The long-term health risks of ketamine, including bladder issues

Various experts and studies have warned of an increase in what has been dubbed 'ketamine bladder' among young people due to chronic use of the drug.

"I can't walk 50 metres without either needing to sit down or needing to run to the toilet," a 20-year-old addicted to ketamine recently told the BBC, showing the extent of the impact it's having on sufferers' daily lives.

But how exactly can ketamine mess up our bladders, what other health risks are there, and why are more young people turning to the drug, whether to self-medicate or recreationally? And at a time when more research is pointing to ketamine as a potential treatment for depression, how does this compare?

Here, we consult two doctors on the rise of ketamine and the potential long-term health consequences of excessive use.

Has there been an increase in bladder issues from ketamine?

Dr Lawrence Cunningham, contributing medical expert at UK Care Guide and retired GP, says, "Indeed, there has been a noticeable increase in bladder issues attributed to excessive ketamine use.

"This condition, known as 'ketamine-induced cystitis', can be quite severe.

"I have treated patients who present with symptoms ranging from urinary urgency and pain to severe cases where there is blood in the urine. This can progress to more chronic conditions where the bladder capacity becomes significantly reduced, causing frequent and painful urination."

"The impact on someone's day to day life can be profound." Some of Dr Cunningham's patients have required extensive treatments, ranging from medication to manage symptoms to more invasive procedures like bladder instillations, or in extreme cases, surgical interventions.

Dr Babak Ashrafi of Superdrug Online Doctor, adds that the effect of these debilitating urinary symptoms and chronic pain can "lead to significant psychological distress and disrupt daily activities, including work, relationships, and social interactions".

What other health risks are there from taking excessive ketamine?

"Recreational use of ketamine is not without its risks," emphasises Dr Cunningham, which aren't just to the bladder.

"Beyond the impacts on the urinary system, ketamine can also cause high blood pressure, poor liver function, and, in some cases, lead to severe abdominal pain known as 'K cramps'.

"Having dealt with this before, it's clear that the recreational use of ketamine masks a range of potential health problems, which can also include long-lasting mental health issues like depression and anxiety, often exacerbated by the drug's hallucinogenic properties."

Dr Ashrafi adds that recreational ketamine use can also pose risks including cognitive impairment, respiratory depression, cardiovascular complications and effects on sexual function and infertility. "Long-term risks may include psychological dependence, cognitive deficits, and damage to organs such as the liver and kidneys," he emphasises.

What is the impact of increased tolerance?

Dr Cunningham explains, "In my experience, chronic ketamine use significantly alters how the body responds to the drug, leading to increased tolerance.

"This means that, practically, over time, users require higher doses to achieve the same dissociative effects, which can escalate the risk of severe side effects and overdose."

While he explains that a 'high' amount of ketamine, particularly among young people, can vary, he adds, "However, it's crucial to note that even lower doses can be harmful if used frequently. The increase in dosage is particularly concerning, as it not only heightens the risk of acute toxicity, but also increases the longer-term physiological and psychological burdens."

Why are more young people taking ketamine?

Dr Cunningham says, "The increase in ketamine use among young people for self medication, recreation, or addiction is, in my opinion, multifaceted.

"In my observations, factors include the drug's accessibility, its initial low cost compared to other recreational drugs, and its growing popularity in certain music and club cultures.

"I've also found that young individuals might turn to ketamine to cope with psychological stress or peer pressure. The dissociative experience provided by ketamine might temporarily lower feelings of depression or anxiety, leading to its misuse as a form of self-medication. Unfortunately, this often spirals into addiction due to the drug's tolerance and dependency properties."

And this, of course, can exacerbate existing mental health conditions.

What about ketamine used as a treatment for depression?

If poor mental health is a risk of recreational ketamine, why is ketamine being used to treat depression?

"More research is suggesting ketamine can help treat depression, but this is not licensed on the NHS. Ketamine is only licensed as an anaesthetic, so any use outside of this indication is off-licence. Whether or not some private practitioners use it is up to them, but any use of this kind must be considered very carefully with strict monitoring," explains Dr Ashrafi.

So in theory, how effective is it? "Some studies suggest that ketamine can provide rapid relief of depressive symptoms, often within hours to days. However, the long-term effectiveness and safety of ketamine for depression are still being studied. Concerns include the potential for abuse, tolerance, and the need for maintenance treatments. Long-term risks on mental health may include exacerbation of psychiatric symptoms and dependence," he adds.

Of course, if used in a clinical setting (like when used as an aesthetic and pain relief in hospitals), doses, quality, safety and individual needs would be more controlled and monitored for the treatment of depression (if done properly) than those using it recreationally for the same purpose (though as mentioned above, can still come with risks).

Watch: Elon Musk insists he only takes ketamine 'once in a while'

Getting help for ketamine addiction

If recreational use has led to addiction, help is out there. "Support and resources are available through addiction treatment centres, mental health services, and support groups to help individuals struggling with ketamine addiction. Early intervention and comprehensive care are crucial for addressing both the physical and psychological aspects of ketamine dependence," says Dr Ashrafi.

Dr Lawrence Cunningham adds, "If young people are using ketamine, it is important they are aware of the potential risks associated with its unsupervised use.

"I would encourage them to speak to a healthcare professional, such as a GP or a mental health expert. They can offer advice and information about the effects of ketamine and how to manage any associated risks.

"From experience, It's also beneficial for them to have access to support from adults that they trust. Often, this conversation can be a good first step for them to deal with the problem through professional services.

"Or, they can access counselling services available through the GP or local authority. These resources can provide guidance and help in understanding the implications of drug use. If immediate assistance is needed, then I'd recommend contacting local health services or dedicated helplines for substance misuse, which can offer crucial support and advice.

"You can find a useful list on the Mind website."

Read more: The most common mental health conditions – and where to get help (Yahoo Life UK, 5-min read)