‘We believe the greatest respect we can pay our clients is to listen,’ Lisa Ogilvie, a psychologist with Acorn Recovery Projects, told the conference. ‘Without the notion of applied expertise, but rather with the intent of learning to be better’. This had been her organisation’s response to the growing demand it was seeing for residential rehab places for ketamine use disorder (DDN, June, page 10). ‘Speaking to our ketamine clients to better learn how we could support them.’
Clear themes had started to emerge, including ‘the acute embarrassment they felt with their bladder issues, which were severely impacting their dignity and self-confidence.’ Acorn had implemented measures such as flexible comfort breaks and more comfortable seating arrangements, but there was one theme that continued to stand out – the lack of relatable peer connection, she said.
UNMET NEEDS
‘Our young ketamine clients didn’t have an outlet where they could go and talk about their sensitive health and social issues with people they could relate to. This saw the inception of our Ketamine Care Hub in Stockport – the first of its kind in Greater Manchester and, to the best of our knowledge, the North West of England and potentially further afield as well.’
The clients had been instrumental in establishing and shaping what was now a very successful care hub, she said. ‘Already in the short amount of time it’s been running we’ve been seeing some great successes, including one of our clients, Ethan, returning home and opening an equivalent service in North Wales.’
‘This time last year I was eight stone, isolated, suicidal, riddled with depression and anxiety,’ said Finn, a founding member of the Stockport hub. ‘I had kidney pains, liver pains, there was blood every time I went to the toilet, broken relationships and friendships – everything that comes with ketamine addiction. I thought it would take my life, or I’d take my own life.’
After a ‘messy’ recovery journey, Acorn had changed his life, he said. ‘We saw the need for peer-led support groups specifically for ketamine, which is something I hadn’t found in my years of trying to get clean and sober. So we set it up.’ The level of need meant that there was now a widespread network of users, ex-users, family and friends. ‘It’s an amazing community where people can ask questions and share experiences, and we also work one-to-one with young people for local services.’
MULTI-FACETED APPROACH
The complexity of what ketamine did to the body needed to be understood, said clinical lead at Delphi Medical, Dr Abida Mohamed. ‘It affects so many different organs. The need for services is vast, and we need to look at multi-faceted approaches to tackle this problem. Otherwise it’s really going to end in a lot of devastation.’
In 2023 Blackpool’s Adolescent Drug, Alcohol and Sexual Health service (ADASH) had approached her at the local Horizon service, as more and more of the young people they were dealing with were presenting with pain and bladder issues as a result of their ketamine use. ‘They didn’t know where to turn.’
The young people felt dismissed by their GPs, she said. ‘The GPs would Google what ketamine was in front of them’, and offer either unsuitable pain management medication or treatment for UTIs they’d tested negative for. ‘So we thought, let’s go to the base of the problem – education and GPs. We looked at four things: information – ‘assume they know nothing’ – harm reduction advice, clinical presentations, and communication. Young people want to trust that you’re listening to them.’
EFFECTIVE PATHWAYS
When the young people were referred to hospital there was often a waiting list of up to two years, she said. ‘We know that with long-term use you cause irreversible damage, so what use is that referral? So we needed to look at effective pathways. With persistence and many emails we approached pain management and urology and got two consultants onboard.’
It became apparent that the young people also had a wide range of other problems, she said – mental health, schooling issues, losing contact with their families. ‘So we decided to do something different – let’s have an out of this world, wish list expert MDT [multi-disciplinary team] panel. And we did it.’
ADASH was the nucleus, but the level of need and the fact that local services of all kinds were struggling to manage young people with ketamine issues meant that others were eager to get on board, she said. ‘Now we’re adding housing, harm reduction, public health.’ Multi-agency working was proving effective, with many decisions being made on the day, she said.
‘Moving forward we’re looking at developing guidelines, streamlined pathways, access to funding and dedicated clinics,’ she told the conference. ‘The key message for me is that we need to work together and listen to young people. If we don’t listen we’re not going to get them on board for the treatment they need. Trauma-informed practice is essential, and when the motivation for change is there from this young person it’s our responsibility to make sure that everything is streamlined so we seize that opportunity for change. The ketamine tsunami is here, so either we prevent a catastrophe or we deal with the consequences later.’
SOCIAL DAMAGE
On the subject of consequences, drug and alcohol policy was an issue where attitudes were ‘often sadly shaped by political prejudice and ideology,’ MP for Easington and chair of the Drugs, Alcohol and Justice APPG, Grahame Morris, told delegates. ‘The desire to seem tough on crime, rather than support people going through a health crisis.’
The reality was that there were more votes in the ‘arrest, prosecution and throwing away the key approach’, he said. ‘This is not only short-sighted, it’s morally bankrupt – and economically and socially damaging to communities like those I represent.’ International evidence showed that ‘treatment, not punishment’ was the way to address addiction and reduce harm – both to individuals and the community, he said. ‘Our objective in the APPG is to be your voice in parliament, bringing politicians closer to providers, practitioners and the frontline, and hearing from your lived experience.’
INVALUABLE INPUT
The APPG supported the Anti-Stigma Network and had campaigned for an alcohol strategy from the new government, as well as to expand access to naloxone and increase diversion schemes. ‘Your input into these debates is invaluable,’ he told delegates. ‘It’s gives us politicians the ammunition, the evidence and the priorities we need to feed directly back to Parliament and to ministers. We need to have people like yourselves holding politicians to account.’
The UK’s approach to drug policy had remained static, he said. ‘It seems to me we’ve been repeating the same policy mistakes for more than 50 years.’ The new ten-year health strategy was a welcome step forward, ‘but it’s not all that we hoped for. So it’s up to us to demand a radical shake-up in drugs and alcohol policy, and we need your help to shape that policy by sharing information and best practice – people who provide and use services shaping decisions in Westminster. You’re the experts, we’re your representatives.’
Policy decisions needed to be genuinely shaped by lived experience, he said. ‘We need to harness our collective power. We often seem to spend too much time in dispute over our small differences in opinion when in fact we have far more in common. We all want to see improved public health services, with people at the heart of them. Let’s unite and use our collective voice to bring about change.’
Watch video footage of session two here.