Non-opiate pathways are now a core part of how many drug and alcohol services operate, reflecting the reality that service users present with a wide range of substance-related needs. When we talk about ‘non-opiate’, however, we often default to the usual list: cocaine, crack, MDMA, cannabis, mephedrone, amphetamine, methamphetamine … the list goes on. All of these arguably demand their own tailored interventions – but one drug in particular is forcing us to fundamentally rethink the way we respond and the conversations we have. That drug is ketamine.
Over the past few years, ketamine use has increased markedly across many parts of the UK. Despite this, the predominant focus – in the media, in conversations in schools, and even in some professional settings – remains on the long-term urological and gastrointestinal damage we associate with chronic use. Yes, ketamine bladder syndrome and other physical harms are very real and absolutely deserve attention. We shouldn’t minimise or dilute those risks. But we do need to ask an equally important question: how do we engage people before that point?
SWITCHING OFF
Right now, many younger and recreational users tell us they ‘switch off’ the moment they hear someone start talking about catheterisation or permanent damage. Not because they don’t care, but because it feels too far removed from their current experience. In their world, ketamine is something used socially, at house parties or festivals, sometimes alongside alcohol or stimulants. Platforms such as TikTok are full of content highlighting ‘how to spit out the drip’ and ‘keep it under control’, often reinforcing the idea that harm won’t happen if you follow these informal rules.
The danger is that the narrative becomes split into two extremes: either it’s ‘totally safe’ or it’s ‘catastrophic’. That leaves very little middle ground for factual, pragmatic conversation – and even less space for early intervention.
This fear-based messaging also has a broader impact. Parents, teachers, youth workers and even GPs often become hyper-focused on the worst-case scenario, inadvertently reinforcing the panic cycle. Young people sense this, expect a lecture, and disengage before the conversation has even properly started. People don’t ask questions because they think they’re going to be judged.
But, as with all harm reduction work, timing and tone are critical. If we can reach people before patterns become entrenched, and if we frame the information with respect and realism, we’re far more likely to influence behaviour. People – including young people – respond much better when treated like adults with the capacity to make informed decisions. Giving clear, evidence-based information about what ketamine does to the brain (the impact on cognitive processing, memory and dissociation), how it interacts with the body (blood pressure, heart rate, digestion), and what the early signs of emerging harm look like can open up completely different conversations.
FACTS NOT FEAR
My experience of working with young people mirrors this. When offered facts rather than fear, they ask more questions. When offered support rather than assumptions, they come back with follow-up questions. Recently I spent time talking to individuals in recovery at the Birchwood Inpatient Unit – all had a consistent message: early intervention would have made a difference. Several described contacting GPs or local drug services, eager for help, only to be turned away or signposted elsewhere because those services didn’t have ketamine-specific knowledge. Others described choosing to disengage because the only support offered focused on opiate-orientated treatment pathways. For many, support only came when they were already in crisis.
KETAMINE RESOURCES
This is exactly why we’ve developed a series of resources designed to support services to become ‘ketamine-responsive’. These include:
· accessible harm reduction posters that talk about nasal safety, mixing risks and signs of cognitive impairment
· short, engaging educational videos explaining how ketamine travels through the brain and the body (aimed at both staff and the public)
· psychosocial toolkits that staff can use directly in 1:1 sessions
· guidance on adapting service pathways and assessments to include ketamine-specific questions and language.
We know that effective engagement doesn’t just come from knowing the pharmacology – it comes from having the confidence and language to hold the conversations at the right time. That confidence then filters into local communities, GP surgeries, schools, colleges, supported housing services and online spaces.
And time really matters. A proactive response gives people the opportunity to recognise changes in their own patterns and seek help early. A reactive response tends to happen only after physical or psychological harm is already present. We have the knowledge and the tools – what we need now is a collective willingness to embed them consistently across the system.
Because if we don’t, then the default route becomes the same one we’ve seen so many times before: panic, restriction, criminalisation. And we can already hear the suggestion starting to circulate: ‘Maybe it needs to go to class A – then people will take it seriously.’ Or we could listen to the evidence, treat people with respect, and respond – before the bladder. Before the cramps.
David Gill runs training consultancy Risk & Resilience
risk-and-resilience.co.uk