On 20 June, in honour of World Psychedelics Day, the Women and Harm Reduction International Network (WHRIN) and TalkingDrugs published a joint position paper on ketamine use and the urgent need for a gendered harm reduction approach.
The paper is available on the WHRIN website and is endorsed by the Southeast Asia Harm Reduction Association (AHRA) and the Academy of Perinatal Harm Reduction.
Titled “Gendering Ketamine Use: Emerging Research and Harm Reduction Recommendations,” the report identifies a critical gap in both academic research and harm reduction guidance: the consistent lack of experiences of ketamine-using women and gender-diverse people.
“This oversight is particularly concerning,” the position paper explains, “given identified differences in how ketamine affects individuals across gender spectrums and associated, distinct implications for harm reduction messaging.”
Seeking to close this knowledge gap, the paper compiles all existing scientific literature on ketamine use, communicating it in an accessible way as well as identifying key areas for future research and harm reduction programming.
A year in the making
Last year, AHRA approached WHRIN – which represents over 50 member organisations around the world – for input on a separate paper about ketamine use in Southeast Asia. After conducting initial research, Ruth Birgin, WHRIN’s coordinator, realised that there was much more to uncover about gender and ketamine use. It is within this context that research and development for the paper began.
A WHRIN working group collaborated with TalkingDrugs to research and compile the report. Keeping the language short, accessible, and jargon-free was central to the project from the beginning to ensure it can be understood by wider audiences.
“We must have information about how to keep ourselves safe and healthy, as our health systems have never prioritized us,” Joelle Puccio, Director of Education at the Academy of Perinatal Harm Reduction and a member of the Strategic Advisory Board, explained.
“This paper is meticulously researched and broken down into plain language, because information is power.”
Ketamine’s growing presence
The report comes at a pivotal moment for ketamine. The number of people seeking treatment for ketamine addiction in the UK’s public health system has doubled between 2019 and 2023. Ketamine production is on the rise in South America, with record amounts seized on the Peruvian and Chilean border in July 2024. Ketamine is a commonly used ingredient for tusi, a drug concoction popular in the region. Ketamine seizures remain high in other regions worldwide, particularly in Europe, East and Southeast Asia, and Oceania.
At the same time, evidence of ketamine’s therapeutic potential for mental health conditions is growing, as it is increasingly used to treat depression, anxiety, and post-traumatic stress disorder (PTSD). Yet, as its medical and recreational use grows, the experiences of women and gender-diverse people who use ketamine are notably absent.
“In my travels, I have met so many gender-diverse people who use ketamine,” Puccio said. “People from many backgrounds and geographic areas are using this medicine as part of sanctioned and unsanctioned self-care.”
Gendered risks and unique biological pathways
Most of the existing research on ketamine is based on rodent studies; those exploring human predominantly use male subjects, with data coming from clinical administration rather than recreational use contexts. This means that much of our understanding of ketamine’s effects are based on patriarchal, binary or non-human evidence, limiting our full understanding of the drug and its effects, benefits and risks.
This perspective is concerning not only because it ignores the existence of trans and intersex people and hormonal variations within each sex. Drug use is still poorly understood in a non-patriarchal manner that perceives it beyond a criminal lens, and beyond our biological traits. but also because drug use for all genders is shaped by patriarchy in complex ways that cannot be understood simply through biology.
Despite concerning research gaps, it is becoming clear that ketamine has a unique synthesis in those assigned female at birth, and that ketamine dependency and the likelihood of adverse effects manifest in sex-influenced ways. As the study explores, emerging rodent-based research shows that oestrogen and progesterone influence ketamine’s impact on the consumer, causing distinct reactions at different points in the menstrual cycle. It also explores a range of other ketamine-intersecting topics, such as breast/chest feeding and pregnancy, to antidepressant effects and dosing.
The dissociative, euphoric, and memory lapse effects of ketamine also have gendered social risks for women and gender-diverse people. Ketamine use can put the user at risk of accidents and assault, while also increasing the likelihood of unprotected sex. Increased suggestibility, impaired motor coordination, and disorientation can heighten the risks of gender-based violence. At the same time, for trans and gender diverse-people, ketamine can increase gender affirmation and alleviate negative consequences of gender dysphoria.
The report culminates with a preliminary list of tailored harm reduction strategies. While harm reduction advice for ketamine exists, the majority have no consideration of gendered differences; the report is a first step to change this picture.
Recommendations include:
- Expand research into more diverse groups using ketamine recreationally, like by people undergoing hormone replacement therapy.
- Strengthening referral linkages to other support services, tailored peer guidance, and the establishment of low-threshold opportunities for access to ketamine for treatment-resistant depression and suicidal ideation.
- Develop evidence-based recommendations around breast/chest feeding and ketamine use while pregnant.
Collaborators hope that the position paper spurs the development of better research on ketamine – research that is grounded in people’s experiences of use, acknowledging that studies on rodents in labs cannot map neatly onto the diversity of gender in human beings.
“Gendering Ketamine Use: Emerging Research and Harm Reduction Recommendations” can be read here.
Source: TALKINGDRUGS