Ketamine: Dreams and Realities by Karl Jansen (Introduction by Emanuel Sferios). Soft Cover, 5.5" x 8.5". References, Index.
MAPS, 2105 Robinson Avenue, Sarasota, Florida 34232, USA. Phone: 941-924-6277. Toll-free: 888-868-6277. E-mail: email@example.com. Publication Date 2001. 355 pages, ISBN 0-9660019-3-1. Price $14.95
The human desire to induce and experience mind-altering effects through drugs is as old as the hills. It constitutes universal human behavior that transcends regional, religious, and cultural barriers. Around the world from time immemorial, individuals have experimented with psychoactive plants often under the guise of spiritual or religious influences, which is in fact no different from some present day abusers of psychedelic drugs who profess pseudo-spiritual inclinations. Today however, it is recreational drug use that has become the major problem, especially among the youth. A plethora of drugs, both conventional and unconventional, is relatively easily accessible in many parts of the world, especially the West.
The World Wide Web has increased popular awareness of psychoactive and mind altering drugs, substantially stimulating curiosity about these substances, and thereby generating a flourishing illicit market that was virtually non-existent a decade ago. At the same time unfortunately, access to Internet web sites that provide accurate, truthful information on drugs is blocked in most homes and educational institutes by specialized software. As a result, young people who are exposed to a greater variety of psychoactive drugs than ever before have few opportunities to obtain information that they can trust. Despite intensive efforts over the last several decades to curb illicit drug use, the number of addicts has not significantly declined. In fact, the draconian and punitive nature of the "anti-drug policy" followed in most parts of the world, including Third World countries such as India has only overburdened law enforcement agencies, and led to a virtual prison population explosion.
Among the more recent entrants in the world of psychoactive drugs is ketamine hydrochloride ("Special K" or "K"), which was actually created for use as a human anesthetic, and is in fact still recommended as a general anesthetic in certain special situations, and in veterinary medicine. Ketamine belongs to a class of drugs called "dissociative anesthetics," which separate perception form sensation. Another important example is phencyclidine ("PCP" or "Peace Pill"). Ketamine is usually cooked into a white powder for snorting (nasal insufflation). At low doses it includes a mild, dreamy feeling similar to nitrous oxide ("Laughing Gas"). Users report sensations of floating in space and other out-of-body experiences. Higher doses produce more powerful and bizarre hallucinogenic effects ("K-hole" or near death experience, with sensations of exiting one's own body). While in a K-hole, it is very difficult to move! People usually remain immobile during the experience. Frequent use can cause disruptions in consciousness and lead to neuroses or other mental disorders. Ketamine can cause a tremendous psychological dependence. The dissociation from one's consciousness experienced with ketamine can be highly thrilling to some people, while to some others it may be terrifying.
With the publication of "Ketamine: Dreams and Realities", Dr. Karl Jansen has provided the first authoritative and comprehensive analysis of ketamine written in simple, comprehensible terminology that can be easily understood even by laypersons. The book brings together may different aspects of ketamine, including conflicting views that have emerged since this drug began to climb the charts of popularity in the 1980s, to provide an objective assessment. While the book is mainly aimed at the general public, there are over 600 references at the end that would satisfy serious researchers. Karl L.R. Jansen, M.D., Ph.D., and Member of the Royal College of Psychiatrists, is the world's leading expert on ketamine. He has studied ketamine at every level while pursuing his doctorate in clinical pharmacology at the University of Oxford, and has published extensively after that on the effects of the drug, problems associated with its abuse, and new methods of treatment of addiction. Dr. Jansen however believes that ketamine can have potent healing powers when used (with caution) as an adjunct to psychotherapy.
Dr. Jansen's book is full of remarkable philosophical and scientific insights making for fascinating reading. In the course of the preparation of this book, Dr. Jansen consulted numerous sources including "the back page of High Times, the front page of the Face, Muzik, and Position Paper culture, to conversations with a wide variety of people who've experienced the drug in different contexts: users, patients and their doctors, drug workers, victims, law enforcement officers, and an array of professionals and experts." Many of the dreams and realities experienced by users are graphically portrayed in Part I of this book, "The Light Within", which concentrates on the effects of the drug when it is taken in a non-medical context. Issues arising out of abuse are covered in Part II "The Dark Side", which concentrates on dependence (addiction), "bad trips," nightmares, and other mental and physical side effects.
Part II also suggests methods for treating ketamine addiction. Important amongst these is an approach called "motivational interviewing", which involves considering both the pros and the cons of a compulsive behavior, in the short and long term. Often medical professionals concentrate only on the "con," and end up unable to help people to fully understand themselves, the nature of their ambivalence, and their decisions. Providing complete and accurate information is more likely than not to reduce drug related harm. Studies have shown that individuals who have heard about ketamine and are determined to try it will do so regardless of negative education or the legal status of the drug. The third part of the book "Unity" deals with research involving the use of ketamine as an aid to psychotherapy.
Some people (including scientific professionals) may feel that a book of this nature about the non-medical use of ketamine, which discusses the subject in a complete way, might actually increase problems by spreading knowledge of the drug's tantalizing effects. However, the truth is that such books can actually reduce harm by presenting accurate information together with harm minimization advice. Focusing only on the negative aspects of drug use may be less successful in protecting public health than helping people to fully understand the issues involved in deciding whether they will or will not use a drug. Wholly negative drug education campaigns have often had little success in most parts of the world. The relative failure of campaigns to reduce smoking in young women is a well-known example.
In the West, few people are unaware of the "horrors of heroin," and yet the use of this drug increased dramatically between 1990 and 1998 in the United Kingdom. It seems probable that a balanced, realistic approach towards ketamine use will at the very least do no harm, and may even have more favorable outcome for public health than the exclusively ultra-negative approach that has been typical of many attempts at drug education so far. The relative failure to improve public health by focusing solely on the negative effects of drugs has led to a new approach called "harm minimization." Harm minimization accepts the evidence that many people will continue to take drugs even when they are fully aware of all the dangers involved. The method seeks to minimize harm through providing safety advice and other means, and hopes that there is a level at which the person may follow this advice and accept help, even if they do not abstain completely. An example is provided by the campaign to provide clean needles to mainline addicts. Provision of safer methods of injecting drugs decreases the risks of death from overdose, or of contracting diseases that can be transmitted via dirty needles, such as AIDS.
This is precisely why Dr. Jansen's book is so important, for after all, the people most likely to be harmed by the use of psychoactive drugs are those who know the least about them with regard to both the potential benefits, as well as the hazards. Dr. Jansen must be commended for his bold and timely contribution to the efforts in understanding and developing a pragmatic public health approach to the escalating scourge of psychoactive drug use. Not only does this book contain a wealth of practical harm reduction information for the ketamine user, it also elucidates for doctors, therapists, treatment providers, and policy makers the enigmatic reasons why many people do make a fully informed choice to use this drug.
This review will not be complete without a word of appreciation for the publishers too. The Multidisciplinary Association for Psychedelic Studies (MAPS) is a membership-based non-profit research and educational organization with over 1800 members. It assists scientists to design, fund, conduct, and report on the risks and benefits of the therapeutic, spiritual, and creative uses of psychedelic and psychoactive drugs. Over the last several decades MAPS has done excellent work in financing and highlighting research relating to a wide variety of drugs, including Ecstasy, marijuana, and psilocybin. Karl Jansen's "Ketamine: Dreams and Realities" is but one more feather to its cap.
-V.V.Pillay MD, DCL
Professor, Dept. of Forensic Medicine & Toxicology
Chief, Dept of Analytical Toxicology (Incl. Poison Information Service),
Amrita Institute of Medical Sciences & Research,
Cochin 682026, South India
Phones: 0484-2804852 (O); 0484-2807055 (R), 9895282388 (Cell)
Dr.V.V.Pillay has been in the vanguard of the movement among medical professionals in India to develop the neglected field of Toxicology. He has published extensively in both the scientific and lay press on matters relating to Toxicology, as well as his chosen discipline - Forensic Medicine. Dr.Pillay has authored 6 books on Forensic Medicine and Toxicology, and has received an award for one of them (Modern Medical Toxicology), generally considered to be a trend setter among books on the subject in India. He has reviewed several books on Toxicology for the Internet Journal of Forensic Medicine and Toxicology. Dr.Pillay received a scroll of honour in appreciation of work done in the field of Toxicology from the Medicolegal Society, All India Institute of Medical Sciences, New Delhi. He has established a state-of-the-art Poison Control Centre, recognized by the World Health Organization at the institute where he is currently employed (AIMS, Cochin). Among his most sought-after publications is a 700 page reference work on Toxicology.
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