The first time Nick (not his real name) tried ketamine, he felt as if he’d entered another dimension. Though he smoked marijuana regularly and had experimented with other drugs, Nick had never even heard of ketamine. But when his friend pulled out a bag of white powder, “I did what anybody else would do at 20 years old. I tried it,” he says. “And I found it really fun, to be honest.” The floaty feeling, like he’d been lifted out of his own body, was “euphoric”, he says. “Like you’re in a fairy world.”

Sixteen years later, reality is biting hard. Nick, now 36, has spent the past three months in recovery for ketamine addiction after more than a decade of heavy use. His bladder is a fifth of the size it should be, he says. It’s “more than likely” that it will have to be removed and replaced with a urostomy bag.

That’s setting aside all the other “brutal things” he’s gone through as a consequence of ketamine addiction – from being bed-bound by pain to embarrassing bladder failures. Now six months clean, Nick still cannot last half an hour without needing to use the toilet. “I am now a disabled person, having been such a fit lad,” he says.

Nick is sharing his story to warn others of the dangers of ketamine, which is rapidly emerging as gen Z’s recreational drug of choice. Widely used in human and veterinary medicine as an anaesthetic, in illicit use the class B substance is typically snorted for its dissociative effects. According to the most recent government figures, use in England and Wales has more than doubled since 2016; among 16- to 24-year-olds, it has more than tripled, and there are stories of addicts as young as 12 or 13. The story is similar elsewhere. In Australia, recreational use of ketamine was reported to have reached a record high last year. In the US, seizures of illicit ketamine grew by 349% between 2017 and 2022. The death of Friends actor Matthew Perry at the age of 54 from “acute effects” of ketamine raised awareness of the risks of addiction.

But most users are under 30 – reflecting its widespread availability and relatively low cost. A gram of cocaine typically costs £80 or more in the UK, but the same amount of ketamine may be as little as £30. Doctors are increasingly seeing people in their 20s and even younger presenting with incontinence and other bladder problems caused by chronic ketamine use. The drug affects the organ’s lining, and over time may cause it to shrink. Users then become dependent on ketamine for pain relief, creating a vicious cycle that’s difficult to break.

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“We’ve got people who are probably 20 or 21 needing major surgery,” says Mohammed Belal of the British Association of Urological Surgeons. This reflects the increase in ketamine use reported just before and during the Covid pandemic, but the recent UK surge is also striking for its geographic spread, Belal adds. Where ketamine used to be localised to major cities, it is now commonplace in other areas, too, including Barnsley and East Anglia. This puts additional pressure on treatment services.

Ketamine “never used to be part of my daily job, and now it is”, says Scott Ardley, a senior treatment adviser at Rehabs UK, who is based in Suffolk. He is receiving more calls from parents concerned about their teenage children and twentysomethings’ ketamine use: “It’s not having it down the pub, or with friends – it’s doing it by themselves, and getting hooked on it.”

Of those under 18 who sought help from NHS alcohol and drug services in the year to March 2023, 6% had problems associated with ketamine – up from less than 1% in 2015. This summer, Shropshire council reported an increase in ketamine-related hospitalisations, coinciding with “a spell of hot weather and the end of exam season”.

Agnes Wootton, from the drug and alcohol support charity With You, says young people are turning to ketamine for the same reasons they might try any mind-altering substance: to escape reality. It is most commonly used as a party drug, and is now “quite socially acceptable” at clubs or music festivals, she says. She has also heard of young people taking ketamine to enhance creativity, owing to the drug’s hallucinogenic effects. “The vast majority” of users stick to that recreational level, says Wootton. But tolerance can build up quickly, potentially leading to dependency and addiction.

“It’s just a sneaky drug – it tricks your brain,” says Nick. After that blissful first experience, he started using ketamine more frequently in social settings. Mixing ketamine with beer “made you feel like you’d had twice as many drinks”. It also didn’t come with much of a hangover. He started using ketamine when he was home by himself – to watch a film, or help him get to sleep. “I’ve realised, as I get older, I was doing it to mask problems I had inside,” he says.

He started smoking marijuana at 12 and never learned to cope with difficult emotions, instead escaping into drugs, he says. When Nick’s grandmother was confined to bed after a fall, ketamine helped him cope with her care. He likens the relaxing effect to cannabis, and even a post-work glass of wine: “You can have a little bit of ketamine, and within an hour, it’s worn off.”

Indeed, one explanation that’s been given for the surge in young people using ketamine is that they are seeking to alleviate symptoms of depression and anxiety, and manage their mental health. “The vast majority are using it to self-medicate for emotional distress,” said Owen Bowden-Jones, a consultant psychiatrist and founder of the Club Drug clinic, in September.

Clinical trials suggest ketamine has promise as a therapy for treatment-resistant depression, but gaps in knowledge about the optimal dose and mode of administration mean it remains experimental. Street supply of ketamine may also be mixed with other toxins, adding to the risks. This year, three Liverpool men were hospitalised with seizures linked to a contaminated batch. But the adverse effects of long-term, heavy recreational use of ketamine aren’t widely known. “It hasn’t really got the kind of negative connotations the other drugs might have,” says Wootton, “and that might partly be because of that lack of education.”

After a year, Nick was using “all the time”, exacerbated by mounting stresses in his work and family life. His addiction was able to progress due to ketamine’s relatively low-key nature. “If you’re taking a stimulant, you’re normally out of it for quite a while, plus you’re going 100 miles an hour – people can really see it,” says Nick. “With ketamine, as long as you’re not having large doses, you can kind of keep it a secret.” His body was registering the toll, however. First, he noticed he needed to use the toilet more often, including during the night. Then he started getting shooting pains in his stomach and kidneys. Still he didn’t seek help: “I didn’t think I had a problem,” he says. Embarrassment about his symptoms was another barrier. “It being your private parts, it’s quite daunting. You don’t want to talk to anybody about it – you feel weak.”

When Nick stopped working due to the pandemic, his use of ketamine rocketed further. Then, one day, “all of a sudden”, those shooting pains became constant. “It felt like my bladder just gave up on me,” he says.

Belal, the urologist, says symptoms tend to present within the first year of heavy use. “If you were to stop, then the bladder tends to recover.” But many people don’t make the association between needing to go to the toilet more frequently and using ketamine. Over time, “the changes within the bladder tend to become permanent”, and the pain worsens – causing people to use the drug more frequently, and in larger doses, as an anaesthetic.

In its third stage, the damage spreads through the ureters up to the kidneys, potentially causing renal failure. Liver function is also affected. Patients then typically need reconstructive surgery, says Belal – but by that point, they are dependent on ketamine for relief. “They just can’t stop, and that makes life extremely difficult in terms of how to manage them … We can’t provide that service until they’ve given up.”

Nick was stuck in that agonising cycle for years. “I’ve gone days and days, lying in bed screaming, feeling like someone’s sticking red-hot needles in my balls,” he says. He couldn’t even go to the supermarket, “because I’d go [down] one aisle then I’d have to go to the toilet … It just destroys you completely.” In May, Nick attempted suicide. “I thought I was beyond help,” he says. “I gave up. I thought: I’m knackered. I’m done.”

Two months later, he moved into Reflections House, a recovery centre in Castleford, where he began unpicking his addiction. “They’ve made me realise that it wasn’t ketamine that was the problem; it was me,” he says.

Ketamine poses a “unique challenge” for treatment providers, says Ardley. Once users are trapped in the cycle of self-medication, it’s not just the mental aspect of the addiction that needs attention: “There’s a physical element, which needs to be taken seriously.” But community services are oversubscribed, reflecting government funding cuts, meaning that by the time people get help, “they’re in a worse situation”, Ardley says.

Private clinics, too, are still developing best practice for ketamine addiction. “There needs to be more people getting together in the UK to understand what treatment works,” says Ardley.

James Pierce from Barnsley Recovery Steps echoes the call for a comprehensive, targeted response to the growing ketamine crisis in the UK. Users have told him of seeking help from drug support services, but finding them poorly equipped to help. “They felt that the worker didn’t really have much insight into ket use, or didn’t really understand the pain they were experiencing,” Pierce says.

Jack Curran, 28, from Bexleyheath, in south-east London, says ketamine is “absolutely ravaging” the UK. He is a recovery worker at the Lighthouse rehab clinic in Southend-on-Sea, and is in recovery himself. Curran started taking the drug after he was seriously injured in a fight at 18. “It not only helped with my pain, but it also calmed my mind down a bit,” he says. Within two years, he was using as much as two to three grams of ketamine daily. He takes medication for rheumatoid arthritis, which delayed the onset of physical symptoms. But when they eventually hit, they were “horrendous”, he says. “I couldn’t go to work – couldn’t do anything. I’d be living in my room with a hot-water bottle, getting in the bath every half-hour or every hour through the night, in absolute, extreme agony.”

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Not only did Curran feel in constant need of the toilet, “it felt like I was peeing glass”, he says. His bladder was riddled with ulcers, and could stretch only to 30ml; normal capacity is between 300ml and 600ml. At 25, Curran was periodically wearing nappies. “I just carried on through this absolute carnage, losing my spiritual, emotional and physical health,” he says. By age 27, Curran had been in and out of rehab without successfully kicking his addiction; he knows “multiple” people who have killed themselves. Curran believes that he, too, would have died, had he not become desperate enough to give recovery another chance. When he checked into a treatment centre for a third time, he says, “I was seven stone; my liver was packing up, and my kidneys … I thought: ‘I’m actually going to die.’”

Now nearly two years clean, Curran’s bladder capacity has increased to around 100ml and he is no longer in constant pain. But he still has to use the toilet every hour, including during the night, and may yet need surgery. “This is what a drug, a little white powder, has done to me – it’s mental,” he says.

Curran finds purpose, now, in raising awareness of the devastation ketamine can cause, and helping others to beat their addiction. Having spoken publicly about his experience, he receives hundreds of messages on Instagram from young people seeking help from all over the world. Some are 15 or 16 years old. Curran tells them to quit before they get caught in the catch-22 of taking ketamine to relieve the pain it’s causing. “As soon as you get in that loop … it makes it 100 times harder to stop.”

Nick also urges caution. He is haunted by the words of a doctor who told him that he’d “chosen the one drug that completely ruins your body”. “I never knew that about ketamine,” he says.

If you are struggling with any of the issues raised in this article, wearewithyou.org.uk offers harm reduction information and confidential online chat with a recovery worker. To find support near you in the UK, use Talk to Frank’s online service finder.

In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.

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This article was amended on 5 November 2024. An earlier version misnamed the drug and alcohol support charity With You and referred to a colostomy bag when a urostomy bag was intended.