Ketamine was derived from phencyclidine to be used for surgical anaesthesia. The first instances of the illicit use of ketamine were reported in the 1960s, with its popularity surging in the 1990s. Crime Survey for England and Wales data has shown a rapid growth in reported use of ketamine.
Use in young people has increased by more than 200 per cent since 2013, and by 2010 26 per cent of surveyed people who used ketamine already reported urinary symptoms such as irritation and bleeding. Case reports from urology services also paint a worrying picture.
The UK government’s focus on reclassification in 2006 and 2014 without a clear commitment to public health measures has coincided with a massive increase in ketamine use in those aged 16-24. Thankfully the ACMD has recommended that the government does not reclassify ketamine as a class A drug, and we await the government’s response.
Generation K
Coact has worked with the peer pioneers from ‘Generation K’ and other experts to gather learning on ketamine, and with HIT have developed a strategic training response to ketamine dependence and bladder syndromes. There has been a remarkable range of peer responses from Generation K around the UK – Coact has now gathered these peer pioneers into a ketamine peer advisory group (K-PAG), which will be a reference point for the development and delivery of this training model. K-PAG will also support advocacy for an enhanced policy and practice response to ketamine.
‘I have worked with the amazing peer pioneers from Generation K to gather peer stories and photos that help explain the realities of the ketamine crisis to drugs and health workers,’ says Amy Massey. ‘I’m proud to carry this community learning into the ketamine course.’
A generation of young people using ketamine has been more heavily criminalised, not provided with known harm reduction advice, and left to approach drug and health services where they must often teach practitioners about their health conditions to receive help.
People with ketamine bladder syndrome are left with a life-limiting condition that can leave them locked at home close to the toilet and/or requiring surgery. The inability to manage severe chronic pain is a key barrier to securing and sustaining positive change, while peers who have achieved abstinence feel abandoned by the system and left with such limited and pain-filled lives that some commit suicide.
SO WHAT’S GOING WRONG?
- The very low cost of a complex drug with significant risks linked to regular use.
- Lack of technical understanding of ketamine and its risks among Generation K.
- The switch from liquid to crystal ketamine, and the introduction of the practice of dissolving ketamine crystal in water and heating it to dry it into a powder.
- The lack of transfer of knowledge between generations of people who use ketamine about the importance of episodic using and hydration.
- Applying more general stimulant harm reduction or recovery models to ketamine – an atypical drug requiring highly tailored harm reduction and treatment responses.
- Lack of integration between general practice, urology services, pain clinics and drug services.
- Once ‘ketamine bladder’ and dependence syndromes have become established, peers report a rapid return of symptoms and fast-rising tolerance even after several years of abstinence.
- A lack of aftercare for people who achieve abstinence but still live with chronic pain leaves them unsupported and hopeless.
- Ketamine is also increasingly cut with other substances, which can include much stronger ketamine-like synthetics.
- Increased criminalisation and lack of legal regulation of ketamine.
Knowledge sharing
Coact has developed a one-day course that brings together different stakeholders from places with significant patterns of ketamine use. The course supports practitioners, local leaders and decision-makers to gather technical knowledge, hear testimonies from Generation K, and explore these issues through evolving case studies.
Participants will learn specialist harm reduction advice, strengthen practice skills and learn strategies that support positive change with ketamine. The event will conclude with partners discussing how to strengthen their local system and response.
Ketamine is causing devastating harms, and requires specialist harm reduction and drug treatment responses. Coact has developed a course model that allows stakeholders from the same system to learn and plan together and agree on how to develop partnerships, protocols and care pathways that address the problem.
WHAT DO WE KNOW?
Ketamine was historically a relatively safe drug, that was usually high purity and had a low overdose risk. - The previous generation of people who used ketamine naturally used episodically and hydrated well, given their connections to MDMA culture.
- Ketamine is a complex drug that behaves differently at different doses, and different people require different doses to achieve the same desired effect.
- There are setting risks associated with taking ketamine in baths or showers, while driving, and there are risks of falling with high doses.
- ‘K-holing’ – a desired state for some, and an accidental state of losing control for others – can leave people vulnerable to robbery, sexual assault or rape in the wrong setting or company.
- Hydration is key while using ketamine, and for several days afterwards. This helps the ketamine residue be carried safely past the bladder and connected systems without irritating or sticking to the bladder lining – which causes ketamine-induced cystitis and longer-term bladder hardening and shrinkage.
- Ketamine tolerance rises fast within a using session. Using ketamine regularly and without breaks leads to escalating tolerance, which does not drop back without respecting the need to take tolerance breaks after sessions. People who use ketamine take a break to let tolerance drop back to base, which is part of the protective rhythm of optimum ketamine use.
- People who use ketamine heavily also experience ‘drip back’ which is the acid-based residue inside the nose falling into the stomach upsetting the balance of the stomach and being another source of pain.
- Some people with ketamine bladder and dependence syndrome have learnt how to manage their acid balance in their stomachs and to cope with bladder and stomach pain through a mix of cessation and a tailored diet.
- Psychological retraining can be required to overcome the urge to go to the toilet, which may continue beyond the resolution of the physical urological condition.
- Ketamine disconnects the conscious brain, throwing you back onto your unconscious mind which is dominated by repeating established patterns and habits. Disconnecting your conscious mind as a temporary break from reality can support exploration of consciousness and spirit – doing it on a sustained basis turns off the part of the brain that is responsible for critical thinking, which hampers discussions around positive change.
Mat Southwell is managing and technical director at Coact. Beccy Rawnsley is operations manager. Amy Massey is ketamine peer trainer.
Coact and HIT offer a one-day learning and development event bringing together 30-50 practitioners, local leaders, and decision-makers. Find out more here.