I just read this JAMA Network article on trip-killers. It’s about using drugs to stop bad trips caused by hallucinogens.
One mentioned was ketamine. When I was working as a consultation psychiatrist, I was called occasionally to evaluate patients in recovery rooms who were delirious from the ketamine that was sometimes used by anesthesiologists.
I found a paper with a list of ketamine’s limitations, which I think is helpful.
Trips and trip-killers can cause problems.
Go Retire Psychiatrist 
When I started out in inpatient work we saw a lot of LSD and PCP intoxication. The theory of decreasing environmental stimulation was popular back then but only worked in the mildest cases. Contrary to the current psychedelic hype we saw a lot of agitation and aggression that was often self directed and used benzodiazepines and antipsychotics – typicals in those early days. These days there are more options. I would have some concerns about the techniques listed.
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“Alex, I’ll take ‘Retired Professionals Who Read Research for Fun’ for 500, please.” This post made me smile, as I spent a few hours reading research yesterday, too. Through a strange alignment of the planets, I also read about Matthew Perry’s ketamine-involved death.
The paper listing ketamine’s limitations led me down a rabbit hole to research on children who received accidental ketamine overdoses in the ED. Most, if not all, had to be intubated. It shocks me that a child can go to the ED and receive 5, 10, or 100x the recommended dose of ketamine. The lay person enters the ED with such trust.
The article on trip-killers is interesting, especially so since the researchers used Reddit for their project. I know that kids these days are micro-dosing Psilocybin and when they take a big trip, they get a trip sitter, so all that sounds accurate. What struck me as most interesting was that the researchers’ best advice to someone freaking out on a bad trip is this: (1) Call a friend, a sitter, or a professional for support, but (2) Try and avoid the ED because the environment there will only freak you out further, and (3) wait it out, because the shrooms or LSD aren’t going to kill you, but what you do while in your freaked-out state may–which takes us back to Matthew Perry’s unfortunate demise.
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