New? Or Undetected?
These problems are surprising to the Erowid crew because, up until a few years ago, we had received no reports of such symptoms being associated with ketamine use. Although we have communicated with dozens of regular ketamine users over the years, including a number of daily and even hourly users, none of those people and none of the submitted experience reports before the mid-2000s described urinary tract problems. We asked ketamine expert Dr. Karl Jansen what he thought about ketamine-associated LUTS, and he replied: "It is a mystery to me also. Nobody I have ever spoken with has had such an issue, and I have spoken with some very heavy chronic users. There has been the mysterious 'K Pains', and it may be--given that they are unexplained--that these do arise in the urinary tract rather than the gastrointestinal system as has been assumed. In short, I know nothing about it beyond the recent reports, and have no ideas about it beyond the above."
Symptoms of LUTS sometimes improve or disappear entirely upon cessation of ketamine use, but not in all cases; in addition, it appears that permanent damage can be done to the bladder and urinary tract. There are indications that higher doses, more frequent doses, and longer-term use can all cause more severe and less-reversible damage. In many of the case reports of ketamine-associated ulcerative cystitis, the medications used to alleviate symptoms were only partially or not at all successful, and the prognosis in advanced cases is dire.
Not So Safe?
The latest information on ketamine-associated ulcerative cystitis may temper the idea that ketamine use won't cause any long-term health issues among those who avoid serious addiction.
It is worth noting again that some urinary tract symptoms are common even among non-ketamine users. In addition, the entire spectrum of symptoms described as being suspected to be caused by ketamine use doesn't occur in all ketamine users who report some LUTS. With proper treatment, most symptoms of ketamine-associated LUTS resolve after cessation of ketamine use, as long as it is confirmed that they are not caused by an infection (UTI) or sexually transmitted disease. It should also be pointed out that mainstream media coverage of this phenomenon could create an impression that the problem is larger than it is.
The wide dose-response range leading to documented cases of LUTS suggests that individual responses to ketamine may be idiosyncratic and unpredictable, making it unclear what level and frequency of use may lead to urinary problems. Nevertheless, frequent ketamine users may want to cut back on their use, and all ketamine users might want to moderately increase their intake of water and pay attention to even minor urinary symptoms.
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