Paul McNamara is a GP and honorary clinical lecturer at the University of Glasgow
Megan Glover is a 4th year medical student at the University of Glasgow
“The first lines of ketamine hit like escape itself — the body loosening, the mind lifting clear, pain falling away as colours bled and folded into each other. For a moment I felt untouchable, almost holy, as if the broken pieces of me had been stitched back together by the drug.
Then came the drop. The K-hole opened and pulled me under, nerves splintering, the world shattering in a thousand directions at once. Soon there was nothing transcendent left — just dribbles that turned to fire, blood in the pan, and the slow, bitter truth that the party was over.”*
Ketamine, once a niche party drug, is at the centre of a public health crisis. Deaths linked to ketamine have increased six-fold over the past decade.¹ Cheap, easily available, and often used as a ‘quick fix’ for mental distress, its popularity is soaring — and so are the consequences. Dependence, organ damage, and worsening depression are no longer fringe problems. We are seeing them in consulting rooms across the country.
A BBC Panorama investigation found ketamine is up to ten times cheaper than cocaine — a price point that removes almost all barriers to access.
Originally developed in the 1950s, ketamine’s dissociative and stimulant effects made it appealing to recreational drug users, though its use lagged behind MDMA through the early 2000s.¹ That has changed. Use rose gradually through the 2010s and has surged in recent years.²,³ Ketamine is now the fifth most popular drug among children and young people — having overtaken cocaine and closing in on ecstasy.⁴
A BBC Panorama investigation found ketamine is up to ten times cheaper than cocaine — a price point that removes almost all barriers to access.⁵ It can now be ordered to your door with a few taps on a phone. Young people describe using ketamine to escape anxiety and low mood. It may offer short-term relief, but dependency quickly follows, locking users in a cycle of worsening depression.⁵
In general practice, particularly in deep-end settings, we see the fallout daily. Yet many patients feel uneasy disclosing ketamine use.⁶ When they do, some report feeling dismissed, or that staff lacked knowledge about ketamine and its effects.⁶ As a result, they rarely present saying, “I have a drug problem.” Instead, they appear with urinary frequency, abdominal pain (‘K cramps’), or nasal problems.⁶,⁷ Three in five users experience each of these symptoms.⁶ Without a high index of suspicion, these cases can easily be mistaken for recurrent UTI, prostatitis, or overactive bladder syndrome.
Chronic ketamine use can lead to severe bladder damage, sometimes requiring nephrostomy or even cystectomy.⁸ Thankfully, these complications remain uncommon — but rising. For those motivated to stop, affordable, tailored treatment programmes remain scarce.⁶
The drivers of this epidemic are not only chemical but social — long waits for mental health support, poverty, and a search for escape in communities with few other options. Systemic solutions — drug policy reform, poverty reduction, education — will take time. But there are practical steps we can take now. We can ask about ketamine use when young people present with urinary symptoms, and normalise routine, non-judgemental questions about recreational drug use. We can meet disclosure with compassion and curiosity rather than surprise or dismissal. And we can raise awareness among colleagues about the physical complications of ketamine use so that these presentations are recognised sooner.
Chronic ketamine use can lead to severe bladder damage, sometimes requiring nephrostomy or even cystectomy.
The NICE Clinical Knowledge Summary recommends that clinicians routinely ask about substance misuse in young people presenting with health problems, offer brief interventions, and refer to structured treatment services when appropriate.⁹
Proposals to reclassify ketamine from Class B to Class A have been met with scepticism from former users, who favour public education and investment in rehabilitation.⁵ Whatever the legal outcome, we have an opportunity — and a responsibility — to improve awareness, reduce harm, and protect young people from the long-term consequences of this drug.
* This opening vignette is based on a fictional composite patient but reflects real user testimony and clinical experience.
References
- Nutt DJ, Williams TM. Ketamine: An Update 2000–2004. 2004 Mar. Available from: https://assets.publishing.service.gov.uk/media/5a7b42eced915d429748de82/ketamine-report-annexes.pdf [accessed 10/10/25]
- Office for National Statistics. Drug misuse in England and Wales: year ending March 2024. Published 2024 Dec 12. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2024#data-on-drug-misuse-in-england-and-wales [accessed 10/10/25]
- GOV.UK. Wastewater analysis: Measuring illicit drug consumption in 2023 and 2024. Published 2025 Mar 17. Available from: https://www.gov.uk/government/publications/wastewater-analysis-measuring-illicit-drug-consumption/wastewater-analysis-measuring-illicit-drug-consumption-in-2023-and-2024 [accessed 10/10/25]
- GOV.UK. Children and young people’s substance misuse treatment statistics 2023 to 2024: report. Published 2024 Nov 28. Available from: https://www.gov.uk/government/statistics/substance-misuse-treatment-for-young-people-2023-to-2024/children-and-young-peoples-substance-misuse-treatment-statistics-2023-to-2024-report [accessed 10/10/25]
- Britain’s Ketamine Crisis. BBC Panorama. 2025 Jul 28. Available from: https://www.bbc.co.uk/iplayer/episode/m002gtgn/sign/panorama-britains-ketamine-crisis [accessed 10/10/25]
- Harding R, Barton T, Niepceron M, Harris E, Bennett E, Gent E, et al. The landscape of ketamine use disorder: patient experiences and perspectives on current treatment options. Addiction. 2025 Apr 28. Available from: https://pubmed.ncbi.nlm.nih.gov/40294641/ [accessed 10/10/25]
- Beerten SG, Matheï C, Aertheerts B. Ketamine misuse: an update for primary care. Br J Gen Pract. 2023;73(727):87–89. Available from: https://doi.org/10.3399/bjgp23X732129 [accessed 10/10/25]
- Anderson DJ, Zhou J, Cao D, McDonald M, Guenther M, Hasoon J, et al. Ketamine-induced cystitis: a comprehensive review of the urological effects of this psychoactive drug. Health Psychol Res. 2022;10(3):38247. Available from: https://doi.org/10.52965/001c.38247 [accessed 10/10/25]
- NICE Clinical Knowledge Summaries. Drug misuse – management. Last revised 2024 Feb. Available from: https://cks.nice.org.uk/topics/drug-misuse-management/ [accessed 10/10/25]
