What is a "K-Hole," and is it Possible to Experience in Ketamine Therapy?

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.

These symptoms are often paired with a strong internal experience, accompanied by out-of-body experiences, visions/visuals, and an altered consciousness. 

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
• Dehydration
• 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. 

‍Anyone using ketamine should consider its potential contraindications and the side effects of ketamine use. 

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
• Seizures

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.

Key takeaways

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.