'Special K' Didn’t Retire When Spravato Arrived

A former Cornell student identified as Jane Doe alleges she was drinking, given ketamine, and sexually assaulted at a fraternity house in October 2024. She said that when she returned to her sorority house, she answered her sisters’ questions about what happened with one word: “Ketamine.” The allegations remain contested, and investigations are underway. The case reminds us, or should, of ketamine’s lurid past. Known as Special K, the drug was nefariously used by some to incapacitate people, mostly females, to exploit them sexually.

I have discussed ketamine’s dark side here before.

Ketamine became an invaluable battlefield medicine during the Vietnam War, in surgery, emergency and pain medicine, and trauma care. By the late 1980s, ketamine had entered its rave-nightclub period. Federal Schedule III control of the drug followed in 1999. Then came Yale’s pioneering antidepressant study.

Ketamine produces dissociation—feeling separated from the body and surroundings. In medicine, this helps patients tolerate painful surgeries. Elsewhere, impaired movement and memory can leave someone unable to protect themselves. At high recreational doses, users describe the “K-hole”—profound disconnection and difficulty moving, speaking, or responding.

For drug abusers, disconnection is the main attraction of ketamine. And for an opportunistic predator, ketamine means an opening to exploitation.

Ketamine blocks NMDA glutamate receptors and stimulates the opioid system.

NYU researcher Joseph Palamar surveyed New York City nightclub attendees, and ketamine use rose from 7.4 percent in 2017 to 14.3 percent in 2024. Nearly double. Young people, clubgoers, and festivalgoers use ketamine. Its psychiatric reputation may make that escape sound safer than it is.

Sexual Vulnerability and Ketamine

The United Nations Office on Drugs and Crime (UNODC) lists ketamine among substances encountered in drug-facilitated sexual assault. Alcohol is much more commonly implicated. Combining ketamine with alcohol increases the risks of severe impairment, unconsciousness, and potentially dangerous breathing problems.

GHB and benzodiazepines, including flunitrazepam—Rohypnol, or “roofies”—are also listed.

Ketamine can be a colorless, odorless liquid, although street ketamine is also sold as a powder.

Not every assault begins with a spiked drink. UNODC also recognizes exploitation after voluntary substance use. Consent to ketamine is not consent to sex. If drugging or assault is suspected, seek medical care promptly. Toxicology testing is time-sensitive.

From Bangkok to Today

While visiting Thailand as a University of Florida professor, I met with local DEA personnel concerned about ketamine misuse and trafficking. Their experiences with ketamine were warnings. Ketamine was cheap, widely used as a club drug, and capable of leaving people incapacitated and vulnerable to rape and sexual exploitation. Lost weekends. Sometimes far worse.

The U.N. reports ketamine mixtures sold in Thailand as “happy water” and “K-powdered milk.” Marketing names. Like “pink cocaine,” which actually contains ketamine; these illicit concoctions, drug mixtures, and doses vary. Buyer beware.

Ketamine Abuse and Diversion

In 2016, my USC colleagues and I reviewed ketamine abuse and diversion, three years before Spravato’s approval for depression. We described cognitive, addiction, and psychiatric problems, sexual assault concerns, severe urinary tract injuries, and gastrointestinal and liver complications from ketamine use.

“Doctors use it” is hardly a recommendation for college students considering ketamine abuse. Doctors also use scalpels. Context again. A party has no emergency recovery room. Friends may also be intoxicated, unable to recognize trouble or help.

Ketamine addiction is also very real. Craving, escalating use, unsuccessful attempts to stop, and continued use regardless of harms are symptoms meriting an addiction evaluation. Opioid-like withdrawal symptoms aren’t required.

Actor Matthew Perry’s Death From Ketamine

Perry’s death in 2023 made ketamine’s risks painfully clear. The medical examiner identified the acute effects of ketamine as the cause.

Ketamine's sedation, dissociation, or unconsciousness can become deadly in a bathtub, hot tub, or pool. An incapacitated person may be unable to keep their head above water or escape.

People entrusted to care for Matthew Perry exploited his addiction for profit. His vulnerability became their business opportunity. What happened to the Hippocratic Oath?

Perry’s toxicology showed buprenorphine, a medication used to treat opioid use disorder (OUD). An SUD history is a major warning flag when considering ketamine for depression. It demands looking for alternatives, careful assessment, supervised treatment, and close follow-up for misuse. Celebrity status should never lower those standards. Celebrities are vulnerable humans, too.

Reports that Presley Gerber received prescribed ketamine before his death at 27 raise the same question: Who protects the patient? His cause of death remains undetermined.

Celebrity use can become an inadvertent endorsement. Familiar face. Unfamiliar risks. Readers may remember who used ketamine and forget what happened next. A famous user is not evidence of safety or effectiveness.

Ketamine and Depression

Spravato is the FDA-approved esketamine nasal spray used for treatment-resistant depression and certain other depressive symptoms. It requires a certified medical setting, supervision, at least two hours of monitoring, and assessment before discharge. It should never be regarded like ordering take-out from local fast foods. Ketamine treatment is approved for anesthesia, but for depression remains off-label. Patients may feel “high” with either IV ketamine or Spravato administered at standard antidepressant doses. Some patients experience euphoria. Others find the experience unpleasant or terrifying. Dissociation is not inherently pleasurable.

Off-label prescribing isn’t illegal. But a prescription does not erase addiction, exploitation, or toxicity risks. Patient pre-screening, ketamine dose, setting, and supervision during and after treatment all matter.

Recovery Requires Much More

Patients with early-onset or longstanding addictions need sustained care. A miracle drug to reverse the addiction clock? Still waiting. Today, evidence-based treatment, follow-up, and recovery support are available.

Physician health programs combine intensive evaluation and addiction treatment with years of monitoring, random drug testing, recovery support, and accountability, a model showing what is possible.

Ask!

On October 13, 2026, Cornell announced it would suspend frat parties and social events for the rest of the academic year. They also announced a review of fraternity life and the culture surrounding sexual violence. It also pledged expanded support for survivors.

Universities should be asking about drug-facilitated rape, alcohol and ketamine use on campus—consider wastewater testing to help track it. If they do not do a complete assessment, they will miss an important opportunity for change.

Campus outreach should name ketamine and its possible use to facilitate sexual assault. Administrators and campus police need training and support to spot and react to suspected drug-facilitated assaults. Students need prompt medical care and an empathetic, clear, accessible way to report. Closing the fraternity party calendar is a step. Changing the culture takes more.

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