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