The experience was a bit like a dialysis clinic, where there are a bunch of beds in a room, tatami screens between the beds, and where a huge 2" diameter syringe dosing pump eases a tiny amount of Ket in the line over 15 minutes.
Aside from the expense, it didn't particularly help my loved one's condition. She said it felt more like it just got her high, and not the kind of high you want. Maybe if they used a stronger dose, but those cost more as I recall.
I feel there are at least three treatments one should try before Ketamine, for PTSD/Anxiety/Depression/Suicidal Ideation.
• EMDR. So successful it's amazing that it's not standard fare in counseling and therapy.
• Neurofeedback. The literature is equivocal at best, but the anecdata is very strong.
• LSD. As our nation struggles with medical marijuana still living on schedule I, LSD similarly inhabits schedule I (where the government knows better than your doctor about there being no possible medical benefit). Studies show LSD is over 10x as successful in curing alcoholism as AA.
I’ve been undergoing EMDR treatment for PTSD and it is quite amazing how well it works. You wouldn’t expect that just watching something move back and forth in front of your face (or having an electric pulse alternate between your hands) in between talking about a traumatic experience would do much, but for me it’s been the most effective thing so far after trying many different kinds of therapy and medication.
I think what a lot of people need when it comes to depression/anxiety/trauma is not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away. A lot of our treatments focus on elimination rather than acceptance and reprocessing.
I think of it like short-term dieting vs lifestyle changes. The former may provide a quick fix, but the latter will usually be longer lasting, healthier, and easier to sustain after the initial push.
This is absolutely the gist of it. Anything that helps you do something along these lines is worth pursuing. It's about building up scaffolding around a disaster area-- not to cut off access, but to put up a useful, multipurpose firewall.
It should absolutely be treated as something very special - it 'just works'.
Using it too often would make it loose it's magic (on a physical level too)
Then again most additions seem to happen with more subtle substances.
MDMA is a way too powerful experience to do it casually.
EMDR is PE with a marketing machine behind it. To quote Robert Ursano, a prominent figure in trauma research and treatment at the VA, “I concur with the view that what's new about EMDR is not helpful and what's helpful is not new,".
There is a disturbing trend of EMDR being billed as a panacea by commercial training institutes without educating clients about equally or more efficacious treatments (PE, CPT) that are studied primarily in academic centres.
0: Chemtob et al., (2000), Davidson and Parker (2001)
I have sent countless patients to therapists purporting to do DBT, CBT, PE, and others - only to review those sessions with them and hear about poorly delivered supportive therapy with questionable boundaries.
EMDR seems to be delivered with something approximating the actual therapeutic model as studied somewhere around 50% of the time. Which, sadly, is pretty good.
I went to a licensed therapist who insisted I call my GP to obtain antibiotics for a cold. I explained to her that antibiotics arent effective on viral illnesses, she insisted that yellow phlegm indicates "an infection" this antibiotics would be effective. I am also anaemic due to a genetic condition, and the anemia is mild but basically untreatable. She suggested I look into treating it with "herbs."
That sort of boundary crossing?
I stopped going to her, obviously. Pisses me off i actually paid her.
Do you have any experience with Schema Therapy practitioners?
What is "PE" in this context?
It was wild and would certainly NOT be my choice for a sedative in that situation. It hit fast and at first I felt high, doctors faces started to "melt", then a huge black abyss was in front of me and I felt like I was falling head first into it.
I started yelling "no, no!" because it was a very uncomfortable feeling.
Then as I was coming to the entire room was warped, with echoing voices and laughter.
I'll pass on that, not sure how that would help with depression. It would have to be a VERY small dose.
I had the same dose for the same reason, it was very disturbing. Apparently the doctor said it was normal for patients to scream that much.
Some follow a low dose of around 30-35mg and some go up to 150mg which I found to be life changing
Particularly in the issues around PTSD that was induced alongside cranial trauma, rTMI is an unlikely treatment, though still viable. The issue is that PTSD and concussions share strong co-morbidities. If you have a concussion, your physician is more likely to suggest other treatments, as rTMI may cause other issues. In reading through the literature, I cannot find a case where an issue was seen, but I can understand the caution with such a new technology. That said, there may have been cases that I am unaware of. I'll be very clear here, I am not a medical doctor. If you are considering rTMI treatment, please see a physician.
And if you're talking about starting an IV on yourself... without training, the risks of really bad health issues, including death, are pretty high. Almost no one outside of professional health care has that training. Even if they did, you still need to be monitored by someone else via pulse ox and sometimes blood pressure for safety reasons, and said person monitoring you needs to have the training to know how to help you if something goes wrong. Keep in mind that if ketamine is effective for you, you will end up needing to keep taking it for a long time, typically every 3-6 weeks, or the effects wear off. That frequency multiplies the risks.
In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.
I know from talking to my doctor that of the $375 I pay, his cost for the ketamine he uses for that one treatment is under 10 bucks. If you've got a medical license, you get access to buy legit pharma drugs very easily. I believe he told me that one vial of Ketamine is something like $20 and there's multiple doses in there.
No one understands the exact mechanism of ketamine for depression even though there has been a lot of research and speculation on this topic. Therefore, you can't say which ROA is best for patients or if one works better than another.
Furthermore, all studies have been small and short in duration so there's no statistical significance to the fact that the IV ROA is used more in studies. If IV was the only route that worked it would be the first anti-depressant with that designation. Because of the cost of infusions patients are right to be skeptical about doctors that are running clinics.
> In short, I see the ratio of risk to effectiveness for home use ketamine to be emphatically not worth it. Unless you have a partner / friend who has the necessary training.
My doctor has clinical experience with ketamine and about 2+ years of prescribing patients with TRD with sublingual ketamine that is taken at home. Ketamine is an incredibly safe drug and nothing about his practice has changed. His insurance has even stayed the same. I know that’s a common justification for high prices from docs that run IV clinics.
The reason I’m not going anonymous on this is because I feel passionately that we need to stem the tide of shady ketamine doctors that don’t give a shit about patients. When I asked my doctor why he wouldn’t charge me a lot of money (he could!) for the treatment he asked me, “Would I charge you a lot for Lexapro because it works?” Good point.
See this book for background on Ketamine and the studies completed:
Ketamine for Treatment-Resistant Depression: The First Decade of Progress (2016)
$130 gets me 3000mg in a spray every month. That's enough for about 4 IV-equivalent treatments even with the low bioavailability. The biggest difference is that the intranasal (of course) absorbs more slowly than an IV, so some of the effects last for 2-3 hours after I stop administering the spray, whereas once the IV runs out, I'm ready to leave the clinic in about 15 minutes. (Taking an uber or the subway rather than driving, obviously.)
The therapeutic index for ketamine is ridiculous and I know I don't have adverse reactions to it, so I'm not at all concerned about harming myself with it accidentally. I wouldn't recommend it for anyone who hasn't had some IV treatments, partly because a small number of people do have strong negative reactions to it, and partly because it would be really difficult to know what kind of effect you need to achieve. It's pretty easy for me to tell how high the levels in my blood are because I'm so familiar with how it feels as the IV dose escalates.
While I wouldn't recommend it for an initial treatment, I would recommend it to anyone who has been successfully treated with ketamine. Unfortunately, I think that it's harder to get now. I know my doctor has stopped prescribing it to patients because too many people were selling or abusing it.
Had your loved one tried ECT prior to ketamine infusion? Though its reputation has been sullied by popular culture, it is bar none the most efficacious treatment we have for treating severe and persistent depression, and its efficacy is well supported by decades of research and outcome tracking.
Where I totally agree with you is ECT. It is, with a bullet, the best-supported intervention for treatment-resistant depression, and it's not even close. It is an absolute tragedy that it has such an unfairly terrible reputation. Even before anesthesia was a universal element of ECT, it was never as bad as usually portrayed in popular culture.
My disdain comes from seeing people I'm close to repeatedly pushed towards those treatments by practitioners who, when asked to provide references supporting their endorsement supply anecdotes about past or current patients rather than DOIs. There are specific TMS protocols that appear to have some growing amount of evidence behind them, but ketamine still seems to be a wildly variable cash grab that requires further data before anything can be said about its efficacy.
Why on earth would you be concerned about a tool which allows clinically depressed individuals to see immediate, significant improvement in their condition with relatively few side effects? You should also not group ketamine therapy with prozac, they are completely different drugs with completely different mechanisms of action, grouping them under a broad "antidepressant!" umbrella is borderline negligent.
Psychotherapy is often a long, drawn out process which doesn't necessarily always guarantee results. Not to mention the large amount of variance between individual therapists.
Psychotherapy is useful as an adjunct to psychiatric drugs, and vice versa. They are both useful tools when fighting mental illness, and are even more efficacious when combined. Drawing a line between the two for ideological reasons, instead of purely evidence-based results, is a mistake.
Similar to how diabetics are dependent on insulin, or schizophrenics dependent on their anti-psychotic medication?
You're also implying that people with severe, clinical depression can assuredly be helped by psychotherapy. I'm sorry, but the literature is far more abysmal than that. Many patients don't even respond to psychotherapy, and need psychiatric intervention in the same way a schizophrenic does.
I would also point out that dialysis, chemotherapy, etc are also quite expensive, time consuming, and difficult to scale. We still consider them valid, life-saving treatments.
Ketamine is not your traditional SSRI. You're making the same error as the other poster in grouping all "antidepressants" under the same umbrella, which is particularly egregious when discussing ketamine.
I lack training in psychopharmacology or neuroscience and thus my interpretation of the research is that of a layperson, but my understanding from talking with psychiatrists on the matter is that it is unlikely that ketamine will become a frontline treatment but its mechanism of action will be explored and lead to the development of new drugs that activate the same pathways in the brain but lack or have lessened anesthetic effect.
This is a horribly ignorant statement. Ketamine therapy is in no way comparable to widespread opioid prescription in risk. You are once again comparing drugs with entirely different mechanisms of action.
PS: Chronic Ketamine use destroys your urinary tract (I know people that wet the bed every night from too much of the stuff). Also, it might cause brain damage, but no one is really sure.
You're advocating buying a black market substance online and then snorting it as the safer option?
Only issue I see with intranasal is that bioavailability is only 33%
Though, ketamine is pretty damn safe, and it's rarely adulterated on the black market. In powder form, it forms crystals so it's hard to fake.
A priori, you can always say that something regulated is more safe than something not. But if you're a savvy consumer, you can significantly mitigate or eliminate that risk.
What is harder to fake it vial ketamine. There is a significant cost to that.
I'm suggesting that if you can't afford a Ketamine clinic: a) Ketamine is generally unadulterated on the black market b) if it is adulterated you can often tell c) unless a professional is administering it, you probably want to snort it and finally d) snorting Ketamine should have roughly the same effects (anti-depressant or otherwise) as injecting it.
Also egcg seems to completely block it's damaging effects
Insufflation is only "just as effective" if your goal is to get an intense psychedelic high.
If your goal is a strong antidepressant effect, insufflation is extremely less effective than IV-drip-over-40min. This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.
Insufflation helps you for a few minutes to a few days, IV drip method works for 3-6 weeks.
What about IM? What about rectal administration? How about sublingual? Are there any papers suggesting that IV is somehow quantitatively different from the aforementioned methods?
My personal experience is that IM, IV, and snorted all made me feel better for maybe a period of 2 weeks. I wasn't necessarily doing a "clinical" dose, whatever that means (maybe 25-75mg of IM or IV and 100-250mg snorted), but the anti-depressant effects all seemed comparable.
A drug crossing the blood-brain barrier is a drug crossing the blood-brain barrier. There should be no difference in administration if we are talking about weeks to months later.
Optimizing the dose & duration to get your mind into that state, and for the right amount of time, makes a huge difference in how long the effects last. This is why I prefer using an actual doctor with ketamine depression treatment experience, because they have experience figuring out the right dose & duration for you.
The time that the effect lasts is variable. A patient may need an infusion every week. That's $26,000 a year in some cases.
I actually had a doctor tell me that the infusions last 6 months.
My previous doctor runs a monthly group meeting where patients get together to discuss their experiences. The vast majority of attendees had positive experiences. So even if you don't trust the doctor, you can trust the living proof of positive outcomes. Sure, you could say that the group self-selects for positive outcomes, but no one claims this treatment is 100% effective, either.
Yes, ketamine docs want you to see a psychiatrist because they don't want to deal with you. It's about the money and having as little responsibility as possible.
A support group to discuss experiences? That sounds like it would encourage a placebo effect.
What makes you think both my doctors don't have clinical experience? (I never stated, you never asked. As it turns out, they both do.) You've turned this conversation into a pissing match about whose doctor is best, which is too petty for me, so this will be my last post in response to you.
> Many of the practitioners aren't even psychiatrists
> ketamine docs want you to see a psychiatrist because they don't want to deal with you
So a ketamine doc that isn't a psychiatrist is bad, in your opinion. And also any ketamine doc who realizes that the situation he's treating requires psychiatry for optimum outcome, recognizes they lack said experience, and makes you go to someone with that experience, is also bad? I'm sorry, but your posts reek more of an anecdotal agenda rather than... science. So, I'm done.
"ketamine doc who realizes that the situation he's treating requires psychiatry for optimum outcome, recognizes they lack said experience, and makes you go to someone with that experience, is also bad?"
The "ketamine doc" you're advocating people should see to treat their persistent psychological conditions such as PTSD or Depression, has no experience or background in treating any psychiatric/psychological conditions at all (and they get credit for recognizing that!).
Given the above, what service does the "ketamine doc" provide other than selling the ketamine? Like, what difference does it make that they are a doc? The access to an IV drip? The ability to google dosage? I can do renal function work ups with my family physician.
I'm genuinely confused on what value they add beyond a street dealer (assuming identical substance quality, home tests do exist).
Which is to say, a doctor is generally understood to be something beyond a prescription pad and should actually be involved in the treatment he's supposedly providing.
Also, I feel like this "treatment" model is highly likely to incentivize profit-maximizing-pill-pushing clinics rather than compassionate therapists.
(1) Safely starting an IV on you
(2) Monitor your heart rate, O2, bp levels during the infusion - sometimes people have problems during infusions, I've never had one, but I feel safer having these treatments knowing my vitals are being monitored
(3) Training to know how to solve emergency health issues you may have during the treatment. I personally value this on-the-spot emergency medical knowledge very highly, but if you don't then I can understand why you might question the value. I am completely and utterly helpless during an infusion, if anything bad happens to me, I will be utterly unable to help myself, even a tiny bit.
(3) Access to pure/safe ketamine
I've never known, or heard of, a psychiatrist that will do all this. They very well may exist but not in my area.
tl;dr - don't need to worry about urinary tract issues unless you're using the drug (1) recreationally; (2) irresponsibly
So you feel like you need to piss regularly, but only a few drips come out. The damage can get so severe bladder gets removed.
At the lesser end of the damage is agonising stomach cramps, no idea what the cause of this is.
source: spent too long in the uk freeparty rave scene when ketamine was legal and people assumed it was completely safe due to lack of come down. Too many people ended up with severe ketamine addictions and many have to know piss through a bag
Also, it's much much cheaper on the black market than ketamine. We're talking around 1000 (recreational) doses for $20. Compared to say 10 (recreational) doses of ketamine for maybe $50?
What is it like to still be living in 2014? MXE hasn't been manufactured in any significant quantity since China banned it years ago. The stockpiles that remained have been stretched out at high prices and have significantly degraded over the years, people are reporting needing 2-3x the previous dose.
MXE does have the same bladder issues, but is taken as a smaller dose so it takes longer to happen.
I started monthly ketamine treatment about 3 years ago for treatment resistant depression. It has helped me immensely. It costs me $375 per infusion.
I tried 1-3 drugs from every class of antidepressant (and a few other types) before ketamine and had limited results. Ketamine, however, has been a godsend.
If anyone has any questions about the treatment, the drug, its effects on me, or anything else, feel free to ask.
Could you describe what your depressive symptoms were like before/after treatment?
How many sessions did it take before you saw improvement?
Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?
Yes. It isn't effective unless you get well into a hallucinogenic state. The antidepressant effect seems to be maximized by setting the dose such that you are fairly "out there", but not so far out there that you get scared, or pass out. (Ketamine is used all the time as anesthesia for surgery, and they give you a much larger dose than is used in depression treatment, because past a certain dose, you just immediately zonk out 100%. Good ketamine therapy for depression is achieved by feathering the dose between the two extremes of zero effect and passing out.)
Hallucination means a lot of different things, but with ketamine it's pretty specific. It's not the kind of hallucination where you're looking around the room you're in and see things that don't exist. With ketamine you basically disconnect from the world you're in at the moment and go somewhere else entirely, in your own head. You will often not ingest input from your eyes, even if they're open. What goes on inside someone's head at this point varies wildly, I could tell you what it's like for me but not sure how much interest there is in that. I will say though that music has a profound impact on what goes on in my head during an infusion, and is a fun way of customizing the ketamine experience. I particularly love using my AirPods for this, because there are no wires and especially under ketamine, it feels like the sound is coming from inside your head, as opposed to feeling like you're wearing headphones.
> Could you describe what your depressive symptoms were like before/after treatment?
My depression manifest itself in extreme anhedonia, and after my 3rd infusion, I played, and enjoyed playing, a video game again, for the first time in over a year. Also, at that point in my life (3 years ago) I was going through a lot of difficult personal life problems, and dealing with those problems went from "completely insurmountable" before, to "this is shitty but I can figure it out" after.
In other words, it helped me deal with my life and enjoy things again, but it didn't turn me into someone who will never experience sadness again. It doesn't mean you'll never have a bad day again, but it does mean you'll be able to handle those bad days a lot better.
> How many sessions did it take before you saw improvement?
The way my doctor recommended starting ketamine treatment was to have 6 doses over the course of 2 weeks (m/w/f, m/w/f), and then after that "as needed", which for me turned out to be every 4 weeks. It was after the 3rd dose in my initial course of 6 that I noticed a significant effect.
> Also, any personal insight on why it was so effective for you? Do you think it helped you view circumstances in your life in a different way (the way other hallucinogens like LSD might)?
I can answer this in two parts.
First, one reason it is effective for me is because I don't take any other drugs that conflict with ketamine. Regular benzodiazepine use, or opiate use, or lamictal (this list is not exhaustive) significantly impact the effectiveness of the treatment. Lamictal completely kills the effectiveness. I had just started on lamictal treatment a month prior to discovering ketamine treatment, and had to come off it for 10 days before starting. Same with benzos.
Second, and this is just my personal theory about my own experience, I think one thing ketamine does that helps me is to get my mind out of ruts. The experience of ego death, or near ego death, that I get with ketamine feels like a complete reset for the problems my brain was relentlessly focusing on before. Afterwards, I still care about those problems, but obsessing over the negative parts of my life abates significantly. I would say that before, my focus on the negative vs positive was quite lopsided to the negative, to the point that I rarely noticed / felt the positives. Whereas now, the two are much more balanced. I still lean a bit towards the negative, but just a bit.
One more personal anecdote: Before ketamine, I was dating a lot, but almost out of desperation because of how extremely lonely I felt, rather than because I was being thoughtful/intentional/patient about finding a great partner. The ladies I dated picked up on this quite easily, and it lead to a lot of negative outcomes. And each negative outcome felt like the world ending, which made things worse. A few months after starting ketamine I tried dating again, and it went so much better. I wasn't as desperate, and I took the time to figure out who I was and what I really wanted, and what I offered. It still took a while before I found the right partner for me, about one year after starting ketamine treatments, but we're happily married!
Of course, don't take any medical advice from anonymous online posts.
Edit: For anyone suffering from suicidal ideation, I recommend trying lithium (in close consultation with your doctor).
Most of them are charging more than $375. This is not regional pricing. There is no reason why an infusion in Albuquerque should cost half as much as an infusion in Chicago. In another comment you suggested these experts should be respected.
> This isn't just my opinion, it's the consensus opinion of ketamine docs across the world.
When doctors are robbing patients that may just be the beginning of impropriety...
That's also untrue. IM, and IV are most faster come offs then insufflation or eating it. Though eating ketamine sucks for the amount you need.
What is true about IV is you can control the amount that actually gets taken in much better.
I agree 100% with this. Furthermore, being able to carefully control the dose and duration is paramount in getting the effects to last as long as possible.
Source: Been having regular infusions every 3-6 months for 3 years, and it still works for me.
I can't say this enough: experience & anecdotes based on recreational ketamine use /do not apply at all/ to clinical use.
I have been to a clinic and even weekly doses don't build up tollerance at all which I find very interesting
Racmic is better
AFAICT, it's not patentable, so nobody would pay for the trials.
Regarding patents . It is possible to patent an ROA method just like what j&j did with s-ket
Suicide isn't new or specific to humans, so calling it "unnatural" seems unnecessarily silly to me.
Self-destruction is found in non-humans, but mostly as a reaction to acute circumstances. I'm assume you are widening the scope of what is suicide to include these examples, but they seem different than relieve of existential suffering that is human suicide.
People attempting suicide due to suffering caused by (treatable) mental illness is an entirely different thing.
Culture might want to look at itself for the answer to the question of why severe mental illness is on the rise.
Suicidal ideation is by definition not healthy. You can argue the ethics of suicide (particularly assisted suicide, which I'm opposed to), but there is no situation where it's a good outcome. It can only ever be seen as the least worst outcome, and if we ever change our collective opinions on that I think we are far down a dark path to great evil.
There's a huge difference between considering suicide if you're terminally ill and in a lot of pain, vs. considering suicide because your life is not going well and you're really depressed, which is something that may be treatable, and I expect the vast majority of suicides are the latter and not the former. I personally know one such example.
As someone whose life has been affected by suicide, and almost affected much more seriously by a close call, I see suicide as the ultimate failure, and think we should be doing everything we can to help people escape from these ideas (and yes, I've done hard work to help someone who had these problems, and that person is definitely doing better, and enriching his own life and the lives of others because of it).
Our world is making us crazy and sick more than it should, so attack the problem at both ends. Figure out the causes and the cures and try to stop the first and accomplish the second.
I agree that human life is valuable, but you have to support your claim in some way. If you can't find a way to support it, then maybe the claim is wrong.
Hunter gatherers have little social stratification but no real wealth inequality because they are limited to what they can carry personally and cooperative health is what keeps them alive. It takes a /lot/ of skill and knowledge to live on one's own in the wilderness without advanced tools like say a steel knife.
Productivity is what creates wealth in a meaningful sense. It can improve and boost living standards per person without a specialized pyramid scheme of labor. Proof? The fact that industrialized societies aren't over 90% farmers and haven't starved to death!
While raw inputs may come from land processing it is where the bulk of value actually comes from. If I gave you a claim to all of the gold in Antarctica it would be of very little value because of the extraction expenses.
I do not believe this. In a world without private property, everyone is entitled to the world's land. Everyone has everything available to them. People survive off the land. Eventually these people don't want to just survive, so they begin to do a single thing all day (hunting, gathering, eventually farming) They trade the output of their labor (their wages of berries, food) for other peoples output.
The introduction of private property allows for some people to collect rent on productivity, without actually being productive. Private property is a tax on productivity and rent will always consume any excess production value.
Progress drives poverty, as well as any inequality in wealth only increasing as time goes on in a positive feedback loop.
"While exploitation may be real presuming that management and capital contribute nothing is just plain not anchored in reality."
I don't believe this either. I believe any rent-seeking is adverse to progress towards eliminating poverty. I see it as a failure of society to allow for the upper class to enjoy greater pleasures as time goes on at the expense of those born poor.
We are all guests on a floating spaceship rocketing through space. The idea of inheritance has no place in a free market in my opinion, it should be taxed as income for the recipient. Inheritance is the vessel through which wage equality is growing larger, in my opinion.
This is disputed by figures as diverse as Aristotle, Spinoza, Hegel and Rousseau. It is not fact at least as presented here without discussion.
>While exploitation may be real presuming that management and capital contribute nothing is just plain not anchored in reality.
The theory of exploitation in Marx or post-Marx (even without the LTV) does not depend on the assumption that capitalists cannot add value. I'd suggest looking at the work of John Roemer and his work on PECP and CECP.
>It can improve and boost living standards per person without a specialized pyramid scheme of labor.
Was this ever cast in doubt? I'd also caution the application of a historical example to the society of today, since the applicability of the principle has not been proven.
>While raw inputs may come from land processing it is where the bulk of value actually comes from.
This is textbook Marx.
How is labor being misappropriated if it's creating productivity?
"Humans have never made a single new thing, at least as far as I know. "
You're typing this on a phone or computer connected to the internet.
"The purchasing of people for labor has long been out of style"
What is the alternative to this that you think is in style?
The alternative to purchasing people for labor has been wages, which is giving back to a laborer the portion of their labor which is not stolen from them.
I am totally unconvinced that any leader seduced by Marx would ever be someone I would care to live under.
Falling for a model of thinking is certainly a sign of a poor leader.
Marx's ideas, aside from being wholly unrealistic, inevitably result in tyranny and misery because man cannot be perfected. If your worldview cannot survive the fact that a lot of people are assholes, it will always fail when you try to put it in practice.
If you look at the Acts of the Apostles, how they are describing the early Christian community sounds an awful lot like what communists are trying to achieve. And it worked, for a time, but this was a small group of zealous believers banding together because of both their beliefs and persecution from without. While this may be the ideal of Christian life, you have not seen any large-scale Christian societies working this way, outside of places like monasteries, where life is very strongly regulated, or other similar small groups (and those often go poorly as well), because it simply doesn't scale.
So we have to create a society that accounts for the fact that a lot of people are greedy and won't work for the common good. We counter that by first teaching that they should, but also allowing for something like capitalism where people's energies can be focused on something that at least has the potential to make others' lives better along with their own (the mythical "enlightened self-interest", which is possible).
The only other alternative is absolute totalitarianism, which is the worst condition humans can inflict on each other.
How do you decide to believe that it is because of lack of scaling and not another factor? I believe wage inequality exists because private property is allowed to be held by citizens and rent taken for the lands productive use.
I think people should be able to own buildings, but the land should all be the governments. A Land Value Tax would be something I would be ecstatic to see. There should be no incentive to hold land and wait for it's value to rise. To do so is unproductive to society and incredibly productive for a single person's return on investment. But their investment is stolen from society at large. (of course theft is a matter of opinion, I don't mean to misconstrue what I believe is fact vs belief)
Science might be finally gaining the upper hand in the drug war against political forces which won the public opinion battle back in the 70s. It's much harder to convince the public drugs r bad if 95% of the "hard" drugs have medical uses.
Ketamine has substantial legitimate medical uses, and is thus legal in those situations.
It also has a very distinct bitter taste, which would make it quite obvious if someone put it in your drink or similar.
Drugging someone else (wether that be with legal drugs or illegal ones) is allready prohibited, no matter the intent.