Yesterday’s post, which highlighted an article from the October 2014 issue of Tatler, reprised a comment from a urologist who said that ketamine ‘works like paint stripper’.

Widespread but not universal

Ketamine became popular in the UK after the Millennium and went nationwide by 2005. With so many more users — most of whom start in their late teens — urologists are seeing some disturbing cases of bladder damage. This started becoming more common as early as 2007.

Erowid tells us that, in that year, ketamine users began seeking medical help for such complaints. Ketamine is popular not only in Western countries but also in Asia. Erowid‘s research on ketamine tells us that a Hong Kong study revealed that the median age of the patient was 22 years. The site emphasises that between 3.6% and 12% might experience lower urinary tract symptoms (LUTS). Therefore, whilst not everyone will have these problems, no one is certain as to who will have them and when.

Erowid adds that it is unclear why such cases are increasing in number. It is not just the ketamine user who buys locally or on the internet. People whose doctors prescribe a short dose of ketamine for medical reasons — pain relief, depression — have also experienced bladder difficulty. These patients normally recover after they stop taking ketamine.

Case study

in 2011, BJU International, a journal for urologists, featured an article on ketamine’s effect on the bladder. It recaps a 20-year old man’s case and treatment. In his case, kidney and digestive functions and tests were normal. The site also has photos from the scans — instructive and good for adolescents to see.

Excerpts follow, emphases mine:

Cystoscopy under general anaesthesia revealed a small capacity bladder (less than 100mls). The bladder mucosa was friable and appeared to be “tearing” with distension. Due to persistent bleeding and mucosal tearing on distension the procedure had to be abandoned and a bladder biopsy therefore was not performed. The patient was then catheterised and treated conservatively.

Based on the cystoscopic findings a bladder perforation was suspected and a post operative CT scan was performed to confirm the diagnosis. The CT scan showed free fluid and gas in the pelvis. There were locules of gas and extensive haematoma within the bladder suggestive of an extraperitoneal bladder perforation (Figures 1 and 2).

A more detailed history at this point revealed that he has been abusing ketamine intermittently as a recreational party drug (not daily usage). His weekly consumption of ketamine was variable and the patient was unable to quantify the amount used. His haematuria settled with conservative management. The catheter was left in situ for four weeks. At the time of discharge from hospital he was advised to stop ketamine abuse. After cessation of ketamine abuse and catheter removal he reported remarkable improvement in his symptoms. There was no further recurrence of haematuria. One year after discontinuing ketamine abuse he has ongoing frequency which he does not find troublesome.

Once his symptoms resolved a repeat cystoscopy and bladder biopsy under general anaesthesia and a frequency volume chart to assess functional bladder capacity were recommended. However the patient repeatedly failed to respond to our requests to attend urology department for further evaluation. He was subsequently discharged from follow up.

Hospital study of patients prescribed ketamine

A thesis paper by Khurram Shazhad attempts to make sense of ketamine’s effect on the bladder. He was part of a team that conducted a study at James Cook University Hospital in Middlesborough. The study examined tissue from patients who had been prescribed ketamine (‘analgesic ketamine’).

Shazhad concludes (p. 85) that the casual user’s bladder problems may heal by themselves once ketamine use stops.

Patients taking analgesic ketamine may experience problems within weeks or months. One patient who had been prescribed ketamine over a period of three years required surgical intervention. Shazhad’s paper also posits that increased concentration and daily use of ketamine may exacerbate bladder problems.

Symptoms to watch for

A 2013 article from The Mirror reported findings from prominent urologists and other physicians who hoped to persuade the British government to reclassify ketamine from a class C to a class B drug. Home Secretary Theresa May did so in 2014.

The article reveals what the symptoms are and how they are treated:

ACMD member Dr Paul Dargan, consultant physician and clinical toxicologist at Guy’s and St Thomas’ NHS Foundation Trust, is preparing a report for the Home Secretary to be released shortly.

He said: “The main area where there’s significant evidence is around bladder toxicity. There is clear evidence of significant bladder toxicity in those who are regular high dose, dependent ketamine users with potential severe and disabling symptoms.

“Significant pain is often a feature which may lead users to take higher doses of ketamine to treat their pain, and therefore a vicious cycle is developing of pain leading to more ketamine use, leading to more bladder damage, passing blood in the urine, having to go to the toilet frequently and having incontinence.”

He added: “Those who have severe bladder symptoms may require significant and life-changing surgery that can include removing the bladder and ending up with a bag to pass urine into, or diversion of the urine into the bowel. Clearly that’s a significant thing for a user to have to end up with.”

Dr Dargan said users across the age-spectrum are having bladders removed, including people in their “20s, 30s, 40s and 50s”.

A young woman described her urinary tract damage after several years taking ketamine (see last comment). She passed jelly-like tissue and blood clots. Her doctor told her that ketamine was altering the inner tissue of the bladder; the jelly-like substance was the affected tissue. The woman was urinating every 10 minutes. Now, having stopped taking the drug, her bladder has healed. She can hold her urine for five or six hours.

A young man writing anonymously for The Guardian tells us:

After about two years of using ketamine, I was spending more and more time in the toilet, and urinating was beginning to hurt.

I developed a stoop because my penis was always burning. One day, on a train, I had my first cramp attack; I thought my lung had collapsed. I went to a doctor, who told me to stop taking K or I would die, but then an older user told me not to worry, it was “just K cramps“. He said that they wouldn’t kill me, but I might wish that they would. Apparently they could last for days.

I still didn’t stop. The cramps got worse, the blood and mucus began to appear frequently in my urine and I had to pee every 20 minutes. I lied more than I told the truth, particularly to my girlfriend, and I hated myself. I couldn’t stand to be around myself and wanted to cause myself harm. K worked on both fronts.

Graphic photos of ketamine-related bladder treatment

In 2013, the BBC aired an anti-drug programme called Old Before My Time.

One of the addicts featured, Chris from Hampshire, had to have bladder surgery and a catheter put in place. He was only 23 by the time this happened. He began smoking dope when he was 12 and moved to ketamine in his mid-teens.

By the time he was 17, he had problems urinating. He ended up with the bladder of an 80-year old and required drastic surgery.

Any youngster who thinks ketamine won’t harm them really needs to see the Daily Mail‘s pictures of what Chris looks like today and the ongoing treatment he needs to undertake.

The Mail describes — with the aid of documentary stills — what he has to do for the rest of his life:

Although he has a new bladder, he is by no means free of health problems.

Every two weeks he must insert a catheter – a thin, flexible tube – into his belly button and syringe out mucus sitting in his bladder.

Viewers see the stomach-turning moment where the mucus fills the syringe attached to the tube in his stomach – a far cry from the hard core raver he once was just a few years ago …

A normal bladder can hold up to 500ml – but Chris’ could hold just 5ml.

Normally, the bladder wall expands when filled with urine and contracts when emptied.

But extreme ketamine use can cause stiffness and scarring in the bladder walls which means it can only expand to a tenth of its normal size.

To avoid a lifetime of incontinence, Chris had two options. He could have a bag attached to his hip – or have his bladder removed totally and a new one made from his bowel – surgery typical in someone 60 or 70 years of age.

He went for the latter – but must now syringe mucus out of his bladder for every two weeks of his life.

His days of playing rugby are over and he is at risk of dangerous kidney infections.

His new bladder won’t forever, either – he will need it replacing again in 20-30 years.

It’s nothing short of tragic.

Memory loss

The Mail article also looked at Dave’s case, featured in the BBC documentary.

Extensive ketamine use has left Dave with a form of dementia more common to elderly people.

Ketamine blocks certain brain receptors.

Today, Dave has problems with memory recall: words beginning with ‘f’ and remembering the names of fruit, to name but two.

At the time the documentary aired, Dave wasn’t yet able to stop using ketamine, although he said he was only taking it once a month. Yet, tests show that he must stop completely for the sake of his cognitive abilities.

Conclusion – make sure young people understand the dangers

The aforementioned anonymous writer for The Guardian (who has now gone back to smoking pot, although he is working and recovered) says:

people should know what they are dealing with. By the time I did, it was too late. There is so much media coverage of illegal drugs, yet K is rarely mentioned, although it is everywhere and spreading fast. Most people who try it won’t develop any major problems, but a minority of users get very sick. A friend of mine lost so much control over his bladder that he had to have a catheter fitted when he was 21, and there are going to be a lot more cases like this. He didn’t know it was addictive either.

Ketamine is not a safe drug, by any means.