While ketamine is only legally available through a clinical prescription or in anesthetic applications —and has been since 1970— ketamine has a history of illegal recreational use.
A term frequently used in reference to recreational ketamine use is “k-hole” —such as being “stuck” or “falling into a k-hole.”
Ketamine use in a recreational setting is potentially dangerous, and comes with its own set of legal and safety concerns.
Let’s explore what a k-hole is, and how a clinically-supervised therapeutic experience helps to prevent k-holes and their less desirable, and potentially harmful effects.
Definition of a “k-hole”
A k-hole is a dissociated, trance-like state that sometimes follows acute, excessive use of ketamine, and most often occurs in recreational settings, such as a nightclub or house party.
A deep, clinically-administered ketamine experience differs from a k-hole experience by providing:
- A safe, clinical setting
- Clinician-prescribed, measured dosages
- Controllable methods of administration, including duration (e.g. intravenous administration)
- Close monitoring of the medicine’s effects on the client
- A supportive container, promoting intentional integration of the experience
Physical effects of a k-hole
Ketamine as a dissociative compound is dose-dependent: the more you administer, the greater the felt effects.
When in a k-hole, an individual may be unable to interact with their surroundings, control their motor functions, or keep awareness of external reality.
For example, an individual may be temporarily unable to speak properly, walk correctly, or maintain their balance. They may even find themselves temporarily “paralyzed” or physically inhibited.
Experientially, it can feel like “falling into a hole,” which is where the specific term comes from.
K-hole experiences are temporary, lasting roughly 30 minutes in duration depending on the context and the dosage. For most, a k-hole experience is deeply confronting and can be a frightening experience. For some, it can be highly transformative and powerful.
What the k-hole experience is like
The experience of a k-hole is psychologically intense and can be likened to a near-death experience. The experience can be thought of as somewhere between a state of deep intoxication and a coma.
Though the experience is intense, it can be either positive or negative depending on the individual’s immediate, or overall mental wellbeing. Some individuals find these powerful and transformative experiences, while others find them disturbing or very challenging.
As a k-hole is attributed to acute, excessive ketamine use, it has many of the experiential hallmarks of a clinical ketamine experience, but with higher levels of intensity.
Markers of a k-hole
Some experiential markers of a k-hole may include:
- High levels of dissociation - A distorted sense of space or time, loss of connection to bodily sensations, and motor control
- Out of body experiences - The sense of taking a third-person perspective or “looking back down at yourself”
- Powerful visions/visuals - Strong psychedelic effects including altered states, visions or visual patterns
- Immobility or loss of motor control - Inability to speak, walk, stand, or exhibit fine motor control.
- Self-transcendence - Positive feelings of self-transcendence, euphoria, or surrender brought that are atypical outside of the experience
Contributors to undesirable experiences
Like all psychedelic experiences, there are many factors —particularly “set and setting”— that contribute to a positive or negative experience.
Because k-holes often occur during clinically unsupervised recreational use, individuals may find themselves in less than favorable circumstances:
- In unfamiliar or crowded public settings
- Lacking adequate peer or medical support
- Mixing ketamine with alcohol or illicit substances
- General unpreparedness for the intensity of the experience
Health concerns/considerations of acute ketamine use
While entering into a k-hole is rarely the aim of an individual, it can easily happen as the individual’s inhibitions are lowered in recreational settings.
In a clinical therapeutic setting, a licensed psychiatric clinician will consider any exclusionary factors that may affect your health, based on your health history and current mental state. From this data, they can apply a clinically-appropriate treatment plan, or recommend refraining from treatment at that time.
Major concerns around excessive recreational ketamine use
There are major medical concerns that surround excessive recreational ketamine use.
Risk of overdose
The most acute concern is the risk of ketamine overdose from excessive consumption of ketamine. Although the risk of overdose is low from ketamine, the risk is greatly increased outside of a clinically-supervised setting.
This risk increases even further when mixed with other substances, such as alcohol, opioids, or other recreational drugs.
Physical safety risks
K-holes most commonly occur in recreational settings where the physical setting is unsafe for those who are acutely intoxicated. This includes risks of falling from heights, drowning, or being physically or sexually assaulted.
Persistent dissociative symptoms
After a k-hole, it may be difficult for an individual to release the feeling of dissociation. They may continue to feel disconnected from themselves, the world, and the meaning of their lives.
Excessive ketamine use can also cause hallucinogen-persisting perception disorder (HPPD) in some individuals.
Short-term side effects
Ketamine has the potential to produce the following short-term side effects:
- Elevated heart rate
- Elevated blood pressure
- Loss of coordination
- Nausea or vomiting
Addictive behavioral patterns
Taking an excessive dose of a strong psychedelic dissociative compound may ingrain addictive behaviors in an individual. Particularly in recreational circumstances, it is possible to become addicted to ketamine. The consistent pursuit of k-hole experiences may qualify an individual for substance use disorder.
An individual’s history of substance use and corresponding disorders are taken into consideration by clinicians during initial screenings as a ketamine therapy candidate.
Long-term side effects
While a k-hole is an acute, temporary experience, there are several long-term side effects possible with extended recreational ketamine use:
- Bladder problems
- Cognitive effects
- Heart problems
So long as there is not an overdose, nor an accident from the loss of motor control and general awareness, k-holes are not intrinsically harmful. However, they should not be sought out.
It’s clear there are major health concerns and considerations related to excessive recreational ketamine use which leads to k-holes.
Are k-holes possible in a clinical or therapeutic setting?
The vast majority of k-hole experiences come from acute, excessive recreational use of ketamine outside of clinical contexts.
K-hole experiences are unlikely to occur when ketamine is prescribed and administered in a safe, clinically-supervised setting.
Ketamine therapy is safe and effective if:
- It’s prescribed, dosed, and administered through a licensed psychiatric clinician
- Time and effort have gone into preparing a supportive set and setting
- There is additional support for the individual throughout the experiences
Additionally, the ketamine being administered in a clinical setting comes from a regulated and trusted pharmaceutical source. In recreational settings, there’s no guarantee that the substance you receive is pure ketamine, or ketamine at all.
These factors and more contribute to making a k-hole experience highly unlikely in clinical contexts.
This is not to say that powerful dissociative and psychedelic experiences induced by ketamine are not possible in clinical contexts —they are. However, it is directly due to the preparation and safety mechanisms in place that these powerful medicinal experiences become deeply healing and supportive for the individual.
A k-hole is commonly experienced due to excessive use of ketamine over a short period of time, especially within recreational contexts.
There are major health concerns directly related to k-holes, most directly the risk of overdose from acute, excessive use. There are also reasonable concerns and considerations related to general ketamine use outside of clinical contexts.
For those seeking therapeutic value from ketamine, a licensed clinician should be consulted, and its recreational use should be avoided.
If you’d like to work with ketamine treatment and psychedelic medicine in a safe, effective, and supportive container, consider seeing if you’re a Mindbloom candidate today.
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This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. If you are in a life-threatening situation, call the National Suicide Prevention Line at +1 (800) 273-8255, call 911, or go to the nearest emergency room.
Important FDA Safety Information
Ketamine is not FDA-approved for the treatment of depression or anxiety. Learn more about off-label uses here.
Side effects of ketamine treatment may include: altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dry mouth, elevated blood pressure or heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses).
Do not proceed with ketamine treatment if any of the following apply to you:
- Allergic to ketamine
- Symptoms of psychosis or mania
- Uncontrolled high blood pressure
- CHF or other serious heart problem
- Severe breathing problem
- History of elevated intraocular or intracranial pressure
- History of hyperthyroidism
- Other serious medical illness
- Pregnant, nursing, or trying to become pregnant
Ketamine has been reported to produce issues including, but not limited to, those listed below. However, lasting adverse side-effects are rare when medical protocols are carefully followed.
While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some recreational users.
- In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
- Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders.
- Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your MindBloom clinician before proceeding with treatment.
- The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents.
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
- Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
- Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
- Continue to take antihypertensive medication as prescribed
- Avoid hangovers or alcohol intake
- Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
- Ketamine treatment should never be conducted without a monitor present to ensure your safety