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Ketamine Abuse and Bladder Disease: The Connection

Ketamine abuse has been linked to a serious bladder disorder. With repetitive and high-dose use, this disorder is more likely.


Ketamine Specifics

The dissociative hallucinogenic drug ketamine, also known by the brand name Ketalar, produces euphoria, feelings of being disconnected from oneself or reality, increased feelings of empathy, amplified energy, and hallucinogenic experiences.

The drug is popular with younger individuals. It is often referred to as a “club drug” because younger individuals use it at bars, lounges, raves, and parties. The drug is often mixed with ecstasy (MDMA) or used as a replacement for ecstasy due to its similar effects.

Ketamine is also known as a potential date rape drug because it can produce amnesia for events that occur when under its influence. It goes by several street names, including Special K, Vitamin K, Kit Kat, K, Cat Tranquilizer, and Cat Valium.

Legitimate Uses

Ketamine was initially developed to serve as an anesthesia drug in place of the highly addictive drug phencyclidine (PCP). However, ketamine produced severe amnesia and other side effects. It is also a significant drug of abuse, so now veterinarians more commonly use it.

It also has legitimate pain-relieving properties and may be used in cases of severe pain, such as pain associated with significant burns, pain on the battlefield, and end-of-life pain.

Ongoing research has identified ketamine as being a potentially effective treatment for severe major depressive disorder, but the drug is not yet formally approved for this use.

It is categorized as a Schedule III controlled substance by the U.S. Drug Enforcement Administration (DEA).

Early Findings Regarding Ketamine and Bladder Disease

Research as early as 2007 suggested that there may be a connection between ketamine use and bladder problems. Two subsequent studies determined that the recreational use of ketamine was associated with bladder disease.

Ketamine Abuse and Bladder Disease

The studies found that direct contact with the lining of the bladder (the epithelial bladder lining), as ketamine was excreted in urine, was directly responsible for certain types of bladder disease. The connection between ketamine and bladder disease was not the result of some other mechanism.

Although much of the early research indicated that the bladder damage was associated with heavy recreational use of ketamine, subsequent findings also suggest that regular use of ketamine for medicinal purposes might potentially produce some level of bladder damage. This would most likely be a problem for individuals being treated with ketamine for major depressive disorder, as most of its other uses are for acute reasons. The drug is not typically used for long-term treatment of pain or other issues.

Ketamine Bladder Syndrome

The above research studies initially indicated that young ketamine abusers who had damage to numerous organ systems as a result of ketamine abuse, such as kidney, liver, and possible brain damage, also had bladder damage.

Subsequent research findings have determined that there is a direct relationship between the development of bladder disease and ketamine abuse over all age groups and genders. The findings indicated that chronic ketamine abuse:

  • Can lead to the development of ulcers on the bladder
  • Can lead to fibrosis of the bladder (the stiffening of the bladder walls and shrinkage of the bladder) (Symptoms often included urinary incontinence, urinary urgency, urinary frequency, pain in the urinary tracts and bladder, and/or bleeding from the bladder.)
  • Decreased bladder capacity — from 500 mL (milliliters) in normal individuals to 50 mL in extreme cases due to significant shrinkage of the bladder.

A variety of diagnoses have been given in these instances, including ulcerative bladder disease, interstitial cystitis, or ketamine cystitis (also referred to as ketamine bladder syndrome or K-bladder syndrome).

Who Is at Risk?

There still appears to be some question as to whether the use of ketamine for medicinal purposes, such as a treatment for depression, would increase the risk of the development of ketamine bladder syndrome. The results of the studies mentioned above indicate that there is a dose-response relationship, such that heavy doses of the drug are more likely to result in bladder problems than small amounts of the drug.

One survey of ketamine abusers in the United Kingdom indicated that within the year before the survey, more than 11 percent experienced some bladder pain. Nearly 18 percent described frequent urinary stress or frequent urination — symptoms that suggest there may be bladder damage in these individuals.

However, research studies that investigated single infusions of ketamine found that less than 10 percent of these individuals reported painful urination or increased urinary frequency, and the symptoms were usually transient. Other research studies that indicate a relationship between the amount of ketamine used and later brain damage support the notion that individuals who use higher amounts of ketamine are at greater risk to develop bladder damage.

Is the Damage Reversible?

The research indicates that nearly half of ketamine abusers report improvement in their urological symptoms after they stopped using the drug. The sooner a person can stop using ketamine, the more likely it is that they will experience relief of the symptoms and some resolution of any bladder problems.

However, it has been suggested that many individuals with pain associated with their ketamine abuse may be embarrassed by the stigma associated with drug abuse and urinary problems. As a result, they may not get the help they need early enough.

woman suffering from cocaine withdrawal

There are many treatments for ketamine bladder syndrome that appear to have varying levels of success. Again, the sooner any intervention can be initiated, the better the chances of a successful outcome.

What Can Be Done About Painful Urination, Incontinence, or Other Symptoms?

Anyone who experiences difficulty urinating, painful urination, or other similar symptoms should discuss their symptoms with their physician. If the person is using ketamine for medical reasons, they can discuss discontinuing the drug with their physician; however, abusers of ketamine may be concerned about the stigma associated with drug abuse.

Individuals who abuse ketamine should understand that the chronic use of ketamine is associated with significant physical, emotional, and cognitive deficits. Discontinuing use of the drug should be a priority.