Month: January 2023

Earlier this week Apple officially released iOS 16.3 updates for iOS, iPadOS, and HomePod. The update brings several noteworthy changes and enhancements to these devices, headlined by support for hardware security keys for Apple IDs and the global rollout of Advanced Data Protection.

iOS 16.3 also paves the way for the new second-generation HomePod, which is scheduled to be released on February 3. But even if you don’t plan on dropping $299 for Apple’s newest smart speaker, you’ll be pleased to learn that iOS 16.3 includes enhancements for the first-generation HomePod and the HomePod mini. Watch my hands-on video walkthroughs for a visual breakdown of what’s new.

Hardware security keys for Apple ID

iOS 16.3 brings a few big new security-focused features to the iPhone and iPad, headlined by support for third-party hardware security keys. Alongside your Apple ID password, hardware security keys can be used in iOS 16.3 as the second factor in a two-factor authentication setup. Thus, third-party hardware security keys replace the six-digit codes that are sent to trusted devices, which otherwise serve as the second factor.

Apple notes that more than 95 percent of active iCloud accounts now use its standard two-factor authentication, but iOS 16.3 affords users the ability to harden this protection even further.

Video: iOS 16.3 changes and features

To be clear, most users will be fine sticking with the standard six-digit code-based two-factor authentication, but for users with particularly high profiles — celebrities, government officials, 9to5Mac bloggers — opt-in third-party hardware key support can strengthen account security even further. Because hardware keys are physical authentication devices that the user has in hand, they can prevent even an advanced attacker from obtaining a user’s second factor via a phishing scam or other attack.

Although hardware keys serve to harden security, they may not be as convenient as traditional six-digit codes sent to verified devices. To use hardware keys, a user must physically have access to the key, and if all keys are lost, then you will not be able to access your account, although you can still fall back on six-digit codes if you remove your keys.

To learn more about hardware security keys, stay tuned, because I have an in-depth video in the works that explains everything. Be sure to subscribe to our YouTube channel for more.

Global rollout of Advanced Data Protection

In iOS 16.2, Apple rolled out its new Advanced Data Protection feature to customers in the United States. Starting with iOS 16.3, Advanced Data Protection is now available to customers globally.

The opt-in feature provides end-to-end encryption for additional data categories stored in iCloud, meaning that Apple no longer possesses the keys to decrypt these categories. Enabling Advanced Data Protection means that these data types can only be decrypted from a trusted device that functions as a key, like a customer’s iPhone.

Updated Emergency SOS call procedure

If you’ve ever accidentally initiated an emergency SOS call from your iPhone, apparently you are not alone. Apple has updated the emergency SOS call procedure to make it more difficult to accidentally call emergency services.

In previous versions of iOS, simply holding the Side button and either of the volume buttons for 10 seconds would automatically call emergency services. In iOS 16.3, Apple requires users to release the buttons in order to proceed with the call.

This update seeks to prevent accidental calls from situations where your iPhone might be inadvertently wedged in a confined space causing the Side and Volume buttons to be pressed. Of course, you can disable this emergency call method by going to Settings → Emergency SOS and disabling the newly-renamed Call with Hold and Release switch.

Along with this update, you’ll also notice a slightly reconfigured UI that illustrates which buttons to press, along with a pulsating light from the camera flash. Users will notice an additional Call Quietly switch within Settings → Emergency SOS. Enabling this switch will silence the warning alarms and flashes when initiating Emergency SOS for a more low-key activation.

Additional bug fixes

• Fixes an issue in Freeform where some drawing strokes created with Apple Pencil or your finger may not appear on shared boards
• Addresses an issue where the wallpaper may appear black on the Lock Screen
• Fixes an issue where horizontal lines may temporarily appear while waking up iPhone 14 Pro Max
• Fixes an issue where the Home Lock Screen widget does not accurately display Home app status
• Addresses an issue where Siri may not respond properly to music requests
• Resolves issues where Siri requests in CarPlay may not be understood correctly
• iOS 16.3 also includes lots of new security fixes for various vulnerabilities.

Support for second-generation HomePod

Last Tuesday, Apple surprise–announced its second-generation HomePod, which is scheduled to be released next week on February 3. iOS 16.3 brings support for the new full-sized HomePod and is a requirement for users wishing to configure the smart speaker.

In my video walkthrough below, I briefly discuss the new HomePod and talk about everything new in this update.

Video: HomePod 16.3 changes and features

Subscribe to 9to5mac on YouTube for more videos

HomePod mini temperature and humidity sensor activation

Even if you don’t plan on purchasing a new second-generation HomePod, iOS 16.3 provides new features. The HomePod mini shipped with dormant temperature and humidity sensors, but they weren’t activated until the release of iOS 16.3. Once you update to the latest iOS 16.3 update, you’ll notice a new temperature and humidity reading under the Home app’s climate section and within each HomePod’s detailed view. You can use these sensors to view current readings, ask Siri about them, or use them with automations to trigger other smart home products.

Remastered ambient sounds for HomePods

Everyone knows that you can play Apple Music on the HomePod, but did you know that you can also request ambient sounds like white noise and rain? In iOS 16, ambient sounds have been remastered, and you’ll now find a direct link to these sounds that can be added to alarms, scenes, and automations. In all, you’ll find seven ambient sounds to choose from, like fireplace, forest, night, orientation, rain, stream, and white noise.

Recurring Home automations using just your voice

You can now create a recurring automation with your voice by saying something like “turn on the desk lamp every day at 10pm.” Once you do, you’ll see the respective automation appear within the Home app’s automation tab.

Siri confirmation tone for completed requests

Siri arrives with a new confirmation tone in iOS 16.3, which indicates when requests are completed for accessories that don’t visibly display a change, or for smart home items located in other areas around your house.

Updated volume controls on HomePod

You’ll find more granular volume controls when using the buttons on the top of your first-generation HomePod to adjust its volume. You should notice that there’s more “dynamic range” between absolute zero and lower volumes.

Sound Recognition

Although this feature is not yet available, the HomePod mini will be updated later with sound recognition support. This feature is currently available as an accessibility setting within iOS 16, as found in Settings → Accessibility → Sound Recognition.

When enabled, Sound Recognition allows your iPhone to listen for specific sounds, such as fire alarms or smoke alarms, household sounds like glass breaking, a knock on the door, or a kettle, people sounds — babies crying, coughing, or shouting — and even sounds from cats and dogs. You’ll then receive a push notification whenever your iPhone recognizes these sounds.

Sound recognition support for second-generation HomePod and HomePod mini will be available later this spring. The HomePod version of Sound Recognition appears to be a pared down version when compared to the iOS 16 accessibility setting.

In a future update, your HomePod will be able to detect smoke and carbon monoxide alarms and send you a notification to alert you. Apple notes that sound recognition will require the new Home architecture update, which Apple pulled back due to some issues but plans to make available again soon.

9to5mac’s Take

iOS 16.3 is a major new update with lots of new noteworthy changes and feature, not just for iPhones but also for the HomePod. And, even if you’re not interested in all of the new bells and whistles, you should strongly consider upgrading due to the number of security fixes included with the release.

What do you think about iOS 16.3, and how has your experience been with it thus far? Sound off down below in the comments with your thoughts.

Check out 9to5Mac on YouTube for more Apple news:

Three years ago, Jared* a 31-year-old venture capitalist, sat in a purple recliner wearing an eye mask, ambient music pulsing through his Beats headphones. As a nurse inserted an IV into his left forearm, he took a deep breath and waited for the ketamine entering his veins to transport him to a different reality.

Jared has dealt with debilitating depression, anxiety, and ADHD for much of his life and hoped ketamine would be his silver bullet. The infusions at the ketamine clinic in his West Texas hometown were a Christmas gift from his grandmother. “She said, ‘What do you want?’ I was like, ‘I want to not be depressed.'” 

Ketamine, also known as K, is an anesthetic commonly used as a sedative and painkiller in human and veterinary medicine. It’s also taken as a party drug, especially in the rave scene. When snorted at low doses it provides a goofy, calming buzz; at higher doses, it numbs the body and can lead to intense psychedelic experiences. In recent years, research has suggested ketamine can also be used to treat depression. Though the US Food and Drug Administration approved an antidepressant ketamine nasal spray in 2019, it hasn’t officially given IV ketamine the green light for mental-health treatment. But at least as early as 2010, doctors and clinicians were beginning to prescribe the drug off-label — a legal and relatively common practice — to patients with particularly stubborn depression symptoms.

Jared, whose VC firm invests in cannabis, ketamine, and psychedelic therapy startups, had been taking antidepressants for more than a decade. He’d recently embarked on what he described as a “plant-based journey” to improve his mental health. He’d tried underground MDMA, psilocybin therapy, and ayahuasca ceremonies with a shaman from the Shipibo tribe in Brazil. So when a local ketamine clinic opened promising to treat a laundry list of conditions — depression, anxiety, PTSD, migraines, fibromyalgia — he figured it may not be a plant, but why the hell not?

For weeks after Jared’s ketamine treatment, it was as though a dark curtain had lifted. His mind, usually hyperactive, was calm and focused. “I was like, oh, this is a fucking super drug.” 

But the infusions were expensive: $400 for six initial IV doses of 65 mg a session. Jared knew a guy who could sell it to him directly for $100 a gram (on the street, ketamine is typically sold in powder form and snorted, like cocaine), so he figured he might as well cut out the go-between. After all, he had used psychedelics extensively and spent years researching drugs. He started taking ketamine on his own. “It helped me,” he said, “until it absolutely didn’t.”

Soon, Jared’s cravings for ketamine became overpowering. “I would try to sneak bumps in while I was driving with my girlfriend when she wouldn’t see it,” he said. “Whether I was on a plane, or in a grocery store, I would find a way.” He became reliant on ketamine to make him feel calm and present; when he wasn’t on K, his tolerance for discomfort or anxiety was basically nonexistent.

It took him a long time to accept that he had a problem, partly because he was hearing about the miraculous benefits of ketamine everywhere. At a fundraising dinner, one of the executives hosting the event spoke openly about how using ketamine had been a game changer for his productivity, and “nobody even batted an eye,” Jared said. At a speaker session at Soho House that he attended last year, a CEO coach talked about prescribing it to corporate leaders to boost their performance. For Jared, who at that time was snorting about a gram a day from the moment he got up to the moment he went to bed, this rhetoric “validated what I was doing.”  

Meanwhile, his life was falling apart. He had started behaving erratically, lashing out on work calls and acting aggressively with business partners and colleagues. He was lying to his girlfriend about his use, and their fights were escalating. Things came to a head one night at Burning Man when, mixing ketamine with cannabis, he had a psychotic break and flew into a violent rage, smashing his face and arm through a glass mirror, despite his girlfriend’s unsuccessful attempts to restrain him. 

The fact he could have hurt his girlfriend was the impetus Jared needed to acknowledge he was addicted to ketamine. Until then, he said, “I thought I could keep using it for the rest of my life.”

About five years ago, more and more of my friends started using ketamine recreationally. The drug seemed to be ascending in New York nightlife in a way it hadn’t since the ’90s. Baggies were passed around at parties as casually as a bottle of Jameson. Ketamine was shaking off its horse-tranquilizer stigma; instead, many of my peers saw it as a healthier alternative to drinking or cocaine. Plus, the drug’s lack of hangover and short high (30 minutes to an hour versus an hours-long LSD or mushroom trip) meant young professionals could indulge without compromising their productivity the next morning.

In 2019, I wrote a piece for New York magazine positing that if every era had its drug of choice, then ours was ketamine. “Perhaps the end of the decade marks the dawn of the dissociation generation,” I wrote. “In 2019, escaping isn’t just something you do for fun. It’s a survival tactic at a time where the world feels so inescapably stressful and out of control.”

A year later the coronavirus pandemic hit, and for some, a bump of ketamine to loosen up at parties became a bump of ketamine to escape the doldrums of quarantine. “Some people get into witchcraft. Some bake bread,” a 30-something journalist in New York City told Vice of her pandemic coping tactics. “I’m doing ketamine.” A cursory scroll through TikTok showed ketamine had become something even more potent than a party drug: a meme. One video shows couples leaning in for a kiss as the iconic Kay Jewelers jingle, “Every kiss begins with Kay,” becomes “Every kiss begins with ketamine.”

Recreational ketamine use is difficult to track, but Joseph Palamar, a leading researcher on club drugs, says he has seen a steady increase in the substance’s popularity in recent years. Palamar conducted surveys at New York City nightclubs and festivals from 2016 to 2019 and found the share of attendees who said they’d used ketamine in the past year more than doubled during that time.

Over the years, the drug’s reputation in the medical community has also started to change. In the mid-2000s, several studies found that ketamine immediately boosted the mood of patients with treatment-resistant depression. Given that existing medication for depression can take weeks to work — far too much time for a patient considering suicide — this represented a potentially lifesaving breakthrough.

In 2019, the FDA approved a derivative of ketamine called esketamine, marketed as Spravato, as a prescription nasal spray to treat depression. In February 2022, a (fairly small) double-blind trial published in The BMJ suggested that ketamine “rapidly induces remission of severe suicidal ideation in adults,” with effects lasting more than six weeks in most patients. Other studies have shown the drug’s promise in treating things like substance addiction, anxiety, obsessive compulsive disorder, and eating disorders, though when the research expands beyond depression, “the quality of the data definitely drops off,” Dr. Gerard Sanacora, a professor of psychiatry at Yale and director of the school’s Depression Research Program, told Medscape. While we don’t know everything about how ketamine works, scientists know that depression and chronic stress can cause the synaptic connections between nerve cells in the brain to weaken. Ketamine can help strengthen these damaged neural pathways, effectively helping to rewire the brain.

In a field that’s had few pharmacological innovations to offer since the 1980s introduction of SSRI antidepressants (such as Prozac), which work to increase levels of the neurotransmitter serotonin, ketamine seemed like a game changer. Countless articles heralded it as a wonder drug. “I Was Paralyzed by Severe Depression. Then Came Ketamine,” read a 2021 New York Times op-ed article, one of many similar pieces published in the past few years. 

The money followed the science. The fact that ketamine was already being used in hospitals as a painkiller and a sedative made it an easy place for psychedelics-curious VCs and investors to channel their dollars. In 2021, the psychedelics-research startup Atai, which is attempting to develop a non-psychedelic form of ketamine to treat depression, raised $225 million in an initial public offering backed by the billionaire Peter Thiel. Loosened restrictions on telemedicine during the pandemic paved the way for startups like Mindbloom and Wondermed to start sending ketamine in the mail. “Before I started” ketamine treatment, “I felt like I had run up a wall in therapy,” reads a Mindbloom Instagram ad that I see on a near-daily basis, featuring a smiling gray-haired woman.

We go on vacation, we go to spas, we get massages for our body, we get away to kind of refresh and disconnect. Why aren’t there things that we do for our mind?

IV ketamine treatment centers charging $400 to $2,000 an infusion popped up all over the country. Coveteur, a site known for tours of celebrities’ closets, did a story on Field Trip Health, the trendy ketamine startup that plans to open 75 clinics by 2024, featuring glossy photos of rooms strewn with rose petals and Tibetan singing bowls. There are now hundreds of these clinics across the US. One in Gainesville, Florida, offers the equivalent of a coffee-shop punch card: Buy 10 infusions, get one for $200, plus a freebie for referring a new patient. Smith Family MD, a South Carolina telehealth clinic run by Dr. Scott W. Smith, prescribes the average patient one 200 mg lozenge every three days for six months. It charges a $250-a-month flat rate, with an estimated $40 to $100 additional monthly pharmacy cost and is able to prescribe in multiple states. On Reddit, where Smith is a frequent poster, he writes that his goal “is to make ketamine treatment more available, affordable, and convenient,” adding: “Viva la revolucion!” 

The revolution appears to be underway. Mindbloom, one of the most prominent ketamine telemedicine startups, was founded in 2018; by fall 2021, the company was valued at $229 million.

“I think in five or 10 years, things like ketamine that are very well studied, well tolerated outside of the mental-health space, will be part of your wellness regimen,” said Richard Chang, the chief growth officer at Hudson Medical, which offers ketamine treatment. “We go on vacation, we go to spas, we get massages for our body, we get away to kind of refresh and disconnect. Why aren’t there things that we do for our mind?”

All the pieces are in place for ketamine to become more available and widely used than ever before. But as an industry emerges around the drug, some scientists and treatment specialists remain skeptical. A 2021 article in the American Journal of Psychiatry noted that the “opportunity and hope” ketamine provides “exist alongside the urgent need to clarify the long-term efficacy of these agents, as well as significant unanswered questions with respect to safety.” Experts have begun to call out the industry’s lack of regulation and aggressive marketing tactics, while even some former ketamine evangelists have started to wonder whether we’ve fully grasped the drug’s potential for misuse.

It’s something I’ve wondered about, too. In the three years since my New York magazine article came out, I’ve watched as several of the friends who inspired that story began to struggle with their ketamine use. Other people in communities where ketamine is prevalent told me they’re seeing the same thing. Kelly*, a DJ from San Francisco, said she and many of her friends increased their use dramatically during the pandemic. She recently estimated that more than 10 people she knew — including her — were exhibiting symptoms of addiction.

An employee at a prominent psychedelics advocacy organization estimates that dozens of the people in her party scene are what she called “high-functioning ketamine addicts.” In December 2020 her best friend, who’d become addicted to ketamine during lockdown, died after ingesting ketamine and Xanax. While deaths from ketamine are rare and aren’t monitored nationally like those from other drugs, the national Poison Control recorded 67 accounts of ketamine “exposures,” which encompass a range of adverse effects, in 2021. That number, though still small in absolute terms, was up 81% from 2019.

The US has a checkered history with so-called wonder drugs. Arthur Sackler’s aggressive marketing push helped earn Valium the nickname “mother’s little helper” in the 1960s; a few decades later, the Sacklers and Purdue Pharma made billions convincing Americans that opioids were as harmless as M&M’s. The original ketamine compound has no patent, which means less Big Pharma money is steering the conversation. But there are still plenty of well-funded VCs with a vested interest in making ketamine as prolific as Prozac — and not thinking too hard about the consequences.

Ketamine is much safer than opioids, which can cause physical dependence and come with a high risk of overdose. “Ketamine used as directed in an appropriate clinical setting very rarely leads to any dependence,” Mindbloom says on its website. Of course, not all use takes place under proper medical supervision.

There’s no widespread data on how many people go from therapeutic ketamine use to buying on the street. But Patrick O’Neil, who works as a drug counselor at the Cast Centers in California, seemed surprised when I asked how many of his handful of ketamine-using patients discovered the drug after visiting a clinic. “All of them,” he responded.

It’s been some of ketamine’s earliest adopters — people most excited about psychedelics as a movement — who have started to sound the alarm about the drug. The employee at the psychedelics advocacy organization said the likelihood that ketamine is much more addictive than conventional psychedelics like LSD or psilocybin needs “to be front and center when you’re interacting with that drug.” 

“It’s a failure of our movement,” she continued, “that this isn’t widely understood.”

Nushama Psychedelic Wellness Center was founded in 2020 by the fashion designer Jay Godfrey and a cannabis entrepreneur named Richard Meloff. The flagship location in midtown Manhattan feels like a cross between a boutique med spa and a high-end workout studio. Plastic flowers hang from the ceiling, and the wallpaper depicts a kaleidoscope of dancing nymphs. In the clinic’s library, Aldous Huxley’s “The Doors of Perception” sits alongside Viktor Frankl’s “Man’s Search For Meaning” and Tim Ferriss’ “The 4-Hour Workweek.” Nushama provides a starter pack of six ketamine infusions, plus a booster, for $4,500. It doesn’t take insurance. 

Dr. Steven Radowitz, lean and silver-haired in a black cashmere half-zip, guides me into a room full of beanbag chairs. He was the in-house physician for Goldman Sachs for more than a decade before he discovered kabbalah, a form of Jewish mysticism, and eventually a new calling in psychedelics.

Radowitz thinks most people can benefit from the insights ketamine therapy provides. His rationale isn’t particularly scientific. He theorizes that we’re all born happy, before the stresses of life pile up and cause us to become “misaligned.” The goal of ketamine therapy is “to become more in balance with who we are,” he says. “It allows us to dim the effects of this overthinking, overprocessing, the intellectualization of life, and allows us a deeper sense of self. It is a spiritual experience.”

Radowitz acknowledged that ketamine has potential for misuse, but he pointed the finger mainly at telehealth providers. He believes the dose of ketamine he provides is so high that the experience is less reliably euphoric — and thus less habit-forming — because of how trippy and emotionally intense it can be. “I don’t think psychedelics have ever been shown to be addictive,” he told me.

Exactly who’s eligible for ketamine treatment varies by provider. Some clinics require a prospective patient to have a formal treatment-resistant-depression diagnosis and be referred by a psychiatrist; others pitch ketamine more broadly as a cure-all for the struggles of modern existence. Nushama, which says it requires a formal diagnosis, touts ketamine on its website as a treatment for depression as well as “other ailments of the spirit.” In November, amid a wave of layoffs in the tech world, Field Trip Health offered a month of free treatment for anyone who’d lost their job.

Finding a ketamine clinic to give me a sample in New York City was shockingly easy. Four of the eight clinics I reached out to were immediately receptive when I asked for a trial infusion for an article I was writing. I chose Lenox Hill Mind Care, an “interventional psychiatry clinic” that treats patients with “highly treatment-resistant psychiatric conditions” and, apparently, journalists. After a 20-minute phone evaluation and a review of some lab results from a physical I did in 2020, I headed to their office on the Upper East Side. There, I sat in a reclining chair and began my infusion. 

As a custom playlist of five trance songs reverberated through my headphones, I felt myself being pulled further and further away from the room. For the next 40 minutes my mind wove through different visions: my childhood home, the Amazon rainforest, outer space, a rave in an abandoned warehouse. The experience felt both deeply personal and embarrassingly cliché. (The Amazon? Really?) Afterward my hands tingled and I felt nauseous for most of the day. While I can’t say I had any life-changing revelations or felt my anxiety ebb, it was a fun, novel experience. If it didn’t cost thousands of dollars, I probably would’ve gone back for round two.  

While some clinics like Nushama offer higher-dose psychedelic trips, others provide talk therapy while patients are on ketamine. Then there are the telehealth clinics that opened during the pandemic, many of which prescribe maintenance doses in the form of ketamine lozenges for people to use at home. In 2021, another article in New York magazine helped readers choose which clinic was best for them as though they were picking a restaurant for date night, with tips like “Field Trip and Nushama are ideal for anxious first-timers” and “If you don’t have a psychiatrist, try Mindbloom.”

Dr. Charles B. Nemeroff, a psychiatrist who is a leading voice on ketamine, told Medscape that he thought fewer than 5% of clinics adhered to the safety standards that he and the Yale psychiatry professor Sanacora recommended in JAMA Psychiatry in 2017. “The vast majority of these clinics aren’t run by psychiatrists,” he said. “Yet no one has stepped up” to regulate them.

Right now, most clinics and telehealth operations that offer ketamine go the off-label route. Spravato, the esketamine nasal spray patented by Janssen Pharmaceuticals, is overseen by an FDA drug-safety program called Risk Evaluation and Mitigation Strategy, meaning it has to be used in a doctor’s office and is available only for those who have tried oral antidepressants. (It’s also expensive, though it can be covered by insurance.) But the regular version of ketamine has no patent. By prescribing it off-label in the form of IV or lozenges, clinics can easily avoid all that red tape; it’s much cheaper, it’s widely available, and it can be prescribed for pretty much anything a clinic deems appropriate. 

Zachary Phillips, a compounding pharmacist in Atlanta who’s been working with ketamine since 2011, says some of the clinics he supplies are “essentially very expensive drug dealers.” He says he tries to work only with clinics that have a psychotherapist on staff and drops providers that start sending in new patients for high doses on a regular basis.

Some people note that we have limited evidence to support using maintenance doses of ketamine over long periods. Celia Morgan, one of the UK’s leading ketamine researchers, told me she had serious reservations about people — particularly those with a history of addiction — having ketamine sent home with them, pointing out that tolerance to the drug increases quickly. 

The Ryan Haight Act (named for an 18-year-old who died after being prescribed Vicodin via telemedicine) typically limits controlled substances being prescribed online. But during the pandemic the act was suspended, and it is set to remain so until at least April. As a result, numerous ketamine startups have pivoted to telemedicine, where they can prescribe ketamine easily with minimal oversight. While telehealth providers are pushing to keep the suspension in place, some states are arguing against it. “I think we’ll look back one day and say, ‘We should have handled that differently,'” said Phillips, the pharmacist, “which has happened so often.”

It was the same routine every day: Nadia* left the hospital where she worked, and as she approached her apartment, her nose would start to run. For the last few blocks of her walk, she’d try to convince herself that this night would be different — “I’m not going to do it,” she’d tell herself, “I’m not going to use ketamine when I get home” — but by the time she’d walked in the front door, thrown down her keys, and reached for the sunglasses case where she kept her supply, the wheel was in motion, she said. “I’m going to do it either until I pass out or until it’s gone.”

Nadia is a physician at a major New York City hospital. For nearly a year and a half, she’s been using about a gram to a gram and a half of ketamine every day. She started taking it for fun at parties and concerts on weekends, but before long she was using it alone. It took a toll on her body. She needed to pee constantly, and the nostril she used to snort had become enlarged and inflamed, making her nose permanently asymmetrical. But she couldn’t stop. “It was all I could think about, and it was all I wanted to do,” she said.

Nadia was particularly drawn to the feeling of the k-hole, the dissociative high that comes from taking a large dose of ketamine. Lying on her floor unable to move, she felt as though she’d left her physical body while her mind explored a higher plane. “It’s like the fourth dimension that nobody can see but everybody knows is there,” she said. “It feels like an escape where you’re totally at peace.”

Initially, she found the ability to flip between normal life and the parallel universe of the k-hole to be therapeutic, but over time it started to feel more sinister. She realized that being in a k-hole felt like her idea of death. “I started thinking about the fact that I like the feeling of being dead,” she said, “more than I wanted to go live my life.”

Even as her use started to increase precipitously, she didn’t consider that she might be putting herself at risk. Ketamine was prescribed as an anesthetic all the time. “Doctors, at least, get very comfortable with it,” she said. Nadia had taken antidepressants for years; ketamine, she figured, was a more efficient solution, even if she purchased it illegally. 

While Nadia says she never got high at work, the drug started to consume her evenings and weekends. When she was using most heavily, Nadia was spending $600 a week on ketamine. She had always been the person who overprepared for every meeting, who meticulously planned her studying schedule. Now she found herself missing days at work, forgetting to follow up with coworkers and patients, and sleeping through shifts.

Nadia could feel her memory and cognitive abilities declining; a few months into heavy use, she noticed she could barely focus enough to read an email, let alone a book. One day, when she was high, she sliced her hand open while baking brownies because she was holding the knife upside down, the sharp edge pressed into her skin. “At the time,” she says, “I didn’t even feel it.” 

After about a year, Nadia’s sibling confronted her and pressed her to get help. While Nadia had downplayed her use, her sibling noticed that she seemed to rely on ketamine to get through every activity, even family phone calls. They asked her whether she really knew what ketamine was doing to her. “Your brain is the most important part of you,” she remembers them saying. “What if everything you’re doing is hurting you, and you don’t even know it?” 

Nadia began combing through research papers to find out more about the drug that had become her lifeline. She found plenty about ketamine’s potential to treat depression and remodel the brain in positive ways. But she couldn’t find a single solid study that outlined its addictive potential or its long-term effects. 

She was, she felt, in uncharted territory. “We know how many people are alcoholics,” she said. “But nobody knows how many of us there are.”

Like Nadia, most of the people I interviewed said when they started using ketamine, they didn’t think it was possible to become dependent on it. Matt, a 25-year-old from Denver who used ketamine heavily and asked to use only his first name, said when he went to rehab in California, the clinicians either hadn’t heard of ketamine or didn’t take it seriously. To get adequate treatment, he began telling people he was addicted to opiates.

We know how many people are alcoholics. But nobody knows how many of us there are.

When I wrote my New York magazine story back in 2019, I was under the impression that ketamine addiction was uncommon, mostly because nobody was talking about it. Researchers I spoke with emphasized that the drug is not physically addictive, meaning it has no withdrawal symptoms. This is significant; the withdrawal symptoms from opioids and alcohol, such as seizure and delirium tremens, can be horrific and life-threatening in themselves and are a major reason people are unable to quit. The fact that ketamine had the potential to be “psychologically” addictive was framed largely as an afterthought.

Yet psychological cravings aren’t something to be dismissed lightly, people who use ketamine told me. James Dear, who now speaks about ketamine-use disorder on his “Break The Chain” podcast, moved from England to Australia, and eventually to New Zealand, where ketamine is harder to get, to escape his addiction. “It feels like ultimate desperation,” he said. “It feels like someone’s clawing at the inside of your mind with just the absolute burning desire to get it. You have to have it.”

Much of the research on ketamine and addiction comes from outside the US, particularly the UK, where the drug has long been a party-culture staple and a public-health concern, and Asia, where it became the drug of choice throughout many countries in the late ’90s and early 2000s. Government data indicates ketamine was the most oft-misused psychotropic drug in Hong Kong from 2006 to 2014. At the time, Hong Kong researchers published papers on ketamine’s negative effects on the brain, and the link between the drug and a chronic bladder condition called urinary cystitis.

Huajun Liang studied ketamine use in Hong Kong before moving to the US, where she’s now a postdoctoral fellow at the University of Maryland at Baltimore. She worked on ketamine studies through the 2010s, including one that suggested people who used ketamine had poorer memory and executive functioning than those who didn’t, and another that showed high rates of depression and psychosis in people who used ketamine. Yet she says that, in her experience, Western countries tend to be skeptical of the research coming out of Asia. Ketamine “is addictive,” she said. “I don’t know why people kind of forgot.”

In the Western world, much of the research on ketamine and addiction has been conducted on rodents. A new study in the journal Nature concluded that ketamine failed to “establish key addiction-like behaviors in mice.” The study also indicated that if mice had a negative experience with ketamine, they stopped taking it. 

Keith Trujillo, who researches ketamine using lab rats, explained that rats communicate pleasure through ultrasonic vocalizations: chirps too shrill for humans to hear. When they’re happy, they’ll chirp away — for instance, when they’re given meth (rats love meth). But when the rats are given ketamine, the response is mixed. “That tells us that there may be something fundamentally different in the way that ketamine makes individuals feel, and we see that in the human literature as well,” Trujillo said. “People will say, ‘I’ve had some great, great times on ketamine, but I’ve also had some awful times.’ And sometimes that awful time will drive them to quit.”

It’s true that, unlike some drugs, ketamine doesn’t provide a uniformly pleasurable experience. For plenty of people, taking a little too much and ending up in a k-hole is enough to turn them off forever. But for people like Nadia who find reality itself to be unpleasant, dissociating feels good. Samuel Kohtala, a postdoctoral researcher at the University of Helsinki who studies ketamine, said that mouse models could tell us only so much and that different kinds of people take the drug for different reasons. He wonders whether certain people, particularly those who are anxious or depressed, may be especially prone to addiction.

These, of course, are the exact people ketamine is advertised to. Many studies found “75% of people who tried IV Ketamine got better,” read a promotional email I got from the ketamine provider Pasithea Clinics last month. Call today, I was told, “to start your journey to a better you!”

Although we have no concrete data on the relationship between positive media coverage of ketamine and rates of recreational use, almost everyone I talked to said they turned to ketamine, or started using it more intentionally, because it had been positioned as a mental-health treatment. 

Eric*, 22, was found to have depression and began taking SSRIs when he was a high-school freshman. In about 2019, he started hearing about ketamine’s potential as an antidepressant. The drug was common in the bass-music scene in Denver, where he lived. Though he’d tried it at parties and concerts, the glowing articles he read encouraged him to start using it more regularly. “They’re using it for therapy, so it can’t be too bad for you,” his reasoning went.

Going to a clinic never occurred to Eric; an infusion cost thousands of dollars, while he could get a bag on the street for $80 to $100 a gram, and he was broke. He tried to create a “clinical setting” for himself, reading up on the therapeutic dose and turning off all lights to deprive his senses. The experience, he said, was “really insightful and profound.”

Eric’s use was manageable for a while, but it increased rapidly in 2020 during a time when his mental health was poor. “I started shooting for the hole every time,” he said, thinking, “fuck it, I’m going to get some K and teleport to this other dimension.” Soon he was using 2 to 3 grams a day and up to 7 on nights out. He had cut off most of his social relationships, and he noticed his brain seemed trapped in a fog. His passion in life had always been making music, but ketamine made that impossible. Urinating, which he needed to do constantly, became painful. 

He started experiencing debilitating episodes of “K cramps,” severe abdominal pain caused by ketamine use, which he called “by far the worst pain” of his life. The most recent wave came a few months ago; he passed in and out of consciousness and threw up while convulsing on the floor. When I spoke with Eric in the fall, he was going into an appointment with a surgeon to discuss treatment for a bilateral hernia from the cramping episode. “Despite all that, I’m still using,” he said. “Nothing has really taken hold of me like ketamine has.”

Eric’s experience isn’t unique. Heavy ketamine use can take a brutal toll on the body, and it can do so remarkably quickly, in some cases after just a few weeks. On the KetamineAddiction subreddit, which has 1,800 members (400 more than when I started reporting this article a few months ago), people describe peeing blood, seizures, hallucinations, permanent kidney damage, and the so-called K cramps. The Global Drug Survey, a large independent and anonymous survey of drug use around the world, has found that one in four people who report using ketamine regularly also describe symptoms of what has become known as ketamine bladder syndrome. In the worst cases, it can lead to incontinence, kidney failure, or people needing their bladders or gallbladders surgically removed. But many doctors in the US simply don’t know enough to screen patients for ketamine-related health issues.

On Reddit, the overall tenor of the posts is desperation. “I hate it so much but I just can’t get myself to stop,” one person wrote. “I wish someone would put me in prison for the next month” because “then maybe I’d be free.” 

Redditors encourage one another to quit, talking others through stages of detox and relapse. “It’s 9AM on day 8 of being off ketamine. Every single moment of the day is pure agony. I feel constantly on the edge of a massive panic attack and have suicidal thoughts from the moment I wake up to the moment I fall asleep,” writes another: “I hope this hell of an addiction to nobody. I hope we will all survive this.”

In spite of everything I was seeing and hearing, I hesitated to cast ketamine in too critical a light. It shouldn’t be hard to acknowledge both truths at once: that ketamine is exciting and potentially lifesaving, and that it can also be dangerous. But America is a difficult place to have a nuanced conversation about drugs. The opioid crisis continues to ravage the country after pharma salespeople spent decades convincing doctors and patients that prescription painkillers weren’t addictive. On the other hand, we’re just beginning to course-correct from decades of policy shaped by the war on drugs, when millions of people — mostly people of color from low-income communities — were incarcerated. The messaging from this era “continues to have a shadow over research,” Trujillo said. The last thing he wants to see is a wave of anti-ketamine alarmism, which he said could “prevent individuals who could benefit from seeking it out.”

For the time being, the pendulum seems to be swinging in the opposite direction. Last fall, Summit Series, a leadership conference for entrepreneurs that has hosted Richard Branson and Bill Clinton, kicked off the festivities with a “guided Wondermed ketamine-assisted sound and breathing meditation.” Attendees were encouraged to show up with their own prescribed Wondermed lozenges. 

Jared says he hasn’t taken ketamine since he smashed his face through a mirror at Burning Man. He’s gone back to searching for a plant-based depression cure. He says he’s been running a lot and recently experimented with a new treatment called NeuroStim that injects stem cells into the brain. “I have a cold plunge that I do every day, and I sauna a lot,” he told me. His VC firm is still invested in a ketamine clinic based in Austin, Texas, but it’s important to him that the clinic doesn’t allow patients unfettered access to ketamine at home.

Jared fears that more stories like his might cast a pall over the psychedelic movement. “I think ketamine could be the thing that sets us all back,” he said.

But sharing stories like Jared’s may be the only way to encourage more research into a drug that’s rapidly becoming a major player in mental health. Across the board, people who’ve used ketamine told me they still saw amazing potential in the drug, despite it ravaging their lives and bodies. Many blamed themselves. If only they’d been able to use ketamine “correctly,” they said, they would’ve seen amazing benefits without any of the downsides. “I do wish I could have controlled it,” Eric said. 

Nadia says she’s been mostly drug-free for three months, though she relapsed on New Year’s. She was seeing an addiction counselor, but she had to discontinue the appointments when her healthcare benefits stopped covering them. She still struggles to resist the cravings for ketamine. At night she sometimes rereads old text-message threads with her drug dealer as though she’s grieving a breakup. 

While Nadia knows she shouldn’t touch the stuff, she still thinks ketamine can help others. “If you’re going to jump on something in the early phases of it coming into our collective use, then you have to accept that there’s consequences and there’s long-term outcomes that we haven’t been able to measure,” she said. “But on the other side of that coin, I love ketamine. And I have conversations all the time where I’m like, you know, you should do ketamine.”

*Names have been changed.