In the UK, ketamine use disorder (KUD) is rising in prevalence and disproportionately affecting a younger demographic compared to substance use disorders more generally. Earlier this year, the government commissioned an updated harm assessment for ketamine, prompted by a 231 per cent increase in reported use among 16-to-24-year-olds since 2013 and growing concerns about the severity of harm it’s causing.
Physical symptoms associated with ketamine use include bladder and kidney damage, incontinence, impaired sexual function, and infertility. These can emerge within just two years of use, and in the case of bladder damage can contribute to the ongoing cycle of ketamine misuse given the drug’s analgesic properties.
Depending on the severity of the KUD, healing is possible following cessation. In the worst cases, however, the damage is chronic and irreversible, which is devastating for a young adult. Compounding the issue is the psychological impact, which is exacerbated by the deterioration in mental health typically seen with addiction. There’s little doubt, therefore, of the urgency with which services ought to respond – whether by implementing preventative initiatives or providing appropriate treatment and recovery options. Determining what works for the evolving needs of an emerging population within addiction services, however, requires careful consideration to ensure that it’s effective.
AGE DISPARITIES
According to UK government statistics, the average age a person engages with addiction treatment services for alcohol use disorder is 46, and 44 for opiate dependence. This highlights the age disparity that services are increasingly seeing, with people with KUD typically presenting in their early twenties. It’s reasonable to conclude that the needs of emergent groups will be different based on factors such as age, lived experience and symptomology. Finding ways to make treatment accessible and relevant for a shifting client demographic is as important as continuing to serve the existing and better understood populations that continue to access services.
Co-producing treatment solutions that work for those they are there to help places value on respect and collaboration, empowering individuals to take an active role in their care to ensure that services are relevant, inclusive and responsive.
Given the young population affected by KUD and the rapid onset of its physical symptoms, this presents services with an opportunity to learn from client experience, and to embed ways of working that are consumer informed, adaptable and hospitable, both immediately and as a model to accommodate future populations. Perhaps it’s the greatest respect services can show their clients – to listen without notion of applied expertise, but rather with the intent of learning to be better.
This is the approach Acorn Recovery Projects has adopted in response to the growing demand they were seeing for residential rehabilitation placements for people with KUD – choosing to speak directly to service users to better learn how they can support them. In doing so, clear themes emerged – for example, the acute embarrassment clients experienced due to bladder issues, which impacted their dignity and self-confidence.
NEW PRACTICES
In response, Acorn introduced new practices to offer discreet solutions, such as providing waterproof mattress protectors and extra bedding, facilities to discreetly dispose of incontinence products, and a change in group structure so that comfort breaks were no longer scheduled but taken as needed. Ensuite room allocation was prioritised when possible, and transport arrangements were altered to accommodate the use of service facilities without having to openly request them.
Another prominent topic was the physical discomfort experienced by clients. As a result, hot water bottles were provided to ease abdominal cramping, adaptable work schedules were accommodated, and medical appointments pre-planned for client reassurance.
Cushions and more comfortable seating options were introduced, which not only helped ketamine clients participate in lengthier groups but made the therapeutic environment more welcoming for all service users. The importance of hydration was recognised, as well as how caffeine is an irritant to the damaged bladder. This knowledge was shared with new ketamine clients, and refreshment options were expanded to include a variety of non-caffeinated options. Another important theme was the limited opportunities for individuals to connect with others facing sensitive KUD-related health issues.
NEEDS RECOGNITION
This observation was not a criticism of existing mutual support groups, but rather a recognition of the need for a new solution where people could openly discuss problems with their contemporaries in areas such as their social lives, intimate relationships and personal hygiene, without fear of shame or embarrassment.
In response, and with direct input from their ketamine service users, Acorn established a ketamine support hub, providing the resources – including a safe environment and staff assistance – for this to operate. This is the first ketamine-specific community resource in Stockport, and has empowered one service user to create a dedicated ketamine service with extended outreach, including an online channel, support for families, and education services for prevention.
Acorn Recovery Projects has demonstrated an effective model of adaptation, centred on engagement with clients to inform practical, dignified, and responsive service provision. Initiatives including discreet symptom management and innovative support structures demonstrate how services can adapt to meet the specific needs of emerging client groups.
If services are to provide inclusive treatment that delivers effective recovery outcomes for all populations it’s vital that they adopt flexible, consumer-informed approaches that prioritise co-production, respect, and accessibility.
Dr Lisa Ogilvie is a psychologist working for Acorn Recovery Projects
The Acorn Recovery Projects team will be presenting on peer support for ketamine use, with young people’s insight, at the DDN Conference on 10 July.
For more information visit drinkanddrugsnews.com/ddn-conference-2025/