Inside the ketamine crisis: why young women are struggling with it
She holds on to herself, tightly, leaning slightly forward, her arms wrapped around her lower body. Spidery lashes line her doe eyes, which meet mine as she talks, slowly and quietly, with long pauses between each sentence. It’s like her words and her memories are falling out of her head, lost somewhere, with little chance of grabbing them back.
She is dressed in a baby-blue matching tracksuit set, has sliders on her feet, and her handbag – which had to be carried in for her – sits nearby. A diamante belly ring pokes out from the top of her joggers. She’s rail-thin; fragile in a way that extends beyond the physical. I fear my questions – questions pulling her into her past – will shatter her.
We don’t have much time to talk, as Kim* needs to go to the toilet every two minutes. When she does go, she tells me, a jelly-like substance, screamingly painful, leaks out of her. Her bladder is ravaged and its lining is shedding – just one of the side-effects of ketamine. The drug, she says in her soft Scouse accent, has ‘stripped me of everything’. Her life is no longer her own. She is 23 years old.
As soon as I arrive in Liverpool, my taxi driver begins to tell me how he can tell, from the moment they pile into his cab, what drugs his customers are on. Ecstasy is ‘in the eyes’, cocaine has ‘them talking all over each other’, and ketamine, he explains, is ‘all in the legs’. And over the past year, there’s been an influx of people – ‘students, mostly’ – Bambi-legging their way into his back seat. This tracks. Although ketamine has been used, both medically and recreationally, since the 1960s, over the past four years its use as a party drug has exploded. Ketamine use in England and Wales hit a record last year with almost one in 25 16-24 year olds having tried it. That’s four times higher than the levels recorded a decade ago. The numbers are growing so rapidly that leading addiction psychiatrist, Owen Boyden-Jones has labelled the addiction levels a "national problem."
Ketamine is a dissociative anaesthetic with some hallucinogenic effects, which vary depending on how much is taken. There are bumps, swiftly snorted, usually off the tip of a key, providing a wavy, dream-like state, or snorting a line, sending you into a ‘K hole’ where it can feel like you’ve departed your body and entered into a completely different realm. However you take it, time is distorted, but the effects only last 30 minutes to one hour, before you are pulled back into the room, and reality. It’s this (the short-term high and its cheap price – averaging at around £20 a gram, versus up to £100 for a gram of coke) that, I’m told, is one of the main reasons behind the drug’s soaring popularity.
While it’s mostly still known as a recreational drug, a more sinister spike in addiction has begun to emerge. Addiction pulling some, like Kim, into its grip, and refusing to release them. ‘We are seeing an increase that is growing at a rapid rate,’ explains Rehabs UK senior treatment adviser, Scott Ardley. ‘20 per cent of our weekly enquiries relate to ketamine, compared with last year, when they’d have been around 5%. The clients are normally between the ages of 16 and 23, and generally a higher percentage of females.’ Government figures show that the number of young people in treatment for ketamine problems has increased from less than 1% in 2015 to 2016, to 5% in 2020 to 2021. This year, it has increased to 6%. This is what I am in Liverpool to investigate. A place where ketamine use is rising, according to the recovery specialists at WithYou, a charity that offers free confidential support to people struggling with drugs and alcohol. Alex Lowry, the young person and family treatment and recovery manager, has let me spend the day with her and her team at the charity’s base in Garston, in the east of the city. It’s here that I meet Kim, who has been engaging with their services for the past five years, after first trying ketamine at 18. Across the country, WithYou has seen a 71% increase in the number of young people (those under 24) being supported for ketamine use during this period.
This is a drastic rise. I spoke to several experts for this feature – doctors, nurses and those who have worked in drug and alcohol misuse services for more than two decades – and all could not stress enough how terrified they are at these numbers, and the state of the patients walking through their doors. People like Kim, who are so frail and in constant pain, or others who are having to resort to using urostomy bags due to the drug’s impact on the bladder. Then there are those, some as young as 21, having to have full bladder-reconstruction surgery to try to rectify some of the damage the drug has done to their bodies. These are people, the majority of whom are in their early 20s, who, despite extreme mental and physical side-effects and a desperate desire to stop, find they just can’t.
And yet there’s a high chance when you read this, I’ll be at a festival watching keys being handed round groups in a crowd and witnessing their wobbling, cowboy-bowed legs (due to the anaesthetic effect of the drug) as they weave their way back to tents. You can’t tell anyone’s individual circumstance simply by looking at them, and not everyone who tries ketamine gets addicted. However, for those who do, its effect, from even just a few months’ use, could impact their health – and livelihood – for the rest of their lives. It can’t just be its price and quick-hit nature that pulls people in. What else is going on? What’s really behind the ketamine crisis?
Trapped in
Kim exists in her bedroom. It’s there, within those four walls, that she spends her days, thinking about ketamine from the moment she wakes up. She’s frail, in constant pain, and sleeps on bed-wetting sheets, shuffling to and from the toilet. ‘I’m like an old woman,’ she says, her bottle of watered-down cranberry juice sitting on the table in front of her. ‘I can’t go anywhere. It’s hard for me to walk a long distance, my appetite has gone. I’m always needing a wee, it’s...’ she falters. ‘It’s embarrassing to talk about.’
When Kim first tried ketamine, aged 18, she was at a party, and she liked how ‘wavy’ it made her. She doesn’t drink alcohol or take any other drugs. She was under the impression it was ‘safer’ than other drugs, due to the fact it wears off quickly. Today, when I ask her what she gets from the drug, she shakes her head. ‘Nothing.’ Her tolerance is now so high, she has to keep using more and more to get the effects that she’d once enjoyed. Details of her life (‘it’s like a circus’) are hard to come by – another side-effect of long-term ketamine use are memory gaps. ‘The damage it’s done to my body... it’s... unbelievable.’ Yet, despite having got clean for a year, and ‘hating’ everything about ketamine, Kim relapsed a few months ago and is still using today.
When I ask her what keeps her going back, she says she doesn’t know. ‘I regret everything. It’s taken everything away from me. My health – I have bladder issues, bowel issues, jelly [the lining of her bladder] comes out and I need to wee all the time. It’s even changed the way I dress, as I have to wear incontinence pads.’
Three-and-a-half hours away, in Bristol’s Southmead Hospital, consultant urologist Dr Carolina Ochoa explains to me exactly what ketamine does to the bladder. ‘Initially, it can be confused with a UTI, as the symptoms may be similar – but it’s not a UTI – it’s the fact that ketamine is excreted through urine, and when it reaches the bladder, it causes a direct inflammation. Essentially, ketamine shrinks it.’ Specialist urologist nurse Jasmine King explains that, by the time they see patients, they’re usually at crisis point. ‘They’re going to the toilet every five minutes, they’re wetting themselves, using pads and there’s blood in the urine, with excruciating pain.’ How much use causes this damage is still unclear. ‘We get a range of people who take it once and feel the impact, others who take a gram every month and some who take it every single day. We don’t know if it’s the amount, duration or a combination of both.’
With early intervention, stopping use, and, in some cases, going on prescribed medication, patients can get back normal use of their bladders. But, once it’s passed a certain point, the damage is done. ‘It’s irreversible and life-long,’ Dr Ochoa says. It’s why she and King are urging those who use ketamine, and healthcare professionals, to put two and two together, and recognise that if they’re experiencing constant UTI-like symptoms, to link that to drug use. As, they hypothesise, particularly in women who are used to having UTIs, this could be one of the reasons the patients they see are (in rough figures) around 60% women to 40% men. We delay seeking treatment as we think it’s ‘normal’.
As we speak, I’m thinking of Kim, whose biggest barrier to receiving support is her constant need to go to the toilet. The first thing she said when offered a rehab place, 50 minutes away from her home, was, ‘How will I go to the toilet on the journey?’ In the end, she arrived by ambulance. On the day I meet her she almost cancels her appointment, as she’s so anxious about getting there. What can be done so she can leave her room and start engaging with the world again? There is one thing. ‘It’s a major surgery that can increase the volume of the bladder by using a part of the bowel,’ says Dr Ochoa. It will help alleviate some of the symptoms, but it is different from the real bladder. ‘People are shocked by that; they think we can rewind time, but we can’t,’ she adds.
But in order to receive this treatment, patients must stop using. ‘We have operated on some patients who have then gone back to ketamine, and we don’t know what the outcome of that is, but it will be much worse. Bowel tissue is a weaker tissue than that of the bladder.’
However, she and King are also keen to stress that, even if patients don’t want to stop, they should still ask for help and seek medical advice as there are several options for support, with hospitals working with charities, such as the Bristol Drugs Project, which can enable them to access help, or alleviate some of their symptoms. ‘We won’t judge,’ says King. ‘We just want people to feel able to come see us, preferably as early as possible.’
It’s a similar approach at WithYou. ‘The ideal scenario is that someone will stop using,’ says Lowry. ‘But we also know that’s not always realistic, and we can help with harm reduction and reducing the amount taken, as well as accessing support.’ The support workers I met were chatty, kind, practical and pragmatic – with Kim they have tried a number of options, receiving funding for rehab and a place at a detox clinic, considering her own complex needs and figuring out solutions that help her. They understand that saying ‘just stop using’ – three words Kim has heard from her friends, family and GP countless times – is too simplistic for something as complex as addiction. And the more I learn about ketamine and its grasp, the more I understand why it is so hard to stop. It traps people in a gluey spider’s web, seemingly providing the ‘cure’ for the very problems it creates.
Down the hole
I was on a rollercoaster; one that threw me out of my seat and into the air. The stars were my only company as I gazed down at the world, far, far away from this planet and my problems. When I returned, back inside myself, I was deeply afraid. With one short, sharp line, I had slipped into a K Hole and, after that, I vowed I would never touch ketamine again. I didn’t like knowing that I could escape everything and everyone so quickly. I didn’t want to escape. I wanted to be here, on this Earth, in my body. But, when writing this feature, I revisited this experience... what if my circumstances were different? What if the escape was exactly what I felt was needed?
‘The world is a terrifying place,’ explains Ryan, who recently celebrated their 24th birthday. I found Ryan on TikTok a few months ago (under the handle @konstigo), struck by how articulate and honest they were about their experiences of ketamine addiction. When we speak, Ryan is three months clean and tells me they receive around 20 messages a day from other people on the app, worried about their own ketamine use.
‘I personally used a lot when I felt manic, or to dissociate from panic attacks, because it was able to numb me,’ explains Ryan. They first took ketamine at a party, aged 19, after being told, out of all the drugs, it was impossible to overdose on. This is not true, you can overdose on ketamine and deaths related to the drug continue to rise – in fact, warnings were recently released regarding a ‘potentially fatal’ batch of ketamine circulating in Manchester, which contained xylazine, a powerful sedative. Ryan then found their use spiralled a few years after initially trying the drug, when completing their master’s degree, after becoming friends with a ‘very weird group of people’. At the height of their use, the aim was to ‘be in a permanent K hole’. They say they now have huge chunks of memory missing from their life.
We know there’s a mental health crisis and both Ryan and Kim, after discovering the drug in social settings, soon turned to it as a form of self-medication. Kim tells me that the drug ‘blots her mind away’, and that her relapse, after a year clean, happened when she struggled mentally when her partner’s domestic abuse led to her child being taken into temporary foster care. ‘Perhaps if I’d been given proper support then maybe I wouldn’t have turned to drugs to quieten the noise,’ agrees Ryan.
It is true, that under very specific and controlled circumstances, ketamine has been found to treat mental health conditions in some patients. In the UK, a handful of specialised NHS sites and private facilities offer the drug for patients with severe depression, who have not responded to conventional treatment. Patients need to have tried at least two types of antidepressant drug and one psychological treatment, as well as having received a referral from their GP or psychiatrist, before completing a rigorous assessment process. But managing this process in professional settings with trained experts is key and everyone responds to the drug differently – for some it works, and for others it doesn’t.
While results have been promising, there is no guarantee that it will work, and the long-term side-effects are still unknown, even in clinical settings. The NHS states that ketamine is still not a licensed drug for depression for this reason. It’s also why, in the UK, clinically administered ketamine is very carefully controlled and only for those for whom no other options have worked.
Without that safety net, self-medication gets messy. ‘It’s really hard to put down a coping mechanism that you know works and exchange it for something healthy,’ says Ryan. ‘But I had no idea what I was sacrificing by using it... my bladder, my kidneys, my liver, my mind, my memories...’
‘We have every sort of story,’ explains King, of the patients she sees in Southmead’s clinic. ‘They do tend to be starting very young, and we see a lot of trauma, depression and those in grief. They’ve started experimenting with ketamine and seen that it can help in the short term.’ But, as Ryan explains, for them, the negatives ended up far outweighing the benefits in the longer term. And as for the initial dream-like state, and the associated feelings of pain being blotted out? The more you take, the less likely you are to experience that. Or instead of soothing you like it once did, it becomes terrifying.
‘I was having these visions and it was getting harder to tell what was real,’ Ryan says. ‘When I was in hospital, coming off ketamine, I kept seeing a little girl in my room, and I kept hearing babies crying and people arguing, but no one else could hear it.’ The healthcare professionals I spoke to for this feature told me that they have heroin patients who have been using for years with less physical problems than many of the young ketamine patients coming through their doors.
On the train home from Liverpool I find myself sobbing: for Kim, who ‘just wants to get better, to get my child back’, and for Ryan, who has ambitions for a successful music career, and is clearly talented, but who misses the ‘creativity and energy that I had. That’s been stolen from me’. They’re both so young, so strong and so determined to get through this, but while they do, I’m desperately sad they may not receive the compassion they deserve. We may think nothing of US-based influencers and celebrities heading to ketamine clinics, enthusing how good the drug is for mental health, but when those like Kim and Ryan self-medicate because they can’t afford the support they deserve, they’re judged. Kim told me, ‘I get looked down on, all the time.’ They’re told this is their fault, as they try to wade through an addiction that has trapped them, like liquid concrete slowly setting. We have a crisis on our hands, but we need to get to the root of why, rather than demonise those caught within it.
WithYou provide a free and confidential webchat service for anyone worried about drug, alcohol or mental health challenges: wearewithyou.org.uk
Catriona Innes is Commissioning Director at Cosmopolitan, you can follow her on Instagram
* Names have been changed
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