Ketamine has been used to induce loss of consciousness for general anesthesia for decades. Recently, this medicine has been used as a second-line treatment in clinical trials and research to treat depression, which has sparked controversy. It is not hard to find news about addiction and misuse, or even death when you search for ketamine. Moreover, this drug is not approved by the FDA to treat depression. Despite its bad reputation, ketamine is a promising medication for depression and an impactful chemical for psychological disorder research.

Let’s first explore the reasons why ketamine can be a good alternative for standard treatment when those common medications do not help alleviate depression. The current antidepressants act to increase the level of serotonin, dopamine, and norepinephrine neurotransmitters in the brain to make patients feel happier. As a new researcher myself, I consider this method ineffective. By enhancing the happy mood to treat depressed patients, researchers and doctors assume that depression is a mood disorder, and patients are simply unhappy. In reality, the causes of depression are much more complicated. A major one involves the alteration of synapses’ size and activity which then affects the connection between neurons. Therefore, in an attempt to treat depression, medicine should aim to fix the changes in how neurons communicate. Through many years of research on cell culture and rodent models, scientists found that ketamine enhances the activity at glutaminergic synapses and increases synaptic sizes, which are heavily reduced in depression. In short, ketamine reverses some of the known physiological alterations. Ketamine treatment has shown success in reducing symptoms of depression in many clinical trials. A patient is eligible if common antidepressants have proven ineffective. Patients are treated with low doses of ketamine along with cognitive behavior training under strict treatment plans with research physicians. 

Despite the promising results, ketamine should not be approved for general depression treatment. Research on ketamine is limited. Scientists have focused on the effects on the damaged parts of the brain (cortex, hippocampus, amygdala, etc.), but they have not explored the consequences of long-term ketamine usage on the brain as a whole. Ketamine is also highly addictive, leading to a potential long-term struggle for patients who are already mentally ill. We should think of the success of ketamine treatment as the groundwork to develop new medications that target the same neurotransmitter (glutamate) but without the addictive effects and other unknown consequences on the brain. Hopefully, a new medicine might offer a better first-line treatment for depression compared to the current antidepressants on the market. 

In most ways, the 2020 election served to underscore how contentious American politics are. Poring over the results, analysts have already begun emphasizing how highly polarized Americans are by metrics such as generation, gender, race, education and geography. Overlooked in this analysis is one important policy area where people  appear relatively unified. In a stunning rebuke to the War on Drugs, drug liberalization ballot initiatives passed across the country.  

This bipartisan revolt against the War on Drugs is striking when recalling that just over a decade ago, cannabis was illegal at the state level for non-medical use in every state. Now, with the results from this election, it stands poised to be fully legalized in 15 states, with some form of medicinal legalization in a further 28 states. Moreover, Gallup recently registered its highest level of support for cannabis legalization in fifty years, with 68 percent of Americans supporting legalization. 

Acknowledgment of the failure of the War on Drugs has also managed to transcend the political divide. In a time of intense political polarization, changed attitudes towards drug use occurred in strongholds of both parties. Voters in blue New Jersey, purple Arizona and red South Dakota all approved initiatives to liberalize drug laws. Indeed, at the state level, everywhere that drug liberalization was on the ballot, it notched a success. 

In ruby red Mississippi, voters resoundingly approved an initiative to legalize medicinal marijuana despite the opposition of Governor Tate Reeves (R). 

In New Jersey, Montana and Arizona, referendums to legalize recreational marijuana use were all passed. Meanwhile, South Dakota passed an initiative to legalize medicinal and recreational marijuana simultaneously. 

Elsewhere, victories were achieved in the decriminalization effort. Understanding the distinction between decriminalization and legalization is key. Decriminalization is not legalization. With decriminalization of certain drugs, though the drug possession and use will remain illegal, infractors will not face prosecution so long as the use is under a certain limit. Instead, violators would face penalties such as fines – similar to speeding tickets.

Additionally, with decriminalization one will not see the emergence of stores selling drugs commercially in contrast to the emergence of marijuana dispensaries following recreational legalization in states across the country. Commercial sale of drugs such as heroin remains criminalized even if personal possession and use is decriminalized.

Advocates have been urging drug decriminalization for years, citing criminalization as being part of the problem of mass incarceration, ineffective as a deterrent and counterproductive to those suffering from addiction. Proponents often point to Portugal as a model. In 2001, the European country decriminalized drug possession and has seen its overall drug usage rate remain stable while accruing reductions in overdose fatalities and incarceration.  

As a reckoning over mass incarceration, the role of the police and racial justice has ensued while more states legalized recreational cannabis use, the movement has notched city-level decriminalization victories across the U.S. Oakland and Santa Cruz, Calif.; Denver, Colo. and Ann Arbor, Mich. have all passed some form of psychedelic decriminalization prior to the 2020 election. 

In Washington D.C., where recreational cannabis use is already legalized, voters took another step to chip away against the War on Drugs. The District voted to decriminalize possession and noncommercial distribution of hallucinogenic mushrooms.  

It was in Oregon, though, that drug reform efforts saw their biggest win. Oregon held its own vote on legalizing psilocybin – the active agent in hallucinogenic mushrooms – for those over the age of 21, which passed comfortably. In an unprecedented move in the U.S., Oregon voters also approved a ballot initiative to decriminalize possession and personal use of all drugs. 

Sponsored by the Drug Policy Alliance, Measure 110 passed with over 55 percent of the vote. In addition to decriminalization, Measure 110 also expanded access to treatment options for those suffering from addiction. Oregon became the first state to decriminalize all drugs for personal use. Though other states, including California, Vermont, and Washington have mulled decriminalization, supporters are hoping that Oregon may act as a catalyst for other states. 

For now, observers can watch and see if Oregon’s experiment replicates Portugal’s success with drug decriminalization. 

Despite all these city and state-level victories, all the drugs discussed here, including cannabis, remain illegal under federal level. This dual nature has led to some obstacles for state-legal cannabis dispensaries and even allowed federal authorities to shut down some that were compliant with state law. Despite this,  there has been some movement in recent years at the federal level. The House is expected to hold a vote on legalizing cannabis at the federal level in the lame-duck session.