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Ketamine and the threat of global prohibition

Ketamine has been on the club scene for decades, although only quite recently are its debilitating long-term side effects coming to light. But it's also a life saver in developing countries where it serves as a cheap and available anaesthetic.

The class of ‘dissociative narcotics’

Commonly pegged as a horse tranquilliser, ketamine has seen rampant recreational use in the club scene for decades. As a ‘dissociative’ drug – one which alters the sensual perceptions of its user – sights, sounds and smells are distorted and feelings of dreamlike dissociation are often invoked.

The hallucinogenic properties of dissociative drugs, including a strong detachment from the self and the surrounding environment, distinguish them from other categories. Depressant effects such as sedation add to the mellow feeling users often experience, contributing to their rising popularity among young people in the UK.

Other substances falling under the category of ‘dissociative narcotics’ include Salvia Divinorum, a psychoactive plant which induces visions and other altered experiences – and Nos (or nitrous oxide), a naturally occurring gas distributed for medical purposes – most notably for labouring mothers. These two in particular have experienced a surge of use over the past few years, while the use of ketamine has remained durable and consistent.

Ketamine bladder syndrome

The drug originated in the US in the 1970s as a prescription anaesthetic, but it soon leaked onto the club scene for recreational use. It has rapidly outgrown heroin as the drug of choice in many parts of the world due to its easy accessibility and low cost, and while it is comparatively safer that heroin, or even alcohol, irresponsible dosage and repeated use can still lead to serious health problems.

Ketamine generally snorted as a powder, but can also be injected in liquid form, and a trip can last up to an hour, with after effects experienced for several hours afterward. Not surprisingly, trips can be ‘good’ or ‘bad’ depending on the current mental state and environment of the user.

Ketamine’s rampant recreational use has long been documented, but many of its damaging physical effects are only now coming to light. One debilitating side effect emerging in long term users is ‘ketamine cystitis’, also known as ketamine bladder syndrome. Long term use has ravaging effects on the bladder, resulting in ulcers and fibrosis – a stiffening of the bladder walls. Sufferers struggle with urinary frequency and incontinence, together with bleeding from the bladder, which in severe cases can require bladder removal surgery.

Emerging harmful side effects from irresponsible recreational use are tarnishing the remarkable value of ketamine in the clinical setting, and threatening its international legal status.

The threat of global prohibition

Ketamine is currently being used in pioneering treatments for depression and other mental disorders, with promising preliminary results. Its most important use however, is as a cheap and reliable anaesthetic in countries where medical resources are scarce. Ketamine also has an important role in veterinary medicine, as a tranquilliser and in providing pain relief for animals.

Ketamine is a cheap and reliable anaesthetic in countries where medical resources are scarce

In March 2016, a vote was held by the UN’s Commission on Narcotic Drugs (CND) regarding the need for international control of ketamine. International control of ketamine would involve limiting its circulation in medicinal settings – or prohibiting it entirely.

Along with other institutions, the WHO’s Expert Committee on Drug Dependence reviewed ketamine as one of a number of drugs that ‘exhibit potential for dependence, abuse or harm’, in order to make recommendations to the CND for this vote. Thankfully, they concluded that ketamine abuse does not pose a global public health threat and that any implemented international control would limit access for those who most need it as a life-saving anaesthetic.

The vote in 2016 was ultimately deferred, meaning that while for now ketamine remains internationally accessible, future attempts may be made once again to globally prohibit it, thus threatening access to safe anaesthetic and surgical care for millions of people.

City Addictions, March 24, 2017

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