What is Ketamine Bladder?

Ketamine or Special K is not new. It’s been used recreationally for a long time as a dissociative hallucinogenic agent and for those interested in LGBTQ+ health, is commonly used in the Chemsex context. However, it also has important medical roles as an anaesthetic and with a rather convincing evidence-base in treatment-resistant depression. But used in the wrong way, it can be far from harmless.

New government figures estimate that ketamine use in England and Wales has doubled since 2016. Unfortunately the wide ranging complications of chronic ketamine use is something I regularly see on call in my clinical practice and in the news this week is the famous but poorly understood K bladder, or as it should be known, ketamine-induced cystitis.

It’s just awful. It causes pain (which can then lead to more ketamine use for its pain-releiving properties), blood in the urine, and scarring that can shrink the bladder, make you need to pee every hour and in some cases, it needs surgical repair. The understandable concerns about K bladder also account for why there is reluctance to make ketamine more accessible as an antidepressant.

So what is the solution? First of all a greater understanding of how ketamine works and its effects on the body so professionals can spot it, and know wnat to ask as part of a broad and holistic assessment. Secondly, we need community drug and alcohol services to think beyong alcohol, opioids and crack cocaine which is the mainstay of what it supports. We not only need more resources to support people, but more catered knowledge to go with it.