researchgate. net
Seizures of ketamine reported to EUDA( EU Early Warning System) and wholesale versus retail prices of ketamine in the Netherlands
EUDA webinar: Ketamine in Europe – www. euda. europa. eu
ten to 15 minutes.‘ That’ s not an overstatement, and it’ s day and night, so it’ s impossible to have a normal life. They pass blood and blood clots, they suffer from incontinence and severe sexual dysfunction in both male and female patients. And these are very young and normally otherwise completely healthy patients.’
In some cases this damage was irreversible.‘ Then I have to remove the bladder and put in a urostomy. When you’ re 25 you don’ t want to live like this for the rest of your life.’ There could also be damage to the kidneys so severe that it required dialysis.‘ So this safe party drug isn’ t safe at all in the long run – there can be severe consequences’
DELAYED EPIDEMIC‘ I really think we’ re going to see a“ delayed epidemic”,’ he warned.‘ The patients I see today started using ketamine years ago, and the symptoms usually only develop after prolonged and intensive use. What we’ re seeing now is only the beginning.’
So why did people present so late? Early symptoms were often ignored or normalised, he said, with many people increasing their ketamine use to suppress the pain. Added to this was an ongoing lack of awareness among healthcare providers, as well as the stigma –‘ that can really delay diagnosis and access to care.’
Patients presenting late with advanced symptoms would also inevitably have an impact on healthcare systems, he added.‘ It means the treatment is really complex and resource intensive, requiring multidisciplinary care. Patients require long-term follow-up, with many of them having chronic disability problems.’
His own ketamine clinic had been established in 2022 in response to growing levels of unmet need, he said. Patients did not fit into standard healthcare pathways, as they had serious medical problems at the same time as substance dependency issues.‘ It’ s really hard to treat only one of those,’ he stated.
Dr Wouter van der Sanden is a prominent Dutch urologist at the Jeroen Bosch Hospital in‘ s-Hertogenbosch, Netherlands. He has gained international recognition as one of Europe’ s leading medical experts on the health impacts of ketamine use, specifically focusing on ketamine-induced uropathy, a devastating urinary tract condition caused by the toxicity of ketamine metabolites on the lining of the bladder and kidneys.
DEDICATED PATHWAY The clinic had its own pathway, with integrated care for urology, addiction, pain and psychosocial support, all in a‘ one-stop-shop’ outpatient centre. The facility was now the national referral centre for ketamine issues in the Netherlands, and was increasingly seeing patients from overseas as well.
The greatest challenge was that his patients were trapped in a‘ downward spiral’, he said.‘ Ketamine causes bladder pain, so they use more ketamine to suppress that pain. That causes even more damage, so the cycle continues. So one of our biggest goals is breaking this cycle.’
However, it was easy for doctors to tell people that their bladder issues wouldn’ t heal while they were still using,‘ so come back when you’ ve stopped’. That was‘ near impossible’, he said.‘ Most of my patients know that using ketamine is bad for their bodies – they suffer the consequences every ten to 15 minutes. But they tell me,“ with ketamine I can at least have an hour of sleep” or“ it stops the pain
enough for me to get my kids from school”. This is the real world for them.’
Breaking this downward spiral required a multidisciplinary approach, he stressed, with urologists, nurses, pain specialists, medication and surgery on one side, and supportive therapy on the other – addiction specialists, psychiatrists, counselling, detox, social care.‘ This is really important.’
The clinic had already seen 500 patients this year, with demand constantly increasing and a current waiting list of around three to four months.‘ So we’ re very busy.’ The median age of patients was 27, and although they were still predominantly male the percentage of females was increasing all the time. Around half were from urban areas, and half were from rural regions – which was interesting as around 95 per cent of the Netherlands’ population lived in urban areas, he pointed out.
INTENSIVE USE While most had started using ketamine in their early 20s there were‘ outliers’ who’ d begun as early as 12, he said, and people would usually start presenting after around three years of intensive use. And by‘ intensive’ he meant between 4g and 100g every week, with a mean amount of 22g per week.‘ So these are very high numbers, very frequent use, very high dosage. We don’ t see people who use it every once in a while.’
Occasional use could easily become chronic use, however, but fortunately not all of the physical damage was irreversible, and three quarters of his patients achieved abstinence within six months.‘ If you look at addiction care, these are really good numbers.’
It was far from just being a medical problem, however.‘ It’ s very important that we talk about this, because these are very young people developing chronic illness during the most productive years of their lives’ – leading to disability, healthcare dependency and increased pressure on health systems.‘ So the rise in ketamine use we see today will become the healthcare problem of tomorrow,’ he stated.‘ But that also means there’ s still a window of opportunity.’ DDN
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