Hong Kong may have seen a record cocaine bust last week, but the drug that really controls our city is ketamine. How did this tranquilising drug take hold of the streets? What is it about K that people crave? And how are the experts combatting ketamine addiction?

Special report by Time Out staff 
Portraits by Calvin Sit

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Hong Kong is awash with ketamine. That’s the word on the street. Whether you know it as K, Kit-Kat, K-chai or ‘that horse tranquiliser the kids are hooked on’, it’s being snorted, sipped and swallowed in bars, clubs and homes in our city every day. But just what exactly is this drug that’s taken such a grip on Hong Kong?

Unlike other street drugs, ketamine has had a very short shelf life. It was first synthesised in 1962 and patented in Belgium in 1963. As an anaesthetic and analgesic, the drug has recognised therapeutic values in veterinary practice and, to a lesser extent, in human medicine. But for entertainment or relaxation purposes, ketamine has developed a far worse reputation. And nowhere more so than in Hong Kong.

Ketamine effects
There are a few ways to take ketamine. You can either snort it in powder form (by far the most popular), swallow it as a tablet (somewhat less popular), sip it in a cocktail (hardly ever done) or, more dangerously, combine it with cocaine (street name: ‘Calvin Klein’ or ‘CK1’) and, again, snort with a Hong Kong Dollar note. All these methods are widespread in Macau, Guangzhou, Shenzhen and especially Hong Kong. Indeed, such is ketamine’s popularity around our shores that drug experts both home and abroad freely admit that our city has now become the ketamine capital of the world.

About 90 percent of all ketamine purchased in Hong Kong will come in powder form. However, when it appears in the form of tablets, the concentration of the drug and other substances is mostly unknown by clubbers and users, and this poses unknown risks in recreational use.

So why is ketamine taken? It can cause perceptual changes or hallucinations like LSD, in addition to its effects on reducing bodily sensations. It can also produce vivid dreams, drowsiness, floating sensations and mild delirium in short doses. Users can trip for up to an hour from snorting a (large-ish) line and may feel the after-effects for some hours. It usually gives the user a floating feeling as if the mind and body have been separated; hence ketamine is known as a ‘dissociative anaesthetic’. This has two connotations. Firstly, it has a direct effect on the brain, inducing a lack of responsive awareness not only to pain but also to the environment around the user. Secondly, it gives a unique feeling of dissociation of the mind from the body (or the so-called ‘out-of-body experience’).

Sensory blockades
Ketamine blocks or interferes with the sensory input of the central nervous system. The drug, in some ways, selectively interrupts association pathways of the brain before producing somaesthetic (the sensation of having a body) sensory blockades. Physically, ketamine has tangible effects too. It produces changes in your heart rate, cardiac output and blood pressure. If ketamine users are taken to A&E units, it’s usually because of tachycardia.

Psychologically, ketamine is enjoyed because it can give users a psychedelic state of mind. Clubbers call this ‘going down the K-hole’. The K-hole, a feeling akin to otherworldliness, allows the user to travel ‘beyond the boundaries of ordinary existence’. The intensity of these psychedelic effects is always dose-related. On a neuro-physiological level, this behaviour actually resembles schizophrenic psychosis.

Tolerance to ketamine develops quickly and often results in an escalation of dosage. Two large lines at a club can quickly become four large lines in a short period of time. It has the potential to cause psychological dependence in some individuals and yet the main ‘down’ effects of ketamine are anxiety, agitation and changes of perception, such as loss of a sense of danger or visual disturbances. In such a condition, the user may be at risk of injuring themselves without knowing it. When coupled with alcohol, falls can happen in night clubs, as can cigarette burns, walking into mirrors and tripping down steps. In London, where ketamine is far less popular, K-users are known derogatorily as ‘zombies’.

K-users may be physically incapable of moving while under the influence of the drug (you can see such casualties at any number of Kowloon KTV clubs). Ketamine can also produce panic attacks, depression, paranoia, and can make existing mental health problems far worse. It’s particularly dangerous when mixed with ecstasy, MDMA or amphetamines and can result in high blood pressure, unconsciousness and, most seriously of all, inhalation of vomit.

In tablet form, ketamine can be very worrisome. Pills in Kowloon are often stamped with the same ecstasy-type logos and can often contain cutting agents which are stimulants, such as caffeine, amphetamine, methamphetamine, ephedrine or cocaine. Information is poor on the Hong Kong streets when ketamine comes in pill form, so the risks can often be considerable.

Research suggests that first-time users of ketamine tend to follow similar consumption patterns as those previously adopted for other drugs. Clubbers often inadvertently buy ecstasy tablets only to find they are ketamine pills, or vice versa. Unsuspecting people will be offered lines of coke only to discover they’ve snorted Calvin Klein, or pure ketamine. This can create psychological risks, especially when there is no warning or support. Indeed, the large numbers of users who head to emergency departments are those who have inadvertently taken ketamine by mistake and have thus experienced anxiety attacks. As for why people desire ketamine, please read on…