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

Be a K know-it-all

At KnowYourStuffNZ we’ve seen quite a bump in the use of ketamine over this festival season (pardon the pun). As we’re responsible ponies who like to make everybody safer, we want to give some easy to digest, legit information about K: no horse-play here. 

Here’s what our friends at The Loop have to say:

“Ketamine is what is known as a dissociative anaesthetic which gives users a sense of detachment from their body and surroundings.”

It’s usually found as a white powder and taken in ‘bumps’ by snorting up the nose (insufflation). A common dose is around 50-80mg, with anything over that considered a strong or heavy dose.

Effects start trotting along within 7-20 minutes, hitting a gallop at about 30-60 minutes, and after-effects lasting from 2-12 hours. Ketamine is still in your system even after you stop feeling effects so having more can produce stronger effects than expected.

Let’s get it all lined up for easy consumption:

Effects Include:Risks Include:
Feeling light and bouncy as a foalAccidents while intoxicated
DelusionsDisturbing hallucinations
Visual hallucinationsPsychosis
Vomiting (Especially if combined with alcohol)Nasal damage
At high doses it leads to the “K-hole”: Users seem unresponsive to others, but experience vivid hallucinationsSlowed breathing, inability to look after yourself, vomiting and potentially death

In our work testing and giving out advice at festivals around Aotearoa, we’ve noticed that a lot more people are horsing around with ketamine in 2020, and a correlated upswing in reports of ketamine-related harm.

Some people are ending up in the K-hole even when they don’t want to, by repeatedly ‘bumping’ the same amount or increasing amounts. The cumulative effect is something to really be aware of friends: reduce the size of each bump if you are going to repeat dose.

Don’t mix ketamine with other drugs: depressants like alcohol increase the risk of passing out and choking on your own vomit. When mixed with stimulants like MDMA it can cause blood pressure spikes. 

If you are seeking the K-hole make sure you are with people you trust. Have a designated   trip-sitter, or at least someone who’s not also K-holing, to make sure you aren’t a victim of “foal play” while you’re incapacitated.

A significant number of regular users experience bladder problems – including UTI’s, cystitis, and a risk of ulcerated bladder requiring bladder removal. We recommend keeping K special and your bladder intact by using it only occasionally.

Once again, because we’ve seen it a lot: don’t mix Ketamine with alcohol. One of the biggest risks is impaired judgement from alcohol mixed with the lack of coordination and dissociation from Ket, leading to all sorts of bad times.

Remember folks, we do regular free drug testing with an infrared spectrometer in various cities around the country: don’t look this gift horse in the mouth! Be sure of what you’re putting in your body.

Sources (of information):