Ketamine was developed in the 1960s and promoted as a dissociative anesthetic because of its ability to induce a lack of responsive awareness not only to pain but to the general environment. The subjective experiences of ketamine intoxication range from pleasant dreams to intensely visual or polysensual hallucinations. Occasionally a brief full-blown delirium occurs. Despite warnings about its abuse potential, ketamine eventually appeared on the streets in the early 1970s in the same way that phencyclidine (PCP) did in the 1960s. By the early 1980s various preparations of ketamine were available on the street with such names as Special K, 1980 acid, and Super C. In the 1990s the social-recreational use of ketamine reemerged in the context of a subcultural music phenomenon known as “acid house” music. Large-scale parties, usually called “raves,” combine acid house music and ketamine use. Ketamine abuse appears to be on the increase. Clinically significant consequences range from occasional flashbacks to delirious reactions, and every type of dissociative symptomology.
Professional and societal debate regarding drug taking and drug-use problems occurs in cycles. In recent years a number of contentious issues have developed about the testing of urine, blood, saliva, and breath for evidence of drug use. Substances evaluated include alcohol, steroids, stimulants, sedatives, opiates, hallucinogens, and a variety of other chemicals both legal and illegal. Legal issues have been raised concerning the validity of testing procedures used and the reliability of evidence obtained, especially with preemployment drug screening. Other controversies center on the right to privacy versus the needs of society, and a variety of related topics. These issues and suggestions for maximizing the effectiveness of drug testing programs while minimizing legal challenges are discussed.
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