When it comes to ketamine detox, it’s vital to remember that one size doesn’t fit all, say Nicola Jordan, Karen Marsh, and Dr Georges Petitjean.
Inpatient detox for ketamine dependence remains relatively uncommon in the UK, and there’s limited national guidance on what ‘good’ looks like in practice. To support local learning, staff at the Dame Carol Detoxification Service in Fareham, Hampshire reviewed outcomes for a small cohort of patients admitted primarily for ketamine detoxification.
Between February 2023 and December 2024 eight patients were admitted for whom ketamine was the primary drug of use, although some also reported using other substances including alcohol, cocaine and cannabis. The cohort included five women and three men, with reported ketamine consumption ranging from three to eight grams per day. The average length of stay was just over two weeks.
All eight patients completed detoxification and were abstinent from ketamine on discharge. As part of routine care, the service completed a seven-day follow-up telephone call with each – all reported that they’d remained abstinent.
A consistent theme across admissions was the need for symptom-led, individualised prescribing. Patients received medications to support withdrawal symptoms and cravings, including treatment for anxiety and agitation, nausea, constipation, pain and – where clinically appropriate – antipsychotic medication for distressing symptoms
While cravings were commonly reported, patients generally described their withdrawal symptoms as manageable with the medication plan and staff support. One area where presentations varied noticeably, however, was bladder pain and urinary symptoms. In most cases, discomfort reduced during admission – the degree of improvement appeared linked to how impaired the bladder was on presentation. All patients reported reduced pain, or no pain, on discharge.
Even in a small cohort, the range of need was clear. Some patients required minimal medication for comfort, while others benefitted from more intensive short-term prescribing. For example, one patient was managed with promethazine and paracetamol to address symptoms and discomfort while another required up to 8mg of diazepam over a 24-hour period, reflecting both withdrawal symptoms and co-occurring issues.
This underlines a key learning point – that effective inpatient ketamine detox may rely less on a fixed protocol and more on responsive prescribing, alongside careful monitoring and adjustment.
All eight patients engaged well with the programme and cooperated with the prescribed medication regimen. Staff noted a strong rapport between patients and the wider community on the unit, with people reporting that they could speak openly without fear of judgement or stigma. Alongside clinical management, patients were supported to identify triggers, build coping strategies, set recovery goals and plan next steps and future support before discharge.
A further observation from staff was that, compared with other groups on the unit, this cohort appeared less likely to request additional ‘as-needed’ medication. Patients often expressed a desire not to become reliant on medication as a solution in itself, and instead valued practical strategies and recovery planning.
Although the numbers are small, the audit highlights the complexity of treating ketamine dependence, particularly when there is additional substance use and significant physical health impact such as bladder symptoms. The overall outcomes are encouraging – all eight patients completed detox, and early follow-up suggested continued abstinence at one week.
The clearest message, however, is that ketamine detox is not one size fits all. Positive outcomes appeared to be supported by a multidisciplinary, individualised approach, combining symptom-led medication with psychosocial support and a therapeutic, non-judgemental environment.
At the same time, bladder issues in particular may not resolve fully by the end of detox. This reinforces the importance of ongoing care, follow-up and clear onward referral pathways after discharge.
As inpatient ketamine detox becomes more common, services would benefit from clearer shared learning and, ultimately, stronger evidence to inform guidance. National monitoring data suggest ketamine-related need is increasing in England for both adults entering treatment and children in contact with specialist services.
Most people, however, will need support in the community. UK evidence on community or outpatient ketamine detox pathways remains limited and uneven, so community models now need proper evaluation, including clinical monitoring, psychosocial interventions and links to physical health input such as urology.
Tom’s Story
A 26-year-old man from Scunthorpe whose struggle with ketamine left him hospitalised with liver and kidney failure shares his life-saving story.
Tom Kirk was told in March 2024 that his bladder, kidneys and liver were functioning at 20 per cent after six years of taking ketamine. Doctors warned him that he would die if he kept taking the drug. ‘My grandma was worrying about having to go to my funeral,’ he says. ‘I was sitting there thinking that no 25-year-old should be in hospital, unable to walk like that because of drugs.’
Having first taken the drug at Creamfields festival in 2018, Tom began to struggle during the COVID lockdowns. When he returned to work, he was spending a £50 daily on ketamine – taking it before work, during breaks, at lunch, and after work. When he was made redundant, his use increased. ‘I’d try to go to sleep but I’d get up to go to the toilet every 20 minutes,’ he says. ‘I was in excruciating pain for hours and hours, sat in the shower – before going back into my room to take more ketamine.’
The drug was ‘escapism from reality,’ he says. ‘And I feel like that’s a big thing for people, especially people with poor mental health – it takes them away from the world they’re in.’ The physical toll was devastating, however. The ureter tubes from his kidneys to his bladder were blocked with infections and inflammation and he was bed-bound for two months, with nephrostomy bags in his back to help him urinate because the ketamine had damaged and shrunk his bladder.
But Tom’s story doesn’t end there. Through WithYou’s support, he secured three months in rehab, and then began attending group sessions at partner organisation, Double Impact.
Today, he works for Double Impact, running a weekly ketamine group and contributing to Lincolnshire council’s ketamine research team. Ketamine cases among WithYou’s young clients rose from under 10 per cent in 2019-20, to 23 per cent in 2024-25, and his recovery work is now about helping others like him.
‘People are struggling and they’re young people – I’m talking 16 to 18-year-olds,’ Tom says. ‘I try and tell my story to share where I’ve been and where I’m at now. It took me being in hospital for a month to get help. Recovery is far from easy. That’s why these groups are so good – these people have the same goals but come from completely different backgrounds.’ DDN
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ACMD advises government to keep ketamine as class B
Ketamine should remain a class B substance, the ACMD has advised. However, police and health professionals need better support to ‘identify, prevent and respond’ to ketamine-related harms, it stresses.
The government asked the ACMD to review the prevalence and harms of ketamine misuse and for its advice on reclassifying the drug to class A last year. ‘After examining the latest evidence, engaging with people with lived or living experience with the substance, consulting stakeholders, and reviewing academic research, the ACMD concluded ketamine should not be reclassified and should remain in class B,’ the council stated.
People with experience of ketamine use and harms said that upgrading the drug to class A would be unlikely to lower rates of use, while health and social care professionals were also largely opposed to reclassification. The AMCD report highlighted that many acute harms experienced by ketamine users ‘are likely to be significantly influenced by using other drugs at the same time, and that reclassifying ketamine in isolation would unlikely reduce prevalence or misuse’. Ketamine was controlled as a class C substance in 2006, then reclassified as class B in 2014.
Among the ACMD’s recommendations are for a national patient safety alert on ketamine to be cascaded to all NHS health organisations, and that drug services, education and social care providers, mental health services, primary care and hospitals should ‘work collaboratively to deliver holistic support’ – including drug treatment alongside specialist urology, pain management, hepatology and gastroenterology services. DDN
Around 30 per cent of CRESCER staff were people with lived experience, she said, and peer workers were involved in every project it delivered. The organisation had developed a training and labour market integration programme, partnering with Lisbon hotels and a tourism school alongside official employment and training bodies. It also ran successful restaurants as well as canteens located in the headquarters of large companies.
The programme had grown from seven to more than 150 houses over the course of a decade and now operated in three cities, with 90 per cent of those supported not returning to homelessness. It took the approach of ‘reframing’ substance use, she explained, recognising that it was a complex phenomenon. The aim was to understand the role it played in that person’s life without moral judgement, and ultimately to co-create realistic alternative pathways aligned with the person’s goals, capacities and circumstances. ‘Change isn’t imposed, it’s built collaboratively,’ she said. ‘We’re not just talking about providing a roof here, we’re talking about security, autonomy, privacy and the sense of ownership’ that came with having a home. 
Wrap around support
I joined Turning Point in 2011 as a recovery worker and started supporting on the programme. When the opportunity came to lead it, I wanted to put into practice my vision of integrating exercise and fitness with substance use recovery programmes. I’d always had an interest in personal fitness training, and by 2015 I’d become a personal trainer and was keen to bring my skills to the service. My goal was to help people move on with their lives by channelling their focus on sport and exercise. 
Structure and routine
Daniel Floyd is coordinator of the Get Connected fitness programme at Turning Point
When Kelly came to the Get Connected fitness programme three years ago, she was drinking all day and could not ‘see a way out’. She initially joined for a month and used the sessions to gain a sense of structure as she prepared to enter residential rehab for alcohol dependency.
Bridges has provided 150 bus tickets to support people to attend hospital and medical appointments.
DDN magazine is a free publication self-funded through advertising.
Shaun’s journey shows that integrating IPS with a person’s clinical treatment can help support them into sustainable employment, which is evident in Shaun’s case as he’s now 18 months into his role as a mechanic. While working with Shaun, we completed a vocational profile and focused on his preferences and skills, which initially were pointing towards being a forklift worker. 
I struggled on for a while then left to embark on vocational training. I completed mechanical and carpentry training but at the age of 18 I slipped into the wrong crowd and started recreational cocaine use – the apprenticeships were paid work, and I was free to use my money how I wanted. 
Broadway Lodge, a residential treatment centre for addiction based in Weston-super-Mare since 1974, has announced that it has successfully secured funding from The National Lottery Community Fund to continue and expand its in-person aftercare and wellbeing provision in Weston-super-Mare town centre. 
Problems like complexity and fragmented systems meant that addiction care was ‘uniquely challenging’, he said. ‘So if we’re able to utilise new technologies to help us in understanding clusters, predictions and preventing further harm, then we should welcome that.’ We all utilised AI every day, often without realising it, he said. ‘So let’s not be afraid of this technology.’ 
‘I’m going to talk about bridging a nursing capacity gap, but it could just as easily be about outreach workers, community services, or a needle exchange bus,’ said Catherine Comiskey, professor of healthcare modelling, global addiction and transformation at Trinity College Dublin’s School of Nursing and Midwifery. ‘It’s a widely applicable approach.’ 
Part of the preparation was to develop an ‘evidence and gap map’, she said. Over a four-year period the project would provide an integrated, cross-border programme of intervention research, training and skills development, working with around 1,500 people and implementing technological solutions. One challenge would be ensuring everyone in the those cross-border regions had access to the innovations, she said. ‘None of us know how this is going to work out, but we’re looking forward to learning.’ 
Many people living with addictions were digitally excluded, she said. ‘Much of that is around the cost of connectivity and data, so we looked at what the motivation would be for them to go digital. What’s the right device for them, what are their literacy levels, do they have an interest in trying to re-engage with the education system, how can we use digital to build up skills and confidence?’ It was important to always provide reassurance around privacy and security concerns, she said, ‘very much designing the whole approach for inclusion’. 
Working with staff from our clinical, pharmaceutical, children and young people and communications teams, we’ve:
DRINK AND DRUGS NEWS (DDN) is the monthly magazine for everyone working with substance use issues. 
Auriculotherapy, or ear acutherapy, was introduced to the UK in 1988 at the Gateway Clinic at Lambeth Hospital and was used widely across drug and alcohol services, including prisons, for more than two decades. In recent years, however, its use has declined. This is due to the difficulty practitioners face in presenting clinical evidence to funders, as well as restrictive local authority byelaws designed to regulate body acupuncture. 
Nick Shough is a NADA-GB registered trainer and the founder of Prick Up Your Ears CIC, 
This year’s 16 Days of Activism Against Gender-Based Violence is a stark reminder that violence against women and girls remains a crisis and that many families are suffering in silence. 
JOY ALLEN, PCC for Durham and APCC joint lead for substance misuse: Addiction is one of the biggest drivers of crime, ill health, and human misery. Behind the statistics is despair. Families are torn apart and communities are living in fear. Prevention is really important for us. The system is under unbearable pressure, especially prison and probation. Treatment and not punishment should be at the heart, and strategy needs to be re-energised after a decade of disinvestment.
PROF ADAM WINSTOCK, consultant psychiatrist and addiction medicine specialist:
JASON KEW, drug and alcohol public health specialist: I know how the law can harm people. ‘Hard to reach’ is a failure of the system. When DRD statistics came out, leaders were saying ‘we need’, not ‘what are we doing?’. Are people hard to reach – or are we hard to change?
DAVID THORNE, chair, Well Up North primary care network: 
VICKY MAJOR, nurse consultant, NHS Northumberland: We asked women using services for their feedback – on keeping women safe, child-friendly spaces, and how to lose the fear around treatment. The things that came out were fear, shame and guilt.
Through conversation with journalist and broadcaster Zoë Grünewald, three people shared lived experience of their struggles – and the things that service providers did that really made a difference. Their names have been changed to respect their privacy. 
