S2L is not a widely recognized street name for any single drug, but online searches and drug forum discussions most commonly associate it with ketamine, a dissociative anesthetic. Ketamine goes by dozens of slang names, including Special K, Kit Kat, Vitamin K, Cat Valium, Jet K, Super K, and Purple. Regional and local slang terms like S2L emerge and spread through social circles without ever appearing in official drug reference guides, which can make identification confusing.
What Ketamine Is and How It Works
Ketamine is a dissociative anesthetic first approved for human use in 1970 under the brand name Ketalar. It works by blocking a specific type of receptor in the brain involved in learning, memory, and pain perception. At low doses, this blockade triggers a chain reaction: the brain releases more of its main excitatory chemical messenger, which in turn boosts dopamine activity in the prefrontal cortex. This cascade produces the drug’s characteristic dissociative effects, where users feel detached from their body and surroundings.
The drug exists as a 50/50 mixture of two mirror-image molecules, called S-ketamine and R-ketamine. S-ketamine is the more potent version at blocking brain receptors, while R-ketamine appears to have stronger and longer-lasting antidepressant effects with fewer side effects. A nasal spray version of S-ketamine alone, sold as Spravato, was approved by the FDA in 2019 specifically for treatment-resistant depression.
Medical Uses
Ketamine is only FDA-approved as an anesthetic. It remains widely used in surgical, operative, and emergency trauma settings for both anesthesia and acute pain control. The doses used for pain relief produce blood concentrations that are a small fraction of what’s needed for full anesthesia.
Outside of its approved use, ketamine is increasingly marketed for psychiatric conditions. Depression, anxiety, PTSD, and chronic pain are the most common targets, though clinics also promote it for conditions ranging from alcoholism to opioid addiction. This off-label use is legal due to a loophole in drug advertising laws, but it means much of the psychiatric use lacks the same level of regulatory oversight as the anesthetic use.
Short-Term Effects and Recreational Use
At low recreational doses, ketamine produces a dreamy, floating sensation sometimes called “K-land,” described as a mellow and colorful experience. Users may feel detached from their body, have difficulty speaking or moving, and experience distorted perception of time and space. At higher doses, the experience intensifies dramatically into what’s known as a “K-hole,” an intense out-of-body state that users often compare to a near-death experience. Some describe feeling convinced they’ve met a higher power.
Common immediate side effects include nausea, dizziness, elevated blood pressure and heart rate, confusion, and vivid or disturbing hallucinations. The dissociative state can impair judgment and coordination, making injuries and accidents a real risk. Because ketamine was originally developed as an anesthetic, higher doses can cause dangerous levels of sedation.
Long-Term Risks of Regular Use
The most distinctive long-term consequence of frequent ketamine use is severe bladder damage. Regular use increases the risk of bladder inflammation symptoms by three to four times. This condition, first documented in 2007 among daily users, involves chronic inflammation that causes painful urination, blood in the urine, an urgent and constant need to urinate, and pelvic pain. The bladder wall can become scarred and fibrotic, drastically reducing its capacity.
The damage doesn’t stop at the bladder. Prolonged use can cause the tubes connecting the kidneys to the bladder to narrow, leading to a backup of urine into the kidneys. This can progress to kidney swelling and, in severe cases, chronic kidney failure. The good news is that stopping ketamine use is usually associated with improvement of symptoms, though some damage may be irreversible if use has been heavy and prolonged.
Dangerous Combinations
Mixing ketamine with other substances that slow the central nervous system is particularly hazardous. Combining it with alcohol, opioids, or sedatives can cause profound sedation, dangerously slowed breathing, coma, or death. This risk is especially relevant in recreational settings where people may use multiple substances in the same night.
Ketamine also raises blood pressure and heart rate, so combining it with stimulants or other drugs that increase blood pressure amplifies cardiovascular strain. People with uncontrolled high blood pressure, a history of heart attack, or aneurysms face elevated risks even from ketamine alone. The drug can also worsen psychotic symptoms, making it dangerous for anyone with schizophrenia or related conditions.
Legal Status
In the United States, ketamine is classified as a Schedule III controlled substance, meaning it has accepted medical uses but carries a moderate potential for abuse and dependence. Possessing it without a prescription is illegal. It can be legally prescribed by physicians, and ketamine clinics operating in a gray area of off-label prescribing have proliferated in recent years, particularly for depression treatment. Internationally, regulations vary, but most countries restrict ketamine to medical or veterinary use.