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Eva Baumgartner

Ketamine as a Recreational Drug
on the risks of consumption-related socio-pathological changes and specific conflict behaviour, and their relevance for secondary preventive institutions

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Inhaltsverzeichnis
1. 2. Introduction The Substance 2.1. The History 2.2. Chemical Information 2.3. Dosage and Use 2.3.1. Oral Consumption 2.3.2. Nasal Consumption 2.3.3. Intramuscular Consumption 2.3.4. Intravenous Consumption 2.4. Effect 2.4.1. Set 2.4.2. Setting 2.5. The dissociative effects of ketamine 2.6. Near-death experiences 2.6.1. What is a near-death experience 2.6.2. The main characteristics of a near-death experience 2.7. Mixed-consumption 2.7.1. Ketamine and “Downer” 2.7.2. Ketamine and GHB 2.7.3. Ketamine and Alcohol 2.7.4. Ketamine and Amphetamines, Metamphetamines and Cocaine 2.7.5. Ketamine and Ecstasy (MDMA) 2.7.6. Ketamine and LSD 2.8. Specific Risks 2.8.1. Physical 2.8.2. Psychological 2.9. Possible Long-term Effects 2.9.1. Psychological Long-term effects 2.9.2. Physical Long-term effects 2.10. Ketamine dependency The medicinal use of ketamine 3.1. Ketamine in emergency medicine 3.2. Ketamine in internal medicine 3.3. Ketamine in the treatment of chronic pain 3.4. Side effects of ketamine 3.5. The use of ketamine in psychotherapeutic practice The legal status of ketamine “Risk Reduction“ and ”Safer use” 6 7 7 7 8 8 8 9 9 9 10 10 10 11 11 11 12 12 12 13 13 13 13 14 14 14 15 15 16 16 19 19 19 19 19 20 21 22 5.1. 5.2. 6. Risk reduction Safer use 22 22 25 25 25 25 26 26 27 28 29 30 30 32 32 32 32 33 33 34 34 34 34 35 36 36 36 36 38 38 40 42 43 44 45 47 48 Empirical Section 6.1. Introduction to empirical section 6.1.1. ChEck iT! 6.2. Method and Approach 6.3. Explanation of method choice 6.4. Questionnaire Development 6.5. Description of the survey 6.5.2. The Realisation 6.6. Evaluation of Data - SPSS 6.7. The Results 6.7.1. Demographic Data 6.8. Consumption patterns 6.8.1. Age of Initial Consumption 6.8.2. Motivation for Initial Consumption 6.8.3. Setting 6.8.4. Changes in atmosphere caused by ketamine 6.8.5. Monthly prevalence 6.8.6. Mixed consumption 6.8.7. Form of Consumption 6.9. Evaluation of Qualitative Questions 6.9.1. What makes ketamine interesting? 6.9.2. Changes in relationships through ketamine consumption 6.9.3. Changes in Friend 6.9.4. Changes in those questioned 6.9.5. Changes in the life of those questioned 6.9.6. Negative Experiences with Ketamine The relevance of results 7.1. Relevance of results for social work Conclusion Epilogue Glossary Appendix 11.1. Questionnaire Bibliography List of figures Author ChEck iT! 3

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Abstract
The subject of the submitted thesis is “Ketamine a Recreational Drug” – on the risks of consumption-related socio-pathlogical changes and specific conflict behaviour as a consequence of its consumption and their relevance for secondary preventive institutions. Ketamine is an dissociative anaesthetic used in veterinary and human medicine. Because of its specific effect ketamine is also used without medical indications, for example in the party scene. The dissociative effect of ketamine can produce a phenomenon referred to as a near-death experience. The special risks of this substance are the high risk of dependency and the readiness to take risks after consumption. The hypothesis of this thesis is that the consumption of ketamine causes socio- pathological changes especially in regard to conflict attitudes. This assumption was analysed with a standardised questionnaire filled out by ketamine consumers at various techno parties. I have also collected information concerning consumption patterns and consumption type. The results of my research appear to verify my assumption. For example, about 78 % of those questioned stated that the atmosphere at parties where a large amount of ketamine is used gets strained, excited and aggressive. 53 % of the persons asked told me that they had noticed a change in their friends’ behaviour after those had consumed ketamine. Ketamine dependence as well as withdrawal symptoms were also important topics in conversations with consumers. I wasn’t able to find anything about the latter in literature. Because of these findings I have come to the conclusion that street work with a low threshold approach is absolutely necessary in places where ketamine is consumed. Keywords Ketamine, K, Keta Recreational drugs Low threshold Dissociative anaesthetic Near-death experiences ChEck iT! Free-techno scene Goa Scene

Preface
This publication is a thesis written by Evi Baumgartner for the completion of her diploma at the Social Workers’ College (academic title: “Magistra (FH) der Sozialarbeit”). Evi Baumgartner specialised in the field of drug-related social work right from the beginning of her studies. In addition to this she has been working with ChEck iT! since the winter of 2003. She had done research in various fields of the electronic music scene already within the framework of her project practicum and therewith carried out important basic research for our work at events. Evi Baumgartner’s work at ChEck iT! focuses on her counselling at events as well as special topic work related to the free-techno scene and ketamine. The curiosity about the topic of ketamine emerged through the work she did with ChEck iT! and it was through this that she decided to write her thesis on the topic of ketamine. She started working for the public medical drug counselling centre Ganslwirt in 2006.

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see: Homepage Ralf Rebmann. URL: www.gifte.de/Drogen/ketamin_bild01.htm, March 2006 see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 1 Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002,853 see: Turner, D.M. Der Psychedelische Reiseführer, Nachtschattenverlag, Germany2 ,1997, 67 see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 2 (S)-Ketamin. Aktuelle interdisziplinäre Aspekte. Editors R. Klose and U. Hoppe. Springer Verlag, Berlin Heidelberg 2002,2 see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 2 http://www.erowid.org/chemicals/ketamine/ketamine_timeline.php translated, 29 Nov 05 see: Internetlexikon. URL: catbull.com/alamut/Lexikon/Mittel/Ketamin.htm, March, 2006 see:Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005,2f

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Cl N H CH3

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Figure 1: various Ketanest® Infusion bottles1

Figure 2: chemical structure of ketamine9

1. Introduction
The following work on the topic of “ketamine as a recreational drug –on the risks of consumption-related socio-pathological changes and specific conflict behaviour, and their relevance for secondary preventive institutions” consists of two large sections. The first section includes a theoretical analysis of the substance ketamine and the second section gives a detailed description of my research and its results. The hypothesis which is investigated in this work is whether or not consumption-related changes can be caused by ketamine, for example increased aggression potential and specific conflict behaviour. Ketamine is a dissociative anaesthetic used in both human and veterinary medicine. The special effects of the substance have led increasingly to its use outside of its proper medical context, for example misuse in the techno scene at techno parties. In this thesis I have investigated the use of ketamine as a recreational drug. In the theoretical section I analyse the history of the substance and explain the chemical structure as well as the numerous possible ways of consuming ketamine. Since ketamine is also used in human medicine, I also list its various current medicinal uses. Furthermore I distinguished the special effects of the substance, whereby I address the special effects as well as the phenomenon of near-death experiences. A subchapter of the topic mixed consumption and polytoxicomania describes the effects of ketamine in combination with a variety of other substances. An exhaustive description of the substance and the possible problems which can arise through consumption are provided in the sections on special risks and eventual long-term effects of ketamine. Also the dependency potential is described in more detail in this connection, in particular the dependency potential of ketamine. Here I will also briefly describe the experiences I had while doing my research. The current legal status of this substance in Austria is also the subject of one chapter in this thesis. At the end of the theoretical section I describe another two social work approaches with low threshold drug-related work, namely ”risk reduction“ and ”safer use“. The empirical section of my work is based on data and facts which I acquired through a standardised questionnaire. In the first part of the empirical section I describe in detail the institution called ChEck iT!. Furthermore I elaborate on the methodology and approach I used in my research. I explain why I chose a questionnaire for my research section and describe my queries on location. In order to give the reader a more complete picture two sub scenes in the techno scene in which I did most of my research are described in more detail. The evaluation of the results in the statistic programme SPSS are explained and the results are displayed in several graphic figures. Here I first describe the group of those questioned, then I deal with the consumption patterns of the consumers and interpret the qualitative questions. In this section of the thesis I will also reveal whether or not my hypothesis was verified or falsified by the research. In the empirical section I also handle to the topic of the relevance of my results for secondary preventive institutions and the work offered by social workers. In conclusion my considerations are presented and the results are combined with theoretical basis in a conclusion.

2. The Substance
Ketamine is a dissociative anaesthetic (see glossary) and belongs to the substance class of phencyclidine derivatives. It is used both in human and in veterinary medicine. 2 Ketamine is an injection narcotic which causes a “complete analgesia with superficial unconsciousness […] with maintained protective reflexes […]“. 3 Ketamine was first produced by Parke Davis and is sold on the market with the names Ketalar®, Ketanest® and Ketanet®. 4 (see Figure 1) In the techno scene it is offered for sale under the names Keta, Special K, Vitamin K, Cat or simply K. 2.1. The History The company Parke-Davis commissioned Calvin L-Stevens, a pharmacologist at Wayne State University, to do research in order to find a substitute for the anaesthetic medicine called phencyclidine (PCP, Angel Dust) which was negatively associated with strong side effects. 5 Phencyclidine was also used in human as well as veterinary medicine. “In the 1960s McCarthy and Chen succeeded in synthesising a PCP- relative: Chlorophenyl-methylamino-cyclohexanon-hydrochloride (CI 581), or ketamine.” 6 Parke-Davis obtained the US patent for the production of ketamine as a medicine in 1966. The psychedelic potential of the substance was discovered by Edward Felix Domino, Professor of clinical pharmacology at the University of Michigan, on the 3 August 1964 in an initial, non medicinal self-experiment. In the 1960s and 70s ketamine was used by the US Army as an anaesthetic for soldiers in the Vietnam War, as well as by doctors, psychiatrists and other researchers as a “recreational drug” for the investigation of consciousness. After the publication of “Journeys into the Bright World” (Moore and Alltounian, 1980) and “The Scientist” by Cunningham Lilly (1984), in which detailed reports of experiences including doses specifications were written, the substance became known world-wide. As a result ketamine was used much more frequently without medicinal indications, with the purpose of investigating consciousness. 7 From 1987 to 2000 a total of 12 deaths could be brought in connection with ketamine (7 in the USA and 5 in Europe), however only 3 of these cases involved ketamine alone. 8 2.2. Chemical Information “Biochemically seen ketamine is a racemate which consists of equal parts of two optical enantiomeres [S(+)ketamine, R(-)ketamine]. (see Figure 2) Pharmacological research could point out distinct qualitative and quantitative differences between the two ketamine-enantiomeres. In addition to this the clinical superiority of s(+)ketamine could be described in various therapy studies. S(+)ketamine mainly conveys the desired effects while R(-)ketamine conveys mainly the undesirable side effects. The clinical advantages apply to the anaesthetic potency, the magnitude of the analgesia achieved, the intraoperative effects as well as side effects and undesirable psychological disorders. The main problem with the clinically used ketamineracemate today lies in the psychological waking reactions and in the waking phase which is in some cases lengthened by hours. […] S(+)ketamine also has a stronger psychedelic effect than the racemate and must be given in much lower doses than the racemate. […]” 10 „“Ketamine influences the working mechanism of the neurotransmitter glutamine acid, the most important stimulatory (excitatory) neurotransmitter in the central nervous system. Ketamine binds with a specific type of glutamate receptor, the NMDA-receptor (N-Methyl-D-Aspirate) and blocks therewith the working mechanism of this receptor. […] The blockade of this receptors information exchange causes a functional decoupling of certain regulation systems in the mesencephalon and the cerebral cortex from the thalamus. The perception and sorting of optical and acoustic signals and other stimulants no longer takes place in its normal fashion but rather in a fragmentary form. Similar to a very strong activation of serotonin receptors, only separate, completely unrelated pictures are processed without any connection to each other and with distinctly changed associations and attributed meanings.

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see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005,2f see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 3 see: Cousto, Hans. Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 3 see: Turner, D.M. Der Psychedelische Reiseführer, Nachtschattenverlag, Germany2 . 1997, 67 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 7f see: Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Germany3, 2000, 297ff. see: Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Germany3, 2000,298 Turner D.M., Der Psychedelische Reiseführer, Nachtschatten Verlag, Deutschland2 ,1997, 67 see: Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Germany3, 2000,298 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 8 see: Lilly John C., Der Scientist. Sphinx Verlag , Basel. 1984, 150ff see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005,8 see: Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Germany3, 2000, 299 see: Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Germany3 2000,298

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see: Hans Cousto: Fachinformation: Ketamin – Mischkonsum, 8

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Ketamine also impedes the peripheral revival of catecholamines like adrenaline, noradrenaline and dopamine and strengthens therewith the peripheral monoaminergic – in particular dopaminergic – transfer. Along with the peripheral transfer, the central dopaminergic transfer is particularly stimulated. This dopaminergic effect appears to be the cause of the euphorical effect of ketamine.” 11 Through experiments carried out on mice it has been shown that ketamine also has an effect on GABA – receptors. There it works in a way which is similar to that seen with GHB (gamma-Hydroxybutyric acid, also known as “liquid ecstasy”), however its effect is not as strong. This means that the mixedconsumption of this substance with alcohol can also be very dangerous, as alcohol considerably intensifies the sensitivity of the GABA receptors and therewith significantly increases the effect of the transmitters. This can lead to an intensification of the dampening factors of ketamine and alcohol in the brain. 12 2.3. Dosage and Use Ketamine is available on the black market as a white, crystalline powder or a liquid. In the pharmaceutical industry ketamine is delivered in the form of an injection solution containing ketamine-hydrochloride. If not otherwise stated on the package, it is the racemate (50% S(+)ketamine and 50% R(-)ketamine). The powdery, dehydrated ketamine available on the black market is ketamine hydrochloride (Ketamine-HCL), therefore the racemate. 13 Ketamin kann oral geschluckt und sowohl intravenös als auch Ketamine can be taken orally or in the form of an intravenous or intramuscular injection. The most frequent form of consumption in the party scene is the nasal consumption in powder form. In order to get this powder the injection solution must be dehydrated. Dehydration is achieved by heating the substance to 95 degrees Celsius and maintaining this temperature until the entire moisture is evaporated and only a powdery substance remains. 14

Some consumers called this procedure “boiling”. This expression is common in the street drug scene. In the following paragraphs I would like to describe the dose and uses of this substance in detail. For this it appears to be necessary to view the different forms of consumption separately. 2.3.1. Oral Consumption In his professional information brochure (Fachinformation: Ketamin-Mischkonsum) on ketamine Cousto, an employee of the drug checking project called “Eve & Rave”, differentiated between a suitable dosage for parties and a suitable dosage for a “real takeoff”. He suggested that the optimal dose for use as a recreational drug was 40-50 mg taken orally. Here the onset of effects would occur approx. 30-60 minutes after administration and would last for approximately one hour 15 In the “Psychedelic Travelguide”(Der Psychedelische Reiseführer) one finds a suggested dose of 200 – 450 mg of ketamine taken orally. In this case the dose represents the amount needed to have a full ketamine experience (not suitable for parties). The effects after the oral consumption of this dose appeared after approximately 5-20 minutes (depending on the amount of time since last meal) and lasted for about one and a half hours. 16 2.3.2. Nasal Consumption In the professional information brochure on ketamine mixedconsumption (Ketamine: Mischkonsum) 20 to 25 mg of ketamine applied nasally (ca. 0.25 to 0.4 mg per kg body weight) is given as the right dose for consumption at parties. While the right dosage for a full ketamine experience is, according to H. Cousto, approximately 150 mg (2.0 to 2.5 mg per kg body weight). 17 This statement corresponds more or less with the dose stated in the “Psychedelic Travelguide”, in which 50 – 150 mg of ketamine taken nasally was described as the optimal dosage. The

onset after ca. 5-10 minutes and the duration of effects also corresponds with this. 18 2.3.3. Intramuscular Consumption “A dose of 100 mg of ketamine, administered intramuscularly, produces an intense psychedelic experience.” The exact dosage necessary varies with body weight and mental condition.” 19 Other dosage suggestions found in professional literature varied from 30 mg to 150 mg consumed intramuscularly. Here the effects appeared already after circa 3-5 minutes and lasted for approximately 40-60 minutes. 20 With 400 to 800 mg of ketamine administered intramuscularly one achieves complete anaesthesia lasting up to circa 15 to 25 minutes. 21 The psychedelic self-experimenter John Lilly gave himself an hourly injected dosage of 50 mg, 20 hours a day with a fourhour sleeping intermission. Even with such a high dosage on such a continual basis a physical overdoses did not occur, however the loss of a connection to reality was a result. 22 2.3.4. Intravenous Consumption In literature from this field one can find very little information on intravenous use because this form of consumption is not very wide spread. This is due to the fact that the high comes very quickly, very similar to the anaesthesia through ketamine, and is much too intense. The consumer is too strongly “dazed” and does not really experience the high. 23 With an intravenous dose of 100 to 200 mg (2 mg per kg body weight) a complete anaesthesia comes after circa 30 seconds, and this condition lasts for about 5 to 10 minutes. 24 2.4. Effect The physical effect of ketamine can range from an anaesthetic effect to a so-called dissociative anaesthesia. The pain analgesic effect appears already before and also lasts longer than the anaesthesia. The psychoactive effect of ketamine is very strongly dependent on the type of consumption and the amount of the dosage. In

his “Psychedelic Travelguide” Turner assigned each psychedelic substance a place on an intensity scale, giving ratings of 1-10 (1 = mild, 10 = intense). Ketamine was given an intensity of 10 to infinite (in comparison: Turner gave LSD a rating of “only” 3 - 7.) The dissociative effect of ketamine means a fragmentary disintegration of the environment and the bodily senses, a feeling of dissolution to the world around it and to feelings within it (ego – border dissolution, ego – disintegration). In professional literature one can find experience reports from consumers in which these users believed to have left their bodies or could not see any demarcation between themselves and the environment (see section on dissociative effects of ketamine). During my research I also met several consumers who told me that they had watched themselves dance or something similar. Furthermore, there are also reports that sometimes find communication extremely difficult. Thoughts can break off and the central thread of the conversation is very easily lost. Often the senses of taste and smell are also deactivated and sounds are perceived in a distorted form. When the consumer closes the eyes or takes a very high doses very realistic dream visions can be seen. Nausea is also often mentioned as a side effect, in particular when the consumer is physically active. Therefore it is suggested that one lie down for the course of a ketamine high. The consumption of ketamine also brings the danger of injury because it reduces the user’s ability to feel pain and the overdose prevents the body from collapsing or passing out. 25 In literature it is also reported that the consumer has no memory of what they experienced while being high. In many experience reports consumers describe dark hallucinations which can trigger extreme anxiety and so-called “near-death experiences”. (see section: Near-death experiences) In addition to the physical effects ketamine also has an extremely strong psychoactive effect, the impact of which, as with every other substance, is heavily dependent on the set and setting.

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vgl. ChEck iT! Booklet, Verein Wiener Sozialprojekte, Universal Druckerei Leoben, Vienna2 , 2002, 9 ICD-10, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme

10.Revision, Deutsches Institut für medizinische Dokumentation und Information; Band I, Urban & Schwarzenberg, Version 1.0, 1994, 329
28 29

Kelly, Kit. The little book of ketamine. Ronin Publishing inc., California. 1999, 19 see: Psychedelische Chemie. Editors. D. Trachsel and N. Richard. Nachtschatten Verlag, Germany3, 2000, 305ff

2.4.1. Set The set includes all person-related factors which are important to the impact, for example one’s body weight and metabolism. In this way the same doses of ketamine would have a much stronger effect on a person who weighs only 50 kg than on a person who weighs 70 kg. The metabolism also varies greatly from one person to another and can be difficult to determine. For example, some people can transform the substances into their effective form very quickly but don’t feel the effects for as long as other people. Previous psychological and physical illnesses are also important factors which belong to the set. Illnesses of the heart, kidneys, thyroid gland or respiratory tract and conditions like epilepsy can have an influence on the effect and can also possibly lead to a dangerous situation. Another very important factor influencing the impact of a psychoactive substance is the current mood of the consumer. Both positive and negative moods can be strengthened by psychoactive substances. 2.4.2. Setting The setting includes all external factors which influence the type of effect produced by psychoactive substances. The factors which belong to the setting are, for example: where the consumption occurs and who the substance is consumed with. 26 2.5. The dissociative effects of ketamine Ketamine has a distinct hallucinogenic as well as a dissociative effect. The dissociative effect of ketamine is described as a separation of body and mind which can lead to out-of-body experiences. When this happens the senses are distorted and a new reality is created in the mind of the consumer. In this way it is possible for consumers to believe that they can watch themselves dancing or see other actions happening from a vantage point outside of their bodies. A dissociative disorder can also occur in situations devoid of the consumption of psychoactive substances, for example it is

one of the psychological disturbances or behavioural disorders described by ICD 10/ F44: “The general characteristic of dissociative or conversion disorders is the partial or total loss of normal integration of memories of the past, consciousness of identity, the perception of immediate feelings as well as the control of bodily movements. All dissociative disturbances tend to go into remission after a few weeks or months, especially when their initial onset is connected with traumatic life experiences. Chronic disorders, in particular paralysis and emotional disorders, develop when the onset is connected with inter-personal difficulties or insoluble problems. These disorders used to be classified as various forms of conversion neurosis or hysteria. Now they are seen as causal psychogenes which are temporally closely connected with traumatic experiences, insoluble conflicts or broken relationships. The symptoms often manifest themselves in a way which fits into the afflicted person’s concept of a physical illness. However the physical examination and questioning give no indication of a somatic or neurological illness. In addition to this the failure to function is an obvious sign of emotional conflict or need. The symptoms can develop when combined with a psychological burden and can often appear very suddenly. Only disturbances in bodily functions which are usually deliberately controlled and the loss of sensual perception are included here. Disorders with pain and other complex physical sensations which are mediated by the vegetative nervous system are classified as somatic disorders (F45.0). The possibility of a later appearance of serious physical or psychiatric disorders must always be considered.” 27 It can also lead to depersonalisation, as described above, when it comes in connection with a dissociative disorder. This specified dissociative effect of ketamine is not observed in any other psychoactive substance and according to professional literature and reports of experiences the ketamine high can not be compared with anything else when it comes to intensity. Ketamine is in fact a close relative of PCP, also referred to as “angel dust”, but PCP usually causes very negative hallucination and is known for its “bad trips” which often end in

psychotic episodes and are accompanied by a high amount of aggression. Ketamine is much less toxic and the effect of ketamine lasts significantly shorter than with PCP where a trip can last up to eight hours. When compared to other hallucinogens, like LSD or DMT, similarities between a ketamine trip and, for example, a LSD trip are mentioned, but the effects do still appear to be different. For example, both substances produce so-called “pulsating” hallucinations (e.g., breathing walls), but a ketamine trip is usually described as being much “heavier”, more powerful and more impressive. Timothy Leary, the LSD researcher, described his ketamine experiences as “experiments in voluntary death”. 28 In the next chapter I will describe yet another special effect of ketamine, the so-called near-death experience. 2.6. Near-death experiences 2.6.1. What is a near-death experience A near-death experience, abbreviated to NDE, is the condition in which one finds one’s self when, for a limited period of time, one is technically clinically dead, for example during an operation, an accident or something similar. A NDE is a very interesting phenomenon –not only in medicine, neurological science, neurology, psychiatry, psychology or theology. 29 Patients who awake from a coma often claim to have had visions of going through a tunnel, seeing a bright light or something similar. Such visions can also be achieved by, for example, consuming a psychoactive substance like ketamine. All the characteristics of a near-death experience can be reproduced by the consumption of ketamine in the right set and setting. There is no indisputable criteria which describes or defines the near-death experience. As already mentioned, those people who have had such an experience usually describe happy, calm and beautiful trips and therefore an entirely positive picture has become the “distinguishing feature” of a neardeath experience. Jansen (2001) believes that these positive reports can be the

result of the fact that dark visions are usually more readily dismissed as nightmares and that those involved are less likely to want to reveal or make reports of negative experiences. In the past it was believed that the major difference between a near-death experience and a ketamine trip was that the latter could be unpleasant and therefore there was no motivation to repeat the experience. Still, some people have found ketamine trips so happy and positive, that they wanted to consume the substance daily, while some “real” near-death experiences were described as dark and frightening. Jansen’s research brought him to the conclusion that the similarity between a spontaneous near-death experience and a ketamine trip is brought about by a blockade of certain receptors in the brain. A sudden decrease in the supply of oxygen or in blood sugar, caused for example by the interruption of blood flow during a heart attack causes an overflow of glutamate. This leads to an over-activation of some brain cells which suddenly die as a result. Jansen compared this process with an air balloon in which one suddenly blows too much air and blows up as a result. Ketamine prevents this destruction. It binds itself to the same receptor points as other substances in the brain. The same conditions which can cause a glutamate flood can also set a flood of other substances free, which in turn bind to receptors in order to protect the cell and in this way lead to an altered state of consciousness. 2.6.2. The main characteristics of a near-death experience One of the important characteristics of a near-death experience is the feeling of certainty in regard to the reality of what is experienced and the feeling that one is truly dead. In addition to this it was impossible for those who had such an experience to describe what happened in words. Another characteristic is the strong feeling of timelessness, of eternity, of peace and joy. Still, in some cases frightening and extremely unpleasant feelings were reported. Sometimes the people involved experienced such incidents at a very high speed. This is often described as a feeling of falling, riding on a wave, of

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see: Dr.Jansen Karl, Ketamine:Dreams and Realities, MAPS, Florida, 2001, 92ff Psychedelische Chemie. Hrsg.v. D. Trachsel, N. Richard. Nachtschatten Verlag, Deutschland3, 2000,306 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005,9ff ICD-10, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme

10.Revision, Deutsches Institut für medizinische Dokumentation und Information; Band I, Urban & Schwarzenberg, Version 1.0, 1994, 310
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see: ChEck iT! Booklet, Verein Wiener Sozialprojekte, Universal Druckerei Leoben, Vienna2, 2002, 65 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005,9ff see: Turner, D.M. Der Psychedelische Reiseführer. Nachtschattenverlag, Germany2 ,1997, 78f

a vacuum, speeding through a tunnel or being swallowed by an emptiness. In many cases the early phase of a ketamine trip is similarly described. In both cases one has no perception of pain and a complete separation from the body (dissociation) occurs. In both, near-death experiences and ketamine trips, visions of landscapes, angels, near friends or partners as well as visions of religious or mythical origin are often seen. Together both experiences have the characteristic of aversion to turn back and return to the condition before the trip or experience. Another typical characteristic of a near-death experience is that one hears the doctor declare the time of death or that one floats above the scene and observes everything that happens. Ketamine trips typically include such out-of-body experiences and floating scenes. But near-death experiences and ketamine highs still include numerous differences and variations of that which has previously been described. 30 In “Psychedelic Chemistry” (2000) the following is added to the characteristics of near-death experiences: Ring (one of the most important near-death researchers) was able to classify 5 stages in the NDE: 1. “Feeling of peace and satisfaction 2. Feeling of a separation from the body 3. Entrance into a dark intermediate world (high speed movement through a tunnel: Tunnel-Experiment) 4. Appearance of bright light and 5. Submersion in light It has been reported that 60 % of the people who had a NDE experience reached stage one and only 10 % submerged in the light.” 31 2.7. Mixed-consumption 32 In professional literature one can find reports of experiences involving the mixed-consumption of ketamine with a wide variety of psychoactive substances. Most consumers of psychoactive substances do not consume only one substance but

rather mixed various substances. This simultaneous misuse or the dependency on numerous substances is called polytoxicomania. Today those in the field of medicine choose the

formulation “psychological and behavioural disorders through the use of multiple substances and consumption of other psychotropic substances” as a diagnosis, as seen for example in ICD 10. In the diagnosis catalogue (ICD-10) this is position F19: “This category is to be used when the consumption of two or more psychotropic substances are involved and it is not clear which substance caused the disorder. This category is also to be used only one or none of the substances consumed can not be surely identified, since many consumers often don’t know themselves what they have taken.” 33 In the following section I would like to give an overview of various combinations possible. 2.7.1. Ketamine and “Downer” A “downer” is a range of different substances which all have a calming and relaxing effect on the body and mind and which often cause euphoric conditions and are characterised by a high psychological and physical dependency potential. So-called downers, for example benzodiacepine, barbiturates and opioides, can have even stronger effects when taken with ketamine, because these substances reinforce each other in their calming and relaxing effects, this can, in turn, result in breathing depression and respiratory standstills which can make intensive medical treatment necessary. 34 In addition to this barbiturates and opiates in combination with ketamine can lengthen the recovery phase and that means it can take much longer for the consumer to feel fit after the effects of the substances have already disappeared. 2.7.2. Ketamine and GHB The effect profiles of ketamine and GHB do not complement each other very well due to the fact that GHB increases physical sensitivity while high doses of ketamine respectively numb

physical sensitivity. Still some experienced consumers describe the alternating consumption of GHB and ketamine as being rather stimulating. A stable, basic constitution in both psychological and physical respects is an absolute prerequisite for such “hot and cold baths”. 2.7.3. Ketamine and Alcohol The combination of alcohol with ketamine brings a high possibility of nausea and vomiting as well as the risk of a breathing depression. After consuming alcoholic beverages one should avoid the consumption of ketamine. 2.7.4. Ketamine and Amphetamines, Metamphetamines and Cocaine These combinations can lead to an overstimulation of the symphatic nervous system (symphaticus). That means it can cause an increase in blood pressure, heart rate and heavy breathing. 2.7.5. Ketamine and Ecstasy (MDMA) According to consumers the consumption of a small amount

bined with high doses of ketamine vehemently advise others against trying this combination. 2.7.6. Ketamine and LSD According to Hans Cousto, the combination of ketamine and LSD appears to be a popular in the party-setting as well as in the scope of psychonautical trips. In the party-setting ketamine is taken at the climax of the LSD effect in order to brighten or intensify the effect. It can also be taken nasally in small doses in order to lengthen the LSD trip. High doses of ketamine are also often taken at the end of an LSD trip due to the fact that the simultaneous end of both the LSD and the ketamine trip can make the fading of the effect of LSD softer and more pleasant. In addition to this the recovery phase after a trip is therewith distinctly more pleasant and relaxed than it would be otherwise. This combination is considered unsuitable for young, inexperienced drug consumers because it requires a certain amount of experience to be able to deal with this high. 35 ZAs an illustration I would like to describe the experience of D. M. Turner who, while walking through Death Valley, consumed 350 µg of LSD ( a doses which would, for most people, be a very strong psychedelic doses) at the beginning and an unknown amount of ketamine at the end of his trip. “[…] As I sat down to rest and closed my eyes, my mind was filled with visions of desert creatures, like snakes and scorpions - with pictures which are typical of desert trips. The next vision was the exact reproduction of a sabre-toothed tiger. […] As my thoughts moved further back into the past I saw creatures from the era of dinosaurs which travelled this region in prehistoric times. As I sat and thought about the past I realised that I must have developed out of such creatures. […] Then my mind opened and time stretched into eternity. […] As the full moon stood high in the sky I arrived at the salt lakes and, at this spot which is the lowest point of the United States, I took the ketamine. I felt myself become part of the earth and penetrated the deep layers of the “spirit” of planetary consciousness. It is common for me and other people who take ketamine to become a part of the earth spirit.” 36

of ketamine together with ecstasy gives the effect of the ecstasy more “colour” and therewith more vivid visions. This is described by most consumers as being very pleasant, favourable and enriching. It is also reported that this combination brings back the memory of the first ecstasy experience, which is described by most consumers as being heavenly. This initial experience can not be “revisited” by the continued consumption of ecstasy alone. High ketamine doses in combination with ecstasy consumption leads to a loss of connection to the world of physical surroundings. The effect profile of ketamine in high doses diametrically opposes the effect profile of ecstasy. That means that the effects of these two substances are completely different. Ecstasy strengthens perception and intensifies the connection between the consumer and the physical environment, while with ketamine the consumer often completely loses his/her connection to the outside world. Most consumers who have had experiences with ecstasy com-

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37 38 39 40 41 42

see: ChEck iT! Homepage. URL: www.checkyourdrugs.at, January 2006 see: Dr.Jansen Karl, Ketamine:Dreams and Realities, MAPS, Florida, 2001, 266ff see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 6 see: Kelly, Kit. The little book of ketamine. Ronin Publishing inc., California1. 1999, 77 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 6 see: Kelly, Kit. The little book of ketamine. Ronin Publishing Inc. California. 1999, 82ff

2.8. Specific Risks 2.8.1. Physical There is a wide range of negative physical effects of ketamine consumption from nausea and vomiting to cardiac arrhythmia and coma. Vomiting and nausea are very common side effects of ketamine consumption, luckily the life-saving reflexes, for example the swallowing reflex and the gag reflex, are still active under the influence of ketamine, otherwise there would more frequently be complications resulting from these side effects. The consumption of ketamine can also lead to nystagmus (an involuntary trembling of the eyeball), dizziness, incoherent speech, increased pulse rate and high blood pressure as well as life-threatening cardiac arrhythmia. There are also isolated reports of ketamine causing cramps, spasms and epileptic seizures. Muscle stiffness, paralysis, deep sleep and anaesthesia can also occur with very high doses. Extreme caution is advised when it comes to the analgetic effects of ketamine, since these can extremely increase the consumer’s risk of accident and injury. 37 Jansen also lists heavy sweating, increased tear production, a hoarse voice, shortness of breath and dizzy spells as general physical effects of ketamine consumption. Ketamine injections can also cause coughing, headaches and incontinence. Many studies deal with the influence of ketamine on the immune system. However the majority of these reports show that ketamine, in contrast to most other anaesthetics, does not appear to have effects of any kind on this system. In a few cases the consumption of ketamine has also been connected to a strong increase in body temperature, but this is strongly debated and the conclusion has been made that ketamine does not lead to an overheating of the body. 38 2.8.1.1. Ketamine Overdose Ketamine is principally considered to be a relatively safe psychotropic substance. That means that the danger of an acute

intoxication is rather low. Risky behaviour resulting from the consumption are the real danger caused by this substance. From 1987 to 2000 seven deaths in the USA and five deaths in the European Union have been connected in some way to ketamine consumption. However in only three of these cases ketamine was diagnosed as the cause of death. 39 An overdose of ketamine is therefore extremely seldom. The experienced “psychonaut” John Lilly consumed ketamine numerous times daily over the course of months without observing subjective physiological damage. A person who consumes ketamine is more likely to die of an accident than of an overdose of the substance. 40 The above-mentioned John Lilly had to be rescued by friends who found him floating face-down in an isolation tank. He had emerged himself in the tank in order to intensify the out-ofbody experience caused by ketamine consumption. He could no longer distinguish whether the near-death experience which he just had was of a psychedelic nature or if it was actually real. For the non-fiction writer D.M.Turner help came too late. He drown in his own bathtub after consuming ketamine. Marcia Moor, co-writer of a book on the topic of ketamine entitled “Journeys Into the Bright World”, also died under the influence of ketamine. She went into a forest on a cold winter night in January in order to consume ketamine and ended up freezing to death. 41 An overdoses of ketamine with fainting and comatose conditions can also be life threatening. With a substance like ketamine where outwardly one can hardly tell the difference between the normal “high” and an overdose it is very important to know what, how much of and how the substance was consumed. 2.8.2. Psychological Ketamine consumption is connected with a wide range of undesirable psychological effects, for example: anxiety, panic attacks, flashbacks, post-traumatic stress function obstructions, sustained perception disorders, mania, depression, suicide, sleeplessness, nightmares, paranoia, hallucinations, deterioration of personality and aggression.

Consumers repeatedly describe the feeling of not really existing or that the world around them seems to be surreal. Karl Jansen believed that this long list of psychological side

effects have more to do with the psyche of the sufferer than with the actual effects of the substance. The connection with the substance is perhaps only coincidental. Psychoactive substances offer an understandable explanation for the problems of their consumers. What Jansen is suggesting here is called predisposition. Predisposition is the medical expression for susceptibility. What this refers to is the susceptibility to specific illnesses. That means that psychological side effects, for example depressions, could arise from a predisposition and therefore possibly do not have to have anything to do with the consumption of the substance. Jansen also wrote that some people who have never consumed drugs, but still suffer from psychosis, tend to claim that someone must have put something in their glass. This is used as a possible and acceptable explanation for the fact that something entirely uncontrollable and unexplainable is happening within them. There are, however, also effects which are definitely connected to the substance, for example a higher dopamine level, from which one comes to the conclusion that there is a connection between the substance and the development of paranoia. Also automatic physical movement which occurs without the conscious excertion or according to the will of the consumer can be attributed to ketamine. The danger of accidents during such activity is naturally great. At this point it is important to mention that all studies that exist in reference to the psychological side effects of ketamine have been studies of ketamine in its medicinal use. The consumption of the substance as a “recreational drug” throws a completely different light on the situation. Here one can not for example forget the role of other substances which were taken before and/or after the consumption of ketamine. I would also like to mention the set and the setting once again. An unfavourable setting leads more easily to an undesirable result. The expectations of the individuals taking the substance are an important part of the set. Knowing this it was

possible to find out for example that the key to a pleasant and positive ketamine experience was to influence the experience from outside. For instance a warm and emphatic feeling can be

developed through a doctor who knows how to emphasise the positive effects of ketamine. In the exact same way, according to Jansen, a negative influence can be achieved, for example through the demonization of the substance in the media. 2.8.2.1. Bad Trip A so-called “bad trip” can appear in several different forms. Anxiety, depression, suicidal thoughts, paranoia, panic attacks and aggression are all common characteristics of a “bad trip”. If a consumer has had a bad trip it can help to take that person to a quiet place, without party lights and with few other people. The consumer should not be left alone and some consumers reported that it helps to speak to the sufferer in a calming voice and to touch them. Whispered conversations and making faces are counterproductive in such situations. If it isn’t possible to maintain a certain amount of identity the consumer usually loses consciousness. In such cases and in the case of long-term symptoms it is essential to acquire medical intervention. 42 2.9. Possible Long-term Effects 2.9.1. Psychological Long-term effects Until today it has not been possible to make any unequivocal statements in regard to the long-term damage caused by ketamine consumption. As with almost every other substance it is assumed that there are risks corresponding to the amount and frequency of ketamine consumption. It is also known that a degree of tolerance can be developed to the substance and that brain and nerve damage are possible with frequent use. The experiences which are usually made with ketamine are connected to positive and pleasant feelings. When one stops taking ketamine after a consumption phase a return to the “normal” mood occurs. So it is possible to occasionally suffer from a depression or depressive phase after a period of chronic ketamine consumption. Hereby the question must be put as

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see Jansen, Dr. Karl. Ketamine:Dreams and Realities. MAPS, Florida. 2001,244f Eve & Rave Homepage. URL: http://www.eve-rave.net/presse/presse05-02-21.html, Safer Sniffing, Redaktion Webteam www.eve-rave.net Berlin , Pressemitteilung vom 19. Februar 2005 ICD-10, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme

45

10.Revision, Deutsches Institut für medizinische Dokumentation und Information; Band I, Urban & Schwarzenberg, Version 1.0, 1994, 306
46

ICD-10, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme

10. Revision, Deutsches Institut für medizinische Dokumentation und Information; Band I, Urban & Schwarzenberg, Version 1.0, 1994, 306
47 48 49 50

see: Kelly, Kit. The little book of ketamine, Ronin Publishing inc., California1, 1999,76f see: Jansen, Dr. Karl. Ketamine:Dreams and Realities. MAPS, Florida. 2001, 166f see: Jansen, Dr. Karl. Ketamine:Dreams and Realities. MAPS, Florida. 2001, 18 Springer, A. Pleasure and death – deadly pleasure, in: Sucht und Suchtbehandlung. Problematik und Therapie in Österreich. Editors. Brosch and Mader. LexisNexis Verlag, Vienna. 2004, 330

to whether or not the chronic use of the substance was used as a form of self-medication for treating an already existing or latent depression. Ketamine can trigger a phase of mania in manic-depressive subjects. The substance has an anti-depressive mechanism and can reverse the effects of the stabilising medication called lithium®. Lithium® works against manic phases and it has been shown that it has several important effects which are the exact opposite of those produced by Ketamine. 43 2.9.2. Physical Long-term effects Varying long-term physical effects of ketamine consumption can arise through the different forms of consumption. As with other substances, long-term nasal consumption can be very harmful to the mucous membranes in the nose. In extreme cases it can lead to a hole in the nasal septum. The sense of smell can also be damaged by chronic nasal consumption. Disorders in the sense of smell can be of toxic origin, for example damage to olfactory epithelia or fila olfactoria caused by the chemical effects of corrosive vapours or can be the result of nasal consumption of substances like cocaine, amphetamines or ketamine. Damage to the sense of smell can have a seriously detrimental effect on the quality of life. If one can not smell one is missing an important aspect of sensory orientation. A regular nasal irrigation is recommended to spare the strained nose. The best method for cleansing is to prepare a salt solution with one teaspoon of salt in one cup of luke warm water. Dip the tip of the finger in this solution and then sniff the solution from the finger tip. If necessary breath in very deeply to assure that the solution is breathed right down into the throat. 44 Further long-term damage can be caused through the injections by intravenous and intramuscular consumption. Absolutely hygienic conditions are essential by such forms of consumption. (see section: safer use) Illnesses like HIV and hepatitis C can, in the worst cases, be the results of unclean substances, needles, syringes or other instruments. The development of infections of the prick point,

abscesses or phlegmones are also dangers of injection. 2.10. Ketamine dependency Before I start with this section it is important for me to explain the difference between damaging use and substance dependency. Here are the definitions of both as found in the ICD 10: “Damaging Use consumption of psychotropic substances leading to adverse health effects. These can appear in the form of physical disorders, for example in the form of hepatitis after the selfinjection of the substance, or in the form of a psychological disorder, for example, a depressive episode caused by massive consumption of alcohol.” 45 (ICD 10 F1x.1) “Dependency Syndrome A range of behavioural, cognitive and physical phenomenon which develops after repeated substance use. Typically there is a strong wish to take the substance and difficulties in controlling the consumption and continued use of the substance in spite of damaging results. The use of the substance acquires the foremost priority in comparison to other activities or duties. An increase in tolerance is developed and sometimes also physical withdrawal syndrome. Dependency syndrome can occur as a result of the consumption of individual substances (e.g., tabacco, alcohol or diazepam), a substance group (e.g., opiate-like substances), or to a wide spectrum of pharmacologically different substances.”46 (ICD 10 F1x.2) In professional literature one finds proof that ketamine has a very high psychological dependency potential. D.M. Turner also stated his need to fight against dependency, after which he gave ketamine the name “psychedelic heroin”. 47 It is highly probable that ketamine has a higher dependency potential that any other psychedelic substance. The amount of consumers which had lost control of their ketamine consumption has been estimated by Jansen to be around 15 %. Jansen includes authors like Moore, Lilly and Turner in this group. 48

In my research I was also confronted with consumers who told me of physical withdrawal symptoms after attempts were made to stop consuming ketamine after a long, intensive phase of consumption. In particular symptoms like fever, cold sweats, sleeplessness and the like were described. In spite of the fact that I was unable to find any hints of a physical dependency in the professional literature, it still appears as if there are consumers who suffer from somatic effects after discontinuing consumption.

change to a form of consumption involving the use of a needle an important natural barrier has been crossed. With the crossing of this barrier the intravenous consumption of other

Jansen states that the following characteristics are convincing proof of dependency syndrome: 1. A strong compulsion to consume the substance without setting an appointed time or amount of substance to be taken. 2. A development of tolerance 3. The consumption of ketamine has a higher priority than other activities which previously were of more importance to the consumer. 4. The neglect of things which were considered to be interesting or which caused pleasure. 5. More and more time is spent in procuring and consuming the substance, in recovering from the effects, in talking about and thinking about the substance. 6. Discussions about the consumption arise within the family and friends, relatives and/or acquaintances express worry and concern. 7. In spite of clear signs of damaging effects, for example problems with the memory or negative influences on relationships, the consumer persistently refuses to stop consuming. 8. A pause in consumption is followed by an excessive, uncontrolled consumption phase. The change from one consumption form to another, for example from nasal to intramuscular consumption, can also be a sign of an existing dependency and can lead to higher physical risk. 49 In my opinion it is important to consider the fact that with the

substances is a distinct, new possibility. Here one should also mention the so-called “needle-craze”. This means the wish to experience the physical administration, the actual setting of the needle, involved in intravenous or intramuscular consumption. This term is often used in connection with opiate dependency and should, in my opinion, also be mentioned here. There are many possible explanations for how a person can become addicted to ketamine. Alfred Springer discusses various points of consideration on the topic of risky drug use in his work entitled “Pleasure and death – deadly pleasure” (2004). Springer claims that in the desire to experience the extreme conditions of the ketamine high (e.g., NDE) there is a principle of so-called “dark hedonism”. Hedonistic motivation can also have “dark” aspects. It can border on tragedy and include a desire for pain or danger. Mystical conditions and the feeling of the proximity of death (near-death experiences) brought about by the consumption of ketamine can be experienced as being pleasurable. “If we stay within the psycho-analytical frame of reference we can assume that individuals who were badly traumatised during a very early stage of development are more likely to become victims of the dangers of destructive narcissistic needs. Such personalities possibly make up the hard core of consumers who, when choosing from all drugs available, still decide to take those drugs which most consumers have experienced to be “terrible”.” 50 This can then be applied to the ketamine consumer and especially to dependency to ketamine. Still: “The similarity of the desired dissociative condition to hysteric conditions, […] allows the assumption to be made that the population concerned is not limited to individuals who have been extremely disturbed at a very early stage of development but also includes people whose psychological organisation has reached a relatively high level and can still be tempted by the experiences which can be brought about by the consumption of so-called “new” drugs.” 51

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Springer A., Pleasure and death – deadly pleasure, in: Sucht und Suchtbehandlung. Problematik und Therapie in Österreich. Hrsg. v. Brosch, Mader. LexisNexis Verlag, Vienna, 2004, 330 see: Estler, Pharmakologie und Toxikologie, Schattauer, Stuttgard5 ,2000, 197ff see: Arbeitsgemeinschaft für Notfallsmedizin. URL: http://www.agn.at/html1.php?hid=16, January 2006 see: (S)-Ketamin. Aktuelle interdisziplinäre Aspekte. Hrsg. v. R. Klose. U. Hoppe. Springer Verlag, Berlin Heidelberg 2002,17ff see: (S)-Ketamin. Aktuelle interdisziplinäre Aspekte. Hrsg. v. R. Klose. U. Hoppe. see: Estler, Pharmakologie und Toxikologie, Schattauer, Stuttgard5 ,2000, 20 see: (S)-Ketamin. Aktuelle interdisziplinäre Aspekte. Editors R. Klose and U. Hoppe. Springer Verlag, Berlin Heidelberg. 2002, 93f

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Springer Verlag, Berlin Heidelberg 2002,81ff
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3. The medicinal use of ketamine
Increased consumption and a dependency mechanism also increase the risk because these result in decisive changes in the 3.1. Ketamine in emergency medicine Ketamine is used as an injected anaesthetic in emergency medicine. Injected anaesthetics are substances which display a very fast anaesthetic effect when administered in the adequate dosage. The immediate onset of the effect and the very limited ability to control the effect are important characteristics of injected anaesthetics 53 Ketamine causes analgesia and sedation, that means it is both pain killing and calming. At the same time protective reflexes (coughing, swallowing) and spontaneous breathing are still maintained. The stability of circulation, the low risk of breathing depression, and the maintenance of the protective reflexes are the most important desirable effects of ketamine. Ketamine is, in a legal sense, not an addictive drug and is therewith much easier to use than other substances, for example opiates. Due to its characteristics ketamine is to be favoured when performing short and painful operations. Among other things, it is suitable for use as a pain killer in difficult rescue operations, in the case of skull and brain traumas, certain respiratory illnesses, for example, status asthmaticus and shock and therefore it is often used in emergency medicine. 54 3.2. Ketamine in internal medicine Ketamine is used as a mono-anaesthetic in internal medicine and distinguishes itself through its dissociative effects. That means a good analgesia (pain killing effect) has been achieved even without the patient completely losing consciousness. Due to its psychoactive side effects ketamine is seldom used as a mono-substance with adults. Ketamine is used more often as a medication for children since with them these side effects appear less frequently. 55 3.3. Ketamine in the treatment of chronic pain Ketamine has a proven acute analgesic effect, but in the treatment of chronic pain one must be aware of the validity of its use over the long term. It seems as though ketamine is one of the few substances which can possibly, in specific cases, impulse structure and impulse economy. The desire for neardeath experiences and to play with death can develop into a strong desire for the real experience of death. 52 Ketamine dependency and the treatment thereof are possibly comparable with cocaine dependency. An exhaustive psychological, physical and social treatment should be carried out. be used as a prophylactic against chronic pain. Data suggests that ketamine can diminish the increase in sensitivity to pain. There are however still problems with the practical use of ketamine in long-term therapy. It is not clear if the cessation of therapy is the result of a loss of effectiveness on the long term or of the side effects. 56 3.4. Side effects of ketamine The undesirable effects are, most importantly, the increase in blood pressure and heart rate at the beginning of anaesthesia. Nausea, vomiting and headaches can all appear in the waking phase. 57 In medicinal use the particularly undesirable and unpleasant side effects are the psychological phenomenon which those ketamine consumers who use ketamine outside of its medicinal context as a treatment are looking for. Hallucinations, confusion and nightmares are often a reason for the cessation of chronic treatment of outpatients. These side effects can return after a few days or weeks. Since these side effects are extremely dose dependent the occurrence of psychological side effects can be avoided through careful dosage adjustment. In emergency medicine one must also take into consideration the fact that a loss of interactive capabilities eliminates the chance of constructive conversation. In addition to this there are reports in professional literature of complaints made against medical personnel as a result of negative dream experiences in patients in the waking phase. In medical practise it is of course very important to inform the patients, when possible before initiating treatment, of the potential side effects and therewith reduce possible anxiety. Before starting therapy it is usually very helpful to make arrangements in which it is made clear that the patient is not required to endure the side effects and that the treatment can be stopped at any time. 58 These undesirable effects are more seldom and less pronounced in children and youths. That means that ketamine is particularly suitable for use as a medication for children undergoing short, painful operations. It has been used, for example, very successfully in the treatment of child burn victims.

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see: Kelly, Kit. The little book of ketamine. Ronin Publishing inc., Califormia. 1999, 14ff see: Kelly, Kit. The little book of ketamine. Ronin Publishing inc., Califormia. 1999, 14ff mündliche Auskunft: ChEck iT! Rechtsberatung, Verein Wiener Sozialprojekte, März 2006

4. The legal status of ketamine 61
3.5. The use of ketamine in psychotherapeutic practice In the mid 1980s the Russian psychiatrist Evgeny Krupitsky studied the use of ketamine in the treatment of alcoholics. He also planned to study the effects of ketamine in the treatment of post-traumatic stress. It is doubted that ketamine can be particularly useful in the psychotherapeutic context, since the substance interferes with all cognitive abilities and therewith causes expressive communication to be impossible. Apart from that, a high doses of ketamine would most likely cut the patient off from his/her environment and severe the tie of the patient-therapist relationship. On the other hand the psychiatrist Karl Jansen supports the argument that ketamine has a therapeutic and psychotherapeutic effect. He states that the changed state of consciousness has in itself therapeutic potential. According to Jansen ketamine consumption also causes a reduced feeling of worry in regard to death and has a connection to an increasing occurrence of selfless actions. The ketamine experience can supposedly be a decisive turning point which can lead to positive life changes. The consumption of ketamine can also have effects which are similar to those of electro-shock therapy used in treating clinically depressed patients. Investigations exist which suggest that ketamine also has anti-depressive characteristics. There are signs that the substance can be capable of reducing anxiety and phobias. The psychotherapist Stan Grof, who studied psychedelic substances and their therapeutic effects over the course of many years, referred to ketamine as an “absolutely amazing substance” and endorsed the noteworthy philosophical and spiritual revelation of this substance. 59 In “The little book of ketamine” Kit Kelly (1999) describes the investigations carried out by two Iranian psychiatrists who exposed their patients, under the influence of ketamine, to frightening situations. These psychiatrists reported that this treatment was successful in reducing the anxiety so significantly that the patients could released from the psychiatric ward. An other group of researchers used ketamine in the treatment of chronically ill patients in order to prepare them for death. They discovered that this helped to reduce the fear of death. In “The little book of ketamine” Kit Kelly writes that ketamine should be given as the first of three injections in state ordered executions. She believed that in this way the death of the worst of all offenders could then be transformed into an ecstatic experience at the expense of the state. 60 In Austria ketamine is classified neither as an addictive nor as a psychotropic substance. The substance is however available on prescription only. In the course of my research I was unable to find any penal provision regarding the possession of this substance by unauthorised persons. As a result, when someone is caught with ketamine he/she can not be criminally prosecuted due to a lack of suitable regulation in the illegal drug code.

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Verein Wiener Sozialprojekte, Leitbild Glossar see: Perspektiven der Drogenarbeit und –politik, Ein Lesebuch anlässlich des 10jährigen Bestehens des Vereins Wiener Sozialprojekte, Hrsg.v. G.Schinnerl, P.Neubauer, 2000, 8 see: Cousto Hans, Fachinformation: Ketamin – Mischkonsum. Dissoziatives Anästhetikum, 2005, 6 ChEck iT! Homepage. http://www.checkyourdrugs.at, January 22, 2006 ChEck iT! Homepage. http://www.checkyourdrugs.at, January 22, 2006 Eve & Rave Homepage. URL: http://www.eve-rave.net/presse/presse05-02-21.html, Safer Sniffing, Redaktion Webteam www.eve-rave.net Berlin , Pressemitteilung vom 19. Februar 2005

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5. „Risk Reduction“and „Safer use”
5.1. Risk reduction “Risk reduction begins before any damage is done and therewith also before any suffering can be caused by the damage. The goal of risk reduction is to prevent damage/suffering even when the fundamental conditions remains.” 62 The term risk reduction is thematically connected with the concept of low threshold drug-related social work. The expression “low threshold” describes the easy, non-bureaucratic access to help and the pragmatic approach for providing help which is tailored to the needs of those who are seeking help and is usually not abstinence-oriented. 63 In the context of low threshold drug-related social work risk reduction is an approach which aims to prevent or at least minimise possible consequential damage and suffering caused by long-term substance misuse. One example of this approach is the following informational publication. I would like to list several points which should be helpful in keeping the risks of the ketamine high to a minimum. • The hallucinations caused by ketamine consumption can be very dark and intense, if one feels insecure or unwell one should abstain from the consumption of dissociative anaesthetics. • Always take only a very small dose with very slow repetition. • Ketamine should not be consumed when one is alone. It is advisable to have a sober person as a “look out”. These rules are especially applicable to ketamine trips which are taken in bathtubs or other water containers. • In order to avoid the risk of accidents ketamine should always be consumed in a sitting or lying position. Many consumers suggest that a warm, calm atmosphere, for example under the covers in bed, is very pleasant. All candles should be put out. One should go to the toilet before the trip, due to the fact that incontinence is often a result of the trip and some consumers are unable to move once the substance has begun to have its effect. • One should not eat anything in the last six hours before consuming ketamine since this is the easiest way to avoid nausea or vomiting. • Intravenous consumption should be carried out slowly (over the course of one minute), otherwise the consumer can suffer from breath depression and a sharp rise in blood pressure. • Activities which require co-ordinated movements, for example driving a car, should not, under any circumstances, be attempted. • Mixed-consumption with alcohol, benzodiacepines, barbiturates and opiates increases the risk of breath depression. 64 • “Ketamine and PCP can reach the placenta and can enter the mother’s milk.. During pregnancy and in the breastfeeding phase one should absolutely abstain from consuming such substances.” 65 5.2. Safer use In the section on “safer use” I would like to name important factors which help to prevent the consumption-related risks of ketamine. That means I will describe how one can consume a certain substance in a certain way with the least possible risk and with the least possible damage to one’s health. When consuming ketamine orally one must bear in mind that the effects can set in very slowly. In order to avoid an overdoses one should remember this and wait before taking another dose. 66 The nasal consumption of ketamine, as well as any other psychotropic substance, dries out the nasal mucous membranes and is therewith a strain on the very sensitive nose. I found a press report on the topic of “safer sniffing” written by Eve&Rave, a drug-checking project in Switzerland. Here I would like to relate its information for consumers. “The following is to be considered for safer sniffing: 1. In general one should pay attention to cleanliness and hygiene. This is especially important when one is sniffing in the toilet facilities of bars/clubs or the like since these areas are known to have more pathogens than other areas. […]. 2. The nose should be freed of all mucus and the nostrils free of all crusted particles before one starts to sniff. Strongly congested or dirty nostrils should be rinsed thoroughly with a mild salt solution. […] In any case it is advisable to regularly moisten mucous membranes which have been dried out through nasal drug consumption. In this connection the use of nasal sprays should be avoided since these can dry out the nasal mucous membranes still more. 3. The lines must be well-prepared. The substance should be crushed as finely as possible into powder and placed on a clean, freshly polished mirror or an other dry, smooth surface. The finer the powder is the smaller the chances are that bigger particles of the substance will get caught in or attach themselves to the nose hairs and therewith damage the mucous membrane of the nose. 4. The tube should be clean and should not have any sharp edges. Rolled banknotes are not advisable not only because banknotes are known to be extremely dirty but also because they are printed with very poisonous ink […]. Therefore it is advisable to […]make a new tube out of a fresh, clean piece of paper after each sniff. Plastic straws are also not suitable, especially when these have been cut with a knife. The sliced edges are often very sharp and there is a danger of injuring the nose. 5. The tube should never be shared. Hepatitis viruses can be transferred by the shared use of sniffing tubes, and not just through sex or the shared use of needles or syringes. The sharing of sniffing tubes is especially dangerous when a nose has been injured since this would allow even the smallest particle of blood to attach itself to the tube and be transferred to another person.. […] 6. Approximately ten minutes after sniffing the nose should be cleaned. In general blowing the nose into a tissue is enough. If the nose is very dirty it should be cleaned with a salt solution. Since the nose is covered with a sensitive mucous membrane which is covered with hair and particles of powder can get caught in these hairs it is possible for bloody skin irritations to develop and that necrosis occurs. Intense necrosis can result in an opening in the nasal septum. Bloody skin irritations in the nose often lead to the development of boils and, in extreme cases, also to the development of carbuncles. 7. If a nostril is bloody or if a boil or carbuncle ha developed in it this nostril should not in any case be used for sniffing psychotropic substances. When one has chronic sniffles one should generally abstain from the nasal application of substances since the danger of additional infections and the development of boils is respectively high under these conditions. 8. A too frequent nasal application of psychotropic substances can lead to damage of the olfactory mucous membranes and can therefore have a negative effect on the sense of smell. Due to the fact that the sufferers of this condition do not notice (smell) anything themselves they first out about their situation from other people who tell them about their strong body odour or about the stench in their living quarters. […] 9. The nose is much more than a fleshy addition to the face, with two holes and through which one breathes and into which one can put a sniffing tube. The nose has various functions, the interference of which can lead to a noticeable decrease in the quality of life. For this reason everyone who uses their nose for the application of substances should take care of their nose. This care includes, for example, the careful application of pure, natural oils using a cotton bud or a paper handkerchief. The oil must be spread gently on the entire inner surface of the nostril. One should not forget to oil the region of skin under the nose since troublesome skin irritation can also arise there. […] If in spite of this care an unpleasant burning sensation still remains, one should stop sniffing for a while. In the case of repeated nose bleeds or the continuation of the development of boils the nasal application of substances should be stopped and a doctor should be consulted!“ 67 In the case of intramuscular and intravenous consumption it is absolutely necessary to always use a fresh, sterile syringe and needle in order to avoid phlegmones and “shakers”. These syringes and needles should not be shared since sharing can lead to the transmission of illnesses like hepatitis and HIV. If for some reason you do not have a fresh syringe and needle you can carry out an “emergency disinfection”. Both the syringe and the needle should be rinsed thoroughly with cold water several times. After that the syringe and needle should each be immersed separately in boiling water for 20 minutes. One more, although not as effective, method of carrying out

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see: „Das gsunde Gansl – eine medizinsche Sonderausgabe“, Sozialmedizinsche Drogenberatungsstelle Ganslwirt, Verein Wiener Sozialprojekte, Vienna, 6 see: medizinische Merkblätter, Sozialmedizinsche Drogenberatungsstelle Ganslwirt, Verein Wiener Sozialprojekte, Vienna, 6 vgl. ChEck iT!– eine Einrichtung stellt sich vor, Verein Wiener Sozialprojekte, Vienna, 2005

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6. Empirical Section
the “emergency disinfection” is to thoroughly rinse in an iodine solution and an alcohol solution. 68 Intramuscular and intravenous consumption should take 6.1. Introduction to empirical section I have been working as a freelance employee for the secondary preventive project ChEck iT! since March 2004. My main duty is to work as a scene observer, in particular in the Goa and Free techno scenes. In the last year I have observed an increase in ketamine consumption. In my opinion at the moment there appears to be a ”ketamine trend“. I was repeatedly confronted with ketamine consumers at scene events. In this connection I asked myself several questions regarding this substance and decided to try to answer these questions in my thesis. These questions were used as the basis for my empirical work. I wanted for example to find out more about specific consumption patterns and forms and about specific issues or problems arising from the special characteristics of ketamine. In the following section I will describe my methods in more detail, present my results and combine these with the theory. In order to make everything more clear I would like to begin with a short description of ChEck iT!. 6.1.1. ChEck iT! 70 ChEck iT! is a co-production of the Association of Viennese Social Project (“Verein Wiener Sozialprojekte”), the clinical institute for medicinal and chemical laboratory diagnostics of the Vienna General Hospital and the Vienna Social Foundation (“Fonds Soziales Wien”). ChEck iT! covers a special field of addiction prevention and is the only institution of its kind in Austria or the European Union. ChEck iT! is anchored in the drug concept of the city of Vienna and is financed through funds from the Vienna Social Foundation and the Austrian Ministry of Health and Women’s Issues (“Bundesministeriums für Gesundheit and Frauen” or BMGF). The target group of the institution is young consumers of psychoactive substances, so-called recreational drugs. ChEck iT! meets those people who are interested in their offers – in the sense of streetwork – there, where they spend time with their friends and where they come into contact with psychoactive substances. That means on site at techno parties and other events staged by the electronic music scene. place in the most hygienic conditions possible. Before and after the injection one should wash the hands and skin should be cleaned with a fresh swab soaked in alcohol. With intravenous consumption it is safest to use the large veins in the arm. Longer, thicker needles lie better in the veins and are therefore gentler to the vein. After the injection one should always press a dry swab on the injection point in order to avoid the development of bruising or calluses. When intravenous consumption is frequent one should always chose a new point of injection and veins should be regularly treated with vein salve. 69 Since 1997 ChEck iT! has been the only institution in Austria which offers a high quality, anonymous and free chemical analysis of psychoactive substances. The chemical tests offer us an opportunity to get in contact with consumers, to give objective information and to warn consumers about particularly risky substances. In addition to this they provide us with basic information for the early recognition of new trends as well as for scientifically based studies on consumption habits, what is being offered, longterm effects and for use in developing concrete steps in the field of health promotion. This information allows for up to date methods for preventing substance abuse and reducing demand.. ChEck iT! pursues an acceptance approach. Drug consumption is not approved of, but provides a repeated starting point for information and advice. Potential consumers of psychoactive substances are taken seriously and can tell someone about their concerns, problems and wishes. The production of information material, like posters, booklets, substance flyers, and the ChEck iT! homepage are also an important part of the services offered by this institution. They make it possible for those interested to get important information at any time, regardless of whether it is for themselves or for passing on to friends and acquaintances. 6.2. Method and Approach The hypothesis of this thesis is that the consumption of ketamine causes changes in social and conflict-related behaviour. In order to verify or falsify this hypothesis I created a standardised questionnaire. This questionnaire was then filled out with ketamine consumers at various techno events and within the framework of my work with ChEck iT!. Of course it was very important for me to be able to establish a feeling of trust between myself and the consumers on site. If this would not have been possible we would most likely not have been able to find anyone willing to fill out the questionnaire with me. It was very important for me to be able to conduct my work in a calm atmosphere and to make it clear to those answering that not all questions absolutely had to be answered. I also made it clear that questions which were

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answered must be done so honestly and with a due amount of consideration. In this regard it must also be mentioned that many of those

questioned were not sober at the time of questioning. That means some of those questioned gave answers under the influence of psychoactive substances. This has, in my opinion, both advantages and disadvantages. On the one hand, this made people more talkative and helped to lower the inhibition threshold. It was, for example, less unpleasant for these people to talk about their ketamine consumption and the changes which arose as a result of it. On the other hand, some of those questioned could not really concentrate on the content of the conversation and I had to repeat some questions several times. Naturally I made sure to choose conversation partners whose communication skills were not too extremely impeded. An basic attitude of acceptance toward the consumers was very important for me. Firstly, because I believe that acceptance is a necessary prerequisite for respectful contact and secondly, because this attitude encourages feelings of trust between the clients and myself. When talking about such “delicate” subjects I find it particularly important to have enough time and the right space for discussion. It is essential to be able to answer questions and deal with insecurities, for example concern regarding the anonymity of the answers, before beginning. This sometimes caused me to be caught in discussions about ChEck iT!, my results and the validity of my questionnaire, before being able to lead a constructive conversation about ketamine. 6.3. Explanation of method choice As mentioned above, I chose to use a standardised questionnaire (see Appendix) to collect my data. This instrument seemed to me to make sense because it was necessary to choose a survey method which could be used where we found the ketamine consumers. That meant that I went to various techno parties with my questionnaire. In this setting I could not have carried out interviews or even thought of recording the interviews on tape because techno parties are much too loud. There is never a suitable place for

such conversations, no calm and quiet room. Outside of this party – setting it would have been difficult for me to find ketamine consumers, and since the purpose of my work was to find out more about ketamine as a recreational drug it made sense for me to carry out my research on site.

of other researchers. Another important basis for my questionnaire were the questionnaires from ChEck iT!. These questionnaires were helpful examples and also made it possible for me

Of course it would have been possible for me to find ketamine consumers at conventional drug counselling centres, but ketamine is used in a different way in the traditional drug scene. The data collected from these clients would therefore not be suitable for my purposes and would not have had any connection to my topic of ketamine as a recreational drug. It was very important to me to be able to fill out the questionnaire with the consumer, in order to be able to start a conversation with them. In this way I was not limited to working with the facts and data which the questionnaire provided, but was also able to make other observations. The same goes for my personal presence at the events, just being there provided me with the chance to observe consumers, with or without filling out questionnaires. Of course personal observations lack objectivity, but I still feel that my assessments provide a valuable additional factor to my research. It is also important to stress the fact that my interpretation of the results is in no way the only “right” one, everyone who wants to can come to their own conclusions based on this data. One more important factor which influenced my choice of method was the fact that I wanted to acquire data on ketamine consumption patterns and forms in the party scene. For this purpose qualitative research, for example interviews, would not have had much validity since very few clients could be questioned in this way. 6.4. Questionnaire Development After it had become clear to me that I should carry out the empirical part of my work with a questionnaire (see Appendix) I had to decide what exactly the question was that I wished to answer with the results. During this process I looked at other studies and attempted to develop my questionnaire in a way that would make it possible to compare my results with those

to make my data useful for ChEck iT!. It was also very important for me to formulate the questions in a way which could be seen as free of judgement and gender-neutral. In my questionnaire there are many open questions without allotted answer format, even though questions with allotted answers are preferable in written questionnaires with an open question form. My reason for choosing this form of questioning is based on the fact that this approach encourages the development of a conversation with those being questioned. Another important consideration involved in the creation of the questionnaires was the length. Naturally I wanted to have all of my questions answered, but it is also important to make sure that the questionnaire is not too long. It was also necessary to cut some questions and to re-formulate others. Once I had chosen and carefully formulated all of the questions I put them into a sensible order and revised the formal conditions. Instructions on how to fill out the questionnaire were not necessary since I would be present while the subjects filled out the form. In this way I was able to answer any questions which might arise in detail. Before I officially started my survey I carried out a preliminary test. I tested the questionnaire on two clients in order to find out how long the questionnaire took to complete, if everything was clearly understandable and if anything needed to be changed. This test showed that some changes in the layout would be useful, some questions needed to be re-worded and that the co-operative completion of the questionnaire would take approximately 20 minutes. 6.5. Description of the survey The survey was carried out at various events in the Goa and free-techno scenes because past experienced had brought to my attention that ketamine consumption is comparatively high in these scenes. This way I could be sure to come in contact with many ketamine consumers. A project practicum which I had previously carried out in these scenes in winter

2003/2004 confirmed the fact that ketamine was relatively frequently consumed in the free-techno scene. In the course of scene observation a fellow student and I col-

lected data in various sub-scenes of the techno scene. We asked, among other things, which substances the people had already consumed. In the free-techno scene 23.1 % of those questioned (n=26) said that they had already used ketamine, whereas when we questioned a comparably large group of people (n=22) at a “Biosphere” event, an event in the commercial techno scene, 0 % of those questioned said that they had consumed ketamine. A further 38.5 % of those people asked in the free-techno scene said that they could possibly try ketamine in the future. In comparison, 0 % of the “Biosphere” attendees could imagine trying ketamine some time in the future. These figures strengthened my impression that there are significantly more ketamine consumers in the free-techno scene than in other scenes. Another reason why I chose these particular scenes for my survey is that these were the scenes for which I had been responsible in my work with ChEck iT!. That meant that I had already been able to make the necessary contacts for beginning my work. This was particularly helpful in my attempts to find out when the events would take place and in procuring free tickets. Here I would like to describe these two scenes in more detail: 6.5.1.1. Free-techno scene The origins of the free-techno scene lie in England at the end of the 1980s (Summer of Love). The scene describes itself as being freedom-loving and close to nature. Most of the events take place in the outdoors, for example in quarries, forest clearings, fields, etc. In the colder seasons or in bad weather the events are moved to old, unused factories, condemned buildings or the like. The scene is organised through individual “sound systems”. A “sound system” is a group of people who collectively buy the sound equipment which is required for making music. The equipment is usually quite extensive and ranges from items

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like record players and huge sound speakers to complete music studio facilities. It is difficult to estimate how many “sound systems” are active in Austria’s techno scene, personally I know

carry out streetwork based social work. I will discuss this point in more detail later in this thesis. 6.5.1.2. Goa Scene Goa or goa-trance is the term for a style of music which is sometimes also called psychedelic-trance. It is a techno style which originated in the mid-90s in the Indian state of Goa. It was initiated mainly by foreign, often Israeli, backpack tourists. The culture arising from this style and strongly connected to this music propagates a positive view of life and strongly supports the ideas and symbols of the hippie generation. Music and culture are combined with psychedelic drugs, which in turn influence both aspects. In this way the expression “music to see” emerged. When one observes the Goa partygoers one often sees signs of the hippie generation, for example the way the people dress is often very similar to the fashion of the late 1960s and 70s. In the Goa scene one notices that the average age of the partygoers is distinctly higher than at other “traditional” techno parties. Due to its Indian roots the music is very strongly connected to Indian religions. The sound of a prayer wheel often accompanies the steady beat of the music and the walls are often decorated with fluorescent portrayals of Ganesha, the elephant god. 6.5.2. The Realisation In order to collect enough data I visited approximately 10 events organised by the scenes mentioned above. However it was not always possibly for me to fill out the questionnaires. Sometimes the events were held in inconvenient locations in which the lighting and infrastructure simply did not allow the questioning to be carried out. On other days the atmosphere at the party was simply not very good and that made it very difficult to motivate the partygoers to fill out the questionnaire with me. Of course my own personal motivation also played a role. Sometimes I simply couldn’t get past my own reluctance to verbally accost various people- this sometimes happened on evenings when I was alone at events and not working in the ChEck iT! tent.

of approximately 20. The basic idea of the free-techno scene is to move from one place to another undisturbed and to have parties wherever one decides to do so. This scene can be found in nearly all European countries and a strong network has been established. This network can be seen in so-called technivals in various countries (Czech Republic, Spain, Holland, Italy...) where “soundsystems” from different countries meet and make one huge event together. At such technivals one can expect to see several thousand visitors. Most technivals take place in summer and there is a large “community” which travels from one technival to the next. Free-techno parties take place in Austria all year round. As far as I know there is on average one party every two weeks in Vienna and its surroundings, Lower Austria and Burgenland. The individual parties are organised by one or more sound systems. The spread of information on coming parties is carried out via word-of-mouth, flyers and so-called “infolines”. The infoline is always a different mobile phone number with a mailbox message describing how to get to the party. As of 11 p.m. on the day of the party one can call the infoline to find out where the “venue” is. This complicated access is used to keep the police away and also to make sure that only a “selected community” comes to the parties. These “chosen few” should all share the same basic political ideals of freedom and anti-capitalism. The motto of the free-techno scene is “Free Music for Free People”! One main goal is to have parties to which no one has to pay an entrance fee. This means that expenses like taxes and rent need to be drastically minimised if the organisers wish to avoid losing money. Venues for which little or no rent is to be paid are chosen. Most parties are not registered in order to avoid paying taxes. The sale of beverages is also carried out privately and usually without tax. In rare cases factory buildings are broken into in order to throw parties there. This means that most of these parties are illegal and as such they are sometimes cleared out by the police. The special conditions to be found in the free-techno scene make it difficult to

In the end there were five events at which I was actually able to fill out questionnaires and acquired data for my survey: 1. Free-techno party in Lower Austria

2. Technival (Free-techno and Goa) in Hungary 3. Festival –Urban Art Forms in Wiesen, Burgenland 4. Free-techno and Goa party in Ernst Kirchweger House, Vienna 5. Free-techno party in the “Arena”, Vienna

to discuss ChEck iT! projects and in the free-techno scene there just happens to be a wide range of prejudices, reservations and rumours about and against the ChEck iT! project!.

Of course I was still able to make observations at the other events at which I did not fill out questionnaires. Some parties, especially the technivals in summer, lasted several days which made it possible to fill out many questionnaires. At two of the five above mentioned parties I worked with the ChEck iT! team on site and at the other three I was alone. When I worked alone it was more difficult to collect data. I constantly had to explain what I was doing, who I was and why I was interested in other people’s ketamine consumption. In such cases helped a lot that I had enough contacts in the scene and therewith had a certain nearness to the scene. Due to this the people I questioned were not particularly distrustful. In the very sceptical and critical free-techno scene it most likely would have been extremely difficult to find people who were willing to fill out my questionnaire with me if I didn’t have the appearance of one who belonged to, or at least knew something about, the scene. I believe that the work with young recreational drug consumers requires social workers to have a certain nearness to the scene and at least the appearance of belonging to the scene. This target group is especially difficult for social workers to reach because they, unlike consumers in the street scene, don’t see themselves as needy clients. Through a certain scenenearness inhibition thresholds can be lowered and this would allow for low threshold work to be done. This way the services which are offered would more likely be accepted. Through my connection to the ChEck iT! stand on site I was spared from constantly having to explain why I was there or why I was asking questions about the consumption of illegal substances. That was naturally very pleasant for me and it also helped to make the clients less inhibited to talk with me. Unfortunately this also meant that I was more likely to be forced

I found it important to try my best to create a relatively calm atmosphere for conversation while filling out the questionnaires. For example I made sure to avoid the possibility of curious people standing too close by and listening in on the conversation and answers. As mentioned above, it was often necessary to answer questions and calm all insecurities before starting with the questionnaire. The greatest insecurities arose in regard to the evaluation of the data. Many of those questioned feared that my results would be used to “demonise” ketamine. In most cases I was able to explain the goals of my research and therewith dismiss concerns. Still there were people who, for various reasons, refused to fill out the questionnaire with me. Some of the reasons given were, for example, that they simply didn’t want to speak openly about their consumption of ketamine or they were sceptical of my work. One should not forget that the people at these events were there to have fun and therefore that were not necessarily interested in spending 20 minutes talking to me and answering my questions. They preferred to talk to their friends or to dance. Although all of these reasons for not answering were legitimate, it was still sometimes a bit depressing when one person after the other expressed no interest in filling out the questionnaire with me. 6.6. Evaluation of Data - SPSS The evaluation and processing of my data was carried out in the SPSS (“Statistical Package for the Social Sciences” or “Superior Performance Software System”). After I finished the outline of my questionnaire I designed a so-called input mask in the statistical called SPSS. All of the questions in the questionnaire which I wanted to process using the SPSS were given variable names, for example the question “How old were you when you consumed ketamine for the first time?” was given the variable name “erstkons”. Then a code plan was created for each variable. For practical reasons I wrote this directly on the questionnaire at the time of questioning, so that I would not constantly have to check the plan while entering the data.

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Frequency Wien Styria LA UA Bgld Szbg Total 20 2 29 2 4 5 62

Percent 32,3 3,2 46,8 3,2 6,5 8,1 100,0

Cumulated Percent 32,3 35,5 82,3 85,5 91,9 100,0

Compulsory school Apprenticeship/ Vocational School Certificate of apprenticeship Vocational school w/o diploma Highschool Highschool College/Technical College University/Academy Graduate

13 1 31 13 1 21 18 1

0
Figure 4: Representation of Education Level [n = 62]

5

10

15

20

25

30

35

Figure 3: SPSS Table “What federal state do you come from?” [n=62]
71 71

Raab-Steiner, E. Skriptum-Sozialforschung, 4th Semester Summer semester 2004, fh-campus Vienna, 12 see: Pill Testing – Ecstasy & Prevention. Editors A. Benschop and M. Rabes, et al. Rozenberg Publishers, Amsterdam. 2002, 114

For example, I always coded the answer “no” with “0“, “yes” with “1” and “no comment” with “99”. Some of my survey questions are not provided with variable names because they are not meant to be processed using the SPSS. These questions are marked for analysis of content. I always tried to enter the data into the data matrix as quickly as possible. The data matrix of the SPSS is a large rectangular matrix in which each line represents one person, or one filled questionnaire, and each column represents one variable. That means that all of the questions in a questionnaire are listed horizontally and all answers to a question vertically. In order to be able to determine which line belongs to which questionnaire I numbered the questionnaires consecutively. While processing the results I discovered several aspects of the questionnaire which should have been done differently. However I was still able to analyse the results which was interested in. One of the questions required to be slightly re-coded after the fact which naturally required a certain amount of extra effort. At this point I would like to present and interpret the results of my survey. 6.7. The Results Here I would like to describe and therewith create a picture of the group of people who were questioned. Then I will analyse and interpret each of the individual questions from my questionnaire in sequence. 6.7.1. Demographic Data In the months of June, July, August and January I filled out questionnaires with a total of 62 people. 60 of these 62 subjects had already consumed ketamine at some point in time and therefore fit into my target group. The two people who had not yet consumed ketamine still wanted to fill out the questionnaire. They felt that it was important for them to express their opinions about ketamine because both had, independently from one another, had very intense experiences with the substance in their circle of friends.

The first question of my questionnaire was if the subject had ever consumed ketamine. If the answer was yes I continued with the questionnaire. If this question was answered with

no I stopped questioning, with the exception of the two cases mentioned above. The rest of the “non-consumer” group is not included in any of my calculations. Naturally the number of people belonging to this group was distinctly higher than 62. The group questioned is made up of 59.7 % male and 40.3% female subjects, that means 37 males and 25 females were questioned. The age of those questioned ranged from 18 to 42, whereby the average age or median was 24. (“The “median” is the point in the measuring scale at which both above and below half of the measured amount can be found” 71). All those questioned were Austrian citizens of which 72.6 %, or 45 subjects, felt they belonged to the “Austrian” segment of society. 16 subjects, or 25.8 %, questioned referred to themselves as “world citizens”. In my opinion this answer reflects the principles and values of the free-techno scene. At the technival in Hungary I also questioned only Austrian citizens. This was partly due to difficulties in communicating with people from other nations and also due to the fact that this technival took place in a location very close to the Austrian/Hungarian border and the majority of the visitors were Austrians. (Figure 3: SPSS Table “What federal state do you come from?”) The high amount of Lower Austrians can be explained by the fact that two of the events at which I carried out the survey were located in Lower Austria (LA). The event in Wiesen in Burgenland does not show itself distinctly in these number. Here it should be mentioned that the Festival Zone in Wiesen is more comprehensive, here one expect to find visitors from all over Austria. The second largest group, as can be seen in this table, is from Vienna. In answer to the question about the current living situation the most common answer (27.4 %) was alone/independent. 23 % of the subjects said that they lived with a partner and the

same amount said that they still lived with their parents or guardians. Only ca. 5 % of those questioned lived with a partner and child(ren). There is therefore no single living situation which can be recognised as occurring significantly more than the others.

include the category university/college student. In this way the group which was formerly assigned to everyone who had completed only high school has been further divided into one group which stopped education after graduating from highschool and another group which is currently involved in further education (university, college, academy, etc.). In summary one can say that more than half of those questioned have not graduated from highschool. I do not think that the level of education of the people I questioned is particularly striking.

In the variable “highest level of education” most, or 38.7 %, of those asked answered with highschool graduation diploma. 30.6 % had completed an apprenticeship, 16.1 % had completed only compulsory education, 12.9 % had visited a vocational school without graduating, and 1.6 %, or one person, had also graduated from a university or college. This variable gives information only on the level of studies already completed and should not be confused with information on the actual amount of education. For example, people who would soon be graduating were recorded as having completed only compulsory education because they had not actually graduated from highschool yet at the time of questioning. The variable “education level”, which I would now like to describe in detail, includes the variable “highest level of education”, meaning the highest level of education which has been completed up to this point, and “current education”, meaning education currently taking place. In order to arrive at this variable it was necessary to re-code everything after entering the data completely. (Figure 4: Representation of Education Level) 13 % of the subjects had completed the compulsory education level. One person was in the process of completing an apprenticeship and approximately 31 %, or 19 people, had already completed an apprenticeship. 13 % of the subjects had attended a vocational school without graduating, and 1.6 %, or one person attended a college or university with graduation. Approximately 21 % of those questioned had graduated from highschool and 18 % are currently carrying out further studies at higher level institutions. One person was a college or university graduate. The main difference between this and the variable described above is that the variable “educational level” was widened to

The answers to the question about the current job situation are not in my opinion particularly expressive. 33.9 % of those asked said that they are unemployed. However this group includes people who are currently studying at institutions of higher learning or are still attending highschool because I unfortunately failed to provide an appropriate possible answer for this group. This means that it is not clear how many people in this relatively large group are really unemployed. 32.2 % of those questioned stated that they were employed full-time, the same percentage claimed to be part-time employed. One person refused to answer this question. In regard to the question about monthly 41.9 % of those questioned said that they earned less than 500 Euros. 25.8 % answered with “between 500 and 999 Euros” and 21.0 % answered “between 1000 and 1499 Euros”. 3.2 % of those asked answered that they had a monthly income of “between 1500 and 1999 Euros” and “2500 Euros or more”. 3.2 % of the subjects refused to answer this question. Here I must mention that I did not specify in the question if these income brackets were net or gross totals and did not clearly define what sources or kinds of income were meant. That means that those questioned could have understood this question differently and answered accordingly. The real value of these results is therefore in my opinion questionable. The demographic data showed clearly that the characteristics of the group I questioned are distinctly different from those of consumers in the commercial techno scene. For example, 17.2 % of the subjects from the study “Pill Testing – Ecstasy & Prevention” in Vienna had foreign ethnic backgrounds. 72

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see: Pill Testing – Ecstasy & Prevention. Editors. A. Benschop and M. Rabes et al. Rozenberg Publishers, Amsterdam. 2002, 67 vgl. Pill Testing – Ecstasy & Prävention, Hrsg. v. A. Benschop, M. Rabes u.a. Rozenberg Publishers, Amsterdam, 2002, 67

Alcohol Cigarettes Cannabis Speed Cocaine Ecstasy Ketamine Magic Mushrooms LSD Methamphetamine Sleeping pills / Tranquillizers Crack/ Cocaine base Poppers et al Heroin Natural Drugs Others GHB 2-CB 3MCV

94 86 77 58 53 27 23 21 21 11 11 8 8 8 7 5 5 0 0

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Figure 5: Monthly Prevalence [n =62]

The majority of those I questioned expressed that they felt that they belong to the Austrian segment of the population and I did not question even one person who did not have Aus-

trian citizenship. My observations also confirmed this demographic data. I think this can be explained by the fact that the various sub-scenes simply attract different types of people. For example, the characteristics of the Goa- and free-techno scenes are possibly not so interesting or easily accessible for youths and young adults who come from families which have been living in Austria for two or three generations. 6.8. Consumption patterns In the next section I would like to analyse all the questions which deal with ketamine consumption and the consumption of other psychoactive substances and interpret the answers. By the following questions the total number of those questioned is 60, because as already mentioned above two subjects can not be included since they did not consume ketamine. 6.8.1. Age of Initial Consumption In order to find out at what the average age of first time ketamine consumers was I asked the question: How old were you when you consumed ketamine for the first time?. The answers showed that the youngest of my subjects was 15 and the oldest was 38 at the time of initial consumption. On average those asked were approximately 20 years old when they tried ketamine for the first time. The median was 19.5 years of age. This average age for initial consumption is in comparison to ecstasy distinctly higher. In the scientific evaluation study Pill Testing - Ecstasy and Prevention it is stated that the ecstasy consumer is, on average, 17 years old at the time of initial consumption. 73 I think that due to its characteristics ketamine is not necessarily a substance which one tries out at the beginning of an experimental phase involving psychoactive substances. In contrast, from what I have observed ecstasy is one of the first illegal substances, with the exception of cannabis, to be tried. This most certainly has something to do with the popularity of these substances.

When one considers the fact that 50 % of those questioned consumed ketamine for the first time at an age under 20, that is still rather young for the initial consumption. Especially

when one considers certain characteristics of the substance, for example the dependency potential. 6.8.2. Motivation for Initial Consumption In order to find out why the consumers decided to try ketamine for the first time I asked the question: “What was the reason for the initial ketamine consumption?” This question allowed for multiple answers. 73.3 % of those questioned answered that curiosity was the reason for consumption. 21.7 % answered that they had heard good things about the substance and 46.7 % took ketamine simply because it was offered to them. 13.3 % stated that they felt a need for a stimulating substance and 23.3 % wanted to consume a consciousness changing substance. The answer: “Everyone I know consumes ketamine” was given by 8.3 %. 11.5 % of those asked also chose the answer “other reason” whereby most of the answers given here were simply variations on the other possible answers. For example “... wanted to know why so many people find it so great”, which is basically the same answer as “I was curious” or “I heard good things about it”. Two answers which were given here are in my opinion noteworthy. These two subjects claimed that they were not aware of the fact that they had consumed ketamine the first time they consumed it. They took something without knowing what it was. This answer is alarming because it suggests extremely flippant and risky behaviour. 6.8.3. Setting The question of the location of consumption or occasions at which ketamine is usually consumed and the people with whom one consumes was also to be answered through my questionnaire. 41.7 % of the ketamine consumers I questioned answered that they usually consumed ketamine at parties. 34.7 % usually consumed ketamine at home. Other answers to the question “in

which situations do you usually consume ketamine?” included “when it is offered to me” (8.3 %), “always” (5.6 %), “when outdoors” (2.8 %), “with cocaine” (2.8 %) and “with LSD” (2.8 %).

The last answer is confirmed by statements in professional literature, according to which an LSD trip in combination with ketamine is supposedly very pleasant. Ketamine is also said to make the effects of LSD last longer (see section on mixed consumption). In response to the question “with whom do you usually consume ketamine?”, 65.2 % gave the answer “with friends“. 20.3 % said that they consumed ketamine alone and 5.8 % with acquaintances. 4.3 % claimed that they didn’t care who they took it with and 4.3 % said that they consumed ketamine with a “look out”. That means with a person who stays with the consumer but remains sober. Although 4.3 % is not a lot I was still surprised that there were ketamine consumers who found such security measures important. This question was asked openly and I categorised it later. Multiple answers were possible. 6.8.4. Changes in atmosphere caused by ketamine My next question was: “How is the atmosphere at parties where more ketamine is consumed than is usual?” Since I did not have allotted answers for this question I had to categorise the answers retrospectively. This was only perfunctorily possible. In order to make the answers clearer I will provide examples of answers. I categorised 78.3 % of the answers as “negative atmosphere changes”. In this category I put answers like oppressive, muffled, extreme, irritated, aggressive, negative, not good, exaggerated, unpleasant, confused, tiresome, primitive and stressful. I categorised 7.2 % of the answers as “positive atmospherechanges”. Some examples of this were: amusing, there was a psychedelic atmosphere and funny. 12 % of those questioned could not answer this and 2.4 % saw no difference between parties where more than the usual amount of ketamine was consumed and other parties. These results show that the parties at which large amounts of ketamine are consumed are not very popular, even among ketamine consumers. In connection with the question “in

which situations do you usually consume ketamine?”, where the majority of those questioned answered “at parties”, these results suggest that many consumers want to consume ket-

amine at parties but would prefer that others do not do so because when too many people at a party consume ketamine the atmosphere is negatively effected. My observations at various events validate the majority of the answers given to this question. When there was a lot of ketamine circulating there was often a strangely unpleasant atmosphere. Several times there were fights and I would describe the atmosphere as being aggressive and irritated. 6.8.5. Monthly prevalence The monthly prevalence shows on how many days in the last month a certain substance was consumed. (Figure 5: Graph – Monthly prevalence) This graph shows that, for example, 94 % of those questioned had consumed alcohol in the last 30 days. What you can not see on this graph is the number of days on which alcohol, or the other substances, were consumed. I had to calculate a parallel. On average alcohol was consumed on 11.5 days, the median was 10. I find these figures interesting considering the fact that alcohol consumption in the techno scene used to be quite seldom and it was even considered to me “uncool” to drink it. 77 % of those questioned consumed cannabis. Here the median was 19 and the average was approximately 18. The high percentage of subjects who had consumed cocaine in the last 30 days is noteworthy – the graph shows that it was 53 %. Cocaine therefore lies in front of ecstasy and extremely close behind speed. The cocaine median was 3 and the spread reaches from one to ten days in the last thirty. 23 % of those asked had consumed ketamine in the last thirty days. The spread ranges from one to 28. That means that someone claimed to have consumed ketamine on 28 of the last 30 days. The median lies at 3.5.

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Figure 6: Form of Consumption [n = 62]

I was amazed to see that 8 % of my subjects had consumed crack or cocaine base in the last month. That would mean 5 people and this figure seems to be very high. Under “others” (Sonstiges) laughing gas, substitol and the Aga – toad (a toad which secretes a hallucinogenic substance) were listed. The substance 3MCV is a so-called “fake-substance”. That means that this substance does not really exist. I placed this in my questionnaire in order to test the honesty of my subjects and since no one claimed to have consumed 3MCV it appears that the group questioned answered truthfully. 6.8.6. Mixed consumption In order to find out what substances ketamine was usually mixed with I asked the question: “When you consumed ketamine the last time did you also consume the following substances 6 hours before and/or 6 hours after?” Multiple answers were possible here. The analysis of this question revealed that 45.2 % of those questioned mixed ketamine with cannabis. 43.5 % stated that they had drunk alcohol 6 hours before or after consuming ketamine and 27.4 % mixed ketamine with speed. Several subjects told me that they always mix ketamine with speed in order to have the hallucinogenic effect from ketamine and still have the energy to continue dancing. 25.8 % had consumed no other substance the last time they consumed ketamine. 8.1 % mixed ketamine with cocaine and 6.5 % mixed it with LSD. 3.2 % also mixed ecstasy with their last ketamine consumption and 1.6 %, respectively, mixed ketamine with mushrooms, metamphetamines and sleeping pills or sedatives. I think that the mixed-consumption with alcohol is seen by most consumers as not being mixed-consumption since alcohol is often not recognised as a psychoactive substance. This is however problematical since the mixture of alcohol with ketamine increases the risk of a breathing depression. (see section mixed-consumption) Some consumers described the influence of cannabis during the “crash” phase of the ketamine high as being very positive. The mixed-consumption of ketamine with LSD and cocaine is described as very pleasant in regard to its narcotic effect.

6.8.7. Form of Consumption How ketamine is primarily consumed in its function as a recreational drug also interested me. The graph below shows that 85.5 % of those questioned consumed ketamine nasally. 1.6 % took ketamine orally and 9.7 % consumed ketamine intramuscularly. (Figure 6: Graph – Form of Consumption) One can therefore say that when consumed as a recreational drug ketamine is usually consumed nasally. I do not find this result surprising since most of the substances consumed in the techno scene are consumed nasally. Still one should not forget the 9.7 % which prefers intramuscular consumption and must note the special concerns related to this form of consumption. 6.9. Evaluation of Qualitative Questions I would like to present and analyse all of the questions which were asked openly and which could not be categorised retrospectively. 6.9.1. What makes ketamine interesting? I received many different answers to the question: “What makes ketamine interesting?” Part of the group questioned answered that the psychedelic hallucinogenic effects of the substance were particularly tempting for them and that ketamine “brought them into an other world”. Another answer was that ketamine had a consciousness expanding effect and

special emphasis on the “warm and soft” effect reminds me of the vocabulary used to describe the effects of opiates. I think that it is most likely exactly these characteristics which are responsible for the fact that a psychological dependency on ketamine can develop. These characteristics are also the reason why ketamine is repeatedly referred to as “psychedelic heroin” in professional literature. To “finish yourself off” or “blow yourself away” are expressions which are not typical of the recreational drug scene. Other substances like speed or ecstasy, also cocaine are popular in the party setting due to their driving, performance enhancing and stimulating effect. With that I would like to say that ketamine addresses very specific needs, for example the need for deep relaxation or to simply “not notice anything more” and it is exactly this effect which make this substance dangerous and dependency possible. In any case ketamine, with its psychedelic effect on the one hand and its sedative effect on the other, is unique and atypical as a recreational drug. 6.9.2. Changes in relationships through ketamine consumption In response to the question if relationships or friendships with other consuming friends were influenced or changed through ketamine consumption 61.3 % of those asked answered with “no”. The remaining 38.7 % expressed that both positive and negative changes were experienced. An example of a positive change is the statement that the consumers looked after each other more while they were consuming ketamine and there was more of a feeling of unity. Some people mentioned that some of the negative changes were that conversations tended to increasingly revolve around ketamine, fights occurred regarding the business aspects of the substance and its consumption and truthful relations within relationships were interfered with. One person said that they were hardly ever sober when together with consuming friends, being together was always seen as an opportunity to consume ketamine. Some of those questioned that relations with each other became more aggressive and that others appeared to have become more greedy.

because of that it was interesting. Other answers included that it was simply something different or that the occasional ketamine high was quite nice. Some subjects said that ketamine was interesting because “it blows you away”, “it has a warm, soft effect”, or because one doesn’t feel anymore, it “finishes” you or makes you extremely awake, or because it is relaxing and chills you out and because it has a calming effect. I would like to discuss this last block of answers in more detail. Answers like “it blows you away”, it “finishes you off” or the

Similar results were seen in regard to the question if relationships or friendships with non-consuming friends had changed. 66.1 % of those questioned said that nothing had changed and 33.9 % claimed that ketamine did have an influence on friendships. Answers to the question of how ketamine influenced friendships or relationships included, for example, that problems or a feeling of distance arose when one person was high and the others weren’t or that non-consuming friends expressed the opinion that the consumption of ketamine was primitive. Another common answer was that non-consuming friends were worried about their consuming friends or had no understanding for the consumers’ actions. Consumers also couldn’t share their ketamine experiences with non-consuming friends. The answers to this question also suggested that the consumption of ketamine caused changes to the social environment and increased aggressiveness. For me it was surprising to hear such answers because it is usually not particularly easy to admit such things and this requires at least a minimum of willingness for reflection. When looking at the answers this way the percentage of people who perceived changes is quite high. It is completely clear that the consumption of any psychoactive substance will have an influence on interpersonal relationships in one way or another. Unfortunately I do not have any data which enables me to make comparisons between ketamine and other substances in this regard. That would be the only way to find out which influences or changes are unique to ketamine. This question also produced answers which gave me the impression that in individual cases some very risky consumption takes place, for example, that conversations increasingly revolve around ketamine consumption and in connection with this fights break out. This suggests that the substance has reached a certain level of priority in the life of the consumers.

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Correlations
Consumed ketamine with expectations Spearman-Rho Consumed ketamine with expectations Correlation coefficient Sig. (2-sided) N Negative ketamine experiences Correlation coefficient Sig. (2-sided) N
** The correlation is significant at the 0.01 level (two-sided).

Negative ketamine experiences 0.542(**) .000 62 1.000 . 62

1.000 . 62 0.542(**) ,000 62

Figure 7: Correlation according to Spearman, negative experiences

6.9.3. Changes in Friend 53.2 % of those questioned answered the question: “Have you noticed that your friends have changed as a result of or have been influenced by ketamine consumption?” with yes. 46.8 % with no. Here the scope of the changes listed is very wide. The following were listed as examples of changes: two deaths in connection with ketamine, dependency, criminal offence, familial problems, depressions and increased aggression. The consumption change to heroin was also described as well as changes in personality, for example, consumers were described as indifferent, greedy, dishonest and bad. Some of the answers were quite unexpected and this often led to long conversations. One very extreme example of this was the occurrence of two ketamine-related deaths in one circle of friends. Here I also heard about aggressive behaviour. Characteristics like greedy and dishonest have already appeared in several questions. The described greed suggests very strongly to me that ketamine dependency plays a role here. 6.9.4. Changes in those questioned As was expected, in contrast to the previous question, here the majority of those questioned gave a negative answer. “Only” 16.1 % of the subjects answered the question: “Have other people told you that they have observed changes in you, or has your mood changed, since you have started consuming ketamine?” with “yes”. But five people stated that they had been observed to be more aggressive and more irritable. Some had already been accused of taking ketamine too often. I do not find it particularly surprising that 79 % of those asked answered this question with “no”. For one thing I can imagine that not all changes are commented on by other people, not even by good friends. Secondly, it is most likely quite difficult for the consumers to take comments seriously and admit that they are true. 4.8 % of those questioned did not answer this question.

6.9.5. Changes in the life of those questioned When asked if something in their life had changed since the first time they consumed ketamine 75.8 % of the subjects answered with “no”. 4.8 % did not answer this question and 19.4 % answered with “yes”. They gave examples of changes like unemployment, convictions, cessation of studies, loss of driver’s licence, positive and negative physical experiences and extreme perception of feelings. In contrast to the questions above, the percentages given here do not so easily reflect consumption-related sociopathological changes. One must say that a very large amount of self-reflection must exist in order to be able to give a positive answer to this question. It is possible that a connection between some changes and the consumption of ketamine can not always be recognised. It is naturally also possible that there really were no consumption-related changes in the group I questioned. 6.9.6. Negative Experiences with Ketamine 62.9 % of those asked said that they had not had any negative experiences with ketamine. 1.6 %, or one person, did not answer this question and 35.5 % admitted to have had negative experiences with ketamine. Speed – for its counter-effect, self discipline, peace and goods friends nearby were the main answers to the question about what would have helped in these negatives situations. Some of those asked also said that they had needed medical help. Here too it would have been advantageous to have had a comparable study with an other substance, as it goes I can not say

to convince the consumers that such experiences are not just “bad trips” and that such experiences are to be taken seriously. Consumers must find out what one needs to be able to come to terms with such experiences and make something positive out of them. One more interesting question which I asked in regard to this subject was if there was a connection between the expectations of the consumers and the negative experiences. In order to calculate this statistically I divided the answers to question 4 of my questionnaire (“What was the reason for the initial ketamine consumption?”) into two categories, namely “had specific expectations” and “had no specific expectations”. I also divided the variable “negative experiences” into two categories “had negative experiences” and “had no negative experiences”. These two newly created variables were then calculated in the SPSS using the Spearman – Rho correlation. (Figure 7: Correlation according to Spearman) This table shows that a weak correlation exists between the two variables, that means that there is a connection. The correlation coefficient was 0.542. That means that a slight to middling correlation exists. In my opinion the connection is, in spite of the relatively low correlation coefficient, still quite distinct. One must take into consideration that most likely not all consumers who really had specific expectations actually realised this and answered this question accordingly. According to the correlation consumers who took ketamine with specific expectations more frequently had negative experiences than consumers who had no expectations. I think that this can possibly be explained by the theory that consumers who expect something specific from the substance are most likely using the consumption of the substance as a form of compensation for something else in their life. The pressure and the disappointment resulting from unfulfilled expectations quite likely leads to negative experiences with ketamine. In addition to this there is possibly a psychological instability which also should be compensated for through consumption. Nevertheless psychological instability connected with psychedelic substances leads to an increase in negative experiences.

As a conclusion to this section I would like to present the results from the question: “Do you have the feeling that you are well-informed about ketamine?”. 54.8 % of my subjects answered this question with “yes”. 35.5 % feel that they are not well-informed and 8.1 % said that they knew at least something about ketamine. 1.6 % did not answer this question. For me it is clear that more education on this subject is definitely needed. Relatively risky consumption is taking place, since people are taking this substance while admitting that they do not think that they are well-informed about it. All in all the results of my empirical research set high demands on social work. In the next section of this work I will address these demands and discuss what social work activities or projects with ketamine consumers should or could look like.

if 35.5 % of the subjects having negative experiences is a lot or little. I would estimate I would say that this is not particularly many, still one should not underestimate the negative experiences caused by psychedelic substances. Extremely frightening and far-reaching experiences can occur and these must in some way be dealt with. Naturally this process does not always have to happen with the help of social workers or psychological professionals. The role of social workers who work with this target group is much more the role of an idea transmitter. It is important for them to be able

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7. The relevance of results
The following section is the most important and most interesting chapter of this thesis. I will now explain how my hypothesis has been verified and show how my results can be combined with social work. I will describe the projects and programmes designed for recreational drug consumers which are currently being offered by various social work institutions and make suggestions regarding what is still needed, if something is needed. The results of the empirical research have verified the hypothesis of my thesis. In evaluation of almost all questions revealed that a tendency toward aggressive and irritated behaviour is caused by the consumption of ketamine. The number of consumers who admitted to have observed a consumption-related change in others or even in themselves is high enough to legitimate the assumption that this change is not occurring only in “isolated cases”. When one takes into consideration the fact that the group questioned consisted of a mixture of people with varying consumption patterns- therefore also consumers who had tried ketamine only a few times- the results of my analysis appear to be even more unequivocal. The evaluation of the questions which were aimed at finding out more about the change in atmosphere is extremely clear. The vast majority of those questioned stated that the atmosphere at events worsened when too much ketamine was consumed. Here it was also said that the atmosphere was more aggressive and irritable. The questions regarding changes in friends and acquaintances and those questioned personally also suggested that consumption-related changes included an increase of aggression and a worsening of the general atmosphere or mood. Although I had expected the results to be like this I was still surprised that they were supported so clearly by my subjects. I did not expect so many of those questioned in my research to be able or willing to talk openly about such changes. If 80 % of those questioned had stated that they had observed a significant negative change starting with the initial consumption of ketamine, these results would not have been realistic and I would either have doubted the validity of my research method or I would have been confronted with a truly alarming situation. All in all I find that the results verify the claim that the consumption of ketamine leads to socio-pathological changes. Of course this does not mean that every ketamine consumer is a ”psychological wreck“ with a distinctly high aggression level. Still the consumption of ketamine can cause problems and negative changes which should not be underestimated and which call for professional help or support of some kind. This is particularly important if the current ketamine trend continues and therewith the number of ketamine consumers increases. This brings me to my next subsection in which I would like to address the relevance of my results for the practice of social work in more detail. 7.1. Relevance of results for social work The target group of recreational drug consumers is a hard group to find access to, but one institution in Austria, namely ChEck iT!, has made it their job to provide support services for this group. The “Verein Dialog” has recently begun to offer a special youth support service at their office in the 10th district of Vienna. However this institution does not do any streetwork and does not work with only one specific group of clients. This means that this institution is a service meant for youths who are actively seeking help and counselling. It can provide help directly or show youths where they can go to get the help they need. However I think that only a small amount of recreational drug consumers actively seek help or even think of themselves as drug consumers with problems. They are most likely deterred by institutions which are connected with the traditional drug scene. ChEck iT! is regularly on site at events in the techno scene and offers information, counselling and the chemical analysis of psychoactive substances. One problem for ChEck iT! is that it can not reach the free-techno scene. There are various reasons for this, for example, as was mentioned above, the events which take place in the free-techno scene are usually not registered and are usually held at locations which are not particularly easy to find or reach. This makes it impossible for ChEck iT! to effectively and regularly reach this scene using its current method of operation. The only chance to attend free-techno events is when a party takes place in a legal location in Vienna, for example in the “Arena” or “Ernst Kirchweger House”. But it is precisely the free-techno scene which, in my opinion, has the largest amount of ketamine consumers with perhaps the most risky consumption patterns. Another factor which limits the efficacy of ChEck iT!’s work is the fact that they are currently limited to visiting, on average, only one event a month. It is however necessary to work with this target group much more frequently in order to build a relationship. The aspects which make relationship building this more necessary with ketamine consumers than with “normal” recreational drug consumers are related to the special characteristics of the substance. Of course I do not wish to suggest that a more intensive social work programme involving the whole drug scene is not necessary. There are several facts in relation to ketamine which are especially alarming, for example the fact that a relatively high psychological dependency potential for this substance has been observed. Several answers to the questions in my questionnaire led me to the conclusion that some of the individuals questioned were already dependent. Ketamine consumers were repeatedly described using the adjective “greedy”. This word is also used very often in connection with the cocaine which is also known to be a substance with a very high psychological dependency potential. It is possible to find correlations between ketamine and cocaine consumers. One such correlation can be seen in the relatively high monthly prevalence of cocaine which was consumed by our ketamine-consuming subjects.(see Figure 5: Graph – Monthly prevalence). One other factor which struck me in regard to ketamine consumption is the ritual of consumption and preparations for consumption practised by ketamine consumers. This is very atypical behaviour for recreational drug consumers. The process of transforming the liquid ketamine into a powder form is one example of the atypical behaviour to which I am referring. This process is often called “Aufkochen” (“cooking”). This expression is actually more common in the “traditional” drug scene and describes a process in the preparation of intravenous consumption. Another example of ketamine’s unique features is that it is also, although not usually, consumed intramuscularly. These two factors suggest that topics which are otherwise to be found in work with “traditional” drug consumption are now suddenly becoming current issues in work related to recreational drugs. The self-destructive components of ketamine consumption and the “dark hedonism” described by Springer also remind one more of opiate consumers than recreational drug consumers. This change results in high demands on social work and calls for more intense work in the techno scene, or in some of its sub-scenes.

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8. Conclusion
In conclusion one could say that there is currently no institution which provides regular, target-group adequate, low threshold services for those in the recreational drug consuming scene, and in particular in the free-techno scene. That means that this scene does not receive any social medical attention, with the exception of the few events where ChEck iT! works on site. My focus is on the free-techno scene because I met proportionately more ketamine consumers in this scene than in others and I found that the “ketamine trend” in this scene was the strongest. Here there is also a higher amount of risky consumption of various substances. This assessment is also reflected in the observations which I made during my research in 2003/ 2004. I think that the work done with this work must be carried out on two levels. First, there is a need for streetwork, or scouting social work, which offers the opportunity of building contacts on site and through which information and counselling, as well as “safer use” and “risk reduction” messages can be presented. The work on site should be carried out as follows: there should be a team of social workers and doctors who regularly, that means 3-4 times per month, attend events in the freetechno scene. One of the important prerequisites of this team is that it has a thorough knowledge of its target-group because otherwise it would be difficult to even get to the events. Without the proper knowledge the team would have access to the scene-internal information which is spread by word of mouth and flyers. Other working principles which are important include, for example, voluntary contact, anonymity, low threshold approaches and objectivity. It is necessary for the team to be made up of social workers and doctors because there are regularly, especially in the free-techno scene, medical emergencies. At these events there are no first aid providers or security personnel on site making medical emergencies quite problematic. One should also not forget that ketamine consumption also often leads to fights which can also result in the need for medical attention. Through the lack pain sensitivity caused by the ketamine high consumers can also injure themselves without even noticing it. Other important services which should be offered are information and counselling. In order to be able to effectively transmit knowledge on “risk reduction“ and “safer use” information materials are naturally extremely important. One could, for example, distribute inhalation tubes for nasal application along with an information sheet or brochure containing information on nasal consumption. The distribution of one-way syringes and needles to intramuscular consumers could be combined with information on application procedure and the importance of using clean needles and syringes and how to dispose of the used ones. In addition to the work on site it is also necessary to react to the fact that a psychological dependency on ketamine can occur. Physical withdrawal symptoms have also been described. At the present I can not say if there will be a need for the treatment of ketamine dependency within this framework of social work. But I can imagine it could become necessary. A drop-in centre with psychosocial care and possibly medical support would then be important. I do not think it would be a good idea to integrate such a drop-in centre into an already existing drug counselling centre because the group of recreational drug consumers does not identify itself with “traditional” drug users. The recreational drug consumers would therefore not be likely to visit such centres. I also think that an institution which specialises on this consumers of this group of substances should be established. This group is large enough to make the creation of such a centre necessary. Alone the number of speed and cannabis consumers would legitimise its establishment. It is important to provide counselling and care for such consumers. Here a low threshold approach is also important. There should be days when people can simply come to visit, just like youth centres. This would give people the chance to take a look at everything, see what is offered and then decide for themselves if there is any programme or service which they would like or need to take advantage of. Consumers to whom contact has already been made on site can be directed there. That means it would also be advantageous for the same team to work both on site and at this drop-in centre. Now that I have presented my thoughts considering the care and services to be provided for ketamine consumers I would now like to address another topic, namely what is the consumption of ketamine a compensation for. Here I will provide suggestions of what a possible list of social work-related services could include. I think that the ketamine high is sought after because it satisfies a basic need. Firstly, one reaches a state of total relaxation through the consumption of ketamine. This feeling is increasingly hard to achieve without some sort of help in our stressful, fast moving world. Secondly, the extreme psychedelic experiences of the ketamine high are something new and exciting. Many youths and young adults find it difficult to understand their feelings and to recognise their own needs. For many it has become a problem to even know if one feels alright or not. They don’t know if they are scared or not, or even if they are sad or happy. I think that this condition can cause an extreme feeling of emptiness. Our society has already tried to fight against this feeling through the development of several trends. For example, extreme sports like bungee jumping and the like are used to give one the feeling of excitement which seems to be lacking. I would also include body cult practices like piercings and so-called “brandings” as belonging to these trends . The experiences which one has when bunjee jumping are definitely so extreme that one is almost forced to feel them and admit that they exist. I believe that the experiences with psychoactive substances work in much the same way. The “normal” high of ecstasy often isn’t enough. In contrast, a substance like ketamine can still impress, due to the fact that it can possibly lead to a truly extreme effect, namely the near-death experience. In order to be effective here it is necessary to provide a whole range of social- pedagogical services. My suggestion would be to provide experience-oriented pedagogical services which provide a “kick”, but do not involve the consumption of any substance. This could include a hike up a mountain, a sailing tour or building a hanging bridge in a forest. The connection of such services with a chance of being out in nature has the additional, positive effect of making it easier to “turn off” the stimulants and stress found in daily life and concentrate on one’s self. This leads to a sensitisation to one’s own body and to nature and often helps people to learn how to relax. I think that such services would be welcomed in the free-techno scene, since this scene is already interested in nature. If this scene is already being cared for in an other way it would definitely not be difficult to carry out such actions in addition. One could, for example, offer such an excursion in the course of a festival which runs for several days. Of course such experienceand outdoor pedagogical services are not the only way to deal with these certain needs. Still, in my opinion, such methods appear to be very well suited for this particular target group. In conclusion, one can say that, as a substance, ketamine is very special and unique, and its characteristics cause completely new problems and force one to address new aspects of recreational drug use. I think the provision of a social care concept dealing with the consumption of substances like ketamine would be a major step in the right direction. One should take the problems which arise as a result of the consumption of so-called recreational drugs seriously, but at the same time make sure that those youths and young adults who are consuming these drugs does not feel stigmatised. This group should also not have the feeling that social workers are trying to change them. Low threshold drug-related social work with an approach which shows the acceptance and understanding of its clients is, in my opinion, the right concept for this type of work.

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74 75 76 77 78 79 80 81 82 83

Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 69 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 373 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 67 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 559 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 1169 ChEck iT! Concept see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 1297 ChEck iT! Concept see: medizinische Merkblätter, Sozialmedizinsche Drogenberatungsstelle Ganslwirt, Verein Wiener Sozialprojekte, Vienna, 6 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 1646 see: Pschyrembel. Klinisches Wörterbuch. Walter de Gruyter GmbH&Co.KG, Berlin259 , 2002, 1448

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9. Epilogue
All of those people who showed an interest in my work and motivated me were a great support while writing this work. Very special thanks go to the entire ChEck iT! team which provided me with information and practical support. In particular I would like to thank Sophie who promoted the publication of this work with so much energy and Alex, who placed all of his knowledge at my disposal for the evaluation of the questionnaire. I would also like to thank Professor Dr. Heinz Wilfing for his good and supportive supervision of my thesis. Furthermore I would like to thank my family and all of my friends. The arguments and discussions on drug policy related topics with you helped me to clearly express my positions and to find my way. Finally I would like to thank all those who filled out my questionnaire and therewith shared their experiences with me and without whom I would not have been able to form an impression on my topic and write this thesis. Party on…

10. Glossary
• Analgesics: “Annulment of sensitivity to pain.” 74 • dissociative anaesthesia: Dissociation means the splitting of consciousness 75 and anaesthesia is the state of insensitivity to pain, temperature and touch stimulators. 76 A dissociative anaesthesia is therefore a condition in which one has drifted away or is dazed. The body is completely free of the feeling of pain, but one is not mentally stunned. • GABA: Gamma-aminobutyric acid, is a neurotransmitter which can be found in 30 % of the synapses in the central nervous system. The GABA receptor is the site of action for many hypnotics and narcotics. 76 • Neurotransmitters: are small molecules that are stored in vesicles and are set free through action potential (electric impulse) in the central nervous system as well as the peripheral nervous system and carry out stimulation transmission 78 (for example noradrenaline, dopamine, serotonine). • Party drugs: “Party drugs” are, in general, the psychoactive substances of the amphetamine- and amphetamine derivative group, in English speaking countries these substances have also become known as “dance drugs”, they are also often referred to as ”recreational drugs“. 79 • Phlegmone: A phlegmone is a spreading inflammation of the connective tissue with local and general inflammation symptoms. 80 A phlegmone is characterised by a reddish, painful, hot swelling. • Receptors: are sensory cells for the reception of stimuli particularly from outside. One needs receptors for orientation and communication between the organism and the environment. 81 • Recreational drugs: “The expression “Freizeitdrogen” is based on the English term “recreational drugs” or “recreational drug use”, this refers to the pattern of consumption and goes beyond the field of “classical” party drugs. At ChEck iT! we understand the term recreational drugs to include the widest variety of both legal and illegal substances - for example from biogenic drugs to cannabis to opiates – which all have one aspect in common, they are or were at least initially consumed by users in a recreational setting.” 82 • Shaker: A “shaker” is a slang expression which refers to an acute reaction of the immune system to contaminated injection solutions. The characteristics, which can carry on for several hours and disappear of their own accord, are essentially like those of a strong case of the flu (sweating, chills, shivers, nausea, fever, headache…). 83 • Thalamus: largest grey brain matter mass in the diencephalon. It is connected to other parts of the central nervous system and serves as a shifting station for optical and acoustic paths. 84

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11. Appendix
11.1. Questionnaire: 7. Please try to estimate on how many days you consumed the following substances in the last 30 days? Alcohol Cigarettes Sleeping pills & Tranquillizer Cannabis Speed Ecstasy Methamphetamine LSD Magic Mushrooms Cocaine Heroin GHB (“liquid ecstasy” Ketamine (Special K) Poppers/Sniffing substances Natural Drugs (windrose, salvia divinorum, etc.) Crack/cocaine base 3 MCV 2-CB (Micros) (Others) …Day(s) …Day (s) …Day (s) …Day (s) …Day (s) ...Day (s) …Day (s) …Day (s) …Day (s) …Day (s) …Day (s) …Day (s) … Day (s) …Day (s) …Day (s) …Day (s) …Day (s) …Day (s) …Day (s) Ketamine Consumption - Social Changes and Conflict Behaviour q Natural Drugs q Crack/Locaine base q 3MCV q 2CB changed in their lives since? (e.g. Criminal offence, trouble with police...)? q yes, how?

1. Do you know ketamine, Special K, K, vitamin K, Keta...; q 1.Yes q 2.No

2. Have you consumed ketamine before? q 1.yes q 2.no

9. How do you usually consume ketamine? q nasal q oral q i.v. q smoked q i.m. q other way____________

q no

15. Have other people told you that they have observed changes in you, or has your mood changed, since you have started consuming ketamine? q yes, how?

3. How old were you when you consumed ketamine for the first time?

10. Approximately how much money do you spend per month on ketamine?

q no

4. What was the reason for the initial ketamine consumption? (multiple answers possible) q 4a.I was curious q 4b.I had heard good things about it q 4c.It was offered to me q 4d.I had a desire for a stimulating substance q 4e.I had a need for a consciousness changing substance q 4f. Everyone I know consumes ketamine; q 4g.other reason ____________________

11. Why is ketamine interesting for you as a drug?

16. Has anything in your life changed since the first time you consumed ketamine (e.g. Criminal offence, trouble with police,...)?

8. When you consumed ketamine the last time did you also consume the following substances 6 hours before and/or 6 hours after? (multiple answers possible): Ä The last time I consumed ketamine I didn’t consume any other substances q Alcohol q Sleeping pills or tranquillisers q Cannabis q Speed q Ecstasy q Methamphetamine q LSD q Magic Mushrooms q Cocaine q Heroin q GHB q Poppers/ Sniffing substances

12. Is your work or are your studies influenced or changed by your ketamine consumption? If so, how?

17. Have you already had negative experiences with ketamine? q no q yes What would you have needed in this situation? What would have helped you?

13. Are your relationships/friendships influenced or changed through ketamine consumption? If so, how? with friends who also consume:

5. In what situation(s) do you usually Ketamine?

5a. And with whom?

with friends who don’t consume:

18. What is it like to “crash” after using ketamine?

6. How is the atmosphere at parties where more than the usual amount of ketamine is consumed?

14. Have you noticed that your friends have changed or been influenced as a result of ketamine consumption? Has their mood been different since the initial use? Has anything

19. Do you have the feeling that you are well-informed about ketamine, or is there something that you would still like to know?

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12. Bibliography
And now a few questions about you personally: 20. Gender: qm qf 21. How old are you? ___________ 27. School Education Which level of education do you have? Incomplete Compulsory school o Apprenticeship/ Vocational School o Vocational school w/o diploma o Vocational school w/ diploma o Highschool o College/Technical College o University/Academy o complete in progress o o o o o o o o o o o o o o • ChEck iT!. Verein Wiener Sozialprojekte. Eine Einrichtung stellt sich vor, Vienna 2005 • Cousto Hans. Fachinformation: Ketamine-Mischconsumption. Dissoziatives Anästhetikum 2005 • Deutsches Institut für medizinische Dokumentation und Information, ICD-10. Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. 10.Revision.Version 1.0., Band I. Urban & Schwarzenberg, 1994 • Estler. Pharmakologie und Toxikologie. Schattauer, Stuttgard5 2000 • Hoppe, U. and Klose, R.. (S)-Ketamin. Aktuelle interdisziplinäre Aspekte. Springer Verlag, Berlin, Heidelberg 2002 • Jansen, Karl. Ketamine: Dreams and Realities. MAPS, Florida 2001 • Kit, Kelly. The little book of Ketamine. Ronin Publishing Inc., Kalifornien1 1999 • Lilly, John C. Der Scientist. Sphinx Verlag, Basel 1984 • Neubauer, P.and Schinnerl, G. Perspektiven der Drogenarbeit und –politik. Ein Lesebuch anlässlich des 10jährigen Bestehens des Verein Wiener Sozialprojekte. Vienna 2000 • Pschyrembel. Klinisches Wörterbuch.Walter de Gruyter GmbH&Co. KG, Berlin259 2002 • Raab-Steiner, Elisabeth. Skriptum Sozialforschung. 4.Semester. Sommersemester 2004. Fh-Campus Vienna • Richard ,N. and Trachsel, D. Psychedelische Chemie. Nachtschatten Verlag, Germany3 2000 • Sozialmedizinische Drogenberatungsstelle Ganslwirt. Verein Wiener Sozialprojekte. Das g’sunde Gansl. Eine medizinische Sonderausgabe, Vienna • Sozialmedizinische Drogenberatungsstelle Ganslwirt. Verein Wiener Sozialprojekte. Medizinische Merkblätter, Vienna • Turner, D.M. Der Psychedelische Reiseführer. Nachtschattenverlag, Germany2 1997 • Verein Wiener Sozialprojekte. Leitbild.

22. Which federal state do you come from? q Vienna q Carinthia q Lower Austria q Salzburg q Burgenland q Tyrol q Upper Austria q Vorarlberg q Styria 23. What is your nationality? q Austrian q Other country: _____________

Internet Addresses • Arbeitsgemeinschaft für Notfallsmedizin URL: http://www.agn.at (as at 03/06) • ChEck iT! Homepage. URL: http://www.checkyourdrugs.at (as at 03/06) • Erowid. URL: http://www.erowid.org (as at 03/06) • Eve&Rave Homepage. URL: http://www.eve-rave.net (as at 03/06) • Internetlexikon. URL: http://catbull.com/alamut/Lexikon/Mittel/ Ketamin.htm (as at 03/06) • Rebmann Ralf. URL: http://www.gifte.de (as at 03/06)

28. What is your current employment situation? q Full-time employment (> 20 Hours/Week) q Part-time employment (< 20 Hours/Week) q unemployed ‡ since when ___________ 29. How high is your monthly income: q less than 500€ q between 500 and 999€ q between 1000 and 1499€ q between1500 and 1999€ q between 2000 and 2499€ q 2500 or more. Thank you for your participation! Books and Periodicals • Benschop, A., Rabes M. et al. Pill Testing. Ecstasy & Prävention, Rozenberg Publishers, Amsterdam 2002 • Brosch and Mader. Sucht und Suchtbehandlung. Problematik und Therapie in Österreich. LexisNexis Verlag, Vienna 2004 • ChEck iT!. Verein Wiener Sozialprojekte. Concept • ChEck iT!. Verein Wiener Sozialprojekte. Booklet. Universal Druckerei Leoben, Vienna 2002

24. To which group in the population do you feel you belong? q Austrian q Other group: _______________ 25. Are your parents employed? What are their professions? ________________

26. What is your current living situation: q living alone/ independent q alone with child(ren) q with partner q with parents/ guardians q partner and child(ren) q together with others q other

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13. List of figures
Figure 1: various Ketanest® Infusion bottles Figure 2: chemical structure of ketamine Figure 3: SPSS Table “What federal state do you come from?” Figure 4: Representation of Education Level Figure 5: Graph – Monthly prevalence Figure 6: Graph – Form of Consumption 7

Author
Magistra Evi Baumgartner Counsellor at events for Check iT! since winter 2003; Special topics: Free-techno scene and ketamine. Social worker in the public medical drug counselling centre Ganslwirt.

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Figure 7: Correlation according to Spearman, negative experiences 36

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ChEck iT!
ChEck iT! means Information and Counselling ChEck iT! works with youths and young adults who consume and the social situation of the consumers are carried out. • The scientific findings of these analyses serve as a basis for psychoactive substances like ecstasy, speed, or cannabis as a part of their free-time activities. ChEck iT!’s goal is to prevent the problems and damage to health which can result from the consumption of psychoactive substances. We try to increase knowledge of the effects and risks of such substances, and prevent the risky consumption of and development of dependency on these substances. • Information, Counselling and crisis intervention are offered by the ChEck iT! Homebase within the framework of eventsupervision, as well as online and via telephone. Once a week a legal advisor is available to provide legal information and counselling. • In order to be able to offer information on the risks of drug consumption we carry out anonymous substance analyses free of charge at the events which we supervise. This service is carried out in co-operation with the Medical School of the University of Vienna. • The web site www.CheckYourDrugs.at offers exhaustive information on substances, including their effects, related risks and dangers as well as on topics regarding health promotion. In addition to this it provides event tips, the results of drugchecks, as well as a “talk base” as a platform for the exchange of ideas and information amongst peers. ChEck iT! is the centre of competence in the field of recreational drug consumption Science and secondary preventive research • ChEck iT! observes the developments in drug consumption and in the drug black market. Through the chemical-toxicological analysis of the drug samples it is possible to gain knowledge of the nature and compound structures of the drugs which are being consumed. In addition to this scientific studies on consumption patterns and motives, concerns, problems the quick, well-founded and pragmatic development of dependency preventing and/or consumption reducing measures. • ChEck iT! is part of both national and international information and early-warning systems dealing with psychoactive substances. ChEck iT! monitors research results and warnings regarding questionable substances and passes this information on to these networks. • The research results are submitted in the form of articles in professional publications or as reports and are presented at conventions or conferences or to political decision makers in the form of concepts. Creation of secondary preventive information material ChEck iT! produces information material on topics which are related to the field of recreational drug consumption and secondary preventive methods. Our information material specialises on youth- and young adult consumption and is designed to be used by all those who work with this target group. A list of the information material available as well as a order form can be found at www.vws.or.at . Continuing Education for Multipliers ChEck iT! strives to pass on the benefits of its years of experience and the scientific findings resulting from its work with recreational drug consumers to multipliers. • ChEck iT! offers further education on, and carries out projects with, those who are involved in work with this target group (youth social workers, teachers, those offering apprenticeship opportunities, etc.). • ChEck iT! offers practicums for psycho-social occupations.

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Eva Baumgartner

Ketamine as a Recreational Drug
on the risks of consumption-related socio-pathological changes and specific conflict behaviour, and their relevance for secondary preventive institutions

ChEck iT! is a co-operative scientific project of

Masthead Editor and Media proprietor: Association of Viennese Social Projects (“Verein Wiener Sozialprojekte”) Rotenmühlgasse 26, A- 1120 Vienna email: vws@vws.or.at, Web: http://www.vws.or.at Author: Magistra(FH) Evi Baumgartner Editorial Processing: Magistra Sophie Lachout Graphic Design / Illustrations: Magister Bernhard Faiss Printing: Reproprint Copyright: © 2007 Verein Wiener Sozialprojekte & E. Baumgartner This work is in its entirety protected by copyright. The use of this work in any form without the explicit consent of the Association of Viennese Social Projects (“Verein Wiener Sozialprojekte“) and E. Baumgartner is prohibited. This applies in particular to copying, translating, micro-filming and saving in electronic systems.

Institute for medical and chemical lab diagnostics

ChEck iT! regularly supervises students who are writing a thesis on topics related to recreational drugs. We are particularly pleased that, through this very informative, hands-on work, we have the opportunity to make this topic accessible to those who are interested in it and all those who work with this target group. The author Magistra (FH) Evi Baumgartner and the ChEck iT! team are pleased to have been able to contribute to the transfer between theory and practise.

ChEck iT! is financed through funds from the Viennese Dependency and Drug Co-ordination (“Sucht und Drogen Koordination Wien”), non-profit companies and the Ministry of Health and Women’s Issues (“Bundesministerium für Gesundheit und Frauen”).

Further inquiries:

HomeBase

+43 1 585 12 12 www.CheckYourDrugs.at Gumpendorfer Straße 8, 1060 Wien

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