other animals, there is thus far no evidence that such an effect occurs in humans. Indeed, such a premise is at complete odds with the wealth of human experience with this agent. However, now that this question has been raised, we are obligated to carefully investigate."

It goes on to describe study models to investigate this question. Not a finding of no evidence in humans but a call to actually investigate. The paper describes the lack of study. It also discusses concerns about,

"children may be experiencing unrecognized central nervous system damage and perhaps cognitive sequelae"

It cites the FDA conclusion,

"the potential threat was sufficient to represent a public health concern."

The introduction states,

"This article discusses the limitations of the underlying animal research on which the FDA and NIH investigations are based, the challenges in extrapolating such data to humans, the need for further animal and human investigations, and the potential adverse effect on clinical practice that might result should the use of ketamine be restricted or the drug removed from the market."

The removed content is clearly a distortion of the source. - - MrBill3 (talk) 10:08, 28 July 2014 (UTC)

Sponsoring a truly evidence-based page on ketamine
I'd like to thank all of the well-intended editors who have deleted or changed entries I added that did not meet wiki standards. I'll always appreciate that, so please never stop.

That said, in real life we learned today that we recently lost our first patient, to a physical illness. We count this case as "passive suicide". Anyone who is data oriented could take this loss and the hundreds and hundreds of people-months of no incidences of loss/hospitalization/suicide attempts in our sub-population of over median beck 40 and you will realize the efficacy of ketamine. We failed to stabilize the patient earlier this year, but with what we know after 400 more infusions the patient would have had a great chance to recover from depression. We are running at a close to 90% response rate now. This is what is happening on the ground. I need to get back to my day job of being the data nerd that is evaluating all of this and the patient advocate who gets to explain why we don't know more yet.

I would ask of this group, that were I to fund an organization like the ACLU or the National Alliance of the Mentally Ill, to edit this page for accuracy and to seek verifiable sources of data that might help the general public, would that be welcomed here?

Geraldwgaines (talk) 07:56, 25 July 2014 (UTC)


 * Absolutely not, sorry. Such editing would violate a bunch of rules. This article needs to be based on properly refereed articles in mainstream scientific journals, not advocacy by paid editors with an agenda. Roger (Dodger67) (talk) 08:41, 25 July 2014 (UTC)
 * Geraldwgaines, I am unsure if your first paragraph is sarcastic. In any case, there are a couple of relevant guidelines: WP:PAY and WP:NOPAY. Axl  ¤  [Talk]  10:35, 25 July 2014 (UTC)
 * hey gang, OP is a new editor who is trying to figure things out and knows he has a lot to learn. Please WP:DONTBITE. Jytdog (talk) 11:57, 25 July 2014 (UTC)


 * You or anyone else, regardless of their organizational affiliation, is welcome to edit here. Furthermore - and again unrelated to any affiliation - if anyone wants training or coaching to learn how to edit here then please ask at WikiProject Medicine's talk page. We do not have an automated or self-guided process for learning Wikipedia things, but if someone starts a conversation with the people there, then we can coach anyone on next steps based on whatever they want to do.  Blue Rasberry   (talk)  13:01, 25 July 2014 (UTC)

Thanks Jytdog, for others I am not being sarcastic and truly appreciative of constructive input. There seems to be a difference of opinion about how the Conflict of Interest Rules Work here. In most situations out in the real world, and according to my reading of Wiki rules, COI's, including compensation, are accepted as inevitable and largely untraceable in the normal course of life - the key is disclosure and being held to the same standard of evidence with your audience aware of the COI - with the role of other editors to validate the entries that are suggested. I have changed the original post to emphasize "edit this page for accuracy and to seek verifiable sources of data" to point out that I believe the activity as described by any entity is exactly the wiki mission. Am I missing something? Geraldwgaines (talk) 13:44, 25 July 2014 (UTC)
 * I do not think you are missing anything but here are some points which regular Wikipedians may be considering when reading your proposal:
 * Most organization's attempts to partner with Wikipedia fail because rarely do organizations want to follow rules here. You are already acknowledging that there are "wiki standards" so that is promising.
 * Money complicates relationships and there are very few instances in which someone has used money to convince a person or organization to do something on Wikipedia which they did not already want to do. I wish you the best in talking with those organizations, but probably the way in any organization is to find a single person there who wants to talk with the Wikipedia community. If you find such a person, then people are here for a conversation.
 * You said "Anyone who is data oriented could take this loss" - this is completely outside the scope of Wikipedia and it scares people to hear anyone talking like this, because conversations that begin this way lead to trouble for all involved. Wikipedia reports what is already published and cannot entertain discussion about future publications.
 * If you, anyone else, or any organization wishes to "edit this page for accuracy and to seek verifiable sources of data" then there is support at WP:MED. Please do so or encourage others to do so, and ask for help and support when you do.  Blue Rasberry   (talk)  13:56, 25 July 2014 (UTC)

Bluerasberry, thanks for your response, it is very helpful in understanding the environment at wiki. Maybe this will help regarding my efforts here - I am using my own name and there is this thing called google which covers me quite nicely. If you dig, you'll find that my data changed the telecommunications laws of this country, twice. And the MMJ laws of Arizona. I actually know how to use statistics to tell the truth, a rare skill these days. I simply do not have the time to edit this page in person. I've already got the ACLU signed up to do a Freedom of Information Act request to gain ketamine data from the government - they or someone else would be happy to edit this page as I've described. This effort is not about Advocacy, it is about civil liberties (the right of citizens to know what their government knows) and specifically at Wiki a page that has been driven by interests that did not want an accurate portrayal of ketamine. Ask 10 people about ketamine, and 8 will say it is a horse tranquilizer and drug of abuse. Two weeks ago the wiki page reinforced that image. Now it does so to a lesser degree. My sole objective is to have the definition of ketamine accurately reflect the available data on medicinal and abuse issues. Geraldwgaines (talk) 18:30, 25 July 2014 (UTC)

A fly by - how did an unsourced comment about abuse enter the first section of ketamine stay for a couple of days - How about a little equal opportunity COI disclosures? Geraldwgaines (talk) 02:37, 27 July 2014 (UTC)
 * "I simply do not have the time to edit this page in person." If you want this page maintained then find someone who does have time. Many people greatly overestimate the number of volunteers at hand on Wikipedia who are able to give time. Find someone who has time and expertise then send them here for training. We are in no position to provide volunteers here, and although some people may help, we get a staggering number of requests for people who want to manage volunteers but few people who actually want to contribute on the ground. Wikipedia really is the world's most consulted source of information on ketamine so if you want to have quick impact at the lowest cost, this might be a good place to share your information.
 * If you want to talk more then post here or email me to talk by phone or video. What you propose seems fine but Wikipedia has hit this wall thousands of times before when someone has information to share but is unable to find someone to volunteer to share it. As much as content help, we could use help getting the COI disclosure that you just requested. We can train for that too.
 * If you cannot provide volunteer time in any way then feel free to request it here or on WikiProject Medicine and wait for someone to appear.  Blue Rasberry   (talk)  13:45, 28 July 2014 (UTC)

rheumatoid arthritis
A 2003 Cochrane review concluded,

"With many other safer analgesics available on the market today and no head-to-head trials suggesting superior efficacy, our review does not support the use of nefopam in patients with RA."

But did find,

"There is weak evidence that nefopam is an effective analgesic when compared with placebo in patients with RA, over four weeks." and "Nefopam appears to have moderate analgesic efficacy in patients with active RA who are not taking other analgesic medications."

While pointing out problems with patients ability to tolerate and possible side effects. The considered the studies they reviewed to have a high risk of bias. Should this be mentioned in an Other conditions subsection of the Research section?

- - MrBill3 (talk) 04:53, 28 July 2014 (UTC)
 * It seems worthy of conclusion. I am not sure why you posted here, because what you are saying is so aligned with what I think anyone would want. You are doing what is expected.  Blue Rasberry   (talk)  14:53, 28 July 2014 (UTC)

Phantom limb pain
A 2011 Cochrane review reports on ketamine for phantom limb pain as follows,

"Morphine, gabapentin and ketamine demonstrate trends towards short-term analgesic efficacy with the caveat that these results were based mostly on small studies that varied considerably and also lacked long-term efficacy and safety outcomes."

Concerns about serious side effects (loss of consciousness, sedation, visual hallucination, hearing impairment, position impairment, insobriety, and elevation of mood) were raised.

stated, "Ketamine, ..., was reported to re- duce spontaneous pain in phantom pain, but it has not gained much clinical popularity because of its only parenteral route of administration and frequent dissociative side effects."

The Cochrane review also discussed Wolff 2011, "The paper recommended that the first line of management is drug therapy that includes amitriptyline, tramadol, carbamazepine, ketamine and morphine, and that pulsed radiofrequency treatment and spinal cord stimulation could be considered but confined within an experimental framework."

I don't have access to Wolff 2011. Is this something that should be added? - - MrBill3 (talk) 03:26, 28 July 2014 (UTC)
 * I also do not have access but to hear that a treatment is "considered but confined within an experimental framework" makes me think that it can be omitted from discussion. I would say add it or not as you like. When I am in the situation where I add information based on one source being cited in another, I do WP:CITEBUNDLE. Here I would cite the Cochrane paper, then at the end of the paper say "which cites" then give the other citation with an indentation. This is only if you want to add this information - it seems like a low priority to me.  Blue Rasberry   (talk)  14:57, 28 July 2014 (UTC)

Should asthma research be added?
I think an "Other conditons" subsection could be added to the "Research" section. Ketamine is being studied as a treatment for asthma. Two recent (2012, 2014) reviews have been published. The evidence is negative or low level but continued research is suggested. Should this be added or is this a case for WP:there is no deadline? My thought is if it is worthy of review by two high quality sources...

The 2012 Cochrane review concluded, "The single study on non-intubated children with severe acute asthma did not show significant benefit and does not support the case studies and observational reports showing benefits of ketamine in both non-ventilated and ventilated children." Suggesting that quality studies were needed to prove a benefit for ketamine use in children with asthma.

While a 2014 ''Expert Reviews of Respiratory Medicine" review concluded, "In summary, there is only a low level of evidence that ketamine may be beneficial in patients with severe asthma exacerbations who are mechanically ventilated. Further investigations are needed to determine the impact of ketamine in intubated and non-intubated patients with status asthmaticus."

Suggested text, "Ketamine is being studied for the treatment of asthma. No benefits have been clearly demonstrated but further research has been suggested."

I am suggesting an "Other conditions" subsection as I expect to find more research. - - MrBill3 (talk) 00:40, 28 July 2014 (UTC)
 * I disagree with your suggested text. Ketamine is widely used in ITU in the treatment of life-threatening asthma, especially in children. I agree that supportive evidence for this use is lacking. I shall have a look for some references. Axl  ¤  [Talk]  09:34, 28 July 2014 (UTC)


 * The Cochrane review [Jat] does not actually say that ketamine is being studied. It does indicate that further research is necessary.


 * Goyal: "It has been empirically used as a bronchodilator in severe status asthmaticus refractory to routine medications and has been found to obviate the need for mechanical ventilation in various studies. The limited magnitude of side effects permits its use in status asthmaticus when all other agents fail. Still, its use in asthma is debatable." Axl  ¤  [Talk]  09:45, 28 July 2014 (UTC)


 * Goyal 2013 looks like a good additional source. With Jat 2012 finding the one quality study showed no benefit and Wong 2014 concluding low level evidence may benefit intubated and further investigation needed, while Goyal 2013 says various studies find it obviates the need to intubate but states use in asthma debatable, what should we say? I fully realize practice may be ahead of research but we need sources for content. Given the extent of study I think something should be in the article. Thanks for your input and the source. Got a proposal? - - MrBill3 (talk) 10:22, 28 July 2014 (UTC)
 * Just as a side note I thought two (or three) published reviews made "is being studied" a statement of obvious fact. Barring that I think the literature search results that are part of the reviews provide evidence that it is being studied. - - MrBill3 (talk) 10:41, 28 July 2014 (UTC)


 * Those reviews are typically published after the fact, i.e. after the studies have been completed. The reviews could be used to support the statement that ketamine "has been studied" (past tense) but not "is being studied". (Actually I don't access to Wong's review so I can't confirm that.)


 * How about: "Ketamine is used as a bronchodilator in the treatment of severe asthma. However evidence of clinical benefit is limited." Axl  ¤  [Talk]  22:22, 28 July 2014 (UTC)
 * That text works for me. I tweaked the references slightly. BTW if you want the title of a ref to link to the PMC version, just include the PMC parameter and do not include the url parameter, the template will automatically link the title. I added the direct url to Goyal as I prefer to provide as many different (free) ways to get to an article.
 * I'll take care to use past tense based on reviews, unless the intro or text specifically says, "is being studied". Upon consideration things no longer studied are reviewed sometimes. Thanks for your contributions and input. - - MrBill3 (talk) 01:40, 3 August 2014 (UTC)

ketamine and depression, some sources for use
just putting some sources here for me or others to use later


 * ECRI Institute, under contract to AHRQ. December 2013 AHRQ Healthcare Horizon Scanning System – Potential High-Impact Interventions Report. Priority Area 05: Depression and Other Mental Health Disorders


 * Caddy C et al. Ketamine as the prototype glutamatergic antidepressant: pharmacodynamic actions, and a systematic review and meta-analysis of efficacy. Ther Adv Psychopharmacol. 2014 Apr;4(2):75-99. doi: 10.1177/2045125313507739. Review.  PMC 3952483


 * Tondo L et al. Options for pharmacological treatment of refractory bipolar depression. Curr Psychiatry Rep. 2014 Feb;16(2):431. doi: 10.1007/s11920-013-0431-y. Review.


 * Naughton M et al. A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. J Affect Disord. 2014 Mar;156:24-35. doi: 10.1016/j.jad.2013.11.014. Epub 2013 Dec 10. Review.


 * Three part series in Scientific American blog. perhaps not MEDRS but useful for context
 * Gary Stix for Scientific American. September 11, 2013 From Club to Clinic: Physicians Push Off-Label Ketamine as Rapid Depression Treatment, Part 1
 * Gary Stix for Scientific American. September 12, 2013 Is Ketamine Right for You? Off-Label Prescriptions for Depression Pick Up in Small Clinics, Part 2
 * Gary Stix for Scientific American. September 13, 2013 Ketamine, a Darling of the Club Scene, Inspires Development of Next-Generation Antidepressants, Part 3

that's enough to generate some good content i think.... Jytdog (talk) 15:55, 28 July 2014 (UTC)
 * Thanks for that research. It seems ketamine may be poised for expanded use. A quick read of that first source and the references it gives seems to indicate some substantial research is under way. I look forward to seeing what content is developed with several reviews already published we should be able to come up with something. - - MrBill3 (talk) 16:48, 28 July 2014 (UTC)
 * sure! i have been reading and intend to add some content but it won't be til the weekend at the earliest. if someone else beats me to it that is all good too. Jytdog (talk) 17:13, 28 July 2014 (UTC)



Discusses use at UCSD.

An animal study but it explores the mechanism and is in Science good for pharmacology. - - MrBill3 (talk) 12:08, 29 July 2014 (UTC)

Thanks everyone for putting some sources out there. A brief note to consider. Most studies note in top line results the raw dose of ketamine delivered without mentioning the time period over which the dose was given. The first pass half life of ketamine is less than 20 minutes. A .5 mg/kg dose dose of ketamine given over 10 minutes affects the mind very differently than the same total dose given over 40 minutes. The various studies are not consistent in their flow rate and need to be so referenced to be accurate. The relevant metric for comparison of ketamine effects for emotional illnesses is mg/kg/hr. Thanks Geraldwgaines (talk) 19:06, 2 August 2014 (UTC)
 * If the reviews discuss this we can take care to see it is included as due. WP doesn't use OR and usually describes things in general encyclopedic terms. - - MrBill3 (talk) 11:54, 3 August 2014 (UTC)

Scams involving Keramine
If you Google Keramine you can see a lot of scams that claim it works for Drepression when it's not FDA approved for that. 65.175.243.206 (talk) 13:53, 1 January 2015 (UTC)
 * Note that it is "ketamine", not "keramine". Those are not really scams:  the evidence that it affects depression is pretty strong.  In any case, (a) ketamine is only available by prescription, so there is a limit to how far a scam can go without breaking the law, and (b) it is actually rather common for drugs to be used for purposes that they are not specifically FDA-approved for.  I don't myself think that our understanding is thorough enough to justify using ketamine clinically at this time, but the main thing is that the word "scam" is probably not justified here.  (I'm not sure what the relevance to this article is, anyway.) Looie496 (talk) 14:35, 1 January 2015 (UTC)

Discovery
In this edit, it is claimed that ketamine was developed (by Craig Newlands) before it was synthesized (by Calvin Stevens) which is a logical impossibility. How do you develop something before it exists? I realize that what the source says, but I am skeptical of the source, especially when other reliable sources (see for example here and here) don't mention Craig Newlands. Boghog (talk) 13:22, 24 December 2014 (UTC)
 * A candidate for immediate reversion if the source doesn't mention him, IMHO. Testem (talk) 13:51, 24 December 2014 (UTC)
 * The source does mention him, but the source itself does not make any sense. Boghog (talk) 15:21, 24 December 2014 (UTC)
 * sources are messy on this, and use "develop" in a sloppy way. probably Newlands discovered it and parke-davis developed it, both chemically (working out better synthesis) and clinically.  this document - not a reliable source - acknowledges the confusion in the sources concerning who "developed" and/or "discovered" it.  this is the kind of question i like... i will work on this over the next few days.  short term this source says Newlands "discovered" and Parke-David developed, which is the most likely right answer at this point. Jytdog (talk) 17:00, 24 December 2014 (UTC)
 * Thanks Jytdog. The last source above at least makes sense. Boghog (talk) 20:59, 24 December 2014 (UTC)
 * I deleted my previous correction about who discovered Ketamine because I could not find reliable evidence suggesting that Craig Newlands ever existed. Gcastellanos (talk) 12:35, 30 May 2015 (UTC)

Neutrality and referencing in recent edit
I have concerns about the large recent edit made by, with edit summary "Added recent statistics and references regarding deaths in young adults, 2005-2013. For section that ,ore than 95% covers governmental regulation, the heading of "Legal status" was elevated to replace the misnomer "Society and culture". Le Prof", (diff). It seems somewhat UNDUE because of the stridency of tone and number of repetitions; also some of the refs are not compatible with WP:MEDRS. The following passage in particular strikes me as not belonging:


 * One expose of a young person's death concludes:""…cocaine, MDMA, mephedrone and LSD can end up damaging people and some can become addict[ed], but it appears none of these drugs has the ability to wreck the body or leave users mentally marooned in the way that ketamine does. Rather than being a window into the soul, for some ketamine has turned into a way of mollifying pain or getting through the day, like heroin and diazepam.""

This is referenced to a website and a newspaper. Looie496 (talk) 14:06, 8 June 2015 (UTC)


 * The rest of the edits seem just a bit imbalanced but this excerpt is particularly out of place. I have removed it. Testem (talk) 20:21, 9 June 2015 (UTC)

Very good neurological chart comparison of Ketamine and other NMDAR antagonist, possible to re-draw as free?
This image would be great to have drawn by someone who has the ability to make it different enough and release it free on Wiki-media to put on the ketamine page. It's a comparison of the binding profile of Ketamine & DXM to the G-coupled protein receptor sites. Nagelfar (talk) 19:38, 24 August 2015 (UTC)

Ketamine Usage with TMS
Success in treatment of depression with Ketamine is optimized when it is used in conjunction with transcranial magnetic stimulation (TMS). A link outlining the treatment may be found here: Researchers Receive Patent for New Depression and Pain Treatment. Article is from the Chicago Tribune. Journal published case reports can be found here and here. SunSw0rd (talk) 22:51, 25 August 2015 (UTC)
 * Please read WP:MEDRS Best Doc James  (talk · contribs · email) 00:03, 26 August 2015 (UTC)

Intro Paragraph

 * Common side effects include psychological reactions as the medication wears off.[4] These reactions may include agitation, confusion, or psychosis.[4][8] Elevated blood pressure and muscle tremors are relatively common, while low blood pressure and a decrease in breathing is less so.[4][8] Spasms of the larynx may rarely occur.

The claim that side effects occur "as the medication wears off" doesn't seem to have any basis. There's no indication in either source (both drugs.com pages) when the side effects occur. This is problematic since it implies lingering effects that may not exist and are not indicated in the references. (Though the special note in ref [4] specifically indicates that while some side effects may recur over a 24h period, no residual psych. effects are known.) Unless anyone has any further info on the side effects, I'd say remove the "as the medication wears off" portion. ParoXoN (talk) 23:11, 16 February 2016 (UTC)
 * it is best to read the body if something seems wrong in the lead. the lead just summarizes the body.   there was more content there for it, and a ref Jytdog (talk) 00:51, 17 February 2016 (UTC)

reactions and supplication
supposedly alternatively, ketamin, inhibits psychosis within the hippocampus, as a prospective psi medication. next, the secret of ancient ketae, est min, elemental "antimony" ketamin could mix with selenium, also seemingly entails combination with benz-thio cyclyenol analogue. lasty, wild keta minerals exist next to the andes such as local of argenina and pacific side of continent southern, — Preceding unsigned comment added by Wezenlucif (talk • contribs) 02:33, 24 February 2016 (UTC)

Expand Depression Section
Numerous studies have emerged stating Ketamine's benefit for treatment-resistant depression, and this is perhaps the most consequential development pertaining to this drug in recent memory. However, the depression section of this article is terse with descriptions of efficacy relying on outdated studies. The article does not describe how the drug acts on depression (hypothesized MOA), the emergence of ketamine clinics delivering infusions to treatment resistant patients, or Ketamine's relationship to the development of glutamatergic antidepressants. The articles on ketamine's enantiomers are even more fully fleshed-out in this respect. 68.185.202.126 (talk) 04:38, 26 April 2016 (UTC)ddiamondds

Ketamine's antidepressant action possibly caused by AMPAR inhibition rather than NMDAR inhibition.
Hi! After seeing it on the NIH Director's blog, I added some information about indications that ketamine's fast-acting antidepressant effects may be caused by one of its metabolites, which doesn't have the same potential for abuse. (Study published in Nature.) It's been integrated into the article for hydroxynorketamine, the metabolite in question. The revert message says to look at WP:MEDRS; this is recently published, so it doesn't appear in any reviews yet, but it seems important enough to include at least some note of it. ("If conclusions are worth mentioning [...] they should be described appropriately as from a single study".) Am I missing something here? Thanks! grendel|khan 00:59, 15 May 2016 (UTC)
 * Thanks for opening this, I was about to. User:Doc James and User:Seppi333, are you good with the current version here?  I am somewhat surprised at myself for arguing to keep this content based on a primary source, but seeing how we do use primaries for purely PK stuff (seppi's objection here was dead on) I don't see a reason to exclude this now.  And it is a major upheaval in the understanding of how this drug works, i think....  If you all say yes wait for a review I can only bow to that, of course. Jytdog (talk) 01:23, 15 May 2016 (UTC)
 * The current version seems fine; the sources for the current statement should only need to satisfy WP:SCIRS, which they do.  Seppi  333  (Insert 2¢) 01:30, 15 May 2016 (UTC)
 * Maybe I'm missing the point here, but the whole reason this is an interesting finding is that HNK doesn't have the same side effects and abuse potential, right? Even if the main question here--HNK has ketamine's antidepressant effects--is still under investigation, that's valuable context, right? grendel|khan 00:33, 22 May 2016 (UTC)
 * It is interesting for a lot of reasons. But we are limited by what we can say based on a given source by the sourcing guideline.  To make claims in content about health we need a review in the biomedical literature.  I have no doubt one will be forthcoming soon that talks about this.  It just a matter of waiting a bit. Jytdog (talk) 01:13, 22 May 2016 (UTC)

Hi
Is Scotland's drug classification different from rest of UK's?--Armanikoka (talk) 00:03, 21 July 2016 (UTC)

Citations needed
In the Anaesthesia section the statement "It is sometimes possible to perform ketamine anesthesia without protective measures to the airways." is not referenced. There does not appear to be a readily apparent source for this statement. This is often the case in animal anaesthesia where Ketamine or a combination with it and another anaesthetic is used without airway support. However in human anaesthesia, it does not appear to be used without airway support due to its pro-salivary properties: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25886322/

In the Vetinary Medicine section, the statement "Ketamine is used to manage pain among large animals, though it has less effect on bovines." is not referenced. There does not appear to be any scientific articles that make note of a lesser effect on bovines relative to other animals. Given the complexity of inter-species dose scaling, I wonder if this statement is useful. — Preceding unsigned comment added by Yossarian54 (talk • contribs) 03:52, 1 February 2017 (UTC)