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between its frequent use and kidney and bladder damage, as well as memory
impairment. Up to this point ketamine was an unscheduled drug for which one
could not be prosecuted for possession, but only for supplying. One might argue
that the previous approach towards ketamine was the closest that the UK drug
policy ever got to a Portuguese-style model of decriminalising people who used
drugs. Reclassification changed this dramatically and contributed to the growing
harms associated with the drug’s use.
Because of the increased difficulties with smuggling the drug (which were also
connected with post 9/11 hysteria and implementation of harsh anti-terrorism
laws), ketamine was no longer available as a liquid on the black market but
emerged in crystal form. This led to consumers baking the drug with little
knowledge that this procedure actually destroyed the quality of ketamine and
resulted in users needing to take more of the drug for the same effect – which
also meant increased danger of ketamine-bladder syndrome.
At the same time, the price of the drug dropped drastically. If psychonauts and
klubbers has been buying it for about £50 a gram, the new generation of
ketamine devotees could get the same amount for a mere £10. A natural
consequence was a vast diffusion of the drug’s users, as this new generation of
K-users, referred to as wonkers, were coming from a very different cultural and
social background from the psychonauts and klubbers. Wonkers were often very
young kids from both rural and inner city areas, with limited education about the
drug and its risks, who valued ketamine for providing a state of intoxication that
offered a way out of challenging, frustrating, alienated and marginalised lives.
Some people in these new groups wanted to escape from the trap of repetitive
and damaging patterns of drug use.
While diverse in nature and background, the wonkers were rapidly increasing
their doses and frequency of use. Since they did not understand how to manage
crystal, they were also likely to bake the drug, lowering its quality and requiring
them to take more for the same effect. Although very few of them overcame the
needle barrier, they were all too often faced with K-bladder, mental health
problems, poor attention span and impaired memory, which are all closely related
to heavy use of the drug. In addition, ketamine's potential for dependence has
taken the majority of its users by surprise.
However, it is important to recognise that there are both psychonauts and
klubbers among the new generations, and these categories are presented as a
way of promoting debate and understanding about the diversity of ketamine
users, rather than attempting to oversimplify or stereotype. Nonetheless, while
accepting this diversity of experience, public perception of ketamine is that it has
become a drug that causes significant damage, giving it a status equivalent to
heroin and crack. Of greatest concern is the rise in worrying health conditions
such as ketamine bladder syndrome and ketamine dependency, which pose new
challenges to both people using ketamine and drug services.
RESPONSE FROM SERVICES
Ketamine users are a diverse population that have not traditionally been engaged
by drug services that can remain overly focused on opiate and crack use.
However, at its core, the response to problem ketamine use reinforces the
importance of a client-centred, empathic approach that responds to ketamine
users by offering chances to explore risk reduction, self-control or cessation.
The key harm reduction messages for active ketamine users revolve around
dose management and hydration. Understanding how to dose, avoiding dose
stacking and learning to take breaks between using sessions are all key to
avoiding unintended K-holes and managing the risk of rising tolerance. Learning
T
he story of ketamine is a powerful illustration of the risks of
abandoning a public health response and limiting drug policy to
crime reduction. UK drug policy has shifted from being driven by
public health concerns in the HIV era to being dominated by crime
prevention. Indeed, the National Treatment Agency (NTA) refused
repeated requests to tackle ketamine, arguing that it was only a
regional problem and not a priority because ketamine users did not commit crime.
In the face of this inaction, a coalition of healthcare professionals, academics,
drug agencies and drug user activists stepped in with the aim of providing
credible information.
EARLY ENTHUSIASTS
The first group of people to recognise ketamine’s non-medical value were
psychonauts – adventurers who sought to investigate their minds using
intentionally induced altered states of consciousness. Psychonauts’ primary
motivation for the use of ketamine-induced spiritual journeys was to transcend
the external world, experience the separation of consciousness from the body
and gain an insight into the nature of existence and the self. They were in the
habit of taking extremely large doses as they were deliberately trying to go into a
‘K-hole’, but since they were mostly using ketamine on a fairly non-regular basis,
their risk of developing K-dependency was pretty low.
In the early nineties ketamine arrived on the New York and London gay club
scenes, where it found an entirely different body of admirers. If psychonauts
appreciated the drug for its hallucinogenic and dissociative properties, the new
audience, called klubbers, discovered its potential to act as a highly effective
stimulant. Ketamine is one of those drugs that are extremely dose-dependent,
and while psychonauts were injecting 100-200ml shots to try to achieve out-of-
body experiences, klubbers were taking small bumps of ketamine, which usually
did not exceed 25ml per dose.
K-dependency was never a high risk for either of these two groups of ketamine
users, given the patterns of dosing, breaks between episodes of using and a
pattern of remaining hydrated – a particular feature of dance drug use. In this
context, ketamine appeared to be an almost dream drug that managed to offer
the cocaine-like stimulation, the opiate-like calming, and the cannabis-like
imagery, while at the same time providing a full-on dissociative and hallucinogenic
experience, with no apparent disadvantages or collateral damage.
WHEN K WENT DARK
The new century brought several changes to the drug market. On 1 January 2006
ketamine was officially designated a class C drug on the basis of the linkage
8 |
drinkanddrugsnews
| November 2013
Cover story |
Ketamine
www.drinkanddrugsnews.com
The ‘dream drug’ ketamine can bring its
users face to face with some stark
realities that aren’t readily understood by
health professionals.
Mat Southwell
and
Lana Durjava
offer practical advice on
understanding and meeting their needs
Getting