LONDON — In September 2006, Peggy Sau-Kwan Chu, a urologist at Tuen Mun Hospital in Hong Kong, saw a patient in his 30s complaining of severe bladder problems. His symptoms included painful urination, incontinence and urinating every 15 minutes. He mentioned to her in passing that he had been using ketamine for the last 10 years.
Two months later a married couple — he 25, she 22 — came with similar symptoms. Chu, suspecting environmental factors, asked if they had grown up near each other, but the couple had not. Nor were they cousins, which ruled out any genetic link. They had, however, both been using ketamine for a protracted amount of time.
Chu, on the hunch that ketamine (a drug whose nicknames include K, Special K and raver’s smack) was causing these severe problems, talked to other Hong Kong urologists and found they were seeing similar cystitis-like symptoms in young patients. Working through a rehab clinic, Chu sent a survey to 97 former ketamine users asking if they had suffered the same issues — 30 percent admitted they did.
“That was when I realized that there was something seriously wrong,” said Chu, who last month presented a paper on the subject to the American Urological Association meeting in Chicago.
What Chu discovered was that heavy and frequent ketamine use inflames the bladder, shrivels the organ and eats away at its muscle, so that the bladder has trouble contracting. Almost as soon as Chu and her colleagues published their findings they said, urologists across the globe contacted them to say they were witnessing the same symptoms.
The use of ketamine — and the health problems it causes — is on the rise around the globe. In 2001 only two countries reported seizures of ketamine — which can be snorted, injected or digested — while that number had jumped to 20 by 2006, in countries from Argentina to Australia to Canada. Use in Asia is particularly widespread and there have been multi-ton seizures in China, Hong Kong and Taiwan.
“K is really taking off in some parts of the world and potentially in others but we just don’t know,” said Jeremy Douglas from the United Nations Office on Drugs and Crime (UNODC). “We need to pay attention to it and we really have to start tracking better information on the drug.”
Ketamine is fairly easily trafficked because in countries like India it can be purchased over the counter — it is used as a horse tranquilizer and in some developing countries it is used in surgery because it is comparatively cheaper than other anesthetics. It can be transported across borders in liquid form with little trouble, because it is odorless and colorless. There have been cases where traffickers have shipped liquid ketamine into a country claiming it was rosewater or massage oils.
There has been enough international concern about ketamine (along with other synthetic drugs) that last year the UNODC launched the Synthetics Monitoring: Analysis, Reporting and Trends (SMART) program to help governments track and screen information on these drugs.
“There is a lot of money to be made from ketamine, which is mostly sourced or diverted from the pharmaceutical industry, [so] it is unclear the extent to which the industry and governments want it regulated,” said Douglas, who manages the SMART program. “Because ketamine is not controlled in many markets traffickers simply have to divert some from the legal trade into the illicit trade [where] ultimately dealers can command a lot more in London from a drug user than can be made selling it for surgery in Malawi.”
Ironically heavy ketamine users may have to have surgery to remove their damaged bladders, as has happened in hundreds of reported cases around the globe. David Gillatt, a urologist in Bristol, U.K., said recently he has been seeing at least one new patient a week with bladder problems linked to ketamine.
“Surgery can affect urinary control, you could be incontinent afterwards, you may have to wear a colostomy bag, it can affect your sex life,” Gillatt said. “It’s not so much a problem if you are 65, but when your bladder is removed at 25, well some of those people are going to have big problems later on in life.”
Karen Joe-Laidler, a sociologist at the University of Hong Kong who has been researching ketamine use, said authorities have set up task forces to try to educate people about the problem.
“One of the more successful outreach programs in Hong Kong was done by a doctor who sent social workers into clubs who handed out leaflets [promoting] getting a physical,” she said. When patients came in health care workers could engage them in drug education.
Ketamine is also proving to be more neurotoxic than ecstasy ever was and there have been concerns that taking it causes depression, anxiety attacks and short term memory loss. In a recent article published in the British medical journal Lancet, ketamine was ranked the sixth most deadly illegal drug on the market — overtaking ecstasy and marijuana.
Another chief concern — this raised by British charity DrugScope — is that chronic use of the drug is on the rise. Drug caseworkers have seen an increasing number of people who have been injecting the drug because they can no longer get the same high from snorting.
Donna Stenton, a caseworker in Nottingham, U.K., told the story of one patient who didn't stop using ketamine even after being admitted to the hospital for severe bladder problems.
While he cut down on daily doses, Stenton said, “He was very much like 'I don’t want to give up using my weekend juice.'"
More on the global rise of ketamine.
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In Colombia, another sort of drug debate
http://www.globalpost.com/dispatch/united-kingdom/090505/ketamine-causes-health-problems