Inpatient ketamine detoxification, characterization of a treatment-seeking population with complex needs

Background
Ketamine acts primarily as a non-competitive antagonist at glutaminergic N-methyl D-aspartate (NMDA) receptors. Ketamine has been useful in veterinary medicine due to its anaesthetic and analgesic properties. Recently, ketamine has been used for its antidepressant properties. Ketamine has psychedelic properties and in recent decades there has been a rise in its recreational use with reports of dependence. The toxic effects, chronic ketamine abuse has on hepatic and genitourinary systems have been researched. The recreational use of ketamine in combination with other central nervous system (CNS) depressing substances has been implicated in both intentional and unintentional overdoses. This study reviewed sociodemographic and associated clinical factors of clients admitted to Chapman Barker Unit (CBU) Prestwich, Manchester, United Kingdom for Ketamine detoxification.
 
Methods
This study reviewed data retrieved from service users receiving treatment for ketamine dependence alone or in combination with other psychoactive substances from the electronic notes system of clients admitted at Chapman Barker Unit for ketamine detoxification between May 2016 and January 2024.
 
Results
Data was retrieved from n=20 clients (10 males and 10 females) with a mean age of 25,25 years (SD 6.02). n=8 used ketamine alone while n=12 used ketamine with other mostly CNS depressant drugs. 87% preferred to inhale ketamine. The average daily ketamine use was  4.12g. A higher proportion of female clients (75%) used ketamine only and used more daily (mean=5.51g) compared to males (mean=2.72g). Most clients had deranged Alamine Transaminases (ALT) on admission with a mean level for ketamine alone users of 128.57IU/L (SD 59.74). 75% had lower urinary tract symptoms (LUTS) that comprised of dysuria, non-haemorrhagic and haemorrhagic cystitis. 87% of ketamine alone users, presented with withdrawal symptoms of cravings, nervous anxiety, palpitations, and insomnia. Medically assisted withdrawals from ketamine consisted of low-dose benzodiazepines and analgesics. 
Seen was a dose-response relationship between daily ketamine use and elevated ALT (mean=4.57g daily use for those with raised ALT compared to mean=2.88g daily use for those without. The same relationship was found with LUTS (mean daily use of 4.88g for those with LUTS and 2.75g for those without). Anxiety and Personality Disorders were the most prevalent mental health conditions in ketamine-only users.
 
Conclusion
Ketamine abuse is a growing problem among young adults with its use among women raising. The dangers of ketamine use in combination with other CNS depressant drugs and the increasing evidence of its toxic effects on hepatic and genitourinary systems need to be further explored. A well-standardised protocol for ketamine detoxification needs to be formulated and multidisciplinary approaches to managing ketamine dependence and its complications should be encouraged. Further research is warranted.