Melanie Cole, MS (Host): Not too long ago, and according to the Los Angeles County Medical Examiner's Office, actor Matthew Perry died of acute effects of ketamine. What even is ketamine? How is it used in medical settings? And what are the dangers of street use? Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole and joining me is fan favorite Courtney Mattley. She's a pharmacist and department manager of pharmacy services at Henry Mayo Newhall Hospital. Courtney, welcome back. I love having you on because you're so educational. So what is ketamine? Gosh, it's all over the news, the media. We see it everywhere.

Courtney Mattley, PharmD: Yeah, thanks Melanie for having me back on. So ketamine is actually something we've used in the hospital for a really long time. It was approved by the FDA in 1970, so it's fairly old, but, because of the situation with Matthew Perry, I think it's just been talked about a lot, a lot more recently, but what we use it in the hospital for is actually very different than what it's used for outpatient in the community setting.

So first I'll go over how we use it in the hospital because that's what I'm more familiar with and then we can go over sort of what's been popular in the last about five years for outpatient use. So in the hospital, we use it a lot in our emergency department actually.

So what it is, is a dissociative anesthetic, which is a very, long name for what it actually does. It has a property that I don't think any other drug has where it dissociates a patient from their body and it actually has some hallucinogenic effects as well, but where we find this very useful is in the emergency department when we have a patient who, let's just give an example, a kid who comes in with the need for stitches.

Now, to get somebody to stop moving and stop flailing around, that's three years old, could be very hard, right? And so one option we can do is to do full anesthesia, and that requires a lot of oversight, getting a breathing tube down their throat. That would be not ideal, right, for something that's going to take five minutes.

But with ketamine, we can give a dose and it actually doesn't affect their breathing like other sedatives do. It has a little bit of a pain relief element. And we can use this medication in the emergency department for a quick procedural sedation situation, which is what's most common. And a lot of them are pediatric cases because we can't really get the kids to stop moving when it's a procedure like that. So that's the number one use that we have for in the emergency department.

It's also very useful for patients who might have a lot of tolerance to pain medications like opiates because ketamine itself is not an opiate. It is a controlled substance but it's not an opiate. So a patient might get pain relief from ketamine who otherwise is not responding to other pain medications that we have in the hospital.

So it's very useful in a controlled environment and that's our number one way that we use it in the emergency department is for a procedural sedation. Now outpatient, you've probably heard a lot about its use for, ome mental health issues, or addiction, something like that.

And that's where I think Matthew Perry, or, I mean, I don't want to speak about that case specifically, but, that's where it's gaining popularity is having this effect on the brain that we're still studying. And we don't really know all of the properties about how it's working. But there's really good evidence that it can help somebody who's had chronic depression or possibly addiction and some other situations that have to do with mental health.

So there's a lot still that we need to learn about ketamine.

Host: That was really informative, Courtney, because I didn't know that it's really just used as a form of anesthesia where you don't have to use tubes and intubation and things, but it can calm the senses and calm somebody down while you're able to do whatever you need to do. But as far as what we do hear all the time is for depression and addiction.

So I'd like you to speak as the pharmacist that you are, is this addictive. Is it dangerous? Are there side effects? If somebody is using it, even under the supervision of a physician, are there side effects?

Courtney Mattley, PharmD: Yeah, of course, just like any other medication, there are downsides to it, and we know that it does get abused on the street. It's definitely a street drug where people can abuse it, usually for the hallucinogenic properties that ketamine has. Is it addictive? No, not in the sense of a withdrawal aspect from like, what we can see with opiates or alcohol, things like that.

But it has abuse potential because of some of its properties, and it's definitely a street drug that is a problem. Dangers and side effects, things like that. It's main, problem, I think, is that, it has this increased blood pressure effect that can be dangerous for people that have high blood pressure.

It can also be used to facilitate sexual assault, which is something that is a problem with the medication. Although it doesn't decrease breathing in a sense like opiates where it has respiratory depression, it does slow everything down and can decrease the breathing a little bit. It also has this effect on salivation and secretions.

So if there's a very large dose given to somebody, they can actually have so much salivation and secretions that they can actually even choke on it. So there's a monitoring that we do to make sure that that's not happening if we're giving the medication. So, is it safer than some anesthetics as far as respiratory depression?

Yes, but there's also some things that need to be monitored from a professional.

Host: How as a street drug is it used? How is it taken when you say it's a street drug? Is this an injectable? Is it an oral? How is it used?

Courtney Mattley, PharmD: In the hospital, it comes in like a liquid vial. So it's always used as an injection. It can be intramuscular or IV but anything that comes as a liquid can be altered on the street into a powder form. It can be crystallized and used as a powder eventually whether it's being smoked, snorted, you know, people get very creative. So it can be liquid or powder but the formulation that we would use in the hospital is a liquid formulation as an IV or intramuscular route.

Host: Knowing so much about it as you do, how have you ever seen it work? First as an anesthetic in the hospital, do you see how well it works? Are the effects pretty immediate? And as far as anybody that's talked to you about use for depression, because it is so prevalent for that now, there's clinics popping up everywhere, have you seen that it's actually a positive force? Or what do you think about it?

Courtney Mattley, PharmD: As the procedural sedation medication that we use, it's great. It really does the job. It works really quickly. If somebody needs to have a little bit of a sedation or dissociative effect, it takes minutes for it to work and it wears off within 30 to 60 minutes. So it has a really good, what we call pharmacokinetic profile for the use in the hospital. Outpatient, I have less experience with personally, but from what I've read and talked to other pharmacists about, they give it a little differently. They give it as a slower infusion, so it doesn't have as many peaks and troughs. And the effects on depression that are reported they seem very positive.

And the, way that it's working as far as what they think is helping the depression has to do with, really what the mind is going through during the ketamine exposure and the way it's reported is that if someone's in a depressive state they really are almost in this like mind block where there's connections in the brain that aren't happening because of the chronic depressive state and if somebody's getting ketamine as a treatment it might open up some of those pathways in the brain to reconnect some of these different routes in the brain, like a little freeway of neurons, and possibly open up and get them out of this depressive state. What we don't know is how long term the effects are as far as getting them out of that depressive state. Is it weeks, months, years? Are they going to need it for the rest of their life? Some of that is still being studied, but, the results look promising.

Host: That's interesting, Courtney. So if you were to summarize today's podcast discussion that we've just had on ketamine, and when people ask you about it, what would you like the key takeaways to be from this conversation? And with the questions that people always have about these things, what do you want us to know?

Courtney Mattley, PharmD: I think ketamine is an interesting drug. If you ask any pharmacist what drug is interesting to them, some people will say that ketamine is the most interesting from any pharmacist standpoint because it has unique properties, it can be used in so many different ways. And we know a lot about the medication from its use in the emergency department, but some of this effect on the brain from a mental health standpoint is exciting to us because it's just now coming out with some of the results.

But, there's still a lot we need to know about this medication. And I think people need to really speak with their physician and their providers if they think that this is something that them or their loved ones can benefit from. And we'll see what it holds in the future. But, it's exciting times in the ketamine world, that's for sure.

Host: Certainly is. And thank you again, Courtney, you are just always such a wealth of information and so much fun to talk to. Thank you again for joining us. And you can find a lot of information on ketamine by going to the CDC website, cdc.gov, and typing ketamine in the search box that's on the top right of the homepage. To learn more about many other things, you can always visit Henry Mayo Newhall Hospital's free online health library. You can find that at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital, and I really want you to remember to subscribe, rate, and review It's Your Health Radio on Apple Podcasts, Spotify, iHeart, and Pandora.

Until next time, I'm Melanie Cole.