Urology departments in England and Wales have reported seeing an increase in the number of 16- to 24-year-olds being admitted for bladder inflammation associated with ketamine use.
Author
- Heba Ghazal
Senior Lecturer, Pharmacy, Kingston University
This appears to coincide with an increase in ketamine use - with the number of adults and teens entering treatment for ketamine abuse last year jumping substantially compared to even just a few years previously.
Ketamine abuse can have many affects on the bladder, causing frequent urination, night-time urination, sudden urges, leakage, inflammation, pain in the bladder or lower back and blood in the urine. These symptoms can be severe, make daily life very difficult and may even be permanent in some cases.
Ketamine was first approved in 1970 for human use as an anaesthetic. More recently, studies have suggested that ketamine used at low doses may have antidepressant effects .
But a growing number of people are now using ketamine recreationally. It acts as a dissociative drug, causing users to feel detached from themselves and their surroundings. It can produce hallucinogenic, stimulant and pain-relieving effects, which last one to two hours .
Users typically snort or smoke powdered ketamine, or inject liquid ketamine or mix it into drinks in order to experience the drug's effects . Snorting usually produces stronger effects and more noticeable symptoms than swallowing it.
Ketamine users can develop tolerance to the drug quickly, needing higher doses to get the same effects. This is probably due to the body and brain adapting to become more efficient at breaking down the drug. Frequent users often need to take twice the amount of occasional users to get the same effect.
Bladder damage
Frequent, high-dose ketamine use can cause serious damage to the bladder, urinary tract and kidneys . In severe cases, the bladder may need to be removed.
The first recorded cases of ketamine affecting the bladder were reported in Canada in 2007, where nine people who used ketamine recreationally had severe bladder problems and blood in their urine. Later, a bigger study in Hong Kong found the same issues in 59 people who had used ketamine for more than three months.
Ketamine, as with any other drug, is metabolised in the body where it's broken down and excreted in urine.
When ketamine is broken down, it turns into chemicals that can seriously harm the bladder. When these by-products stay in contact with the urinary tract for a long time, they irritate and damage the tissue .
The bladder is damaged first , because it holds urine the longest. Later, the ureters (tubes connecting the kidney to the bladder) and the kidneys can also be affected.
Over time, the bladder can shrink and become stiff, causing strong urinary symptoms. The ureters can become narrow and bent, sometimes described as looking like a "walking stick." This can lead to backed-up urine in the kidneys (hydronephrosis).
Ketamine also increases oxidative stress, which damages cells and causes bladder cells to die. This breaks the protective bladder lining, making it leaky and overly sensitive.
All these changes can make the bladder overactive, extremely sensitive and painful, often causing severe urges to urinate and incontinence .
Bladder damage from ketamine use happens in stages .
In the first stage, the bladder becomes inflamed. This can often be reversed by stopping ketamine and taking certain medication - such as anti-inflammatory drugs, pain relievers or prescription drugs that reduce bladder urgency and help the bladder lining heal.
In the second stage, the bladder can shrink or become stiff. In this stage, treatment is similar to stage one, but a bladder wash may also be required. This is where a catheter is used to put liquid medication directly into the bladder. The drug coats the bladder's inner lining, helping to restore its protective layer and reduce inflammation.
Botulinum toxin injections may also be used to relax the bladder and reduce pain and urgency. Stopping ketamine remains essential to prevent further damage.
In the final stage, permanent damage occurs to the bladder and kidneys. Over time, if the kidneys are affected, it can lead to kidney failure. Dialysis (a treatment where waste products and excess fluid are filtered from the blood) or even surgery may be required to repair kidney function and the urinary system.
Although ketamine has been a class B drug since 2014, it's unfortunately affordable and accessible - costing as little as £3 per gram in some parts of the UK. Raising awareness about the risks of ketamine use is essential to prevent these serious health problems.
Heba Ghazal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
