Recreational ketamine: from pleasure to pain

Abstract

What's known on the subject? and What does the study add? There is a very limited literature on the syndrome described in this review. The largest series comes from Hong Kong and includes 59 patients – this was largely a description of the presenting problems and established the link between these symptoms and ketamine. Prior to this much smaller case series (including one from the same group) were all that exists. An increasing number of UK urologists are reporting seeing these patients and we have formed a collaboration interested in understanding the pathology and establishing an effective treatment pathway for these patients. This paper aims to consolidate this knowledge. Ketamine has become increasingly recognized as a drug of recreational use. Individuals using significant amounts have developed symptoms including a small painful bladder, ureteric obstruction, papillary necrosis and hepatic dysfunction. The present paper examines the current literature on the relationship between ketamine use and these symptoms. Our own clinical experience and the data available clarify the causal relationship, and further data help to elucidate the mechanism of damage. On the basis of continued work and development with patients who are ketamine users we suggest an assessment and treatment regime that includes cessation of ketamine use and adequate analgesia to overcome symptoms. In conclusion, it is important for medical practitioners who encounter patients with these symptoms to ask about recreational drug use. Ketamine remains a safe and effective drug to use under appropriate medical supervision. Patients identified as suffering from this syndrome will need to be referred to a urological unit with an interest in the treatment of the condition.

Ketamine-Associated Urinary Tract Dysfunction: An Underrecognized Clinical Entity

“…A new clinical entity characterized by irritative lower urinary tract symptoms related to ketamine use among young adults has been reported recently [4,5,6,7]. The mechanism of ketamine-associated urinary tract dysfunction remains unclear.…”

Acute and Chronic Toxicity Pattern in Ketamine Abusers in Hong Kong

“…There are also features of small, painful bladder and upper urinary tract obstruction. Apart from Hong Kong, ketamine cystitis is known and reported in countries including Canada, Japan, Taiwan, the UK, and others [4,5]. The causative agent for ketamine cystitis is believed to be ketamine itself or its metabolites.…”

Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse

“…In recent years, ketamine abuse has been found to cause severe LUTSs and Hong Kong is one of the earliest countries/regions to report the newly established clinical entity of ketamine-associated uropathy. [11][12][13] Ketamine is the most popular psychotropic substance being abused by people aged <21 years in our society. 14 The aim of the present study was to investigate the prevalence of LUTSs in our adolescents and the differences between those with and without psychotropic substance use.…”