Signs of Ketamine Addiction

The main signs of ketamine addiction are needing more to get the same effect, using more than you meant to, spending lots of time getting or using it, and continuing even after it causes problems. Physical clues can include bladder pain or frequent urination, stomach cramps, and memory or concentration trouble. If you notice several of these signs, it is a good time to talk with a doctor or a treatment provider.

Ketamine can be hard to spot because its effects wear off fairly quickly and people often use it in social settings. This guide explains what to look for in yourself or someone you love, and what to do next.

Misuse Versus Supervised Medical Use

Ketamine is an anesthetic used in hospitals and veterinary care, and it is a controlled substance. A related drug, esketamine (Spravato), is FDA-approved as a nasal spray for certain adults with depression. Its label carries a warning that it can be abused and misused, so it is only given in certified health care settings, under direct observation, with at least two hours of monitoring after each dose.

Using ketamine as directed in a supervised medical setting is not the same as misuse. The signs below describe use outside of medical guidance, or a pattern that has become hard to control. If you receive ketamine or esketamine from a provider and worry about how you feel between doses, or find yourself wanting more than prescribed, tell that provider honestly. For background on the drug itself, see our overview of ketamine addiction, risks and treatment.

Behavioral Signs

NIDA lists several signs of ketamine addiction that match the general pattern of substance use disorder. These are often the first things family members notice:

• Tolerance: needing larger amounts, or using more often, to get the same effect
• Losing control: using more, or for longer, than planned
• Time spent on the drug: a lot of time getting ketamine, using it and recovering from it
• Hazardous use: using in situations that are physically dangerous, such as alone, near water, or before driving
• Continuing despite harm: keeping on even though it is causing health, relationship, work or school problems

Other changes people often notice include pulling away from friends, losing interest in activities, money going missing, secrecy about where they have been, and new friends who center on partying or drug use.

Signs Someone Is Under the Influence

The DEA and NIDA describe effects that can show up during or soon after use:

• Seeming detached, dreamlike or "not there"
• Confusion, slurred speech or trouble walking
• Rapid, uncontrolled eye movements and enlarged pupils
• Drooling or watery eyes
• Stiff muscles or trouble moving
• Nausea, dizziness or blurred vision
• Not remembering what happened while high

At high doses, people can enter a "k-hole," a state of extreme detachment from their body and surroundings. They may be unable to move or respond.

Physical Signs of Long-Term Use

Some of the clearest signs of ongoing ketamine use show up in the body over time.

Bladder and urinary problems

NIDA describes ketamine-induced uropathy, a treatable but potentially serious bladder condition with symptoms that look like a urinary tract infection. According to StatPearls, a clinical reference from the National Library of Medicine, symptoms can include:

• Needing to urinate very often or urgently
• Pain or burning when urinating
• Blood in the urine
• Pelvic or lower belly pain
• Leaking urine

A young person with repeated "UTIs" that do not clear up is one pattern doctors watch for. This damage can become hard to treat, so getting checked early matters.

Stomach pain

Long-term use can cause cramping abdominal pain, sometimes called "k-cramps." StatPearls also notes that heavy, ongoing use may affect the liver and bile ducts.

Mental and Emotional Signs

Long-term, heavy ketamine use is linked to memory problems, depression and anxiety, according to NIDA. StatPearls adds that chronic use can cause lasting trouble with memory and concentration. You might notice:

• Forgetfulness or difficulty following conversations
• Trouble focusing at work or school
• Low mood, anxiety or irritability, especially between uses
• Changes in sleep and energy when not using
• Paranoia or, at high doses, psychosis with false beliefs that can last for weeks after frequent use stops

Some people also have flashbacks or visual disturbances days or weeks after using. The DEA notes reports of hallucinogen persisting perception disorder after ketamine use.

If low mood includes thoughts of suicide, call or text 988 right away. Our guide to ketamine withdrawal covers what to expect emotionally when someone stops.

Quick Checklist

One or two of these signs alone does not prove addiction. A pattern of several, especially tolerance and continued use despite harm, is a strong reason to get an assessment. You can read more about risk in is ketamine addictive?

Emergency Warning Signs

Call 911 if someone who has used ketamine:

• Cannot be woken or is unresponsive
• Has very slow or shallow breathing
• Has chest pain, a seizure or a very fast heartbeat

The risk is higher when ketamine is mixed with alcohol, opioids, sedatives or other drugs. A NIDA-funded study found that combining ketamine with opioids or GHB caused the most serious health problems.

What to Do If You See These Signs

If you are worried about someone else, choose a calm, private moment when they are not high. Share what you have noticed without labels or blame, and say you care. Expect some denial; one conversation rarely fixes everything.

If you are worried about yourself, a primary care doctor is a good first stop, especially for bladder or stomach symptoms. Be honest about how much and how often you use so they can check for damage.

There is no FDA-approved medication for ketamine use disorder, so treatment relies on counseling and behavioral therapies such as cognitive behavioral therapy, along with medical care for any physical harm. Good programs also look at depression, anxiety and any other substance use at the same time, since these often travel together.

Care ranges from outpatient counseling to residential programs. A short stay in ketamine detox can help when someone is using heavily or also using other substances. Our ketamine rehab hub lists programs nationwide, and you can search by place, such as ketamine rehab in California, Los Angeles or Denver, or use the state directory. To check what your plan may cover, see our insurance guides.

Recovery Is Possible

Many people recover from ketamine addiction, and some of the physical harm, particularly bladder problems, can improve when use stops and treatment starts early. Noticing the signs is the first step. Reaching out for help is the next one.

Sources

• Ketamine (National Institute on Drug Abuse)
• Ketamine Drug Fact Sheet (U.S. Drug Enforcement Administration)
• Drug and Chemical Information: Ketamine (DEA Diversion Control Division)
• Ketamine Toxicity (StatPearls, NCBI Bookshelf)
• Spravato (esketamine) Prescribing Information (U.S. Food and Drug Administration)

Related guides

• Ketamine Addiction: Signs, Risks and Treatment Options
• Ketamine Withdrawal: Symptoms, Timeline and Treatment
• Is Ketamine Addictive?
• Does Aetna Cover Adderall and Prescription Drug Rehab?
• Does Cigna Cover Adderall and Prescription Drug Rehab?
• Does UnitedHealthcare Cover Adderall and Prescription Drug Rehab?

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