Both ketamine and ecstasy are popular psychoactive drugs consumed by recreational users for their positive, psychological effects. (4,13)
Any recreational user consuming more than one addictive drug, whether this is on separate occasions, in sequence (one after another) or simultaneously (mixed in together and taken at the same time) can be defined as a polysubstance user.
Combing drugs is always fraught with danger due to the unpredictable effects that are generated when two psychoactive substances interact with each other.
It is always challenging to assess how any individual drug will affect a person due to the vast individual biological differences between people and the variation in dose strength and chemical content of any single drug.
It becomes even more difficult to predict the effect that will occur when a recreational user consumes two harmful drugs within a short space of time (1-2 hours). (3)
Polysubstance use has become a common behaviour on the club and party scene over the past two decades as recreational drug users are constantly looking for new experiences and an even greater high.
This may partly be because they have built up a tolerance to one drug and are looking to experience a greater high than they can achieve by consuming one drug alone. (3)
Ketamine is a sedative, dissociative anaesthetic drug that has many medical uses, but it is widely known for its use as an anaesthetic drug used to help sedate humans and animals before they undergo medical procedures.
Ketamine can also produce mild psychedelic experiences (trips)and changes to our perception that offer unique experiences for recreational users.
At low, to moderate doses, users may experience a slight detachment from themselves (their mind may feel separate from their body) and their environment, often known as depersonalisation. (12,13)
Higher doses of ketamine lead to users becoming more affected by ketamine’s anaesthetic effects which begin to kick in.
This causes difficulties with movement and users often feel numb when they experience this effect. They may also experience more powerful hallucinations which are not always pleasant. This state is often referred to as the “K hole”. (4,6)
Most recreational users tend to snort or inject ketamine to obtain the positive effects of ketamine more quickly.
Injecting the drug into the bloodstream enables its effects to be felt by the user in minutes as this method of administration enables ketamine’s chemicals to pass quickly through membranes and cross the blood-brain barrier to take effect.
However, ketamine can also be crushed into a white powder and snorted, which allows the user to experience its positive effects quickly but not as quickly as if it was injected into the bloodstream. (4,12)
MDMA stimulates the central nervous system and if it is taken in higher doses can lead to significant changes in our perception.
This leads to the user experiencing a relaxed state, pleasant body sensations and a feeling that they are floating. Taking MDMA can lead to the user experiencing hallucinations. (5)
MDMA does generate feelings of warmth and compassion and anyone taking the drug will feel a strong sense of connection with the people around them. This is why it is known as an “empathogen” drug as there is a striking increase in feelings of empathy generated by the chemical properties of the drug.
However, there have been deaths reported after taking MDMA due to heart attacks and strokes and even overheating if recreational users consume a lot of water during or after taking MDMA. (9)
The effects of MDMA are very difficult to anticipate at times because manufacturers of street drugs tend to include other drugs in the MDMA doses they design as well.
So, there is always a great deal of uncertainty about the exact chemical composition of any ketamine dose that is consumed.
This means that the chemical balance of MDMA can be different on each separate occasion a person takes the drug.
Close analysis of recreational drugs by scientists has found that doses of MDMA sometimes contain methamphetamines, cocaine, cathinones and even on occasions ketamine.
This makes it a highly dangerous drug in its own right before its interaction with other addictive drugs such as ketamine can be considered. (5)
Research indicates that a large proportion of recreational users who mix drugs tend to prefer the combination of ketamine and MDMA (ecstasy).
Both MDMA and ketamine are powerful psychoactive drugs and when combined together their chemicals can interact to produce an even more powerful effect which can be greater than the sum of their individual effects. (3,8)
Recreational users who experiment with mixing drugs have coined the term “Kitty flipping” to describe the act of taking ketamine and MDMA together. The term “flipping” is used to describe the act of combing two drugs together.
The fact that these two drugs are viewed (rightly or wrongly) as opposite drug types to each other by recreational users makes this particular combination of substances an appealing one to experiment with.
Recreational users hope that the combination of MDMA which generates feelings of warm love and human connection and ketamine, which has mellow, sedative characteristics will provide the polydrug user with a heightened and pleasurable experience. (3,8)
Recreational users are motivated to mix ketamine with MDMA for several reasons, firstly combing the drugs leads to a “trip” (experience) that is different and much more heightened than taking each drug on its own. (3,6)
It is also apparent that some users snort or inject ketamine sometime after taking MDMA to help reduce the unpleasant effects of coming down from ecstasy, which tend to be predominantly psychological in nature, such as:
One of the dangers of mixing recreational drugs is that there is likely to be much uncertainty about the strength of each drug and also which other drug chemicals are present in the dose.
It is therefore difficult for a recreational user to know exactly how much ketamine and MDMA he/she has actually consumed.
It is worth bearing in mind that doctors warn patients taking controlled (dose strength is known), medication about the dangers of consuming alcohol whilst taking prescribed medication. This suggests that there is an even higher risk involved when combing two recreational drugs whose potencies and chemical content are unknown.
Recreational users who attempt to mix the drugs together without having experienced either of the drugs separately are at greater risk of experiencing difficulties.
They are prone to suffering from extreme, negative symptoms as their bodies have not had sufficient opportunity to build up a tolerance to both drugs.
There is not a great deal of research on how ketamine and MDMA s interact even though they have become popular drugs to combine in recent years.
However, it is extremely difficult to assess the effects for one particular person based on the experiences of another as there is a multitude of factors that need to be considered, including:
Some of the negative consequences of polydrug use that have been well documented include:
Taking ketamine in combination with stimulant drugs like ecstasy can place great strain on the heart and can also increase the risk of the user becoming more anxious and agitated causing a decline in their mental health. (10)
On some occasions, there is a possibility that MDMA can also contain ketamine.
This depends on how the drug is produced as all chemists who create drugs for recreational purposes will vary in the balance and strength of the chemicals they use to make the drug.
This means that the strengths and chemical content of the drugs are unreliable which can place recreational users at risk if they combine ketamine with MDMA which also contains ketamine.
Recreational users who combine MDMA with ketamine are therefore at a high risk of suffering an overdose if they are unaware of the exact chemical makeup of the MDMA that they are mixing with ketamine.
Even though ketamine is used as an anaesthetic in medicine its use is overseen by skilled medical professionals who are monitoring the effect ketamine is having on the patient and who can administer precise amounts when treating patients.
This is not the case with recreational users who combine ketamine with MDMA which may contain extra ketamine.
The difference between a high and a low dose of ketamine is quite small so any mistakes or miscalculations relating to the dose strength of either drug could easily lead to an overdose. (3,8,10)
Symptoms indicating a ketamine overdose include:
Recreational users who regularly experiment with mixing drugs such as ketamine and MDMA are at risk of increasing their tolerance to both substances.
It is very common for recreational users who have built up a tolerance to one substance to turn to polydrug use to experience a greater high.
A person who has increased their tolerance to one drug such as ketamine is very vulnerable to becoming dependent on another drug as well if they regularly engage in the practice of mixing drugs.
Another concern for recreational users who regularly experiment with mixing drugs to obtain an even greater high is the risk of psychological dependence.
Eventually, the euphoric experiences recreational users obtain by using one drug will lessen in intensity.
As a result of this, they will become constantly preoccupied with chasing the next high and may push themselves towards dangerous territory in their quest to experience this.
Recreational users who have been taking drugs may progress to experimenting with drug combinations if they have developed a tolerance to the drug they usually take.
Mixing drugs together enables recreational users to achieve a more intense high than they have previously had and this can be a strong motivating factor for the continued practice of mixing drugs.
Some of the symptoms to look out for in recreational users that may suggest they are addicted to more than one substance include:
Recent research has revealed that the prevalence of polydrug use and dependence are often underestimated as treatment programmes tend to only focus on one substance when treating patients.
However, in reality, is not uncommon for substance misusers to have other co-existing dependencies as well. (1,6,11)
Statistics report that over 10% of individuals diagnosed with a substance use disorder have dependency issues with alcohol or other psychoactive drugs as well.
This may have arisen because they developed a high tolerance to one substance (for example ketamine).
To overcome this they decided to combine ketamine with drugs with stimulant properties such as MDMA to obtain higher feelings of euphoria. (3,8)
Research in the area of substance misuse strongly indicates that being dependent on one substance dramatically increases the probability of becoming addicted to another substance.
Polysubstance users overall tend to have less successful treatment outcomes compared to patients who are addicted to one substance alone, and are also likely to:
It is harder to treat polysubstance users because there are interaction effects between the drugs which are harder to predict and more challenging to plan detox treatment and psychological therapy programmes for. (6)
Anyone who constantly experiments with drug combinations such as ketamine and MDMA to keep chasing a high may be suffering from an undiagnosed mood disorder or have developed depressive symptoms due to prolonged substance use.
Either way, a person who is constantly seeking to achieve a high by combining drugs is likely to have a mental health condition as well as a substance use disorder that they will need to seek treatment for. (6,7)
The nature of the addiction means that if this mental health condition is not recognised and treated then polydrug abusers are likely to escalate their drug use by combining potent psychoactive substances together which could have long-lasting harmful effects on them. (5)
Therefore, if substance misuse professionals should come into contact with polysubstance users during the course of their work they should consider the possibility of arranging a mental health assessment for them.
This will help to establish if they are showing signs of a mental health condition such as depression (mood disorder) or anxiety. (7)
Once this has been established a comprehensive treatment plan can be devised for them by substance misuse professionals to meet their complex treatment needs.
(1) Black, D., Grant, J. (2013) DSM5 Guidebook: The Essential Companion to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. APP. London.
(2) Brown University, USA, (2023) What are the short-term effects or risks of using ketamine?available@What are the short-term effects or risks of using ketamine? | Health Promotion | Brown University
(3) Crummy, E., O’Neal, J. & Ferguson, S. (2020) One is not enough: Understanding and modelling polysubstance use. Frontiers in Neuroscience. available@ One Is Not Enough: Understanding and Modeling Polysubstance Use – PMC (nih.gov)
(4) Department of Justice / Drug Enforcement Agency (2022) Ketamine Fact Sheet. available@Drug Fact Sheet: Ketamine (dea.gov)
(5) Drug Enforcement Agency (2022) Drug fact sheet: Ecstasy (MDMA). available@Drug Fact Sheet: Ectasty/MDMA (dea.gov)
(6) Ghodse, H. (2002) Drugs and Addictive Behaviour: A guide to treatment Cambridge University Press.
(7) Herie, A. & Skinner, W. (ed) (2014) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
(8) Lankeneau, S., Clatts, M. (2005) Patterns of Polydrug Use Among Ketamine Injectors in New York City. Substance Use Misuse. 40 (9-10). available@ Patterns of Polydrug Use Among Ketamine Injectors in New York City – PMC (nih.gov)
(9) NHS Inform (2022) MDMA (Ecstasy). available@MDMA (Ecstasy) | NHS inform
(10) Public Health Agency (2022) Mixing: Reduce your risk of harm. available@ Mixing_leaflet_05_2019.pdf (hscni.net)
(11) Rassool, G.H. (2011) Understanding Addictive Behaviours. Palgrave MacMillan. New York.
(12) Rosenbaum, S. et al (2022) Ketamine. available@Ketamine – StatPearls – NCBI Bookshelf (nih.gov)
(13) Yin, H, (2021) What ketamine actually does to the brain. New Frontiers: Psychiatric and TMS.available@What ketamine actually does to the brain – New Frontiers Psychiatry & TMS | Milwaukee Psychiatrist
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
