The growing popularity of ketamine use is not matched by knowledge within treatment services. Sara Woods went to harm reductionists Mat Southwell and Amy Massey for some clear and informed advice. Ketamine is popular in a few regional pockets in England. It is particularly prevalent at squat parties in the big cities and the more rural free parties in the west and east of the country – events usually held in a field or barn, where a generator pumps electronic music. The larger parties can go on for three days as long as the police don’t come. Partygoers often use cocaine, MDMA, LSD or ketamine, with the combination of cocaine and ketamine (CK) becoming increasingly popular. The ketamine is snorted in quantities that vary from person to person, but this can mean taking up to 10g at one party. The authorities have prohibited ketamine, but do little to inform about it, and support services for this user group are scarce. Users are often unaware of the substantial medical risks they are taking and the measures they can take to decrease such risks. Besides, many users do not seek help for serious complaints, because they feel misunderstood by medics and other support services. This all gave plenty of reasons for K-users Amy Massey and Mat Southwell to take action. Together with other K-users, these harm reduction activists aim to improve information exchange and access to healthcare and other services. Harm reductionists Mat Southwell and Amy Massey Mat has been an active harm reductionist since the 1990s. As a representative of the Dance Drugs Alliance, he was committed to the interests and health of clubbers, and has also been involved in the development of a professional response to crack use. They developed a simple checklist for GPs, which breaks down predominant crack-user issues into primary health problems and makes it easier for GPs and drug users to talk to each other. ‘They often have a mutual fear of each other, but such a list gives practical handholds in consultation and brings the two closer together,’ says Mat. A similar checklist has been developed for ketamine – the ‘K-check’. Users can bring the K-check along to their GP visit. In the meantime, the government is not taking responsibility. According to Mat the national government says it’s a regional problem, and local addiction treatment centres do not have the capacity to get involved. This is a big problem, because even though the group of problematic users may be small, they are suffering serious physical and mental consequences. In the most extreme cases, people in their twenties had their bladder removed. ‘These users are being neglected. There is barely any information on how to reduce risks,’ he says. Moreover, in 2014 ketamine was further criminalised, resulting in higher penalties for possession, which – as predicted by expert advisors on the topic – only worsens the situation. As Home Secretary Theresa May opted for increased criminalisation of ketamine use against the advice of the ACMD working group. ‘I gave evidence to the Advisory Council on the Misuse of drugs working group on Ketamine,’ says Mat. ‘It was called by Theresa May, then home secretary, to advise on the ketamine situation. My evidence said problems arose after criminalisation and that more criminalisation would deepen problems. But ketamine was further criminalised regardless. The view of key people in the working group was that Theresa May decided on a path of more criminalisation before they reported. This is what has resulted from a political move to be seen as tough on drugs regardless of actual impact of policy.’ For a while Mat distanced himself from ketamine harm reduction, hoping that others would pick it up. Sadly, this did not happen. And then, in 2016, Amy contacted Mat. She had watched one of his online videos on ketamine and came with a cry for help. Amy is 28 years old and has been using ketamine for around seven years. Through her personal party network she already knows about 100 to 200 ketamine users, many of whom now have serious health problems – bladder and kidney trouble, mental health issues, and terrible pains in the stomach, known as ‘K-cramps’. ‘A lot of the people I know walk around with severe pains for a long period of time, because they do not get any help, and they use more ketamine to soothe the pain – something that usually only exacerbates the problem’ says Amy. She too has sought medical help several times for her K-cramps, and often medics had no idea what to do with her problem. Twice they even prescribed painkillers that worsened the situation. Not just the emergency services, but also urologists – who usually treat much older people – are struggling with this patient group. Even the addiction treatment services often have too little specific knowledge of ketamine and offer standard treatments – such as the 12-step-programme – that do not address the demand and needs of most ketamine users. As a result, many K-users have little trust in medical or drug services, leading them to walk around with problems for unnecessarily long periods. Thus, Mat and Amy came up with the peer project ‘Straight from the horse’s mouth’. The project aims to provide users with better information about safer use, but also to improve access to care. Amy knows many users, Mat knows many professionals. Together they build bridges and create a space where K-users are not judged, and where they can learn. ‘Medics often have little understanding for continued drug use, despite the harm people inflict upon themselves,’ says Mat. ‘In our project, users share their experiences and knowledge with each other. They respect each other. If someone pees a lot or has blood in their urine, that person is stimulated to go and see a medic. That way chronic bladder disease – or even worse, the removal of the bladder – can be prevented.’ Practical advice on safer K-use is also exchanged. ‘For instance, before snorting ketamine it is much better to grind the crystals with a pestle and mortar, rather than heating them’, Mat tells us. ‘Because when you heat the crystals you lower the quality of the drug, and bacteria are released. Also, many problems can be prevented by drinking plenty of water during and after use, so you rinse the ketamine out of your body.’ Amy and Mat started a secret Facebook group with around 50 members so far. It is a safe space where ketamine users can share their health problems and advice with each other. ‘On YouTube we want to start a talking heads video dialogue between peers and professionals,’ they say. ‘We hope that commitment to the project will increase through social media, such as Facebook and YouTube. Soon the first YouTube video will be available online. In the future, we are hoping to offer even more, such as an online learning environment and meetings.’ If you are an experienced ketamine user interested in exchange on this topic you can contact Amy Massey or Mat Southwell by sending them a message via Facebook. Sara Woods is project leader for the Amsterdam harm reduction organisation Mainline. Sara Woods is project leader for the national department of Mainline, a harm reduction organisation based in Amsterdam, which works nationally and internationally to promote health, rights, and quality of life for drug users. This article is a version of Sara’s Dutch article, published in Mainline Magazine.