Ketamine dependency can cause permanent bladder damage

April 30, 2024

3:46 pm


If you are not a horse, stay away from Ketamine! What I mean is, unless you have four legs, a tail and eat carrots from a bucket after a meal of hay, then this is not something anyone should be using: Except for when it is prescribed during a medical procedure. It is not a new drug and has been around since the 1970’s in America but started to be used in Belgium in the 1964. It was derived from PCP (Angel Dust). According to the World Health Organization, it is the most used anesthetic in the world. It was first discovered in 1956 by Victor Maddox, in America, when it was used as an analgesic (pain killer) in monkeys. On August 3, of that year, intravenous ketamine was injected into a human being for the first time. Subjects described the experience as “floating in space, as if they were disconnected from their body and environment with a loss of feeling in their limbs.” It was widely used by the US military during the Vietnam war and was referred to as “the buddy drug” because it was so safe to administer, even your untrained “buddy” on the battlefield could administer it to a wounded soldier without fear of over-sedation. In medical fields it is known as a dissociative anesthetic and is an injectable drug (when used in a clinical setting) or as a nasal spray. It is dissociative because it is psychedelic. It makes the recipient feel detached, separated from their physical environment other drugs that have similar effects are PCP, nitrous oxide and methoxetamine. Ketamine, also known as Special K or Super K, is a short-acting anesthetic drug with hallucinogenic effects. It can change how you perceive sights and sounds, make you feel like you’re not in control, and make you feel detached from the world around you or any pain you’re feeling. Yes, there are studies being conducted into the possible clinical uses of ketamine in the field of alcohol dependency, most noticeably a study at the University of Exeter However, this is a study that looks at combining Ketamine and therapy for abstinent patients: It is not suitable for those who are currently drinking. In any event: this is a properly supervised study under strict guidelines with incredibly stringent safeguards in place.

Within the field of psychiatry, Ketamine is now being used for treatment resistant depression. A new drug, called Spravato was licensed, in the United States of America by the Food and drug administration, though only if administered in a doctor’s office/hospital via a nasal spray.

Ketamine is cheap. Drug wise, a leading charity that provides up to date and very reliable information on the use of illicit drugs state that a gram of Ketamine currently costs, in the UK, £20-30. As information on the Global Drugs Survey website clearly states, Ketamine has been around for over four decades but, for the last two, has become an international party drug.

When used it can have a very quick effect, especially if injected. A response can be felt in seconds. When snorted, it can take as little as five minutes before the user feels the effects and snorting is the most common method of use outside of a clinical setting. When drunk, it can take from five minutes to half an hour before any effects are realized. Typically, the effects can last from one to two hours. However, some users will report that their judgement, senses and coordination can be affected for more than a day. While it has been described as the ultimate psychedelic and it is not unknown for users to develop a tolerance for it. Furthermore, it can be abused by those who have easy access to it (veterinarians and anesthesiologists). Those using it often sustain physical injuries, falls, etc. during what can be described as a “K haze”. Chest pain, abdominal pain and a “bad trip” can also occur. One of the most significant issues connected with use is Ketamine dependency and bladder damage.

To date, the exact cause is not known but is believed to relate to how Ketamine is broken down in the body: It’s pharmacokinetic properties. Currently, there are no curative options for Ketamine induced bladder pain and it is managed using pain control. The longer the person is on ketamine, the more severe the symptoms and the less chance there is of reversal Symptoms include:

  • Frequency (needing to urinate more often)
  • Blood in the urine
  • Urine tract infections
  • Pain on urination
  • Needing to pass water quickly (urge incontinence)
  • Renal failure

It is not uncommon for people to have to endure long term (if not permanent) catherisation. I have seen young men, in their 20’s, who have ended up having life with a catheter bag. As one said to me, “A real passion killer.” In 2013, Channel 4 news investigated the phenomena of Ketamine induced bladder damage. They interviewed Mr. David Gillatt, one of the United Kingdom’s leading urological surgeons. He reported that, by June, he had already removed three bladders that year. In the interview, he reiterated how severe use can lead to permanent catherisation. Indeed, he described how Ketamine “Gets into the urine and inflames the bladder. It makes the linking come off like a burn. And then, as it tries to heal itself, scarring occurs, and the bladder shrinks. Mr. Gillatt went on to explain how it is not uncommon for users to experience pain in the lower abdomen as well as experiencing the other common problems of blood in the urine and bladder control issues. A patient, interviewed by channel four news at the time, explained how she had to have part of her bowel used to recreate her bladder, after it was removed. This forced her to stop working and she detailed the extreme pain and frequency of toilet visits: She had been using the drug for four years, sometimes up to fifteen grams a day. Channel 4 News investigated figures that demonstrated a rise in the number of people being referred to urologists with ketamine related bladder issues in three cities: In Bristol, between 2012 and 2013, surgeons reviewed 25 ketamine cases –which was an increase of more than 90 per cent on the previous year. In Leeds, 24 users were referred to urologists – a 50 per cent increase on the previous year. And in London, 75 per cent of those who were seen in specialist drug scene clinics reported physical symptoms of Ketamine use. In 2019, Public Health England expressed concern that increasing numbers of young people were using ketamine. The Guardian newspaper looked at data analysis of which indicated the number of police seizures of the drug increased by 30% from the 2018 According to Home Office figures, while the overall number of drug seizures by police fell by 2% in 2017-18, officers carried out 653 confiscations of ketamine in 2017-18, up from 504 the year before. This represents the third year-on-year increase after seizures of ketamine fell dramatically in 2013-14, around the time that supplies of the drug dried up following a crackdown on its production in India and it was reclassified as a class B substance in the UK. While withdrawal can be largely psychological, there can be physical symptoms, namely:

  • Agitation
  • Confusion
  • Psychosis, including delusion and hallucination
  • Loss of motor skills
  • Rage
  • Nausea
  • Decrease in respiratory and cardiac functions
  • Insomnia
  • Shakes
  • Hearing loss
  • Fatigue
  • Cognitive impairment

(Source: Despite what others may tell you: There is no safe level of drug use. Any use of any drug, whatever it is and however long someone has been using a substance. There is always a degree of risk! With Ketamine and other dissociative drugs, there are some factors which may influence the effect a drug has on someone. These can be:

  • The state of health of a patient.
  • Their age and weight
  • Tolerance (have they taken it for some time)
  • Other drugs taken at the same time
  • The amount of the drug taken
  • purity and strength of the drug
  • The environment in which the drugs were taken

There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug. How does Ketamine work in the body? There are two main ways in which drugs work in the body. They are either agonists or antagonists. The easiest way to explain this is that agonists encourage an action and antagonists stop an action. Ketamine is an antagonist. In short, it interferes with a brain chemical: Glutamate. Thus, by taking Ketamine pain recognition is reduced: Which is good as it is used, clinically for pain! For those who simply cannot access treatment, there is guidance on how to try and minimize the effects of Ketamine. While I would always recommend that clients seek appropriate, residential care, it cannot always be accessed. Thus, it is generally advisable that, if someone is concerned about their use of Ketamine but is not able to come into treatment, they should try, in the first instance, to reduce the amount of Ketamine they are using and to do so away from unsafe environments such as nightclubs. It is really important to ensure that, when using ketamine, a client is well hydrated: Before, during, and after use. Also, to ensure their nose is cleaned out after a session. As always, try not to mix ketamine with other drugs. This is especially so with other drugs that depress the central nervous system (alcohol, benzodiazepines) as these could accentuate the effects of Ketamine and put the client at serious risk of a medical emergency. When someone is injecting Ketamine, it is important to ensure that they are using clean needles. Lastly, under no circumstances should someone, under the effects of Ketamine, attempt to drive. The Scottish charity Crew, on their website, give some additional tips They recommend that anyone thinking of taking an illegal drug should spend, at least two hours researching the drug they intend to take and to eat at least two hours before. Crew also suggest testing the drug with a drug testing kit: This is invaluable advice. After all, unless you purchase something from a pharmacy, it could be anything! Their advice is also to measure doses with scales and to start low and slow with a test dose: first. Preferably with a “sober” friend who can render medical assistance, if necessary. For women, vomiting after use can reduce the efficacy of the contraceptive pill and it is advisable for men and women to think about safe sex: Ketamine can seriously interfere with decision making. There is specific guidance for those who snort Ketamine. Firstly, the drug should be ground down/crushed as much as possible. This will make it easier to judge a dose and will also speed up absorption into the body, while also reducing the damage to soft tissue from abrasion. Unlike the movies, the use of bank notes should be avoided: They can cut the nose (use a paper straw). Users should position the straw as high up the nose as possible and alternate nostrils. It is not uncommon for users to experience a “drip” at the back of their throat, and it is advisable for users to spit this out. Vitamin E oil for the nose can help to reduce inflammation. Crew also suggest that it may be useful to dissolve Ketamine in water and use it as a nasal spray. For those who choose to swallow Ketamine, the same advice applies with regards to grinding it down: as much as possible. Clinically, swallowing Ketamine, which is less common, will not have the same euphoric effect as snorting it, but will still cause damage to the bladder. Injecting Ketamine increases the risk of overdose. It can also cause soft tissue damage and life-threatening infections and abscesses. Some general advice applies to those who inject:

  • Only use new, sterile, packaged equipment. This is available free from local drug services. It is important that users fully explain to their drug workers that they are using Ketamine as it is injected into muscle, not a vein, and therefore requires larger needles. It goes without saying that needles should never be used. To do so runs the risk of HIV, Hepatitis, etc.

Contrary to myths and urban legends, injecting Ketamine does not reduce the risks of bladder damage. It has been known, for many years, that using Ketamine during pregnancy is dangerous: It can pass the blood-placental barrier. Furthermore, some recent studies have shown that use in pregnancy can affect the developing brain of the fetus. With regards to breastfeeding, this is not an area that has been widely researched. However, it is known that small amounts of Ketamine do get into breast milk. As of February 2023, there have been four reported cases of infants who did not experience side effects from breastfeeding, despite the mother being given Ketamine during labor. As with all pregnancy-related matters, mothers are very strongly advised to speak to their midwife/medical team. Every pregnancy begins with a small risk of a birth defect (around three to five percent). This is known as the background risk. Currently, there are no studies that indicate a heightened risk of birth defect in those women using Ketamine. Timeline of withdrawal It can take between three days and two weeks to withdraw from Ketamine. Usually, it is not life threatening but, at the very least, could be uncomfortable. From experience of treating patients withdrawing from Ketamine, the symptoms of withdrawal normally begin to show between 24 and 72 hours (about 3 days) after the last use.

Between 24-72 hours (about 3 days), it is not unusual for clients to have a tremor, complain of being tired, unable to sleep, being angry and depressed as well as experiencing delusions, hallucinations, feeling sick and experience fast breathing. Some clients can experience some degree of hearing loss and even double vision.

Symptoms should settle down by day four but may continue until the end of the first two weeks. After that, there could be some longer-term psychological issues. After two weeks, most withdrawal symptoms should have stabilized. However, the nerve cell damage in the brain may be permanent and certain psychological issues may persist.

While there are no recognized national, or international, guidelines of the clinical management of withdrawal it is not uncommon to provide some very short-term medications to patients to help them over the initial phases of withdrawal. However, these are adjunctive and should never be provided on a long-term basis.

As I said at the beginning, if you are an injured horse and if a vet administers it, sure: use ketamine. However, if not, it is best to avoid it. After all, a catheter bag can be for life, not just for Christmas. Why put yourself through all the pain and discomfort?

Ketamine: If you are not a horse, stay away!