Taken orally:
- since you have to take more K to achieve the same level of effects relatively, and that bigger amount corresponds to more metabolites / side-effects / toxicity you could indirectly say that oral use will eventually cause more problems for the same intensity of effects.
- but it's not entirely a fair comparison since the effects are different. Orally everything undergoes first-pass metabolism which converts a maximum amount of ketamine into the metabolite norketamine. This substance is considered to feel more body-high ish, but also dirty, and less psychedelic / mentally interesting and just less intense by comparison. Probably a lot of ketamine's aftereffects via whichever ROA are caused by norketamine.
Other ROAs carry not only arguably more or less toxic effects but also different kinds of damages and risks.
- with nasal use you screw up your nose. In my experience direct irritation felt as pain when snorted, or drip, are not your biggest problems when snorting. And for occasional use snorting seems absolutely fine and it would seem like overreacting to resort to other ROAs. But if you use it more frequently, your nose can really get chronically congested and the linings can get damaged, you get scabby nosepicking situations that can make it worse, and getting sinusitis much more often is a serious concern.
- Plugging... not that I never plugged anything before, but with K personally I would say I would not want the concerns with nasal use to apply to my rectum...
- Injecting: I never IV'ed and am not planning to, but with dissociatives in general I did switch to IM use. The risks there are mostly in applying that ROA incorrectly or maybe seriously overusing and not leaving your muscles alone. With injection the least amount of material is needed and it feels cleanest, but it MUST be done right and the filters are expensive. I personally did not get more compulsive with IM but I can understand if people do, and especially with IV use. Switching to injection is no light hearted matter and I would never recommend it off the bat.
But you can use the change in risks to your advantage.
