dissociatives

Dissociatives are a class of psychoactive substances characterized by inducing dissociation, a subjective splitting or detachment from the self and surroundings. They often provide analgesia and amnesia, and at sufficient doses may produce vivid perceptual changes and out-of-body experiences. Most dissociatives act as antagonists of NMDA-type glutamate receptors, though other mechanisms contribute to their effects.

Common substances in this category include ketamine and phencyclidine (PCP), which have long histories as anesthetics and have been used recreationally. Dextromethorphan (DXM), a cough suppressant, can cause dissociative effects at high doses. Nitrous oxide, used medically as an inhaled anesthetic and analgesic, also produces rapid dissociation. Synthetic dissociatives such as methoxetamine (MXE) and 3-MeO-PCP have appeared on the recreational market.

Medical and research use: Ketamine remains an approved anesthetic and is used off-label for pain management and, in some cases, treatment-resistant depression. Nitrous oxide remains in clinical use in controlled settings. Dextromethorphan is sometimes used at excessive doses as a recreational dissociative; its toxicities are primarily related to overdose and potentially dangerous interactions with other substances.

Risks: Acute effects include cognitive and motor impairment, confusion, agitation, and impaired judgment. Chronic use of some dissociatives, especially ketamine, is associated with urinary tract problems and memory disturbances. Inhaled dissociatives carry risks of hypoxia and accidents, while others can cause dependence and tolerance.

Legal status varies by jurisdiction. Ketamine and PCP are controlled substances in many countries; DXM is available over the counter in some places but regulated in others; nitrous oxide is regulated in some jurisdictions due to potential abuse.