Let’s imagine a person who has never heard of ketamine before. They set off on a Google-fueled mission to educate themselves, and, being a reasonable person, they limit themselves to news articles published within the last year from a variety of large reader-base publications and other credible organisations from the UK. Within a few minutes, they’ve found the following articles:
- “Ketamine may offer hope to those with treatment-resistant depression.” – NHS: Oxford Health, September 2023
- “Warning after rise in Shropshire ketamine hospitalisations” – BBC, June 2023
- “Ketamine injections effective for treatment-resistant depression, trial finds” – Medical News Today, July 2023
- “Increase in young people taking Ketamine prompts health warning” – Devon City Council, UK, April 2023
- “Ketamine saved my life!” – Daily Mail, August 2023
- “’I lost everything’: Inside Britain’s ‘worrying’ ketamine problem” – ITVX, UK, July 2023
What would your takeaway about ketamine be if this person were you? Would you see it as a wonder drug and the next big breakthrough in the treatment of depression, or nothing more than a resurgence of a harmful banned substance that peaked in popularity in the ‘90s and early 2000s?
As with most things drug-related, the answer isn’t as clear-cut as we would hope for. While there are very credible claims that it is an effective treatment for depression, we have to come to terms with the fact that it is making a strong comeback in the UK as a harmful party drug. This time around though, it is rapidly gaining popularity among our younger citizens, with many teenagers and school-aged children experimenting with ketamine, getting addicted to ketamine, and having to face the harsh and unforgiving consequences of habitual ketamine abuse.
This article aims to give you a working overview of ketamine as a medical and narcotic drug, as well as discuss the long-term effects of its abuse, withdrawal symptoms, and treatment options.
A brief history of ketamine
Ketamine was developed in the 1960s as an alternative to PCP, which was used as a post-operative analgesic at the time. Ketamine proved to be highly effective in this role and produced fewer negative side effects. By the 1970s, it was even FDA-approved as a field anaesthetic for US soldiers fighting in Vietnam. Towards the end of the 70s, other analgesics without the psychedelic effects had been developed, and ketamine lost favour as a medical drug for the next 40 years or so. In 2019, both the FDA and European Commission approved (S)-ketamine (a similar chemical with fewer psychedelic effects) nasal sprays for treatment-resistant depression and studies into its anti-depressant properties continue today.
(Wei et al.) (Li and Vlisides).
Ketamine as a narcotic drug
Just as many other narcotics today started their lives as medical drugs with the intent of bringing hope and relief where other medicines have failed, ketamine also made the move to the streets where it’s known as ‘K’, ‘Special K, ‘Vitamin K’, and many other monikers. It’s a popular club or party drug with hallucinogenic and dissociative effects, distorting the user’s perception of sights and sounds and creating the sensation of disconnection with the body. Users report that the effects are similar to those of other party drugs such as LSD or PCP; however, ketamine trips last only 30 to 60 minutes as opposed to several hours (Drug Enforcement Agency). This, along with the fact that it’s relatively cheap to procure, both contribute to ketamine’s popularity as a narcotic drug in the club and rave scenes.
Within a few minutes of ingesting ketamine, either as a snorted powder, injected or mixed into a drink as a liquid, or smoked with or without other drugs such as cannabis, amphetamines or cocaine, the user will experience an increase in heart rate and blood pressure. Other physical effects include involuntary rapid eye movement, dilated pupils, excessive salivation and tear secretion, and stiffening of the muscles (Drug Enforcement Agency).
While ketamine abuse is nowhere near as prevalent as alcohol or opioids, there has been a noticeable and alarming uptick in recent years, particularly among those aged 16 to 24. Devon County Council saw a 53% increase in the number of young adults reporting ketamine use since 2022; Merseyside Police have hosted ketamine awareness drives aimed specifically at schools; and the Wrexham Police Department has issued a special warning to parents about the dangers of ketamine.
Thankfully, fatal ketamine-only overdoses are rare. At high doses, ketamine causes unconsciousness (known as the ‘K-hole’ among users), preventing further ketamine use. The risk of a fatal overdose increases when ketamine is taken alongside other drugs, especially depressants such as benzodiazepines or alcohol. Contaminated batches of ketamine also present a danger to users, as seen in Shropshire no more than a month before writing this article (September 2023).
Effects of long-term ketamine misuse
Ketamine is associated with a low risk of developing physical dependence; however, it’s a high-risk drug when it comes to psychological dependence. Its strong and pleasurable effects, coupled with its low price and ease of availability, lead to many users developing a ketamine substance use disorder (SUD). In the long term, ketamine abuse can have a catastrophic effect on the human body comparable to any other hard drug, including opioids and amphetamines.
Long-term ketamine misuse is associated with:
- Ketamine-induced cystitis (inflammation and damage to normal bladder function) can lead to lower abdominal pain, pain in passing urine, and needing to urinate more often. In severe cases where the bladder is damaged beyond healing, the patient might be forced to live with a stoma – a surgically made hole in the abdomen that allows body waste to be removed into a bag. Urinary tract complications are the most commonly reported serious side effect of ketamine abuse, leading to the coining of the term ‘ketamine bladder syndrome’ (Pappachan et al.).
- Liver and gallbladder dysfunction. Ketamine is metabolised (broken down) in the liver and the metabolites are excreted into the urine and bile. These toxic metabolites can cause liver fibrosis (Wong et al.), an excessive accumulation of scar tissue that may lead to serious health effects such as cirrhosis, an increased risk of liver cancer, and varices.
- Cerebral atrophy or ‘shrinking of the brain’. A 2022 systematic review published in Frontiers in Neuroanatomy found that persistent recreational ketamine misuse is associated with lower grey matter volume and weaker connections in white brain matter (Strous et al.). Both of these findings indicate that ketamine abuse may lead to cognitive decline, including memory impairment, attention deficits, and an increased risk for psychotic symptoms such as hallucinations and delusion.
Long-term ketamine abuse is also associated with dependence, addiction, and tolerance.
Ketamine withdrawal symptoms, timelines, and treatment.
Unlike opioids or benzodiazepines which very quickly and effectively form physical dependencies and are thus associated with extreme withdrawal pain and discomfort, ketamine is more associated with psychological dependency. While going through ketamine withdrawal is still uncomfortable, it doesn’t usually require full-on medical supervision or intervention the way that codeine or other opioids do. You can see a rough breakdown of the commonly experienced ketamine withdrawal symptoms, their timelines, and treatment options below.
| Timeline | Withdrawal Symptoms | Treatment of symptoms |
|---|---|---|
| First 24 to 72 hours | Anxiety
Sweating Fatigue Increased Heart Rate Increased Sensitivity to Pain |
Rest
Hydration Supportive Care |
| 3 to 7 days | Ketamine Cravings
Irritability Sleep Disturbance |
Counselling/Therapy for Cravings
Sleep Aids as per Physician’s Recommendation |
| 2 weeks and beyond | Persistent Cravings
Depression Cognitive Difficulties |
Ongoing Counselling/Therapy
Antidepressants as per Physician’s Recommendation |
When discussing drug withdrawal of any kind, it’s important to remember that there are a number of factors that influence exactly which symptoms the patient might experience and at what level of intensity. Patients with similar health and abuse profiles might experience different symptoms at different intensities and timelines for reasons that are unknown and unpredictable in advance. Before undergoing any sort of drug detox, please consult with a physician for advice on what to expect and techniques or medications to deal with the symptoms.
Gladstones Clinic Ketamine Addiction Rehab Treatment
After more than two decades of helping people recover from every type of addiction you can imagine, it’s fair to say that Gladstones Clinic has our finger on the pulse of what is happening in the world of drug abuse, and in recent years we’ve noticed a sharp uptick in the number of people approaching us for help in beating their ketamine addiction. While we’re always grateful for the opportunity to help people turn their lives around – many of our addiction specialists have first-hand experience with addiction having beaten their own – it is worrying to see the number of families contacting us looking for help for teenagers as young as 13.
Unless taken as a prescribed treatment for depression, ketamine remains a dangerous and harmful drug in the hands of a teenager. Teens who get caught up with ketamine run a dangerously high risk of developing serious health and developmental problems, including irreversible organ damage and neurological changes that could scar them for life. Seeking help from a recognised and reputable organisation before permanent damage is done will undoubtedly pay dividends for the rest of their lives.
Gladstones Clinic offers residential addiction rehab centres in London and the Cotswolds. Our modern approaches to addiction treatment and wide range of supplementary therapies both contribute to our high success rate in treating all types of addiction in all types of people. You’re welcome to visit our Rehab for Teenagers page to learn more about our experience in helping teenagers reclaim their lives and giving them the tools, information, and inspiration needed to become happy, healthy, and well-adjusted adults.
Please contact Gladstones Clinic at 0808 258 2350 or through our portal for an obligation-free discussion about ketamine abuse and our residential treatment options.
Other useful family links:
Works Cited
Drug Enforcement Agency. “Drug Fact Sheet: Ketamine.” DEA.gov, 2020, https://www.dea.gov/sites/default/files/2020-06/Ketamine-2020.pdf. Accessed 21 September 2023.
Li, L., and P. E. Vlisides. “Ketamine: 50 Years of Modulating the Mind.” Frontiers in Human Neuroscience, vol. 10, 2016. Frontiers, https://www.frontiersin.org/articles/10.3389/fnhum.2016.00612/full. Accessed 21 09 2023.
Moore, E., et al. “Extended Duration Ketamine Infusions in Critically Ill Children: A Case Report and Review of the Literature.” J Pediatr Intensive Care., vol. 10, no. 3, 2021, pp. 221-227. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354343/. Accessed 20 09 2023.
Pappachan, JM, et al. “Multiorgan dysfunction related to chronic ketamine abuse.” Proc (Bayl Univ Med Cent), vol. 27, no. 3, 2014, pp. 223-225. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059572/. Accessed 21 09 2023.
Roxas, N., et al. “A Potential Case of Acute Ketamine Withdrawal: Clinical Implications for the Treatment of Refractory Depression.” The American Journal of Psychiatry, vol. 178, no. 7, 2021, pp. 588-591. Psychiatry Online, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20101480. Accessed 20 09 2023.
Strous, JFM, et al. “Brain Changes Associated With Long-Term Ketamine Abuse, A Systematic Review.” Frontiers in Neuroanatomy, vol. 18, no. 16, 2022. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8972190/. Accessed 21 09 2023.
Wei, Y., et al. “A historical review of antidepressant effects of ketamine and its enantiomers.” Pharmacology Biochemistry and Behavior, vol. 190, 2020. Science Direct, https://www.sciencedirect.com/science/article/pii/S0091305720300289?via%3Dihub. Accessed 21 09 2023.
Wong, G., et al. “Liver injury is common among chronic abusers of ketamine.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, vol. 12, no. 10, 2014. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/24534547/. Accessed 21 19 2023.
