Upgrade ketamine to class B, urges ACMD

Ketamine should be upgraded from a class C to class B drug, the Advisory Council on the Misuse of Drugs (ACMD) has recommended.

The recommendation follows increasing evidence of bladder damage caused by frequent use of the drug, says ACMD, as well as the growing numbers of people seeking treatment for ketamine-related problems – up from just over 100 to more than 800 in the five years to 2010/11.

The drug was controlled as class C in 2006, following a previous review by ACMD, with home secretary Theresa May telling the council in 2012 that a review of the latest evidence was ‘now warranted’ (DDN, April 2012, page 4).

While the drug is used safely in ‘a number of areas of human and vetinary medicine’, says Ketamine: a review of use and harm, frequent use in high doses can cause severe damage to the bladder, urinary tract and kidneys, with some heavy users having to undergo bladder removal.

Among the new report’s recommendations are that more is done to make people aware of the long-term physical risks of frequent use, as there is ‘currently no evidence-based ketamine education or prevention work being delivered in schools in the UK’, as well as awareness raising around how ‘the analgesic, anaesthetic and dissociative effects of ketamine can potentially make users vulnerable to robbery, assault and/or rape’.

The drug should also be considered as dependence-forming for some users, it says, and wants to see treatment services ‘able to respond to this need with NICE-recommended psychosocial interventions’. Healthcare practitioners – ‘particularly, but not just, GPs’ – should also be asking those presenting with unexplained urinary tract symptoms about ketamine use, it says.

‘The harm ketamine posed to users prompted the ACMD to recommend its control in 2004 – since then, we have seen evidence of a worrying trend of serious bladder damage occurring among frequent users,’ said ACMD chair Professor Sir Les Iversen. ‘In some cases this has led to young people having their bladder removed. It is a potentially dangerous drug at high doses and with frequent use with serious psychological and physical implications for those who misuse it. That is why we have recommended it is re-classified to class B and that there is an improved public health message around the risks associated with ketamine.’

DrugScope welcomed the review but said that reclassification would not be enough to address the public health problems associated with the drug. ‘Drug users, nightclub and festival staff and healthcare practitioners all need to be better informed about ketamine, its effects and potential for dependency,’ said director of communications and information, Harry Shapiro. ‘This is especially important in general health settings when people present with unexplained bladder problems, to prevent long-term and potentially life-changing health issues.’

Available at www.gov.uk/government/organisations/advisory-council-on-the-misuse-of-drugs

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