Young Peoples Substance Misuse Treatment Service KETAMINE

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Young Peoples Substance Misuse Treatment
ServiceKETAMINE
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KETAMINE
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KETAMINE

• Ketamine was first synthesized in 1962 whilst
  searching for an alternative to the anaesthetic
  PCP. It was mass-produced by the pharmaceutical
  company Parke-Davis and was extensively used in
  the Vietnam War.
• Ketamine is a central nervous system
  depressant and belongs to a class of drugs called
  "dissociative anaesthetics", so called as they
  separate perception from sensation. Other drugs
  in this class include PCP and Laughing gas
  (nitrous oxide).

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KETAMINE

• Ketamine acts primarily via the NMDA receptor
  system. It also has effects at many of the other
  neurochemical systems including the opiate
  system, the dopamine system and the
  serotonin/5-HT (5-hydroxytryptophan) system.
  These systems are responsible for the actions of
  other drugs of abuse such as heroin, cocaine and
  ecstasy.

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KETAMINE

• Ketamine is either sold as a dry white powder
  or a clear liquid (in its original pharmaceutical
  packaging).
• The powder is made by drying the liquid. The
  residue from this drying process is then crushed
  and snorted in small doses (called bumps).
• Ketamine can be injected IV, IM, subcut

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• One litre of Ketamine liquid could yield
  between 50-80 Grammes of Ketamine.
• Extraction of the Ketamine from the liquid is a
  simple process using a microwave.

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KETAMINE EFFECTS

• Maximal blood levels are reached after
  approximately 20 minutes by snorting and 30
  minutes orally.
• Oral administration results in high levels of
  the metabolite norketamine, this has mainly
  analgesic effects and users report a different
  type of drug effect because of this. The duration
  of the pleasurable effects last approximately one
  hour, dependent upon route of use, although the
  effects of the metabolites will persist for
  longer.

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KETAMINE EFFECTS

• In large doses of ketamine produces a dream-like
  dissociative state and hallucinations. It has a
  number of contradictory effects, including
  stimulant, sedative, anaesthetic, and
  hallucinogenic properties. Users describe feeling
  like they are drunk, stoned, and tripping all at
  once.
• Ketamine blocks the neurotransmitter
  receptors, causing a user to feel distanced from
  his/her environment. It causes the user to feel
  euphoric and insensitive to physical pain.

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KETAMINE EFFECTS

• Use of ketamine can produce profound effects
  on memory.
• There is some evidence to show that subtle
  memory deficits persist for longer than 3 days
  after use and that these deficits are worse for
  regular users of ketamine.

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KETAMINE RISKS

• It is difficult to regulate a "dose" of
  ketamine, and there is only a slight difference
  in dose between the desired effects and an
  overdose.
• Ketamine is a depressant, at higher doses it
  can dangerously reduce heart rate and respiratory
  function. Combining ketamine with other
  depressants, like alcohol, diazepam, or GHB, can
  produce delirium, amnesia, impaired motor
  function or depression at high doses.

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KETAMINE RISKS

• In general, literature on the consequences
  of long-term ketamine use is sparse, but reports
  suggest that flashbacks, memory, attention and
  vision impairment may result from frequent and
  prolonged use.
• Tolerance develops quickly, requiring more
  of the drug to achieve the same repeated high.
• Stimulant-like weight loss and loss of
  appetite may occur during periods of heavy use,
  as well as psychological dependence, psychosis
  and gradual loss of contact with the real world.

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KETAMINE RISKS

• Ketamine produces stimulation
  of the cardiovascular system. There is an
  increase in heart rate, cardiac output and blood
  pressure.
• Ketamine has a bronchodilatory effect but
  pharyngeal and laryngeal reflexes are maintained.
• Cough and swallow reflexes being maintained
  protects users from harm because there is no
  suppression of the gag reflex even when extremely
  intoxicated, unlike sedative intoxicants such as
  alcohol, a user is less likely to choke and
  aspirate if using solely.

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KETAMINE RISKS

• Like other hallucinogens, it can also cause
  severe flashbacks.
• Frequent use and higher doses can cause
  disruptions in consciousness, paranoia, neurosis
  or other mental disorders, kidney and liver
  damage.

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INTERACTIONS

• When ketamine related deaths are reported the
  usual co-intoxicants are opiates and alcohol.
• No clear conclusions can be drawn as to the
  interactions of ketamine with recreational drugs
  or alcohol.
• Research has shown it is likely that ketamine
  has a synergistic effect with cocaine.

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KETAMINE RELATED DEATHS

• UK records of deaths where ketamine was
  detected on post-mortem has been reviewed. Nine
  deaths were identified from1993 to 2003. In many
  cases where ketamine is involved they will be
  missed, as it is unlikely that it is routinely
  screened for.
• In only one death was ketamine the sole drug
  identified, this may be due to under-detection in
  post-mortem as ketamine does not form part of
  routine screens for drugs of abuse, rather than
  it being a safe recreational drug.
• Opiates and alcohol were the most common
  other substances found at toxicology. Opiates
  were the most common co-intoxicant, followed by
  amphetamines and cocaine.

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Ketamine in Bristol

• Increase in presentation to service since 2006.
• By September 2007 a regular drug of use for young
  people.
• Accounts for all of current IDUs in service.
• Since spring 2009, all injecting ketamine users
  in service have experimented with heroin/crack
  use.

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Service Response

• Work with users as normal
• History of chronic ketamine use
• Presenting or reporting recurrent urinary tract
  infections UTIs
• Suprapubic /loin pain no response to simple
  analgesia
• Macroscopic haematuria
• Incontinence

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Service response

• Referral for investigations for urinary tract
  infection
• Assessment of renal function
• Cystoscopy examination of the bladder by means
  of an instrument inserted via urethra
• Bladder Biopsies chronic inflammation denuded
  epithelium

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Service Response

• Young people frighten
• Hear stories from older users
• Not sure what to expect from urology departments
• Urology departments not set up to deal with
  anxious young people/drug users
• Young people DNA appointments

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Service Response

• Specialist clinics set up between urology and
  substance misuse service
• Workers work with young people explaining what to
  expect from appointment at urology
• Workers prepare YP as much as they can
• Workers remind YP of appts and provide transport

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Service Response

• Adult services have run workshops for users
• - talking about use,
• -giving harm reduction messages
• -Information gathering

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Ketamine

• Whats happening in your area
• Urinary and gastrointestinal problems well known
  to users
• Use appears to be increasing in young people
• Users unaware that damage could be permanent

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Ketamine

• Ian Vincent - Clinical Nurse Specialist
• Bernadette Chinnock - Service Manager
• Young Peoples Substance Misuse Treatment Service
• (CAMHS)
• www.openingdoorsbristol.org.uk