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Ketamine for Pain vs. Ketamine for Escape: The Line Between Use & Abuse

Avatar photo Ian Young
19 Aug, 2025
05 min read

Introduction: When Relief Turns Into Reliance

Ketamine’s Dual Identity: Anesthetic and Psychedelic

Ketamine exists in two worlds. In hospitals, it’s a powerful anesthetic and painkiller. In nightclubs and unregulated clinics, it’s a dissociative escape hatch. This duality makes ketamine uniquely dangerous when misused.

Medical Marvel or Misused Medicine?

The same drug that provides breakthroughs in depression treatment can also be used for numbing trauma, avoiding emotions, or chasing euphoria. The difference lies in intention, setting, and supervision.

Legitimate Medical Use of Ketamine

Pain Management in Hospitals and Chronic Pain Clinics

Doctors may use ketamine in:

  • Surgical anesthesia (especially for children or patients with allergies to opioids)

  • Infusions for chronic pain, like fibromyalgia or complex regional pain syndrome (CRPS)

In these settings, dose, frequency, and patient response are monitored by trained clinicians.

Esketamine (Spravato) for Treatment-Resistant Depression

  • FDA-approved in 2019, Spravato is a nasal spray version of ketamine

  • It’s used in cases of treatment-resistant depression with suicidal ideation

  • Administered in clinics under supervision—never at home

Emerging Research in PTSD and Suicidal Ideation

Some studies show low-dose ketamine can help patients process trauma, reduce suicidal thoughts, and improve emotional resilience. However, all these studies involve strict protocols and psychiatric oversight.

Recognizing Ketamine Misuse

Using Ketamine Without a Prescription or Clinical Supervision

If you’re obtaining ketamine through:

  • Online pharmacies

  • Party scenes

  • Friends or dealers
    …it’s considered unauthorized use, even if your intention is therapeutic.

Red Flags: Dosing Alone, Frequent Use, Avoidance Behavior

Watch for signs like:

  • Increasing dose without guidance

  • Using to avoid emotional pain

  • Using at home or unsupervised

  • Rationalizing use despite negative impacts

Psychological Cravings vs. Physical Pain Relief

Pain relief is measurable—emotional escape is more subtle. If your use is more about numbing feelings than treating physical pain, you may be crossing into misuse.

FDA and Global Warnings About Ketamine Abuse

FDA Warnings on Compounded Nasal Spray and Telemedicine Loopholes

The FDA has issued warnings about unregulated ketamine being:

  • Sold through telehealth platforms without oversight

  • Compounded into nasal sprays not approved for at-home use

  • Linked to misuse and overdose

How Regulation Differs by Country

  • In Thailand, ketamine is classified as a Class 2 narcotic—strictly regulated

  • In the UK, it’s a Class B drug under the Misuse of Drugs Act

  • Many countries are tightening access as misuse increases

How to Know If You’ve Crossed the Line

Self-Assessment: Am I Using for Healing or Hiding?

Ask yourself:

  • Am I avoiding emotional discomfort?

  • Am I honest with my doctor about my use?

  • Do I feel guilty or ashamed after using?

From Chronic Pain to Emotional Numbing

Sometimes what begins as a physical pain solution morphs into an emotional crutch. This often happens gradually and without awareness.

Emotional Dependency Without Physical Symptoms

Unlike opioids or alcohol, ketamine may not cause severe physical withdrawal. But psychological dependency can be just as crippling:

  • Anxiety when not using

  • Obsession with the next dose

  • Loss of meaning or purpose outside of the drug experience

The Role of Trauma and Depression in Ketamine Misuse

Self-Medication Patterns

Trauma survivors often reach for substances to:

  • Disconnect from memories

  • Silence inner voices

  • Temporarily “feel nothing”

Ketamine is highly effective at doing all three—which is why it’s so misused.

The Trap of Temporary Relief

Ketamine offers short-term relief, but the effects wear off quickly—leading to a cycle of:

  • Brief calm

  • Emotional crash

Craving more
This pattern reinforces dependence without true healing.

Holina’s Approach to Treating Ketamine Misuse

Supporting Both Chronic Pain and Emotional Healing

Holina offers:

  • Clinical support for clients with legitimate medical needs

  • Emotional and psychological therapy for trauma, depression, and dissociation

  • Holistic alternatives for pain and anxiety relief

Integrative Treatments for Mind and Body

Our programs blend:

  • Trauma therapy (EMDR, CBT, DBT)

  • Somatic practices (TRE, bodywork)

  • Mindfulness and creative therapies

Setting Boundaries Around Medical Use

We work with each client to:

  • Review their medical history

  • Consult with outside physicians if needed

  • Establish clear, healthy guidelines for any future medication use

Alternatives to Chronic Ketamine Use

Physical Therapies and Somatic Work

  • Acupuncture

  • Thai massage

  • TRE (Trauma Release Exercises)

These practices reduce chronic tension and restore body awareness.

Non-Drug-Based Pain and Mood Management

  • Cold exposure and contrast therapy

  • Movement practices like yoga or qigong

  • Guided breathwork and vagus nerve activation

Breathwork, Yoga, Trauma Release Techniques

By processing stored trauma, these methods help clients:

  • Sleep better

  • Feel grounded

Reduce panic or depressive symptoms without relying on substances

Frequently Asked Questions (FAQs)

Is it safe to use ketamine for chronic pain?

Yes—when prescribed and monitored by a medical professional. Misuse often occurs outside of this framework.

Can I become addicted if I’m using it medically?

Yes. Even under medical use, some people develop emotional dependence or misuse patterns, especially if trauma is unaddressed.

What’s the difference between esketamine and street ketamine?

  • Esketamine is a purified form approved by the FDA

  • Street ketamine is unregulated and often mixed with other substances

How can I tell if I’m abusing ketamine emotionally?

If you use it to avoid feelings, disconnect, or self-soothe without medical guidance, it may be misuse—even without high frequency.

Does Holina allow clients who used ketamine medically?

Yes. We support both medical users and recreational users who feel they’ve lost control or developed reliance.

Are there safer alternatives to long-term ketamine use?

Absolutely. At Holina, we provide natural and integrative strategies for pain, depression, anxiety, and trauma recovery.

Conclusion: Use, Misuse, and the Power of Awareness

It’s Not About Blame—It’s About Balance

Whether you started with chronic pain or emotional hurt, awareness is the first step. Ketamine misuse isn’t a moral failure—it’s a coping mechanism. But healing requires choosing a new path.

Holina Helps You Reset the Relationship with Ketamine

At Holina Rehab, we offer the tools, care, and community you need to:

  • Reclaim control

  • Process underlying wounds

  • Build a life you don’t need to escape from

📞 Admissions Support: +66 (0) 626 418 369
🌐 Learn more at: holinarehab.com

About Me

Avatar photo

Ian Young

Ian Young is the Global Manager at Holina Care Centres in Koh Phangan, Thailand. Ian oversees the rehabilitation programs that blend the 12 Step model, NLP, and various evidence-based therapies with holistic healing practices. Holina Rehab treats addictions, trauma, anxiety, and depression, offering comprehensive care in a serene resort environment. Ian, a charismatic speaker and author of “It’s Not About Me,” leverages his own recovery journey from addiction to inspire and guide others toward a fulfilling, addiction-free life.

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