Can anything stop the ketamine crisis?

0:00Hello, Ed Conway here. Here is what might sound like a slightly random question. What do AirPods, bananas and a pair of shoddily made running trainers from the 1970s have in common? On the surface, not very much. But on my podcast, Stuff Matters, I will uncover the deeper stories behind each of them. You will see how together they tell a fascinating new story about the world we live in. The first full series of Stuff Matters is out now. Just search for it on your podcast app and follow. Coming up on The Daily, caught in the K-hole, a Sky News investigation reveals the lives ruined by Kettleman.

0:38Hello, Ed Conway here. Here is what might sound like a slightly random question. What do AirPods, bananas, and a pair of shoddily made running trainers from the 1970s have in common? On the surface, not very much. But on my podcast, Stuff Matters, I will uncover the deeper stories behind each of them. You will see how, together, they tell a fascinating new story about the world we live in. The first full series of Stuff Matters is out now. Just search for it on your podcast app and follow.

1:12Cheap, potent, readily available. Ketamine is quickly becoming just the latest drug to prompt panic in the authorities. And yet, it's not exactly well known outside those that use it and those who must pick up the pieces. Because, as you're going to hear, habitual use can have terrible effects on the body. Incontinence, kidney failure, chronic pain. And so, the government is currently considering whether to recategorise ketamine as a Class A drug. And we're going to be discussing the pros and cons of that later with a pharmacologist from King's College London. First, though, our North of England correspondent, Shingi Marariki.

1:52So ketamine was actually originally developed in the 60s as a battlefield anesthetic. So it's used in the Vietnam War. It's a really strong painkiller essentially and it's still used in medical settings. It's a really good drug when you need to ease pain. But in like a recreational setting, if you're on a night out or if you're partying, then the ketamine that we're talking about in this story is a crushed powder, makes you feel detached, dissociated, dreamlike, like essentially spaced out. So you've got the medical anesthetic, both used for people and animals, which is why people call it a horse tranquilizer as well.

2:27And then you've got the party drug. And it's not as if this has come out of nowhere. I mean, ketamine has been around for a number of years. It's just what the frequency, the damage that it's causing that's put us onto this story. It is, it's the damage it's causing and just how commonplace it is. So just quickly taking a look at the statistics that we have between 2023 and 2024, the number of young people reporting having a problem with ketamine past cocaine for the first time. The number of ketamine users starting treatment was eight times higher than it was in 2014 to 2015. Shiggy, whenever we see drugs like this, you know, accelerating in use, we often get our first indication of it at a rehab centre and that's where you went.

3:06Tell me about your trip. So I went to Birchwood on the Whirl, which is run by a charity called Kaleidoscope House, and it was just really eye-opening and quite intense in terms of an experience. So there I met Jo, who manages Birchwood, who's worked in healthcare for 25 years or so, said she's never seen anything quite like this. And in her conversations with us beforehand, she just kept on making the point that I know people have been on heroin, but the damage that ketamine does is so quick and so life-changing in that time span that it's impacted her and her work. So in Birchwood, there were 14 out of 25 beds the week before we went that were taken up by ketamine users so they're inundated with it and when we went there we also spoke to Callum and Nicole two people who had used ketamine and become addicted and were there to detox and rehab and hopefully go back out into the community well let's start with Nicole I don't regret taking ketamine you don't regret it no if I didn't take ketamine in that period of time I wouldn't be here it was a coping mechanism for a while until it destroyed my life.

4:12I found out that my damage is irreversible because I have permanent scarring in my bladder now so even if they do manage to stretch my bladder or do something with my bladder or even if my bladder doesn't need removing I'm still going to be in chronic pain probably for the rest of my life. For her she said that ketamine was her saviour when she first took it which was on a night out with friends where she didn't want to drink She saw the bag, she picked up the bag, she took it and she said, I just remember thinking, this is my drug. And for her, it was a difficult childhood. It was issues that had happened in her adult life and struggling to cope more broadly that put her onto ketamine and that dissociative feeling and that kind of that lightning of a really heavy load.

4:56But she presumably is in rehab, not simply to deal with the addiction, but to deal with the effects of the drug. I mean, how has it affected her? It's multifaceted. So she's got what you would describe as ketamine cystitis, which has a number of issues, but they are bladder issues from your issues with your urethra to your blood in your urine and agonizing cramps and spasms. The first elements of that ketamine cystitis inside the first year and then in the second and third year, they just become gradually worse and you're going to hospital because of the cramps and the pain it causes you. You're in and out of consciousness.

5:33this. And she was telling me that morning before we got to meet her and interview her, getting up was just agonising. Every day is chronic pain. And she's had a range of kidney issues as well as bladder issues. And some of those kidney issues, doctors just haven't been able to work out to the point where she's had kidney procedures like an ephrostomy, which helps drain fluid in your kidneys. She had that without pain relief because the doctors are like, you're on ketamine, you're addicted to a painkiller. So we're not going to give you a painkiller. And she's in the hospital screaming. Callum, another of those you met at the rehab centre, what's his story?

6:07I was told I had a couple of days to live before I came into here, which is when Jo came to mind and she'd seen me for the first time, just looking at me, she said I'm getting you in, I'm getting you in, I need to help you and stuff, which I've never felt like someone's going to help me before then. The reason I would be taking it a lot is because of the pain and when you're on that you don't feel the pain, it's only once you get off the catamaran you realise the pains that you've got and the problems that you've gotten majorly. Because when you're on it, you know you've sort of got pains, but you don't think they're that bad.

6:39People, I know, drank 30, 40 years. My liver's worse than theirs, like, from just Kessman. What are you thinking, just at this moment? At this moment, it's just this, yeah, you just realise what you've done to yourself, and you wish you could go back. You know there's no going back, but it's just building off that, really. That's the way I just have since being here, just looking forward. I just want to get myself back on track. That's it, really. So Callum just described himself to me as a lad from Cheshire ways, and he was quite sort of measured and quite introvert. So he had been on ketamine for around three years before he went to rehab.

7:18His father was an alcoholic and he was caring for his dad. And then when his dad sadly passed away, he was like, oh, there's this drug that I've taken from time to time at festivals. I know it will help me kind of ease the mental pain and detach. So I'm going to take it. And then he was just in this pattern of daily use to the point where it caused him liver issues, bladder issues, and then multiple organ issues. He was six stone when Joe, who runs Birchwood, went to his house, saw him and said, I need to get you into rehab. You need to recover. What are the clinicians saying? Obviously, Joe at the rehab center has a very decent window on what is taking place.

7:56but the medical professionals. There must be a degree of concern about this explosion in ketamine use. So we spoke to the consultant urologist at Pinderfield Hospital. She used the word explosion and she said that they're seeing many more patients compared to maybe three or four years ago. And she said essentially the capacity is reduced. So a healthy bladder is going to be able to hold around 500 mils. A ketamine bladder is holding around 100 mils if not less, so it just shrinks down, walnut-sized in some cases. There's that common refrain, if you like, that no drug does this amount of damage to your kidney and your bladder this quickly.

8:36She's doing bladder removals more frequently. She's seeing young patients as well. She said one as young as 14. So she is alarmed. Thanks, Shingy. Look, such is the concern about the rise and shift in ketamine use that the government is considering recategorising it as a Class A drug. Carolyn Copeland is Senior Lecturer in Pharmacology and Toxicology at King's College London. Dr Copeland, just explain exactly what that would mean. I mean, it was already recategorised from a Class C to a B, wasn't it? It was made a Class C drug and then it was upgraded to Class B in 2014. And that was due to the perceived risks and harms of the drug by increasing the penalties for its supply, manufacture or possession.

9:19All that we've seen since it becoming a class substance, be it initially when it was a class C and now a class B, is that there is clearly not a deterrent for its use because that has continued. And so my worry with making it a class A substance is that that's not really going to do much in terms of a use deterrent. And that really needs to be thought of very carefully as to what is going to be able to be achieved by making it a class A substance. Do you think it deserves that kind of class A categorisation in the sense that there are recreational users of this drug doing it regularly, kind of weekend, every second weekend, for whom the negative health outcomes are not there in the way in which we saw when we took our trip to the rehab centre?

10:07So judging whether or not a drug is class A, class B, class C, you aren't just looking at the direct harms for the user. You're also looking at the indirect harms to other people. So things like drug driving. You're also looking at the harms that have happened on the process of the drug getting to that person. So the trafficking, the county lines, the use of children to traffic drugs and things like that, that you need to be taken into account overall. And it's difficult to sort of say this is what definitely makes a class A substance. If you're looking at heroin, for example, that's a class A.

10:39We have thousands of deaths due to heroin each year in the UK. But then we have LSD as a class A substance as well. And we've had, I don't think, even 10 deaths in the past two decades. So fatality is not the only determinant of what classification a drug is. I wonder if we have perhaps been here before, that there have been drugs which have arrived on our shores that the authorities haven't picked up on quickly enough or haven't recognised we're going to be having such negative impacts on large parts of society. Now, we know about ketamine. I'm just wondering whether perhaps the authorities have not been as sharp, have not been as wise as people like you to the changing pattern of usage of ketamine.

11:18What I am worried about is if ketamine is made a class A substance, what is going to come next? So we've seen with the opioids, the emergence of these synthetic opioids like fentanyl in the US and mitazines here in the UK, which is super potent and even more dangerous than the original substance. And if we control ketamine further, are the drug gangs going to be looking for an alternative that can then be sold, which is even more potent and even more dangerous? And if you needed an indication of the necessity for intervention on this topic, more young people have tried ketamine than have tried cocoon.

12:00I mean, there you have it in a nutshell, don't you? People are taking up this drug, they are using this drug and perhaps not knowing the huge consequences that could flow from it. It's very concerning, you know, drug use in any demographic. And, you know, one of the more visible ones is young people and they're the ones that make the headlines when bad things happen. But there are a lot of people that use ketamine, many established drug users. And, you know, I think they deserve our sympathy and help just as much as any demographic that uses them. It's just in this particular case, it's something that speaks to a lot of us when we see our young people using the drugs.

12:37Dr Koblin, how concerned are you about ketamine? I'm concerned that something more than making it a class A drug needs to be done. We did an analysis of deaths following illicit ketamine use five years ago. And we made this fairly wild projection, what looked like wild projection, of deaths following ketamine use in 2019 would reach over 60 people. So that's one death a week. And we recently redid an analysis which showed that that number was actually true in 2019. We did get over 60 deaths occurring. But since then, it's got even worse and we have even more deaths which have happened. And it's not just sort of carried on the trajectory, but it's actually significantly escalated since then.

13:28And we're looking at possibly 200 deaths happening in 2024. Thanks, Caroline. And we'll head back to Shingy for a couple of final thoughts. I mean, starting with whether or not you think people have been too slow to recognise the problems that come with greater ketamine use. They are behind the curb. So Joe describes this as a tidal wave that we need to get ahead of and we are nowhere near that. For her, it's the fact that this drug can do so much damage and then by linkage to that, it needs so many agencies to support someone. So it might be mental health agencies to support people like Callum and Nicole who are going through things.

14:09And then you've got the return to society and the kind of psychological process there. Then you've got the health agencies. If you've had a more difficult upbringing and background, it may tie into those social factors that mean that you are more likely to have had traumatic things happen to you. Therefore, you might be more likely to turn to something like this drug. But where the social impacts on each person's story kind of interconnect with something else is that it's cheap. It is you could get a bag for around£30, an estimate I've been given, and you can get that very easily. So it's it's not too much more expensive than going out for, I don't know, three or four drinks and you can get a hold of it.

14:51And it's kind of now seen as more socially acceptable and socially understood in certain settings. like Nicole was about to go out for drinks and the ketamine was just there. Callum had been at festivals and the ketamine was also there. So it's just that combination of all of those things. But I do think there are people who may need help from other agencies, maybe mental health services, for example, not getting it, turning to this drug that they can get quickly. But that's where I think experts and policymakers are looking at the government's decision to potentially reclassify ketamine and saying, actually, hold on, there needs to be a bit more nuance.

15:27Adding to the punitive measures when there are loads of social measures at play is not going to do anything. So therefore you do need to go out and educate people. And that's something that the people I spoke to, particularly Callum and Nicole, but also Jamie was an anonymous man who lost his bladder to ketamine. All of them, they said to me, we want people to know about our stories to the point where Nicole wants to eventually join Joe delivering talks across the country and spreading the messages, spreading the word. So I think education is a key component of this for not just experts and people helping those who are impacted by the drug, but those impacted people themselves as well.

16:08Thanks, Shingy. His full report is over at skynews.com. You can also find it on the app. The Daily's back tomorrow. Hello, Ed Conway here. Here's what might sound like a slightly random question. What do AirPods, bananas and a pair of shoddily made running trainers from the 1970s have in common? On the surface, not very much But on my podcast Stuff Matters I will uncover the deeper stories behind each of them You will see how together they tell a fascinating new story about the world we live in The first full series of Stuff Matters is out now Just search for it on your podcast app and follow