Going Down the K-Hole

The feeling of being in a K-Hole. Source: Coaster420 / Wikimedia Commons. 

Content warning: mentions of injury, death, earthquakes, and medical procedures.  

*Names have been changed. 

University life can be a drag, with plenty of bumps on the way. But those bumps might not be your typical hurdles; they might just be white powder on a key. 

Ketamine: the up-and-coming recreational drug that fills the noses of many curious drug-takers. Sometimes known as horse tranquiliser, this drug has taken university culture by storm, as MDMA slowly flails behind as ketamine take first position on the recreational drug podium. 

“It’s like you’ve smoked 100 cones. Everything was really funny and it felt like you were floating. Everything was simpler, nothing was very deep,” said Laura*. 

Canta talked to anaesthetist Dr Anne Maxwell* about the medical world in which ketamine has a place, and the recreational world it is now entering. 

Source: Psychonaught / Wikimedia Commons. 

This anaesthetic has been used by doctors and veterinarians since the 1950s, and is now used in emergency departments to rapidly ease pain. Maxwell explains how the drug is generally used in her field for its anaesthetic purposes, especially in combination with other drugs. “We call it an induction of anaesthesia, combining ketamine with other things like morphine to make people go to sleep.” 

This transition from consciousness to unconsciousness is not an uncommon use of ketamine. In 2018, it was famously used in combination with other drugs to sedate the 12 boys in Thailand who were trapped in the Tham Luang Nang Non cave system. Maxwell revealed the prominence of ketamine “in the field”, as the combination of ketamine with other drugs has been vital in order to save lives. 

Amidst the devastation of the 2011 Ōtautahi Christchurch earthquake, doctors were forced to apply their skills in ways they would have never expected. A financial advisor named Brian Coker was heading out for lunch when a staircase collapsed on him, trapping his legs under rubble. Coker was one of many trapped in the fallen PCG building. 

Dr Lydia Johns Putra was one of the few doctors called to the scene, working through rubble and darkness in order to reach Coker. Making their own make-shift operating theatre, Johns Putra amputated his legs with just a pocket knife and a hacksaw. 

Johns Putra told The New Zealand Herald that they had an anaesthetist as part of the team, reiterating how that was “very important”. 

Maxwell recalled the use of ketamine for many in the PCG building, as the drug has “really good pain-killing properties, as well as making people not remember what's happening.” 

The power of this drug, and its ability to devoid a patient of pain as well as memory, can be seen in euphoric medical experiences. 

When asked how the K-hole appears in medical situations, Maxwell acknowledged the drug’s ability to form hallucinogenic and “out-of-body” experiences. Patients “look like they’re awake, but they’re not forming memories.” 

Maxwell’s mind darts back to a memory of an elderly man who was having his toes amputated. After giving him ketamine as his anaesthetic, he began wailing. “He said he had been surrounded by all of his grandchildren, his mokopuna, including some that were dead, and he thought it was actually a really special thing.” 

The hallucinogenic properties of this drug prove evident in this anecdote, as despite his physical distress, his hallucination was something positive. This experience echoes Product Design student Caleb Palmer’s journey with ketamine as an anaesthetic. 

At age 13, Palmer snapped both forearm bones clean in half during a football game after going up for a header. His bones needed re-straightening before he got a cast, so the doctors injected Palmer with ketamine to relieve pain and memory from process. He “embarked on a journey” that he still remembers vividly to this day. 

“I was big into Star Wars and Avatar at the time, and I started dreaming that I was flying around on a sky bison visiting all the Star Wars planets. It was bliss.” He recalled trying to force himself back into an unconscious state when he started to wake again. 

Similar to Maxwell’s experience with the elderly man, Palmer’s physical presence in the room was far different to what he was dreaming. 

Six months after the surgery, his father explained to him the experience he witnessed. “He recalls me screaming in pain every time the doctors wrenched on my arm, and was at the point of demanding they stop due to how horrible it was to see. They assured him it was alright, and that the ketamine had me disassociated from what was really happening.” 

Maxwell explained how they do see people go down the K-hole, but they avoid it by giving them other medicines to reduce its severity. She reiterated that most people don’t remember the K-hole sensation. 

Maxwell said in relation to the use of ketamine in a medical sense, “We are aiming to make people unconscious usually, and we have the skills and equipment to manage this situation. That is not the case for laypeople [non-experts] and in those situations, it could be fatal.”  

So what is a K-hole and how does it differ in the recreational world? 

The NZ Drug Foundation’s Deputy Executive Director, Ben Birks Ang, said that it’s where people feel disconnected from – or unable to control – their own bodies, including the ability to speak or move around easily. 

Most people snort "bumps" or small lines of about 30 to 60mg, with the effect coming on within about five to 15 minutes. However, 100mg is usually enough to enter a full dissociative state, better known as the K-hole. 

Maxwell said that the dose people are taking recreationally is smaller than what they would use to drift someone off to sleep, but those smaller doses are what might be used medically if someone had pain. 

Many university students immersed in the drug and alcohol scene would have witnessed people fall into this state, but without the presence of medical professionals. 

Birks Ang said, “Things like the K-hole state can be really distressing, not just for the person but also for the people around them.” 

Victoria University student Amy* said, “My friends used to take a lot of ket. They literally couldn’t communicate with me, you could just tell their body was working so much slower than their brain.” 

The university party scene already involves a high consumption of alcohol, and with the mix of depressants such as ketamine and alcohol, the side effects can be dangerous. “The combination’s more dangerous because they have an additive effect, like stopping you breathing, losing consciousness, and so forth,” said Maxwell. 

On the use of ketamine recreationally, she said, “I guess it's like any drugs. People who don't know what they're doing, and that would be most people using recreational drugs, are at risk of the harms from it.” 

“The drugs that people are getting recreationally are not necessarily pure. So with that combination with the likes of alcohol, people will lose consciousness really easily.” 

She further commented on ketamine’s ability to sometimes make people vomit, which causes danger as “they may breathe it into their lungs and that sort of thing could be fatal.” 

Ketamine holds a multifaceted role in the medical field and its recreational use requires caution and informed decision-making. So, while ketamine might offer some a temporary escape from reality, the allure should never eclipse the potential risks and pitfalls of the K-hole.  

Stay safe, stay informed, and always prioritise your well-being above all.