Ketamine is a commonly used recreational drug that presents several challenges for medical practitioners.

 

In A&E

Ketamine is a dissociative anaesthetic that leads to excessive sedation, confusional states and psychotic experiences

•        Ask about it in patients with these symptoms
•        Note- its effects are enhanced by alcohol

There is no antidote so supportive treatment is necessary, but benzodiazepines may be co-administered to relieve acute distress.

 

Patients with urological symptoms

A new syndrome of  ‘ketamine induced ulcerative cystitis’ has recently been discovered with heavy use of the drug. This is similar to ordinary cystitis, but it doesn’t respond to any of the usual cystitis treatments. Cases so severe that cystectomy is necessary are now being reported – so:

•        Have a high index of suspicion in young people with cystitis, particularly men
•        If ketamine is being used, give strong advice to stop.

Psychiatric aspects*

In addition to the harms listed above heavy ketamine is associated with dependence (addiction) and impaired memory. In these people stopping use should be encouraged.

•        There are no specific treatments for ketamine withdrawal which is relatively short-lived
•        Addiction symptoms such as craving best handled by standard psychotherapeutic interventions
•        Memory will probably improve with abstinence

For more details see the new ISCD report – Morgan & Curran (2011) Ketamine use: a review.  Addiction. (Published online 21.07.11)

____________________________________________________________________________________________

* Ketamine may also precipitate psychosis in individuals with a family history of schizophrenia