KETAMINE
With the number of ketamine users growing all the time it’ s unacceptable that they’ re being overlooked when it comes to accessing appropriate treatment, say Riley Johnson and Shayla Schlossenberg
POOR RELATIONS
When someone in England presents to drug treatment, that individual is categorised based on what drug( s) they are experiencing difficulties with, in one of four categories: opiates, non-opiates, non-opiate and alcohol, or alcohol-only. Where poly-drug use is present – for instance, if a person uses both crack and heroin – they would be labelled as an opiate user by this system.
‘ Non-opiate’ users are defined as‘ people who have problems with non-opiate drugs only, such as cannabis, crack and ecstasy’. Of course, these drugs are all very different and may require different specialist interventions to help an individual meet their goals. Nonetheless, in many services we’ ve found that people classed as‘ non-opiate’ users are more likely to be sidelined from receiving‘ structured treatment’.
This is defined as a‘ package of concurrent or sequential specialist
drug- and alcohol-focused interventions... [ which ] requires a comprehensive assessment of need, and is delivered according to a recovery care plan, which is regularly reviewed with the client’. Structured treatment is meant to be one or more psychosocial interventions and one or more pharmacological ones, not one or the other – and all groups should be receiving a health assessment at the start of treat ment regardless of if there’ s expectation of prescribing in the service.
Previously in this series, we’ ve highlighted that some drug users do not receive an offer of structured treatment despite a clear need, as in the case of those with benzodiazepine dependences. Today we have another non-opiate group who we’ d like to draw attention to – ketamine users.
In recent months, the Release helpline has received a noticeable increase in the number of calls from people using ketamine who are asking for advocacy, often seeking to access residential rehabilitation.
RESIDENTIAL REHAB Residential rehabilitation support is a tricky topic for our advocacy – these programmes are very diverse and the evidence supporting them in different cases is quite mixed. In a 2020 study by Wakeman et al, outcomes for more than 40,000 people with opioid use disorder were compared based on form of treatment received against a baseline of no treatment at all. Treatment with‘ buprenorphine or methadone was associated with a 32 per cent relative rate of reduction in serious opioid-related acute care use at three months and a 26 per cent relative rate of reduction at 12 months compared with no treatment’. Meanwhile, individuals who went the detoxification and residential rehab route, and those who received psychosocial treatment only, did not experience either
‘ reduced overdose or serious opioid-related acute care use at three or 12 months’.
We do not oppose access to residential rehabilitation nor refuse advocacy support to those who seek it, although we are realistic with people that the guidelines do not offer clear support for this form of treatment. Rather, we take seriously the fact that if the people contacting us – who are very often more knowledgeable than us on these matters – are unified in this desire, then likely something is seriously amiss in their community services.
FUNDING RESTRICTIONS Castel’ s case is one example. Castel has been using ketamine daily for around two years and had been with her local service for a year when she contacted Release. She reported being told by multiple workers in her service that, due to funding restrictions, it was‘ almost impossible’ to access rehabilitation for ketamine use. Castel also said that she’ s had to be the one to initiate all her key-working sessions, and when she asked about harm reduction was told that‘ there isn’ t really much harm reduction for ketamine’. She also had to educate her keyworker on the risk of bladder damage from regular ketamine use.
Her situation is unfortunately maxicam / iStock
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