hand holding bag of ketamine
Photo by Georgia Love for DoubleBlind

WTF is a K-Hole?  

We asked experts about falling into the abyss—and how to get out again

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DoubleBlind Mag

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Published on
Updated January 23, 2024

DoubleBlind Mag is devoted to fair, rigorous reporting by leading experts and journalists in the field of psychedelics. Read more about our editorial process and fact-checking here.

Michael, a 34-year-old in New York City, was dancing in an empty office with friends one night when he tried ketamine for the first time. “The first bump made me feel like I was swimming merrily through the air,” he remembers. After the second bump, however, he collapsed on the couch for about an hour, “able to hear the music but no longer able to communicate with my body or activate its motor functions.” Michael fell into a k-hole.

What is a K-Hole?

A K-hole is, in simple terms, “a profound dissociative state induced by high doses of ketamine,” says Ryan Sultán, MD, assistant professor of clinical psychiatry at Columbia University and medical director at Integrative Psych. “It’s characterized by a profound sense of detachment from one’s surroundings and even one’s self. For some, it can feel like an out-of-body experience or a dreamlike state, whereas for others, it can be more disturbing, like a nightmarish episode.” K-holes tend to involve “altered perception, loss of bodily awareness, and extreme introspection,” says Sam Zand, DO, Chief Medical Officer at Better U.

Safety Note

Ketamine overdose can be directly fatal in high doses and indirectly fatal even in lower doses due to severe injury and potential drowning.  It is not recommended to mix ketamine with other substances without medical supervision. It can be difficult to move your body after using this medicine, thus safety and surroundings should always be considered before use.  Always remain mindful and preference the lowest possible dose when engaging with ketamine outside of a provider’s care. It’s not recommended to use ketamine alone.

Michael, who has experienced several subsequent K-holes, describes feeling “immobilized” during the second one: “If I wanted to move even a finger, I’d need to swim upward back into my original body to do so. Yet I kept sinking [… fearing] that I may never regain autonomy over my body.”

A K-hole can be a challenging experience, but fortunately, there are precautions someone can take to minimize the chances of falling into a K-hole and maximize the chances of getting out. Here’s some helpful information to have about k-holes before you decide to take ketamine.

Avoiding K-Holing

If you’re going to use ketamine, the best way to avoid a K-hole is to take ketamine under a professional’s guidance. Many clinics offer ketamine therapy sessions supervised by doctors and/or psychologists, who keep the dose low enough to prevent K-holes while still providing a profound experience. “Dosages for medical use, such as for depression treatment, are typically much lower and administered under controlled conditions,” says Sultán.

READ: Does Ketamine Have a Dark Side?

hand reaching for bag of ketamine
To reduce the risks of falling into a K-hole, Sultán advises against using ketamine alone | Photo by Georgia Love for DoubleBlind

There isn’t any simple rule of thumb for avoiding K-holes when using ketamine recreationally. “The specific dose of ketamine required to induce a K-hole can vary widely based on an individual’s size, tolerance, metabolism, and other factors,” says Sultán. The best strategy is to start with the lowest dose possible, then work your way up if you feel OK. James Giordano, PhD, professor of neurology and biochemistry at Georgetown University Medical Center, advises that people using ketamine “start low and go slow”—especially if they haven’t used it before, as even a low dose can put a beginner into a K-hole. 

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“The specific dose of ketamine required to induce a K-hole can vary widely based on an individual’s size, tolerance, metabolism, and other factors,” says Sultán.

What Is a K-Hole Like? Not Just Another Bad Trip.

Someone in a K-hole may feel like they’re “floating in the vastness of space” or sinking into the floor, says Sultán. “There are also reports of vivid visual or auditory hallucinations, time distortion, or a profound sense of connectedness with the universe,” he says. “On the flip side, others might experience fear, anxiety, or feeling trapped.”

People’s sensory experiences while in a K-hole vary widely. “For some people, it’s very, very dark—literally dark,” says Giordano. “It’s without light. Or, there’s colors, and they can then interpret those colors in particular ways that have meaning for them, and other individuals feel as if they’re seeing things on film.” Some people may feel they have traveled to a different place in the universe or even to the past or future. 

Many people will be physically immobile while in a k-hole. “For most individuals, the k-hole prompts a pretty profound level of inactivity. They may not be externally responsive to stimuli and conversation,” says Giordano. “But for other people, they become agitated and hyperactive.” Daniel Saynt, founder of the New Society for Wellness in New York City, describes a K-hole as similar to sleep paralysis: “You are mentally awake, but your body is unable to move.” 

READ: At-Home Ketamine: Is It Worth It?

person getting IV ketamine therapy
A number of clinics offer ketamine therapy sessions supervised by doctors and/or psychologists, who keep the dose low enough to prevent K-holes while still providing a profound experience | Adobe

A K-hole tends to last anywhere from half an hour to two hours, says Giordano. However, because of ketamine’s dissociative effects, the subjective experience of time spent in a K-hole can vary drastically. “Hours can feel like minutes,” says Saynt. “Minutes can feel like hours.”

Some people find a K-hole to be a spiritually transcendent experience. “They feel not only out of their body but literally out of time and space,” says Giordano. “They find it liberating; they find they’re no longer bound to the realities of their body or space-time, so they find it to be a different dimension. […] They’re experiencing the world as if their body is more ethereal.”

The Risks of K-Holing

“What’s important to remember is ketamine is used as an anesthetic, and so the phenomenon you’re inducing is progressive anesthesia,” says Giordano. “The word ‘anesthesia’ means ‘I don’t feel.’ […] What you’re getting is dissociation not just from bodily sensation but also from cognitive perception. That level of sensory disconnect and cognitive unfamiliarity can be terrifying.”

In addition to psychological distress, a K-hole can carry physical risks. “There’s a risk of injury if one tries to move while heavily dissociated,” says Sultán. “Moreover, consistent use of high doses of ketamine can lead to bladder issues, cognitive impairment, and addiction.” If someone overdoses on ketamine, they may experience cardiac or respiratory issues, says Giordano. Someone seeking a K-hole experience may become desensitized to ketamine and need to take a lot to get the desired effect, making them susceptible to overdosing.


Safe(r) Travels

Looking for more harm reduction information? Visit DanceSafe.

Michael recalls vomiting on more than one occasion while in a K-hole. “I frantically attempted to semi-blindly weave through the sea of people without stepping on anyone, in search of a restroom, but only made it as far as a trash can at the entrance, where I vomited for over five minutes,” he remembers of one instance at a festival. “Thereafter, I made a hazy beeline for my tent and laid motionless on my sleeping bag, vomiting several more times before finally falling asleep.” Going to sleep when you’ve been vomiting carries the risk that vomit could get into your lungs if it continues in your sleep, says Giordano. 

On top of that, the sense of paralysis people can experience in a K-hole can become dangerous when you are in a public place or with people you don’t know. “Being in a K-hole can be scary, but mainly because your body is in a state where it can’t protect itself from others,” says Saynt. “If you are experimenting with the drug, it’s really important to choose a safe environment.”

To reduce the risks of falling into a K-hole, Sultán advises against using ketamine alone. Giordano adds that it’s risky to combine ketamine with other drugs. “If you mix ketamine with anything else, all bets are off,” he says. “There’s absolutely no way to predict what that experience is like. Do not mix ketamine with other psychedelics.”

Consent, environment, and situation are all important factors to consider with ketamine. Some people who engage with ketamine do so with malicious intent. Britta Love, a somatic sex educator, recommends only using ketamine with trustworthy people who have a solid understanding of consent. The people around someone who’s using ketamine “should just be holding space as they journey out of their body as well as holding to any pre-negotiated agreements,” she says. If two (or more) people want to have sex on ketamine, they should establish everyone’s boundaries before consuming the substance and not go beyond them, even if they want to. Harm reduction educator Mohawk adds that one should “avoid attempting sexual gymnastics that you’re not used to and tearing an orifice,” as ketamine relaxes your muscles.

“Ketamine, like alcohol, is a substance that some might take or encourage others to take in hopes of tension easing, boundaries relaxing, and gaining sexual access,” says Love. “This is a territory ripe for boundary violations and assault, as we cannot give our embodied consent while consuming a dissociative substance. Ketamine can slow reflexes and imbue a sense of distance between what’s physically happening in/to the body and what’s being experienced.”

“… We cannot give our embodied consent while consuming a dissociative substance.”

Although some may seek out chemsex situations, some people do use ketamine for malicious or self-serving purposes. Ketamine—along with GHB and alcohol—is among a handful of drugs used as “date rape drugs.” People looking to commit assault may encourage the use of ketamine because many people will take it voluntarily, says Mohawk. Being in a k-hole—or even a less intense ketamine-induced state—also compromises your ability to consent or respond as you’d like to unwanted contact. “I don’t believe anyone can consent in a k-hole,” says Mohawk. “There’s not a universal dose of ketamine that would be considered ‘consentable.’” Always remember: assault, sexual assault, and rape are illegal and punishable by law, regardless of whether you’ve used ketamine or any other substance.

Can You Get Out of a K-Hole?

“Once in a k-hole, it’s challenging to exit intentionally, as one’s sense of control is often diminished,” says Sultán. The only surefire way to get out of a K-hole is to wait it out. However, some techniques someone might use to get out of a K-hole include deep breathing, touching an object like a stress ball or even just some cold water, and using the 5-4-3-2-1 method: “identifying five things one can see, four one can touch, three one can hear, two one can smell, and one can taste,” says Sultán. Saynt was once pulled out of a k-hole by his friend’s cat pawing at his head.

5-4-3-2-1 grounding exercise
Some techniques someone might use to get out of a K-hole include deep breathing, touching an object like a stress ball or even just some cold water, and using the 5-4-3-2-1 method

“Practicing breathwork and relaxation techniques prior to session can help prevent anxious or uncomfortable feelings,” says Zand. “Being supported and reminded that things will be OK shortly can help.”

If someone is with you, they can talk to you or gently touch you to try to get you out, says Giordano, who recommends having a trip sitter who can take on this role. The tripsitter can try saying something like “I’m here with you. You’re safe,” “feel the ground beneath you,” or “this will pass, and I’m here with you until it does,” says Sultán. However, this is not guaranteed to bring someone back to reality. “The higher the dose of ketamine, the harder it will be to come out of a k-hole,” says Giordano.

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Through integration, someone can find the lesson in their ketamine trip, then “take that experience with them and carry it over into other experiences in their life,” says Giordano—“not necessarily to repeat the K-hole phenomenon but to superimpose the meaning they get from it onto other things.” 

What to Do After Coming Out of a K-Hole

While falling into a K-hole can be very unpleasant, someone can use this as a learning and growing experience. “Talking with a trusted friend, therapist, or support group can help in processing the experience,” says Sultán. “Just as someone might dissect a vivid dream to derive meaning, discussing and analyzing the K-hole experience can yield personal revelations.” Journaling is another method that might help someone make sense of what happened, says Zand.

Through integration, someone can find the lesson in their ketamine trip, then “take that experience with them and carry it over into other experiences in their life,” says Giordano—“not necessarily to repeat the K-hole phenomenon but to superimpose the meaning they get from it onto other things.” 

Was this article on k-holing helpful? Deepen your learning here.

Yes, ketamine dependence is a thing. “We are seeing more ketamine abuse, particularly in the last several years with all the publicity surrounding ketamine for depression,” Wesley Ryan, MD, tells DoubleBlind. Ryan is a psychiatrist offering ketamine-assisted psychotherapy.

Looking for more information on drugs, sex, and consent? Sex educator Britta Loves explores how to set and respect boundaries.

Testing your drugs can save lives. Here’s why it’s recommended to test before you ingest. Find ketamine test kits through DanceSafe.

Disclaimer

In the event of an emergency, please dial local emergency services. For mental health care related to substance abuse in the U.S., please dial the Substance Abuse and Mental Health Services Administration National Helpline at +1 (800) 662-4357.

This article is intended for harm reduction purposes and should not be used in place of medical advice. DoubleBlind does not advocate participating in illicit activities. Always consult your local drug laws before engaging with any illicit substance.

DoubleBlind Magazine does not encourage or condone any illegal activities, including but not limited to the use of illegal substances. We do not provide mental health, clinical, or medical services. We are not a substitute for medical, psychological, or psychiatric diagnosis, treatment, or advice. If you are in a crisis or if you or any other person may be in danger or experiencing a mental health emergency, immediately call 911 or your local emergency resources. If you are considering suicide, please call 988 to connect with the National Suicide Prevention Lifeline.

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