Ketamine danger

  • Health
  • Sunday, 20 Mar 2011

The long-term use of ketamine does not only affect users’ minds. Studies show it destroys their bladders too.

BY the time David*, 35, showed up at his urologist’s office in need of bladder enlargement surgery, it had been two years since he first experienced problems urinating. Coincidentally, it was also three years since he started taking ketamine regularly at nightclubs after work.

The memories from last year are still fresh in his wife’s mind. “At the time, his condition was really bad. He was constantly in pain, he could not eat, and he was not able to urinate, although he felt like going to the toilet all the time,” Sally* explains. “He could barely function, let alone go to work.”

David’s symptoms were a result of a damaged and shrunken bladder – a condition doctors are increasingly starting to notice in people who use ketamine regularly since reports first surfaced in Canada and Hong Kong in 2007.

“When he first started having problems, his doctor had warned him that it could be due to the drug (ketamine). But he continued using it,” Sally’s voice broke as she recalled her ordeal. “Even now, after the surgery, he is still unable to stop completely. The addiction to the drug is so strong.”

Not ‘just’ a party drug

As a frequent nightclub goer, David just wanted to “have some fun”, says Sally. He found out, soon, that those moments of ‘fun’ with ketamine turned into something he craved and depended on.

Ketamine, most commonly known on the street as K, Special K, Cat valium and vitamin K, started out as an animal sedative and a human anaesthetic agent in the 60s to 70s. However, due to its psychedelic and hallucinogenic effects, it soon became a popular recreational drug used at dance or rave parties in the 80s.

Often sold in the form of a white powder, ketamine can be added to beverages, snorted, consumed in a tablet form or injected.

“One of the myths people believe about ketamine is that it is not addictive. Just because ketamine does not usually give its users physical withdrawal, they think that they can use it and stop it anytime they like. They do not know that when they stop, they will feel uneasy,” says Pengasih president, Datuk Mohd Yunus Pathi.

This kind of psychological dependence is similar to that of smoking, or craving for certain foods and drinks, he explains.

At Rumah Pengasih, a drug rehabilitation centre run by Pengasih, roughly 10% of its monthly intake of up to 120 clients abuse ketamine.

The trends – our music, culture and lifestyle – have changed, says Yunus. With the increasing demand of modern society for its members to be confident go-getters, the drugs of choice among people have evolved from “downers” (depressants) like heroin and morphine in the 60s and 70s, to “uppers” (stimulants) like ketamine and ice (methamphetamine) today.

“With ‘uppers’, users are still functional. They think that they can do anything,” Yunus elaborates.

Effects on the brain

The effects of a ketamine “high” usually lasts about an hour, and can take up to three days for the effect to completely wear off. The effects of long-term use, however, last longer. Given time, the effects – especially on the brain and bladder – can be permanent.

As ketamine can alter its users’ state of mind, chronic users can develop some form of mental illness, says consultant psychiatrist and director of the University Malaya Centre for Addiction Science Research, Professor Dr Mohammad Hussain Habil.

Ketamine users can experience psychosis, or become paranoid and suspicious of their surroundings, he explains. As a result, they usually are referred to psychiatrists when they start to display aggressive and violent behaviour.

“Our biggest concern is the use of ketamine among adolescents, whose brains are still developing. The toxin may inflict more damage to the brain, and without early intervention, we are afraid it may result in permanent brain damage,” Prof Hussain cautions.

And the bladder

Perhaps more than brain damage, doctors are now concerned about another debilitating side effect, which is the one David has: bladder damage. “I think the trend is increasing after we discovered (the association between ketamine use and bladder problems),” says Hong Kong Tuen Mun Hospital urologist Dr Peggy Chu, the lead author of one of the first published papers on the link.

In their first paper, published in 2007, Dr Chu and a group of urologists from Hong Kong described the symptoms present in 10 of their patients who abused ketamine for about one to four years.

All of the patients described in the paper had pain and difficulty urinating (dysuria), despite having the often pressing need (urgency) to urinate frequently (once every 15 minutes). They also had problems holding their urine (urge incontinence), and when they did so, blood was found in their urine.

These symptoms are not unfamiliar to Klang Valley consultant urologist Datuk Prof Dr Tan Hui Meng, as he has seen patients with similar predicaments about 10 years ago. “We’ve seen them, but at that time it wasn’t linked to ketamine yet,” he notes.

However, as it is already well-recognised today, whenever he meets young people who come to him to with severe bladder pain, blood in their urine, and complains of the need to relieve themselves frequently without apparent reasons (infections or cancer), he will always ask them if they are abusing drugs.

“As ketamine is also a good anaesthetic, the bladder pain they feel may go away once they take more of it. And that will damage their bladder further. It becomes a vicious cycle,” Prof Tan adds.

He does not discount the possibility that other substances may also cause similar bladder damage. “One of my patients developed similar symptoms because he was consuming a tonic he was told is good for his health,” says Prof Tan.

While all of these symptoms can be caused by infections, and even cancer, Dr Chu and her colleagues did not find bacteria in any of their patients’ urine samples. What they found, instead, were inflamed, shrunken, and scarred bladders that could no longer hold normal volumes of urine.

“When people get ketamine-related cystitis (inflammation of the bladder), their bladder’s ability to hold urine can be reduced from the normal 400 to 500ml to as low as 20 to 30ml,” says Associate Professor Dr Ong Teng Aik from the University Malaya Medical Centre Department of Urology.

The scarring of the bladder and the ureters (the tubes that channel urine from the kidneys to the bladder) can cause the ureters to be obstructed, Assoc Prof Ong explains. ”When urine cannot flow down nicely, it backs up and causes the kidneys to swell. This, in turn, can cause kidney failure.”

When this happens, patients might have to undergo surgery to enlarge their bladders, or procedures to insert stents (plastic tubes) to keep their ureters open. If the damage is too extensive, some may need to have their bladders removed.

The question is, how long do you have to take ketamine regularly to experience the symptoms of bladder damage?

It is difficult to tell, because some patients report symptoms just months after regular use, while others report them only years after. And given the nature of drug addiction, this patient data may be unreliable, says Dr Chu.

From a study on 59 patients with such symptoms, Dr Chu and other urologists in Hong Kong estimates that urinary symptoms can occur in about 30% of ketamine abusers.

Are the effects reversible? It depends on how long, how frequent, and how much ketamine a person has taken. In Dr Chu’s experience, some patients who lost 90% of their bladder capacity due to ketamine use (for about six months to two years) had managed to regain about 70 to 80% of their normal bladder capacity.

“If anyone who has abused ketamine for eight to nine years develops bladder damage, it is usually not reversible.”

Stop, and don’t start

Besides the effect ketamine has on the brain and bladder, long-term ketamine users also experience gastric symptoms, nose bleeds, and abdominal pain, says Gleneagles Medical Centre consultant urologist, Dr CS Loh.

Although there is currently no data to compare the use of ketamine to other drugs, based on the seizures of the drug by custom officers, the testimonies of free availability by its users, as well as the falling street prices, there is a major problem at hand, says Dr Loh, who is also a board member of the “Drs Who Care” programme. (Drs Who Care is a Federation of Private Medical Practitioners Associations Malaysia public outreach programme to improve access and the quality of addiction treatment in Malaysia.)

Following the Hong Kong urologists’ findings in 2007, Hong Kong authorities have further tightened its laws against the possession of ketamine. “Before June 2008, it is only when you are found in possession of 25g of ketamine you can be put into prison. But after that, once you are found in possession of more than 1g of ketamine, you will be put into prison,” says Dr Chu.

In Malaysia, ketamine is categorised as a Schedule I drug in the Dangerous Drug Act 1952. This means unauthorised possession of it is illegal.

An adult can be fined up to RM100,000 or put into prison if they are found in possession of ketamine. And if caught in possession of large amounts of the drug, he or she can be charged under Section 39B of this Act, which carries a mandatory death sentence if convicted.

Also, if one is convicted of the administration or consumption of ketamine, one can be fined up to RM5,000 or imprisoned up to two years.

Despite such strict laws, ketamine is relatively easy to purchase. “I was quite surprised to find out that even a 13-year-old can buy ketamine from pushers on the streets easily,” says Prof Hussain.

Making things worse is the likelihood that young people still choose to take the drugs despite knowing the dangers of their actions. “Stay away from drugs is a slogan we can see everywhere in the country. Yet, young people are still using it,” says Yunus.

But if you are using, or persuaded to use, drugs for reasons other than helping your body heal, it may help to remember this advise from clinical psychologist and addiction counsellor Chris Sekar: “All drugs are dangerous. There is no such thing as a safe drug.”

For ketamine, there is one more reason to stop, and not to start at all: you do not want to be walking around in adult diapers at the age of 20.

* Names have been changed to protect identities.

Indicators of ketamine-associated bladder complications.

WHEN a patient is young and has no apparent reason for the symptoms below (eg. infections or cancer), it could be indicative of ketamine-associated bladder complications.

1. Lower urinary tract symptoms

Urgency and frequency: feeling the pressing need to relieve the bladder every 15 minutes or less.

Dysuria: uncomfortable or painful urination.

2. Pain

Suprapubic pain: Pain in the groin, where the bladder is located.

Middle back pain

3. Incontinence

Urge incontinence: Leakage due to inability to hold back urine

4. Urine abnormalities

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Health , ketamine , urology , bladder problems , abuse , effects


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