"Kitty flipping", the practice of combining MDMA (ecstasy) and ketamine, is often confused with the term "candy flipping," in which MDMA is combined with LSD. Historically, kitty flipping refers to the use of MDMA and ketamine within the same short time period, but new drug seizure data suggest that MDMA and ketamine are also pre-mixed and sold for "kitty flipping". The term “kitty flipping” or use of ketamine plus MDMA can lead to tachycardia, hypertension, and hyperthermia. SummaryKitty flipping is mixing the dissociative effects of ketamine with the entactogenic effects of MDMA. At the same time, ketamine is being legally administered by clinics as an at-home off-label drug used for psychiatric treatment.