The devastating power of ketamine or how a 'safe' party drug can destroy your urinary health.

Nearly everyone who like me has travelled to the USA extensively in the past will have noticed how much the country has changed in the past decade. Gone are the days when you would only see an occasional homeless person walking around at night. Nowadays the country is flooded by both illegal immigrants (who are mostly harmless) as well as countless drug addicts. Some (like Hunter Biden) are wealthy enough to be well taken care of, but others aren't as lucky.

Apart from having to steal in order to obtain their drug of choice, they are also ruining their health. This is called the 'opioid crisis' for real, and an utterly tragic one most of all, because many of these addicts started as regular patients who simply were suffering from intense pain.

Fentanyl is the best known of those drugs that kill, but ketamine is less well known. To my shock and horror, we have our own fair share of ketamine addicts in the Netherlands as well. Here, due to a less lax prescription policy among physicians, most become addicted in the 'party scene'.
Nonetheless, ketamine on which I want to focus is a highly addictive drug, which also ruins people's health in an amazing fast pace as soon as people need several grams of their drug of choice. More specifically it ruins their urinary health, and quite a few young people end up having to wear a stoma.
The most sorrowful takeaway from listening to the podcast below was how the chronic addict got severe urinary problems and was in constant pain due to his abuse, but then used ketamine to lessen the pain!

For those who can understand Dutch : "de verwoestende kracht van ketamine"
Let's find out more about ketamine!

What is ketamine?

Ketamine was first developed around 60 years ago. Initially, it was used mainly as an anaesthetic for animals. However, since its development, it has proven useful in other healthcare settings.

These days, ketamine has several medical purposes:

• as a general anaesthetic, to put people to sleep for surgery
• as an analgesic, to provide relief from pain
• as part of a specialist treatment programme for depression

Why do people take ketamine?

As Ketamine became more popular in the medical world, it gained interest as a party drug. You may have heard people calling it by its other street names: special K, Kit-Kat, Vitamin K, Cat Valium, or Dorothy.
It is especially popular in the club scene among young adults.

People first started using ketamine as a recreational drug in the 1980s. At the time, people mistakenly thought it was less dangerous than other “club drugs”.
Ketamine is a dissociative drug. This means it acts on the receptors in our brain and makes reality appear distorted. Taking ketamine can lead to certain effects some people find pleasurable. For example:

• a feeling of disconnect from reality and its problems
• experiencing visual or auditory hallucinations (seeing or hearing things that aren’t there)
• decreased sensitivity to pain

Ketamine is defined as a dissociative anesthetic due to its sedating effects, which produce an out-of-body experience where users feels detached from themselves and their surroundings. Ketamine also distorts the user’s perceptions of sight and sound and can make it difficult to move.
Typically, the high lasts less than an hour.

At extremely high doses, users have reported feeling as if a “near-death experience” , an effect known as the “k-hole,” is happening. Other users report that they experience a “state of utter bliss” on ketamine. Ketamine can be used medically, sometimes to sedate children who have had adverse reactions to other anesthetic medications or in radiation or burn therapy.
It is also used in situations where sedation is necessary, but stronger anesthetics may be too much for the individual to handle.
Higher doses (typically injections) can lead to where the individual has what is described as a near-death or out-of-body experience and feels completely detached from reality. The drug can make its user feel numb, which may lead to accidents and serious injuries.

Ketamine (sold under brand name Ketalar) is a schedule III controlled substance, the same category as codeine and anabolic steroids.
Schedule III substances can lead to physical dependence, and are very likely to lead to psychological dependence.

Ketamine has a short-lived high and tolerance to the drug builds up quickly, requiring users to keep increasing quantities as they chase the initial high.
It is illegal to use ketamine without a doctor’s prescription.

Ketamine is produced as a liquid, which can be injected; it also appears as a white or off-white powder, which is snorted or dissolved in water and drank, or as a pill. It has been used as a date rape drug because it is odorless and colorless.

Ketamine effects and abuse

Quote from heavy ketamine user Chris, National Geographic video “The K-Hole”
"It’s a really ugly thing for people to look at, but you’re personally in the total state of bliss and happiness. But when other people see you, you’re drooling on yourself and can’t stand up."

Addiction to ketamine

An addiction to ketamine is difficult to overcome without help. Even when someone wants to stop using the drug, chemical changes in the brain make it nearly impossible to stop without professional help.

Once an individual crosses into the addicted state, they spend their days feeling utterly detached from their surroundings and become incapable of leading a normal and productive life. They are usually cognitively impaired at this stage, with speech and memory both affected.

Signs of an addiction to ketamine include:

• increasing the amount of use
• becoming obsessed with the next hit
• spending excessive amounts of money on the drug
• failing to keep up with responsibilities such as school and work
• building up a tolerance and needing more and more to feel a high
• neglecting friends and family

Seeking professional help is key to recovery from ketamine addiction. Treatment can help stabilize the brain’s chemical balance, making it easier to begin the psychological recovery process.

Due to the unpredictable nature of ketamine, it is difficult for the user to gauge how much is too much. Sometimes an overdose can occur after a small dose of ketamine, especially if other drugs or alcohol have also been ingested. Many accidental overdoses occur when a user attempts to reach the “k-hole.” Because it is a tranquilizer, complete loss of mobility can occur; this is especially dangerous if the user cannot ask for help. Respiratory failure is the leading cause of death from a ketamine overdose.

Other adverse side effects of ketamine use include:

• increased heart rate
• elevated blood pressure
• muscle rigidity
• respiratory issues
• flashbacks of hallucinations
• paranoia
• depression
• long-term cognitive difficulties

Physical effects from ketamine, even when the drug is taken at small doses for short periods of time, can last up to 24 hours after the last dose. Some of the common prolonged side effects include:

• loss of coordination
• stumbling
• muscle weakness

The ketamine comedown

Even after using ketamine for a brief period of time, there is a high probability that a user will experience what is called a “comedown.” The comedown is a drug-induced equivalent to a hangover and can be intense and dangerous. Since ketamine is designed as a sedative, it is very likely for users to experience intense confusion and delirium when the initial peak effects or “high” dissipates. These individuals may also experience muscle weakness, anxiety, and feelings of hopelessness and helplessness. They may also experience numbness, impaired vision, and severe confusion that often leads to aggressive behavior, amnesia, and delirium. These symptoms are more likely to occur at higher doses of ketamine, often via repeated use over many hours, or when combining ketamine with alcohol or other drugs.

Common drug combinations

Ketamine is often combined with other drugs, which can make the negative side effects of ketamine even worse. Ketamine in its liquid form can be easily mixed into an alcoholic beverage or added to marijuana joints. Mixing ketamine with alcohol or other depressants is especially dangerous, as ketamine is itself a depressant.

Combining ketamine with other depressants may lead to a serious reduction in heart rate and respiratory function.

Ketamine can also be combined with other powdered drugs such as MDMA, also known as ecstasy, pressed into a tablet form, or placed into a capsule. Mixing ketamine and MDMA can be especially dangerous, as MDMA is a stimulant and ketamine a Depressant. Other drugs that are commonly mixed with ketamine are psychedelics such as LSD and DMT.

What is Ketamine Bladder Syndrome?

Ketamine Bladder Syndrome is a bladder condition caused by the use of Ketamine.

Other names for this condition are: Ketamine-associated cystitis, Ketamine-associated urinary tract pathology, Ketamine uropathy, K Bladder
These names all refer to bladder damage from Ketamine.
Doctors documented the first case of Ketamine Bladder in 2007. Since then, healthcare professionals have been noticing many more cases.

What does ketamine do to your bladder?

In Ketamine Bladder, the walls of the bladder become irritated and inflamed. Healthcare professionals refer to this inflammation as cystitis.
It is not entirely clear why Ketamine Bladder develops. Experts believe that bladder damage occurs due to the breakdown products of Ketamine.
When someone takes Ketamine, the body breaks it down into metabolites. These metabolites leave the body via the bladder. As they come into contact with the bladder wall, they cause inflammation.
If left untreated, Ketamine bladder can have serious consequences. The inflamed bladder tissue can eventually become scarred. This is called fibrosis. Once scarred, a damaged bladder cannot be fully treated without major surgery.

What are the symptoms of Ketamine Bladder?

If you have a Ketamine Bladder, you may experience the following symptoms:

• pain on passing urine
• blood in urine
• incontinence (having accidents)
• needing to go to the toilet more frequently
• feeling a sense of urgency to pass urine (even when it hasn’t been long since you last went)
• needing to get up in the night to pass urine
• pain in the lower abdomen and pelvis area

A quote from Jamie, a heavy user : “At one point I couldn’t actually pee because my blood was clotted. I actually thought my bladder was going to explode. It was the worst pain I have ever had. I never want to feel that again. I thought I was going to lose my bladder.”

How is Ketamine Bladder diagnosed?

Ketamine Bladder was only recently discovered as a complication of Ketamine use. Because of this, there are no clear guidelines on how to diagnose it.

Determine whether you have inflammation in your bladder (cystitis)
Determine if the inflammation was caused by Ketamine use
Firstly, your medical team will ask questions about your symptoms. They will also ask questions about your life to try and identify the cause of the symptoms.

Depending on your symptoms, your medical team may feel that investigations are necessary.

While some of those investigations are as straightforward as obtaining a urine sample, others might require more preparation and possibly a waiting list.

It is important to raise your concerns about your symptoms to your GP and be transparent about your Ketamine use.

For you to be able to fully concentrate on your addiction recovery , it is advisable to get the necessary tests as advised by your GP before your admission to a rehabilitation center whenever possible.

What’s the test for Ketamine Bladder?

The following tests may be useful in diagnosing Ketamine Bladder.

Ultrasound and CT Scans
Healthcare professionals can use scans to help diagnose Ketamine Bladder. Ultrasound Scans and Computed Tomography (CT scans) can be particularly useful. These scans can look at the bladder wall for inflammation and thickening.

Cystoscopy Camera Test
Your medical team might suggest a camera test called a cystoscopy. This test involves passing a small camera into your bladder. This will allow your medical team to examine the appearance of the bladder wall. In previous cases of Ketamine Bladder, these camera tests have shown inflammation.

Bladder biopsy
During the camera test, your medical team may decide to take a small tissue sample from the bladder wall. A specialist doctor will be able to look at this sample under a microscope to help reach a diagnosis.

Urine sample
A urine sample can be particularly helpful in ruling out other causes of your symptoms. Certain markers in your urine can suggest a different cause of your symptoms, such as a bladder infection.

Depending on your symptoms, your healthcare team might also send a sample to the lab to look for bacteria or bugs.

Other causes of bladder symptoms

Other medical problems may be causing your urinary symptoms. Some of these are easily treatable, whilst others may be more serious.

Medical problems which may cause similar symptoms:

• bladder cancer
• prostate cancer
• enlarged prostate
• bladder stones
• medication side effects
• bladder or kidney infection

If you are experiencing bladder symptoms, it’s important to seek help as soon as possible. Many of these conditions can be easily treated if you seek help early.

Is there a cure for Ketamine Bladder?

Unfortunately, there is currently no established way to treat Ketamine Bladder. Treatment is focused on reducing the symptoms and preventing further damage. It is not uncommon for symptoms to fluctuate and last for weeks or even months after stopping the use of Ketamine.

Stopping ketamine use

The only way to prevent Ketamine Bladder is by stopping ketamine use completely. Stopping ketamine may be enough to reverse the symptoms. In one study group, 51% of people said that their symptoms improved after stopping ketamine.

Controlling the pain and discomfort caused by Ketamine Bladder

The other important step in treating Ketamine Bladder is controlling the pain. Your healthcare team will give you advice on painkillers.
Nonsteroidal anti-inflammatory medications (NSAIDs), Paracetamol, sometimes other medications alone or in combination can be used to help alleviate pain. For some patients, taking certain medications rectally rather than orally prove to be more helpful.
Medication to help reduce the urgency and frequency of urination can also be trialled.

Other treatments for Ketamine Bladder

Other treatment options are still rather experimental. One study showed that a treatment called botulinum toxin might be useful. You might have heard of botulinum toxin as Botox. It is often used in cosmetic procedures to relax wrinkles around the face. In Ketamine Bladder, doctors can use botulinum toxin to help relax the muscles in the bladder. This can help reduce the symptoms caused by the bladder muscles being overactive.

Surgery for Ketamine Bladder

If your bladder is irreversibly damaged by Ketamine, you may need surgery to remove your bladder.

Are there other long-Term effects of ketamine?

As more research is published, we are seeing the link between Ketamine use and a number of long-term consequences.
Ketamine use can cause long-term mental and psychological problems. These include poor mental well-being, memory issues, and even schizophrenia-type symptoms.
In terms of its effect on other organs, experts have also observed that long-term Ketamine use can also cause liver damage.

Conclusion

The perception of ketamine has shifted significantly from its origins as an animal anesthetic to its current role as a recreational drug with severe health implications. While ketamine has legitimate medical uses for anesthesia, pain relief, and depression treatment, its misuse in the club scene has led to widespread addiction and health crises, particularly Ketamine Bladder Syndrome. This condition causes severe and often irreversible bladder damage, highlighting the drug's destructive potential when abused.

The broader context of drug addiction underscores a complex landscape where ketamine, though less known than fentanyl, contributes to the opioid crisis. The severe cognitive and physical impairments associated with chronic ketamine use underscore the necessity for professional intervention in addiction recovery. The unpredictable and dangerous nature of ketamine, especially when combined with other substances, further complicates its misuse.

Despite the initial belief that ketamine was a safer recreational drug, its long-term effects, including significant mental health issues and physical damage, reveal a stark reality. Effective public awareness, regulation, and treatment strategies are essential to address the growing problem of ketamine addiction and mitigate its devastating impact on individuals and society.