Ketamine powder form

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Try out PMC Labs and tell us what you think. Learn More. Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users IDUs in cities across the United States. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills.

Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine.

Injection initiation is a ificant event in the life of a drug user since it places the person on a trajectory towards increased health risks, including exposure to bloodborne pathogens, drug overdose, and drug dependence Chitwood et al.

Studies targeting young injection drug users IDUs have focused on factors associated with injection initiation Fuller et al. However, these studies have not examined risk behaviors at injection initiation linked to a particular drug type. Furthermore, limited research has been directed towards understanding the ificance of expanding injection practices from a single drug to multiple drug types among young IDUs, and the health consequences associated with initiating a new drug. ly, we studied the first injection of ketamine among a small sample of young IDUs and reported that ketamine injection involves particular paraphernalia and high-risk practices that are unique to this type of injection drug use Lankenau and Clatts, Here, we advance our prior study by examining the first injection of ketamine among a larger sample of young IDUs with varying histories of injection drug use; some initiated injection drug use with ketamine while most initiated with other drugs, such as heroin or cocaine.

Ketamine, a legally manufactured pharmaceutical originally developed in the s as a surgical anesthetic Corssen and Domino,is consumed recreationally for its dissociative qualities among a wide variety of users.

Ketamine powder form

Recent reports suggest that prevalence of ketamine use is increasing in Europe Travis, and Asia Joe Laidler,but stabilizing or declining in North America Community Epidemiology Working Group, ; Johnston et al. Research conducted in the United States, England, and Australia indicates that ketamine users tend to be white, male, younger under 30 years oldurban-dwellers, and moderately to well educated Clatts et al. Ketamine is occasionally found in pill form and ingested orally Jansen, Though, its more ubiquitous powder form is commonly administered intranasally Curran and Morgan, ; Dalgarno and Shewan, ; Dotson et al.

More recently, ketamine has emerged as a drug increasingly common among new subgroups of young IDUs Community Epidemiology Working Group, ; Dillon et al. Our prior research Lankenau and Clatts, ; Lankenau, ; Lankenau and Sanders, in press suggests that ketamine has several properties that make it somewhat distinct from other injectable drugs regarding form, mode of administration, and drug using histories among users, which may result in different injection practices. First, originally packaged in liquid form for medical and veterinarian use, ketamine can be converted to powder for recreational intranasal use.

Like other powder drugs, such as heroin and cocaine, ketamine can be mixed with water and injected. Liquid ketamine is sold in a pharmaceutically-sealed vial and contains a lid deed to be pierced by a hypodermic syringe. Second, ketamine can be administered both intramuscularly and intravenously among recreational users. Some IDUs preferred injecting ketamine intramuscularly because it was a less stigmatized mode of administration, presented fewer injection risks, produced a longer lasting high, and was easier than injecting into a vein.

Ketamine powder form

Third, ketamine injectors were often a heterogeneous group with varying histories of injection drug use. Ketamine also appealed to more experienced IDUs who wished to experiment with the drug, but preferred injection as the mode of administration.

Our prior research detailed particular practices associated with ketamine injection initiation and types of IDUs who inject ketamine. Several aspects of the first injection, however, remain unknown, such as circumstances of first use, potential high-risk behaviors learned during the first injection, and the impact of first use on future drug using behaviors.

This contrast is important since newer IDUs may present different drug using histories and injection risk behaviors during the first injection of ketamine compared to more experienced IDUs. This approach is particularly useful for describing hidden populations of IDUs who are unlikely to appear in sentinel data Clatts et al. Towards this end, ethnographers interviewed key informants, such as directors of homeless shelters, health clinic staff, needle exchange coordinators, or outreach workers, who might have direct or indirect contact with young ketamine injectors.

These individuals typically had limited or no knowledge about ketamine injectors, yet some directed ethnographers to locations containing populations of young IDUs. Based upon data collected during the CAP, ethnographers recruited young ketamine injectors in each city using a combination of chain referral sampling Biernacki and Waldorf, ; Penrod et al. Both are non-random yet effective methods for sampling hidden populations. While random sampling may be possible for enrolling certain stigmatized or hard-to-reach populations, such as young MSM MacKellar et al. Additionally, newer sampling methodologies that attempt to overcome the difficulties associated with non-random samples, such as respondent-driven sampling RDS; Heckathorn,are problematic for enrolling ketamine injectors.

The incentive structure directing RDS recruitment could encourage young people in the targeted neighborhoods, which contained many homeless and marginally employed, to misrepresent their drug using history in order to qualify and receive the study incentive. Guided by our sampling methodology, ethnographers entered neighborhoods in each city reported to contain populations of young people and IDUs, observed the activities in the area, engaged young people in informal conservations, and screened individuals who might meet the enrollment criteria.

This process helped facilitate rapport with the target population and recruit associates of ly enrolled individuals. Ethnographers repeatedly targeted these neighborhoods until 50 or more young people had been sampled in each site. Based upon our ketamine research Lankenau and Clatts, recruiting 50 injectors in each site was determined to be the minimum sample size necessary to describe basic relationships among variables of interests.

Young people were eligible for study enrollment if they were between the ages of 16 and 28 years, and had injected ketamine at least once within the past 2 years. These criteria were selected to enroll a sample of young IDUs who could describe recent ketamine injection events. A series of screening questions focusing on health behaviors, recent drug use, and history of homelessness were asked in order to hide the true enrollment criteria.

Since all individuals enrolled into the study received a monetary incentive, ethnographers were careful to listen for convincing descriptions of practices and experiences associated with ketamine injection prior to enrollment. Before beginning an interview, individuals ed informed consent documents approved by local Institutional Review Boards from each site.

Marks Place, and Tompkins Square Park. All New York interviews were conducted during a 5-month period between April and August All New Orleans interviews were conducted during a month period between March and May All Los Angeles interviews were conducted during a month period between January and June Each of the above-mentioned neighborhoods contains commercial shopping districts frequented by young people, local residents, and tourists. The types of businesses, physical spaces, and interactions within each are strikingly similar: bars, tattoo shops, retail stores, parks, panhandling, sex work, and drug selling.

While clubs were initially targeted as possible recruitment sites in each neighborhood, only ketamine sniffers were encountered in these venues.

Ketamine powder form

Ultimately, streets and parks became the primary physical spaces for conducting observations and recruiting IDUs in each city. While the interview guide contained eight domains or modules, the majority of the data reported here is largely based on the first ketamine injection module, which asked a series of detailed questions about the location of the event, members of the injection group, mode of administration, and risk practices.

Context-based questions, which include information about relationships and personal circumstances, have been shown to increase the accuracy of recall of drug using events Bedi and Redman, Additionally, we collected data on several aspects of syringe use and injection practices related to infectious disease risk Bluthenthal et al.

The interview guide, which contained both structured, close-ended questions and probing, qualitative questions, was administered on laptop computers using Questionnaire Development Software, and interviews were recorded with digital recorders. Following the interview, digital recordings were transcribed into a text document and analyzed using ATLAS ti, a qualitative software program.

ATLAS ti assisted in the coding and sorting of transcribed narratives into salientsuch as injection group or injection experience, which were then analyzed for variability and specificity.

Ketamine powder form

A review of interview data from all three sites revealed 17 interviews that were deemed questionable or unreliable. These interviews, which contained inconsistencies within the transcript indicating that the young person had misrepresented their age, their drug using history, or had never injected ketamine, were excluded from analysis. Across all three sites, the sample is largely male, white, heterosexual, and in their early 20s see Table 1. Some worked jobs in the formal economy on a full-time or part-time basis, such as retail store clerk, messenger, and day laborer, while others earned money or sustenance through participation in the informal street economy, which included panhandling, sex work, and drug selling.

Most had been to a drug treatment or detoxification facility. A majority received mental health treatment, which could have included psychological therapy, psychiatric care, or a stay in a mental health facility. Almost all had histories of criminal justice involvement, such as an arrest or incarceration in a local jail or state prison.

Overall, Table 1 reveals a sample of high-risk youth with extensive experiences of homelessness and criminal justice involvement, and low participation in the formal economy despite relatively high rates of high school completion. New York, New Orleans, and Los Angeles were originally selected as recruitment sites since prior research demonstrated that ketamine was being injected in each city Lankenau and Clatts, Yet, only one-fifth initiated ketamine injection in the city where they were recruited.

This discordance may be partially explained by the high percentages of currently homeless, those with a history of homelessness, and those defined as homeless travelers. Consequently, many were no longer living in the same city where they first injected ketamine.

Ketamine powder form

Since recruitment site does not necessarily reflect location of ketamine injection initiation, we report data in the aggregate rather than by site. Table 2 presents a history of illegal drug use among the sample. The average age at first ketamine injection equaled Heroin use is ificant among these young IDUs: a large majority had ever injected heroin; heroin was the drug most commonly first injected; and heroin was regarded as the drug of choice for most youth.

Methamphetamine and cocaine were also important drugs given the high percentages that had ever injected either drug or initiated injection drug use with either drug. In total, over half of the sample

Ketamine powder form

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