When Welsh drag performer James Lee Williams appeared on the first season of RuPaul’s Drag Race UK in 2019 as The Vivienne, they made history and wowed fans by becoming the reality competition spinoff’s first-crowned champion. But when the 32-year-old performer unexpectedly died on January 5, many wondered about the cause of death. On Monday, their former manager revealed that they died “from the effects of ketamine use causing a cardiac arrest,” raising questions about the uses and safety — especially since the dissociative and hallucinogenic anesthetic is increasingly used to treat anxiety and depression.
“I hope that by us releasing this information, we can raise awareness about the dangers of ongoing ketamine usage and what it can do to your body,” Williams’ former manager Simon Jones told Attitude magazine. ”Ketamine usage is on the rise, particularly amongst young people, and I don’t think the full dangers of the drug are being discussed.” Williams’ family has pledged to work with the UK-based addiction recovery charity Adferiad to help raise further awareness about ketamine.
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During their Drag Race appearance, The Vivienne admitted that they had previously struggled with ketamine addiction, saying, “It was the loneliest part of my life, I was killing myself… and my family [didn’t] even know.” The drag performer said they sought recovery assistance from the Armistead Center, a now-closed LGBTQ+ health center in Liverpool, England, and had been sober for two years before appearing on the reality competition.
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From anesthetic to depression drug: a medical history of ketamine
Ketamine was first synthesized in 1962 as an alternative form of anesthesia. Unlike other anesthetics, it stimulates the cardiorespiratory system, ensuring patients keep breathing during surgical procedures. Military field doctors began widely using ketamine for emergency surgeries during America’s war on Vietnam through the 1960s until its 1975 conclusion. The anesthetic gradually became popular for treating injured patients suffering from reduced blood flow due to traumatic shock.
In modern medicine, ketamine is used in surgery and to reduce pain and nausea in post-surgery patients, patients experiencing chronic nerve pain, and patients who have a resistance to opioids. Ketamine also has dissociative effects and can cause auditory or visual hallucinations, a sense of detachment from one’s physical or mental self (something known as depersonalization), or an altered perception of the external world (known as derealization).
During the 1970’s, ketamine became a party drug in the United States. It proliferated on the street drug market during the ’80s and the rave scene of the ’90s in the form of capsules, powders, tablets, liquids and injectables. The drug eventually became known as “Special K” (sharing a name with a popular adult breakfast cereal).
Because the drug increases blood pressure, causes intense hallucinations and can lead to disorientation, confusion, or loss of motor coordination, it is sometimes used as a rape drug and can be deadly and addiction-forming. The U.S. government criminalized the recreational use of ketamine in 1999, though its recreational use continues both domestically and internationally to this day.
Nevertheless, medical researchers have found that ketamine can have rapid-acting effects as both an antidepressant and anti-anxiety medication in people who have not responded to selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and other SSRI drugs.
Serotonin only makes up about 20% of the brain’s overall chemistry. Ketamine has been found to affect parts of the brain not affected by SSRIs by increasing GABA and glutamate, two other neurochemicals found in the brain. The increase of these chemicals stimulates the brain’s core and increases connections between the brain’s nerve cells, both of which usually decrease during depression.
In 2019, a mirrored form of ketamine, known as esketamine, was approved by the US Food and Drug Administration (FDA) as a nasal spray for people with depression who were resistant to other forms of treatment.
“We think [ketamine use] may open a critical period in which the brain is more plastic, both at the cellular level and possibly even at the functional level, where we can start to work to change people’s reference of thinking or their ability to respond and adapt to new social or environmental stimuli,” said Dr. Gerard Sanacora, MD, director of the Yale Depression Research Center.
Some doctors are still skeptical about ketamine’s psychiatric uses
Due to legal loopholes around drug advertising, healthcare providers have increasingly prescribed ketamine in psychiatric clinical settings, with hundreds of ketamine clinics opening nationwide since 2019. Clinics now claim the drug can treat depression, anxiety, post-traumatic stress disorder, chronic pain, Lyme disease, alcoholism, and opioid addiction, though not all of these claims have been tested, according to Dr. Caleb Alexander, MD.
“There is a remarkable dearth of evidence of well-controlled, randomized, blinded trials, which really represent the gold standard for how we assess effectiveness,” Alexander said in January 2024. “Many trials only look at short-term, not at moderate or long-term, outcomes of effectiveness. And the measures of effectiveness are often quite limited.”
In ketamine clinics, healthcare providers administer ketamine via intravenous (IV) infusion or via nasal spray. The effects can take from 15 minutes up to an hour to manifest, compared to the nearly six-week period that it can take for SSRI medications to deliver effects. Medical providers sometimes monitor ketamine users’ vital signs (like heart rate) to ensure safety or conduct re-evaluations to determine the drug’s effectiveness.
While studies have shown that ketamine can have a positive effect on people with depression, Harvard Medical School DR. Peter Grinspoon, MD, writes, “Ketamine doesn’t offer a cure; rather, it improves symptoms of depression for a certain amount of time.” That is, ketamine just reduces symptoms of depression over the short term and is suggested alongside psychotherapy to help decrease depression and anxiety.
Alexander expressed particular concern about ketamine’s safety because it can be ordered online and used in non-clinical settings.
“It can cause mood changes, ranging from euphoria to suicidality. It affects behavior, ranging from sedation to violence. And it typically reduces cognition,” he adds, noting, “The biggest concern is that the effects aren’t always short-lived and the onset of these effects isn’t always immediate.”
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