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Management of complications of ketamine abuse: 10 years' experience in Hong Kong.

Y L Hong, C H Yee, Y H Tam, J Hm Wong, P T Lai, C F Ng

Hong Kong medical journal = Xianggang yi xue za zhi April 2018 DOI: 10.12809/hkmj177086 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Review Peer reviewed
Topics Ketamine Esketamine
Keywords Gastroenterology Neuropsychiatry
Key findings The authors report that ketamine abuse can cause lower-urinary tract symptoms including frequency, urgency, nocturia, dysuria, urge incontinence, and occasionally painful haematuria, along with upper-urinary tract pathology such as hydronephrosis and neuropsychiatric, hepatobiliary, and gastrointestinal complications. They contend that sustained abstinence is key to recovery, since relapse usually leads to symptom recurrence, and describe a four-tier treatment protocol combining medical and surgical management with multidisciplinary care.

Abstract

Ketamine is an N-methyl-d-aspartate receptor antagonist, a dissociative anaesthetic agent and a treatment option for major depression, treatment-resistant depression, and bipolar disorder. Its strong psychostimulant properties and easy absorption make it a favourable candidate for substance abuse. Ketamine entered Hong Kong as a club drug in 2000 and the first local report of ketamine-associated urinary cystitis was published in 2007. Ketamine-associated lower-urinary tract symptoms include frequency, urgency, nocturia, dysuria, urge incontinence, and occasionally painful haematuria. The exact prevalence of ketamine-associated urinary cystitis is difficult to assess because the abuse itself and many of the associated symptoms often go unnoticed until a very late stage. Additionally, upper-urinary tract pathology, such as hydronephrosis, and other complications involving neuropsychiatric, hepatobiliary, and gastrointestinal systems have also been reported. Gradual improvement can be expected after abstinence from ketamine use. Sustained abstinence is the key to recovery, as relapse usually leads to recurrence of symptoms. Both medical and surgical management can be used. The Youth Urological Treatment Centre at the Prince of Wales Hospital, Hong Kong, has developed a four-tier treatment protocol with initial non-invasive investigation and management for these patients. Multidisciplinary care is essential given the complex and diverse psychological factors and sociological background that underlie ketamine abuse and abstinence status.

Comparable studies

Other narrative reviews on ketamine, most cited first.

Study Year Design Participants
Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms 2018 Review
Mechanisms of Ketamine Action as an Antidepressant 2018 Review
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression 2021 Review
Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) 2013 Review
A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders 2017 Review and consensus statement

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Ketamine Esketamine Addiction Depression Philosophy of mind