Trust doctor warns about the dangers of Ketamine misuse | News

By Dr Alison Downey, Consultant Urologist

As a urologist, I'm trained to treat bladder cancer, kidney stones, prostate problems – conditions I typically see in older patients. But over the past few years, my clinic has been overwhelmed by a completely different patient group: teenagers and people in their early twenties, arriving with bladders so damaged they need the kind of major reconstructive surgery I'd normally reserve for cancer patients.

The cause? Ketamine. A cheap party drug that's destroying young lives in ways most users never imagined.

Urology departments across the country are already stretched really thin, and the surge in ketamine cases has been massive – an increase I and my colleagues are simply not equipped to handle. The youngest patient I've seen started using ketamine at just 12 years old. Most are in full-time employment, ordinary young people who thought they were making a harmless choice.

Here's what many don't realise: ketamine is particularly dangerous because it damages the one organ system it passes through – your urinary tract. The drug is broken down in the liver and excreted in urine, which means it sits in your bladder, where it becomes toxic to the surrounding tissue.

Over time – and I'm talking months to years depending on how much and how often someone uses – the bladder becomes inflamed and ulcerated. The lining breaks down. The muscle wall thickens and scars, a process called fibrosis. The bladder shrinks. A normal bladder holds around 500ml of urine. My ketamine patients often have bladders that hold just 50-70ml – barely three tablespoons.

The result? They need to pass urine every 10 to 15 minutes. They experience desperate urgency. Many become incontinent. The inflammation causes blood in the urine and excruciating pain that worsens every time they try to empty their bladder.

And here's the cruel irony: because ketamine is an excellent painkiller, many of my patients start using more of it to manage the very pain it's causing. It becomes a vicious cycle – the drug that's destroying their bladder is the same drug they turn to for relief.

What's particularly insidious about ketamine damage is that you can develop symptoms within weeks or months, or it might take years. There's no way to predict who will or won't develop problems. By the time patients seek help – often delayed because of the stigma around both drug use and incontinence – significant damage has already occurred.

Many have already been treated with multiple courses of antibiotics by their GP over six to twelve months before they're referred to me, all the while continuing to use larger doses of ketamine and crossing the threshold into irreversible damage.

When the damage is severe enough, it doesn't stop at the bladder. The inflammation and high pressure can cause urine to back up into the kidneys, or patients develop strictures – narrowings – in the ureters, the tubes that drain urine from the kidneys. This can lead to kidney failure. I've had to insert nephrostomy tubes – external drainage tubes directly into the kidneys – to prevent complete renal failure in young people who should be decades away from such problems.

Beyond the urinary system, I've seen patients with liver failure from ketamine cholangiopathy, heart failure, severe abdominal cramping, rectal prolapse, and erectile dysfunction in men. I've sadly had deaths from renal, liver and heart failure.

Now, here's the fundamental problem: although ketamine causes devastating urological damage, this isn't a urology issue. It's an addiction problem. And surgical departments like mine are not set up to help people stop using recreational drugs. I don't have the training or the community connections. I've managed by running joint clinics with my local addiction service, but many hospitals don't have this option.

While patients are still using ketamine, there's very little I can offer medically. The symptoms will only worsen if they continue. I can prescribe medications to calm the bladder and help with pain. I monitor their kidneys with scans and blood tests. But I can't do anything more invasive because the treatments won't work and the risk of complications is far higher in active users.

The good news – and there is some – is that it's not always irreversible. If people can stop completely, a significant proportion will see complete or near-complete resolution of their symptoms. I usually start to see improvement by six months of cessation.

But for those who can't stop, or who've used too heavily for too long, the damage is permanent. After six months of abstinence, if symptoms persist, they may need minimally invasive treatments like Botox injections into the bladder. In severe cases – and I'm seeing more of these – they need major reconstructive surgery: removal of the bladder entirely (cystectomy) and creation of an ileal conduit, where they'll wear a bag to collect urine for the rest of their lives.

This is surgery with significant risks, long-term follow-up requirements, and profound impacts on quality of life – sexual dysfunction, body image issues. For someone in their twenties, it's devastating.

The message needs to be clear: ketamine may seem like a harmless party drug. It's cheap, easily available, doesn't give you a hangover. But what you don't notice in those early months or years of use is the silent, progressive damage it's causing to your bladder and kidneys.

By the time you start experiencing symptoms – the constant rushing to the toilet, the pain, the blood in your urine – the damage may already be permanent. Your twenties should be about building your life, not learning to live with a urostomy bag.

The perception that ketamine is 'safer' than other drugs is dangerously wrong. It's not what you're risking in the moment that should worry you – it's what you're destroying, invisibly, for the future.

* First published in the Daily Mail