really interesting substance because it sits in a paradox,’ EUDA scientific analyst Dr Rita Jorge told the agency’ s Ketamine in Europe webinar.‘ Two realities exist in the same molecule. On the one side, it’ s an essential medicine. On the other, it’ s an illicit commodity. That makes it, by nature, a policy challenge.’

Availability was constantly increasing, she said, with the wholesale price dropping and growing numbers of seizures in Europe( DDN, March, page 5).‘ The question is where is it coming from – is it from EU production, are people stealing finished medicines, or is it

something else? The answer is that it’ s something else.’

While most illicit supplies of ketamine had been diverted from legal supply chains, this was from the active pharmaceutical ingredient( API) side, she explained, before being passed to an illegal third party.‘ So it’ s not the finished medicines, but the large bulk imports’ – typically from India.‘ Because we’ re not talking about a strictly illegal substance, the financial incentive with the somewhat lower legal risk might be explaining this large expansion in the market.’

INCREASED USE Recreational use had increased significantly over the last

decade, said urologist at the Jeroen Bosch Hospital’ s dedicated ketamine clinic in the Netherlands, Dr Wouter van der Sanden.‘ The problem we’ re heading to is that around 25 per cent of recreational users go on to report urological problems.’

The drug was cheap, easily accessible and perceived as relatively safe, he said.‘ My patients say things like,“ It’ s also used in hospitals so how bad can it be?” or“ You can’ t OD on it” or“ It’ s not addictive”.’ Some of his patients had also heard about ketamine’ s legitimate use in treating depression and were self-medicating with it for their mental health issues – going from recreational use at the weekends to using it daily.

The physical consequences of these increasing rates of use were something he saw every day. A normal healthy bladder could easily hold around 400- 500ml of urine before someone had the urge to urinate, he told the seminar.‘ Think of a severely damaged ketamine bladder as an espresso cup – it only holds around 40-50ml of urine. Now imagine the inside of the bladder covered with sandpaper, and the outside with barbed wire.’ The symptoms could be‘ devastating’, he said.‘ I see young people in wheelchairs because the pain in their pelvic region means they’ re unable to walk.’

His patients frequently had‘ extreme urinary frequency’, he continued – sometimes every

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