Ketamine bladder: 0 stars, do not recommend

Ketamine bladder is starting to rear its ugly head in New Zealand’s party scene, and it’s less fun than it sounds.

Ketamine use over time causes ulceration of the bladder wall and scarring of the elastic muscle fibres — the fibres which help your bladder expand and contract. If you’re only using it a very occasionally you run a low risk of damaging your bladder. If you use it very frequently, say 2-3 times a week over a period of a month or so, you’re more likely to develop ketamine bladder.

What is ketamine bladder?

Ketamine bladder syndrome, also called ketamine cystitis, happens when the ulceration and scarring on the bladder becomes so severe that it can’t expand.

Normally a human bladder can hold up to 500ml of urine before you need to pee. With ketamine bladder the bladder’s maximum capacity can shrink to only 50ml. This means that you need to pee every 15-20 minutes, and your capacity for ‘holding on’ vanishes. People will often wet themselves if they can’t find a toilet on time.

Besides peeing lots, what are the other symptoms?

Ketamine bladder hurts. Lots. The early signs of ketamine bladder feel like a UTI. Things to watch out for are:

  • Pain when you pee
  • Cramp-type pains in the lower belly between your hips and behind your pelvic bone
  • There can also be blood in your pee
  • If you have a vagina, having sex can become super painful or impossible.

If you use ketamine frequently over a long period of time you can do irreparable damage to your bladder.

The early stages of ketamine bladder can be treated with injections of Botox into the muscles of the bladder, along with a course of muscle relaxants. In a worst-case scenario, it can be treated with surgery. The bladder is removed and replaced with a bag that sits outside the body and is emptied like a colostomy bag. It can also damage your kidneys, which means you’ll need dialysis.

When should I see the doctor?

This isn’t the kind of thing you should put off. Talk to your GP as soon as things start getting sore. Make sure you mention to your doctor that you’ve been taking ketamine, or they’ll treat it like a normal UTI and give you antibiotics. This will be less than helpful.

Ok nope. All of that sounds awful. How do I avoid that?

Our advice is to go easy on the ketamine and save it for special occasions. Especially seeing as how if you use ketamine frequently you build up a tolerance. Over time you need more ketamine to get the same level of high. K-holes are only a sometimes food.

There haven’t been any other nifty tricks developed that can save your bladder, unfortunately. All of the recent studies show that the method you take it (orally or snorting) doesn’t have an effect on the damage done to the bladder. Same as using a ‘spit cup’ to catch the saliva after you’ve snorted it. It reduces the dose entering the digestive tract via the back of the throat, but if you can feel it taking effect in your brain, it’s in your blood stream and will get to your bladder.

Staying well hydrated and peeing soon after you’ve bumped can help get rid of the ketamine that’s in your bladder after it’s gone through your digestive tract, but that’s not going to help with the ketamine that’s in your bloodstream, which also has an effect on your bladder wall.

The tricksy thing about ketamine is that it’s an anaesthetic. While you’re on your ketamine buzz, you won’t feel pain. If your body takes any kind of damage, you won’t feel it until you’ve come down. That’s not great for anything that needs immediate attention, like pain when you’re peeing.

(Special thanks to Mr. Frank Kueppers of Urology Associates for the medical info for this post)

Further reading

Be a K know-it-all — KnowYourStuffNZ’s top harm reduction tips for ketamine
Ketamine and bladder damage — Know the risks — High Alert’s article on ketamine bladder
Recreational ketamine: from pleasure to pain — UroToday article about the research in Hong Kong and the UK on ketamine’s effects on the bladder

So you want to test your MDMA?

Hooray, you got the message that there’s crap drugs around! Now what?

If KnowYourStuffNZ is running a clinic near you, come see us! The spectrometer is more accurate, and the only way to detect when two psychoactives are mixed together. Reagent tests alone can’t rule those mixes out.

Until we have funding, we can’t be everywhere though, so the next best thing is to grab a reagent test from Cosmic NZ or The Hemp Store and test it yourself. They sell different types, and a few of the most useful ones for identifying cathinones are shown below, along with some guidance for interpreting your results.

The following are test results from reference samples that were identified on the spectrometer

Reagents can only determine the presence, not quantity or purity, of a particular substance. Dark color reactions will tend to override reactions to other substances also in the sample. A mix of MDMA and eutylone (or another cathinone) will look like an MDMA result.

If your results suggest MDMA, treat it like it’s a mix: take only a small amount to begin with (no more than half your usual amount) and dose slowly over time, waiting to feel the full effects. If anything feels ‘off’, don’t take more. Don’t mix it with other drugs or alcohol.

Eutylone can feel like weak MDMA, but wears off faster, leading people to re-dose and get into trouble later on. It is unpredictable and can cause severe side effects at low dosages for some people, while others can take quite a lot before realizing things aren’t feeling so good, and by then it’s far too late to avoid eutylone’s nasty side effects. Pretty universally, people agree it’s just not fucking worth it.

If the reagent either doesn’t change any color during the first 30 seconds or if it produces some other color-change sequence, then the sample definitely does not contain any MDMA. The colour chart included in each kit may give you more insight, but it may also be highly adulterated with one or more unknown substances.

All of these tests, except the MDMA Purity one, require only a few grains of sample (~5mg). About half the size of a match-head, or a small grain of rice. The MDMA Purity test requires 20mg.

EZ Ecstasy Test (Cosmic)

Analogous to the Marquis reagent from the Hemp Store kits
*We have found this test to be the most user-friendly*

The EZ “Ecstasy test” is a small amount of clear liquid that may be slightly crystallized. This test will go purple-black if the sample contains any MDMA, and yellow if it contains only cathinones.

This is important because if the sample contains for example, 10% MDMA and 90% cathinone, it will give a purple-black hit consistent with MDMA. The yellow colour of all the cathinone present will be completely covered by the purple. These tests can only detect cathinones if they are not mixed with another substance.

NarcoCheck Cathinone Test (Cosmic)

Image showing the results of the Narcocheck reagent test for cathinones. It goes dark yellow-brown in the presence of eutylone and dark blackish purple in the presence of MDMA

The Narcocheck Cathinone test is a small amount of clear liquid that may be slightly crystallized. This test turns a dark orangey/reddish brown it in the presence of eutylone. Do not take it if it turns red, yellow, orange or brown.

If the test is positive for MDMA it will show a purpley black. This colour is dark enough to completely obscure any cathinone reaction that may also have happened in a mixed sample.

EZ MDMA Purity Test (Cosmic)

We do not endorse this test for determining purity. We recommend only using it for ID purposes as shown.

 

The EZ MDMA Purity test is two layers of clear liquid. If the sample contains eutylone and no MDMA it will remain clear. If it contains MDMA it will go a yellow-brown on the top layer and the bottom layer will remain clear. This test cannot detect mixes of the two.

If any other colour change is observed or the bottom layer changes colour there are unidentified adulterants in your sample and you should not take it.

EZ Ketamine Test (Cosmic)

The EZ Ketamine test is yellow, and will change to an orange-brown in the presence of cathinones. In the presence of MDMA it will go a purple-black or blue-black. As above, the presence of MDMA will obscure any cathinone reaction that may also be happening.

Washing away the Bath salts Myth – Part Two

This is Part Two in a short series by our South Island manager Finn Boyle about cathinones and the importance of nuanced language when we talk about them.

We highly recommend you read Part One which explains the history of cathinones how meaningless and misleading the term ‘bath salts’ is.

Lazy Language and the Responsibilities of Media

The Local Context:

In early July 2020, a flurry of articles and news pieces told the story of a drug-crazed young person clawing their own eyes out.

Reportedly, this person had taken what was only ever described as ‘bath salts’.

It may be that this person had taken a cathinone such as N-ethylpentylone, which has caused hospitalisations in NZ and around the world. As far as we know, no one actually tested this drug and identified it properly.

It certainly wasn’t done by KnowYourStuffNZ as some media first implied (later redacted). Nor was it tested by Police. Given the rapid media releases, it probably wasn’t identified in medical toxicology screening either.

Read the Herald article
Read the Stuff article

Predictably, the sensational headlines made a splash. Reporting on events like these is not inherently bad, but the lazy and inaccurate reporting is. Our drug market is cloudy and confusing enough without media compounding that.

This media attention had two main effects as seen from the perspective of KnowYourStuffNZ:

  1. On a positive note, the stories raised awareness of the risks of taking unknown substances (the person believed they had taken MDMA). That week, we had a large influx of people using our service in Dunedin. More people being curious and informing themselves? CHOICE!
  2. The myth of ‘bath salts’ is perpetuated along with a lack of nuance and useful information. This leads to greater harms further down the track.

As discussed in Part One of this series; some cathinones such as methylone are relatively low-risk and we know a fair bit about them. Others, such as n-ethylpentylone and eutylone are very dangerous, especially if people don’t know they’ve taken it.

The International Context and how we got here

Cue: American Media Shitstorm

Florida Man takes ‘bath salts’ and proceeds to eat faces
The Miami Cannibal aka ‘the Causeway Cannibal’ is an infamous example of gratuitous headlines claiming that ‘bath salts’ are leading to sensationally violent events.

Watch the CNN news clip about the Miami Cannibal

But here’s the twist: The Miami Cannibal tested negative for Cathinones or any other drug other than Cannabis.
Read the Boston Globe article with the drug test results

International media has had a feeding frenzy on this unsubstantiated “wave of drug-related violence”. There is a severe lack of high quality journalism investigating drug use/markets internationally, but especially in Aotearoa.

Names are important

Why does this all matter, you might ask?

When you call a substance by its individual name people know what they’re dealing with. They know how much to take, whether or not to take it after the kind of day they’ve had or what they might have already taken or what kind of experience they want to have.

If something is called a ‘bath salt’, and ‘bath salts’ have a presumed effect, the person runs the risk of expecting one type of reaction while getting something potentially far worse because they’ve taken a different substance.

But they’re all bath salts, amirite?

The time of Cindy:

Cindy wanted to use MDMA on the weekend. Cindy bought her MDMA from a trusted friend, but she was well aware that often even dealers don’t know exactly what they are selling. She decided to test it.
Cindy had heard that using reagent testing only to identify MDMA can be inaccurate and easily duped, so she took it to KnowYourStuffNZ to have it tested on a spectrometer.

It turns out that Cindy’s tan/brown crystal ‘MDMA’, which all her mates looked at and said “yeah, that’s good gear. I know cause its brown” was actually mephedrone.

Mephedrone: 4-MMC, 4-methyl-methcathinone aka Meow Meow, M-Cat or…’bath salts’.

Cindy learns that mephedrone is a reasonably well known drug which is part of the cathinone family. She learns about the unique profile of mephedrone, with its high intra-nasal bioavailability (very strong when snorted), short effect period (real short peak, quick come-down) and considerable neuro-toxicity (long term use = harm to your brain).

Cindy also learns how this is different from many cathinones and that each one needs to be considered individually for its effect and risk-profile. Cindy chooses to use her mephedrone because she decided that although the long-term and chronic effects are potentially harmful, she thought that experimenting with it once, after being informed about its effects and used in a safe, controlled environment, would be unlikely to cause significant harm.

The time of Jimbo:

Cindy told this story in full to her buddy Jimbo but he was playing Zelda at the time and didn’t really take it all in.

What he did remember from Cindy’s tale is that sometimes people call cathinones like Cindy’s mephedrone ‘bath salts’.

This sparked Jimbo’s memories of all those media headlines about cannibals and eye-gouging, so he thought he knew exactly what she was getting herself into.

Later that weekend Jimbo was hanging out with his other mates who also had some brown rocks they presumed to be MDMA.

They decided to test it but they hadn’t really planned ahead so KnowYourStuffNZ wasn’t open that day and they didn’t want to wait. They went to the local head-shop to buy an MDMA test kit which showed that they didn’t have MDMA either! Their kit gave various yellow/orange results which seemed to indicate their sample actually contained a cathinone.

No one had heard much about cathinones but they did recognise the little bracketed “bath salts” next to it!

But Jimbo knew that Cindy was pretty sensible and she was planning to use her ‘bath salts’ – so they can’t be that bad – right?
Plus, they had paid like $300 for a gram of this and they weren’t about to go ask for a refund from the random dude they bought it off.

So they racked up some lines.

That’s when Jimbo remembered what Cindy said about high potency when snorted. So they made the lines a little smaller than usual. Half an hour later, Jimbo and his mates were barely feeling anything. They figured that maybe their bath salts were cut or just “shit gear”.

So they racked up some bigger lines and snorted them.

This cycle continued into the wee hours of the morning. After a few lines, Jimbo and his mates started to really feel the effects. It certainly wasn’t the familiar, empathic high of MDMA, but they were wired and couldn’t stop talking about their great business plans, so it was pretty fun.

However even after they stopped snorting lines, the effects kept building and building. 6 hours later Jimbo was over it and ready for bed. But his high was not abating.

Now, as you might have guessed, Jimbo and his mates weren’t taking the same thing as Cindy.

While Cindy knew her cathinone was mephedrone and learnt about the specific effects. Jimbo and his mates just knew they had ‘bath salts’ and expected to have the same high as Cindy.

In fact, Jimbo and his mates had the novel cathinone called eutylone.

Eutylone: n-ethyl butylone, bk-EBDB or…’bath salts’

If Jimbo knew that this particular substance is actually a cathinone and not a ‘bath salt’, which includes a number of common, widely available stimulants, perhaps Jimbo would have wanted to know about the specifics of his gear:

If Jimbo had known what the unique profile of eutylone is he would have known that we don’t know much about eutylone.

It’s quite new and there’s almost zero evidence-based information available. From what we learned with the eutylone outbreak over the 2020-2021 season:

  • We now know eutylone has a slow onset and long effect-window (it keeps you awake for ages)
  • We now know eutylone, especially in high doses, causes strong stimulant effects and undesirable effects such as increased heart rate and body temperature, agitation and short-temperedness, vomiting, and seizures. In extreme cases the lack of sleep can cause psychosis
  • We now know eutylone in high doses can still make you feel sick up to 10 days after taking it

But Jimbo didn’t know this. So Jimbo endured the next 48 hours of tooth-grinding anxiety and agitation as the stimulant slowly worked its way through his system. Jimbo eventually felt overcome by the walls closing in around him as he sweated his nuts off in a shivering fever.

Jimbo considered running down the street naked, screaming about Hitler. He also considered what it would be like to eat someone’s face – cause that’s what all the news stories said about bath salts.

Thankfully, like most people who take eutylone, Jimbo didn’t do anything too regrettable and didn’t end up in hospital. Supported by his friends, Jimbo made it through his harrowing experience relatively unscathed.

Call the substance what it is

If journalists genuinely want to inform people about dangerous substances they’ll use the right names. If it’s an unknown cathinone like C86 was back in 2019, then they’ll say ‘unknown cathinone’.

If it’s a known cathinone, they’ll say ‘eutylone’ or ‘n-ethylpentalone’ or ‘alpha-pvp’ or ‘mephedrone’ or whatever the hell it’s called. Known substances have known risks. No decent journalist would use ‘opioid’ if they’re talking about oxycontin, or ‘miscellaneous white stuff’ if they’re talking about ketamine.

If the journalist is a sensationalist that wants to get everyone rarked up, they’ll use the term ‘bath salts’.

‘Bath salts’ isn’t something that requires any actual research into the story and has a history of cannibalism, self-mutilation, and basically being the monster under the bed to shock people into clutching their pearls. It’s the low-hanging fruit of headlines.

These ‘journalists’ don’t give a toss about the damage they do by being deliberately vague. Don’t give them your clicks.

Washing away the Bath salts myth – part one

This is Part One in a short series by our South Island manager Finn Boyle about cathinones and the importance of nuanced language when we talk about them.

Calling cathinones ‘bath salts’ is oversimplification

Cathinones are here to stay. We need better language to help manage their presence in our drug market.

Cathinones are a very wide and diverse family of stimulant drugs. Calling them “bath salts” is misleading. Calling a wide range of substances the same name gives the illusion that all cathinones will have the same effect.

Just as not all viruses cause the same kind of illnesses, not all cathinones cause the same kind of experience. Lumping all cathinones under the ‘bath salts’ label makes effective communication around this topic confusing and difficult.

We need to move away from the label “bath salts” and start using language that allows for the variety within the cathinone family.

Where did the ‘bath salts’ thing come from anyway?

In the early-mid 2000s a new type of stimulant emerged. Methylone, also known as bk-MDMA, the first popularised drug in the cathinone family. Methylone, it turns out, is relatively low-risk as it has a similar chemical structure and effect to MDMA.

Other chemists and legal systems soon caught onto the existence of methylone.

As has played out in every story of ‘Drug Market vs Prohibition’ since the alcohol prohibition era 100 years ago, a predictable game of cat and mouse began.

Law-makers tried to legislate against the new substances and chemists played with the structure of the molecule just enough to maintain similar user effects but different enough to avoid being classified as a controlled substance.

Throughout this cat and mouse story, chemists and distributors sold new/novel substances in a quasi-legal way. Marketing them as “not for human consumption” meant that the substances didn’t break any drug laws.

So, cathinones imported into the US began to be sold legally by being called ‘bath salts’. In the UK it was ‘plant food.’ Cathinones are neither of these things.

All this happened in the US and the UK, but New Zealand inherited the term through moral-panic based US news media around Alpha-PVP.

‘Bath salts’ could mean anything

‘Bath salts’ as a label means nothing.

Hundreds of products containing hundreds of ingredients have been sold under this moniker, including pleasant-smelling things that you put in your bath water, inert things that do absolutely nothing, mild stimulants that make you chatty for a few hours with no real ill effects, and foul-tasting things that keep you awake for days or could kill you.

Over about a decade where this was common practice, a countless number of substances were sold in packages labelled as ‘Bath salts’ or ‘Plant Food’.

The majority of these substances were cathinones. Sometimes they would be blended with synthetic cannabinoids, herbal ingredients and other more socially acceptable stimulants such as caffeine.

The Potency Effect

Also perfectly in line with that old Drug Market vs Prohibition arc is the trend known as the Potency Effect, The Alchian-Allan Theorem, or ‘the iron law of drug prohibition‘.
It states

‘Criminalisation and prohibition of a drug will induce a market effect which rewards higher-potency forms of the drug.’
E.g why import a tonne of unrefined Milk of the Poppy when you could bring in a tonne of Heroin with the same logistical challenges and 1000x the potency/profit?

Slow, unresponsive legislative systems around the globe have tried to keep up with pharmacological innovation by defining and regulating against specific compounds such as methylone. Drug producers have been incentivised to develop more varied and higher potency substances – leading to substances such as the very dangerous n-ethylpentylone.

Thanks to the innovation of drug manufacturers we now have a large family of cathinones that have varying effects, all being called ‘bath salts’.

Some drugs in this family such as methylone are relatively low-risk. Others such as n-ethylpentylone, alpha-PVP, or eutylone are high-risk.

When cathinones are sold as MDMA things go bad

Cathinones are often sold deceptively or unknowingly as MDMA. They are often cheaper and more available than MDMA or other amphetamines, especially since COVID-19 hit.

This is incredibly problematic. If people unknowingly take a cathinone in place of MDMA and have a difficult time, telling a medic that they’ve had ‘bath salts’ could mean they’ve had a miscellaneous drug, or they could have eaten something from in their Nan’s toiletries cabinet.

Using the term ‘cathinone’ lets the medics know immediately that they’re dealing with one of a particular family of drugs and need to give medical care accordingly.

We’ll talk about the main problems that arise from the press continuing to use ‘bath salts’ in Part 2.

High levels of eutylone substitution found in O week testing in South Island

Drug checking by KnowYourStuffNZ in Christchurch this week reveals that there is still a lot of eutylone around. 40% of the samples we tested yesterday for UCSA and LUSA’s O week events have turned out to contain eutylone. Last week in Dunedin we found 45% of samples brought by people thinking they had MDMA were actually eutylone.

We saw a lot of this at New Years and it’s still around. Eutylone has been linked to a number of hospitalisations, and a much larger number of people just having a terrible, scary time, with some feeling unwell up to 10 days later.

With a lot of student and other events on this weekend, we recommend that you test your drugs. If you can’t test them, seriously consider not taking them. You cannot tell the difference between MDMA and eutylone based on sight or smell alone. We’ve found eutylone in many different forms this year, including pressed pills and crystals of all sizes and colours, so no type of substance is safer than another.

Our teams are in Christchurch 3pm-8pm tonight (Tuesday 23rd), and will be in Dunedin on Thursday, Friday and Saturday, 12pm-6pm. Please use the service if you can – but be mindful of our resources and if you’ve had stuff tested, please share your result with friends using the same source. Otherwise, reagent testing is a good option for eutylone. Here’s a link to info on how to reagent test for eutylone.

This week’s testing has identified two pressed pills that contain eutylone only and no MDMA.

Red Bulls

Rectangular pill with rounded corners, just over 1cm long with a Red Bull logo. Weight: 440mg. Estimated to contain 300-350mg of eutylone. This is a dangerous amount of eutylone and we recommend not taking these pills.

Blue Playboys

Round blue pill ~8mm in diameter with a Playboy logo. This pill was not weighed, but the spectrometer came back showing at least 50% eutylone so it is likely this pill contains over 100mg of it.

What does eutylone feel like?

Initially eutylone feels like MDMA – euphoria but that fades after an hour or so. You may think it is weak MDMA and be tempted to take more. Don’t.

We are hearing far too many tales of miserable experiences with eutylone. The tales are all similar: “last night I took some, after an hour or so I thought it was wearing off so I took some more, was awake all night, and now it’s midday and I can’t sleep and I feel like shit”. In some cases, people have had to wait more than 48 hours before they could sleep.

What are the health risks from eutylone?

Not being able to sleep is the best outcome. Other risks include anxiety, headaches, stomach upsets, agitation, and paranoia. We know of at least two people who have needed medical help, one of whom was having seizures. The worst outcome is vomiting, convulsions, and possibly death.

What to do if you have taken eutylone?

If you have taken it, don’t take any more. Rest, eat, and wait it out. Avoid cannabis, alcohol, and caffeine. Definitely don’t try to drive.

If you have a racing heart, elevated temperature, extreme anxiety, numb, tingling, or cold fingers or toes, or haven’t slept for more than 24 hours, don’t wait. Seek medical help.

If you are looking after someone who has taken eutylone, help them to stay calm and remind them that they will just have to wait it out. Staying on the couch and bingeing TV might not sound like an exciting time, but it’s the best thing they can do in this situation.

Links to more information about eutylone:

Story from someone who took a large dose of eutylone

What to do if you’ve accidentally taken eutylone

Cathinones to look out for this summer

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