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HUNTINGTON BEACH, Calif. -- A woman accidentally overdosed on topical ketamine after putting an empty tampon applicator covered in the dissociative anesthetic in her rectum, according to a case study presented here.

The 34-year-old, who worked in a podiatry office, said she had heard from a pharmaceutical representative that ketamine, a pain killer that has a history of misuse for its hallucinogenic effects, isn't heavily regulated, reported Lesley Michael, DO, and , of Mount Sinai Beth Israel in New York City in a poster presentation at the American Academy of Addiction Psychiatry annual meeting.

"We don't usually think about ketamine being a component in topical creams," said Waisbren in an interview with 番茄社区app. "[The woman] went to a couple of websites and forums to see how she could get high [on topical ketamine]."

The authors noted in their presentation that a Google search revealed Internet message boards that discussed the recreational use of intrarectal ketamine. "To date this is the first case report on the recreational use and overdose of a topical ketamine compound," they stated.

The ketamine compound cream contained 10% ketamine, 6% gabapentin, 2% baclofen, 2% diclofenac, and 2% lidocaine. The woman had a history of depressive disorder, borderline personality disorder, alcohol use disorder, and cocaine and prescription opiate use disorder. She had been using the ketamine cream for a year and had required an increasing amount for hallucinogenic effects, the authors said.

The patient presented to the emergency department unconscious and, about 3 hours after ingestion, became minimally responsive. She had dilated pupils, and was tachycardic and tachypneic. Her blood pressure was normal.

She became agitated and reported distressing hallucinations, but those improved after she was given intravenous lorazepam. The cardiac workup included transthoracic echocardiogram and cardiac enzymes, both of which were negative.

The patient was eventually discharged with a referral for outpatient rehabilitation and treatment for addiction.

"Topical ketamine compounds, often prescribed in pain management settings, can be used recreationally to produce hallucinogenic effects when administered rectally," they wrote. "Depending on the amount and composition of the compound used, there can be serious mental status changes and cardiac consequences, which in this instance, resolved without major interventions.

The authors pointed out that websites like provide information on drug use experiences. "The popular use of Internet forums and message boards to disseminate information on ways to misuse common household items and unregulated substances has undoubtedly propagated new avenues of ketamine abuse," they wrote.

"Consultation-liaison psychiatrists should be aware of the potential mental status changes and symptoms associated with topical ketamine abuse and overdose," they said. "Furthermore, the popularity of compounded creams containing ketamine for outpatient analgesic purposes, particularly in an unregulated manner, raises the likelihood of increasing incidence of misuse."

They added that because the compound formulations are often tailor-made, it can be difficult to specify ingredients, raising the likelihood of an overdose.