Ketamine abuse

• Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist, developed in the 1960s as an anaesthetic
  • amongst recreational users with low tolerance a dose of 10-30mg (a "bump") will induce a mild "trippy" euphoric feeling. As the dose is increased the dissociative effect becomes more marked. It is this dissociative state that most recreational users seek when they use ketamine. This state can be reached with around 50-100mg in non-tolerant users
  • ketamine is increasingly becoming a drug of daily and habitual use amongst younger people, with elements of loss of control, compulsion and a move from social to more solitary use. These users report a rapid increase in tolerance to the drug and a distinct psychological withdrawal syndrome
    • during detoxification, severe anxiety with physical symptoms and increasing urinary tract pain may occur
    • ketamine users who are dependent may be using anything from 1-15 grams per day and suffer a range of side effects including cognitive impairment, increasingly restrictive friendship groups, vulnerability (it is impossible to look after yourself or your belongings whilst under the influence of ketamine), lack of energy, anxiety and urinary tract problems
      • Ketamine associated ulcerative cystitis
        • commoner among those who use ketamine daily or at high doses, it can also occur with lower dose recreational ketamine use
          • 1. The urinary cystitis like symptoms are caused by ulceration of the bladder. This may progress to chronic problems with a shrunken inflamed bladder and suprapubic pain, dysuria and haematuria, as well as urgency, frequency and incontinence. Ketamine and at least one of its metabolites appears to be toxic to the epithelial lining of the urinary tract system
          • 2. The renal and urinary systems may become obstructed with a gelatinous precipitate, which is probably sloughed epithelium. This may progress to a narrowed or scarred ureter with subsequent renal problems
          • 3. The biliary tree may also become obstructed and dilated
    • most users snort ketamine, but worryingly, we know there is an increase in young people injecting ketamine (intramuscular or intravenous), in the belief that they will be able to use less, get a better hit and avoid some of the adverse effects. All the usual safer injecting advice should be given, plus advice that injecting is unlikely to avoid urinary tract symptoms or K(ketamine) cramps

Reference:

• 1) SMMGP (October 2009). Network:1-3.