Knowing ketamine users: Results from an online investigation

Abstract

Ketamine use has spread in Spain in recent years. In order to inform harm reduction projects, an online research was carried out. Among other variables, sources of information, topics of interest for ketamine users, harms experienced, risk behaviours and harm reduction behaviours were researched in a sample of 392 ketamine users. Ketamine users tended to consider themselves as moderately or well informed about ketamine, and their main sources of information were friends and websites. Health professionals and drug professionals were not relevant sources of information for ketamine users. They engaged in several risk behaviours and the use of harm reduction behaviours has to be improved in order to minimize harms. These issues must be a priority for harm reduction organizations who work with ketamine users.

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Knowing ketamine users: Results from an online investigation
Claudio Vidal Giné1, Jose López Guerrero1, Estrella Villalba Ruíz1
1
Energy Control - Asociación
Bienestar y Desarrollo (ABD), SP
ABSTRACT
Ketamine use has spread in Spain in recent years. In order to inform harm reduction projects, an online
research was carried out. Among other variables, sources of information, topics of interest for ketamine
users, harms experienced, risk behaviours and harm reduction behaviours were researched in a sample of
392 ketamine users. Ketamine users tended to consider themselves as moderately or well informed about
ketamine, and their main sources of information were friends and websites. Health professionals and drug
professionals were not relevant sources of information for ketamine users. They engaged in several risk
behaviours and the use of harm reduction behaviours has to be improved in order to minimize harms. These
issues must be a priority for harm reduction organizations who work with ketamine users.
CORRESPONDING AUTHOR
Name: Claudio Vidal Giné
E-mail: claudiovidal@energycontrol.org
1. Introduction
There is a growing perception in some
Spanish regions that recreational ketamine
use has spread in recent years, although the
real extension of its use remains unknown.
Maybe due to this recent spread, we are
lacking sufficient information to implement
harm reduction initiatives that surely and
effectively meet ketamine users’ realities and
needs.
Ketamine users are an under-researched
and hard-to-reach population, and only in
recent times has ketamine use become a
topic of interest for researchers, mainly due
to urinary symptoms in some users. In fact,
only a few publications were identified by us
in relation to recreational ketamine users
(e.g., Copeland and Dillon, 2005; Corazza,
Assi and Schifano, 2013; Dillon, Copeland
and Jansen, 2003; Jansen, 2000; Kalsi, Wood
and Dargan, 2011; Raynaud-Maurupt, Bello,
Akoka and Toufik, 2007) and only one was
published in Spain (Barriuso and Markez,
2004).
Some harm reduction strategies have been
implemented in recent years. Of those, the
majority were informational strategies
directed to inform ketamine users about
related risks and harm reduction behaviours.
For this reason, it’s important to know if
these strategies are well-adjusted or matched
to ketamine users’ needs and realities. In this
sense, to know what kind of sources of
information (and their credibility) ketamine
users employ, what kinds of information they
want to receive, what harms they are
experiencing, in what risk behaviours they
engage, or whether they practice or not
certain harm reduction behaviours, is crucial
in order to plan and implement actions
directed to this population.
Our research seeks to fill this gap in our
knowledge and understanding of ketamine
users and provide useful information that can
be used by harm reduction projects.
2. Method
According to previous research and the
areas of interest set by the research team, an
online questionnaire covering several issues
was developed. Along with sociodemographic
data, the questionnaire asked for: (1) degree
to which ketamine users considered
themselves informed about ketamine, (2)
sources of information used (friends,
websites, specialized internet forums, drug-
related professionals, health professionals,
books or magazines, media, non-
governmental organizations, and dealers) and
(3) degree of credibility for each source, (4)

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type of information they would like to be
informed about, (5) risk perception of drugs
used in the last year, (6) risk perception of
several risk behaviours (like injecting
ketamine or sharing straws), (7) how
frequently they engaged in risky behaviours,
(8) if they had ever experienced certain
harms, and (9) how frequently they practiced
certain harm reduction behaviours (See
questionnaire at:
http://ketamina.energycontrol.org).
Several notices were posted on the Energy
Control website, Facebook Fan page and
Twitter and shared with other harm
reduction organizations inviting people who
had used ketamine at least once in the last
year to enter
http://ketamina.energycontrol.org and fill an
anonymous questionnaire about ketamine
use.
For each variable, descriptive statistics were
calculated and, depending on the type of
variable, chi-square tests or mean
comparison tests were performed in order to
investigate gender differences. All data
analysis was performed with SPSS 15.0
statistical package.
3. Results
Between February 23 and June 21, 392
ketamine users (261 male and 131 female)
entered and completed the questionnaire.
Mean age was 26.1 for men and 25.7 for
women.
In general, ketamine users considered
themselves as moderately or well informed
about ketamine. Among their sources of
information, friends and websites were the
most employed, and their credibility was also
high. Disappointingly, health or drug-related
professionals were less used than dealers,
for example, and their credibility was also
lower. In relation to what type of
information ketamine users would like to
receive, information about ketamine
pharmacology and the risks associated with
its use were the main topics of interest for
them.
Ketamine users perceived that some drugs
and behaviours were risky. In general, all
substances were rated with a mean score
ranging between 2.3 (magic mushrooms) and
3.7 (mephedrone) on a 5-point scale. On the
other hand, risk perception for risk
behaviours ranged between 2.6 (mix
ketamine with cannabis) and 4.5 (inject
ketamine and share injection equipment) on
a 5-point scale.
Nearly 60% of the sample had experienced
memory problems and confusion and 34% of
the sample suffered from cystitis, slightly
more women (36.6%) than men (33%),
although this difference was not statistically
significant. The prevalence of other problems
was: changes in mood or behaviour (49.2%),
falls (40.1%), sleep problems (39.8%),
flashbacks (25.8%), and stomach pains (25%).
There were some risk behaviours prevalent
among ketamine users: mixing ketamine
with other drugs (83.4%), taking more
ketamine than was planned (82.7%), sharing
straws (68.9%), being a passenger in a
vehicle driven by a person who was under
the effects of ketamine (62.5%), and driving
under the effects of ketamine (30.1%). The
prevalence of injection was 6.9%. No gender
differences were identified except for driving
under the effects of ketamine that was more
prevalent among men (36%) than among
women (18.3%). In both men and women,
frequency in which they engaged in these
behaviours was variable, although a distinct
group engaged in them between
“sometimes” and “seldom”.
Finally, the percentage of ketamine users
who always engaged in the harm reduction
behaviours mentioned in the questionnaire
was as follows: space out the occasions you
take ketamine, 37.2%; space out doses, 27%;
setting a limit in the quantity of ketamine you
will take, 18.6%; avoid mixing ketamine with
other drugs, 8.7%; testing ketamine before
taking it, 7.4%; and agree that someone in
the group will not take ketamine, 3.8%. No
gender differences were observed.
4. Discussion
Ketamine users are an under-researched
and a hard-to-reach population. For this
reason, it’s important to develop innovative

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methods in order to obtain information
about them that can be useful for harm
reduction organizations. In this sense, online
research carried out by these organizations
can be an excellent tool due to their
proximity to drug users, especially through
the Internet, and their credibility.
Several themes emerged from the data.
First of all, it’s crucial to improve credibility
and use of health and drug professionals,
who can be extremely useful when problems
are experienced. On the other hand, it’s
important that harm reduction organizations
become aware of the possibilities that the
Internet offers them when developing
informational strategies.
Although ketamine users perceived the
risks associated to some drugs or to some
risk behaviours, they frequently engaged in
some behaviours that posed a risk to them.
It’s necessary to develop strategies
specifically addressed to the reduction of
these behaviours. Similarly, it’s necessary to
develop new strategies in order to improve
ketamine users’ adherence to harm
reduction behaviours because, although
many of them practised the majority of harm
reduction behaviours mentioned in the
questionnaire, the frequency in which they
did them was variable and the number of
ketamine users who “always” did them was
low.
Online questionnaires allow us to obtain
information quickly and at less cost than
other methods on drug use patterns and
other areas of interest for harm reduction
organizations. These organizations are in
direct contact with drug users and can easily
incorporate such methodologies into their
work. This will get harm reduction strategies
more tailored to the needs and realities of
drug users.
5. References
Barriuso, M., & Markez, I. (2004). El uso de
ketamina en el País Vasco: de fármaco
anestésico a droga de fiesta. Vitoria-
Gasteiz: Servicio Central de Publicaciones
del Gobierno Vasco.
Copeland, J., & Dillon, P. (2005). The health
and psycho-social consequences of
ketamine use. International Journal of
Drug Policy, 16, 122-131.
Corazza, O., Assi, S., & Schifano, F. (2013).
From “Special K” to “Special M”: The
evolution of the recreational use of
ketamine and methoxetamine. CNS
Neuroscience & Therapeutics, 19, 454-
460.
Dillon, P., Copeland, J., & Jansen, K. (2003).
Patterns of use and harms associated
with non-medical ketamine use. Drug and
Alcohol Dependence, 69, 23-28.
Jansen, K. (2000). A review of the nonmedical
use of ketamine: use, users, and
consequences. Journal of Psychoactive
Drugs, 32, 419-433.
Kalsi, S.S., Wood, D.M., & Dargan, P.L. (2011).
The epidemiology and patterns of acute
and chronic toxicity associated with
recreational ketamine use. Emerging
Health Threats Journal, 4:7107. DOI:
10.3402/ehtj.v4i0.7107.
Raynaud-Maurupt, C., Bello, P., Akoka, S., &
Toufik, A. (2007). Characteristics and
behaviors of ketamine users in France in
2003. Journal of Psychoactive Drugs, 39,
1-11).