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NETWORK A national newsletter on substance misuse management in primary care
network
NETWORK 27 OCTOBER 2009
Ketamine
Are you missing ketamine use as a possible issue when impairmentnull increasingly
assessing patients? Rachel Ayres, Fergus Law and restrictive friendship
Angela Cottrell discuss the rise onullketamine use and the
groupsnull vulnerability nullt
need to consider this when patients present with bladder
is impossible to look
and abdominal symptomsnull Ednull
after yourself or your
belongings whilst under
Association onullketamine with unenulllained bladder and
the innullence of ketaminenull lack of energynullannullety and urinary
abdominal symptoms
tract problems. It is this last issue that we wish to highlight in
Increasing numbers of people are using ketamine recreationally
particular.
throughout the null. It is especially prevalent amongst younger Ketamine associated ulceratinull cystitis has only recently been
people and many users are seeking help from their Gnull but may described in the literature
nullnullnullnullnull
. Its symptoms are well known in
not be disclosing their ketamine use. the ketamine using community but users may not be aware of
nullckgroundnull nulltamine is an Nnullethylnullnullspartate nullMnullnull
the long term implications or the imperative to cut down or stop
receptor antagonistnulldeveloped in the nullnulls as an anaesthetic.
their use once such symptoms have developed. The symptoms
Amongst recreational users with low tolerance a dose of nullnullnull
can be severe enough to renullire hospitalisationnull progress to
mg null nullumpnull will induce a mild nullrippynulleuphoric feeling. As the
severe complicationsnull and can result in irreversible bladder
dose is increased the dissociative effect becomes more marked.
and renal damage. Although commoner among those who use
It is this dissociative state that most recreational users seek when
ketamine daily or at high dosesnullit can also occur with lower dose
they use ketamine. This state can be reached with around nullnull
recreational ketamine use.
nullnullg in nonnullolerant users. nulltamine is increasingly becoming
1 Chu et al (2007) ‘Street ketamine’-associated bladder dysfunction: a renullrt of ten
a drug of daily and habitual use amongst younger peoplenullwith casesnull nullnnullnullonnullnulldical nullurnalnullnullunull1nullnull :null1-null
elements of loss of controlnullcompulsion and a move from social to 2 Chu et al (200null nulle destruction of the lonuller urinary tract by ketamine abuse nulla
more solitary use. These users report a rapid increase in tolerance
nenullsyndromenullnullitish nullurnal of nullolonull nullternationalnull102 (11): 1nullnull1null2null
to the drug and a distinct psychological withdrawal syndrome.
null Cottrell et al (200null nullinary tract disease associated nullth chronic ketamine usenull
nullitish nulldical nullurnalnullnullnull nullnull
nullring detonullficationnull severe annullety with physical symptoms
and increasing urinary tract pain may occur. nulltamine users
null Cottrell nullnullllatt (200null Consider ketamine misuse in nulltients nullth urinary symnull-
toms (editorial)null nulle nullactitionernull2null(1711): null
who are dependent may be using anything from nullnullnull grams
null Shahani et al (2007) nulletamine-associated ulceratinulle cystitis: a nenullclinical entitynull
per day and suffer a range of side effects including cognitive nullolonullnullnull(null: null0-null2null
nullcontinued overleaf
In this issue
Effective pain management for drug users in acute hospital settings is something that Caryl Beynnull describes how in nullverpool they have designed a system to give a
appears to be difficult to achieve. Dawn Wintle describes how a team approach clearer picture of nullen drug use has been involved in an individual’s death, in order
that treats the patient with dignity can work. Page 3. that the right lessons can be learned. Page nullnull
Ayesha Hurst describes the increase in use of alcohol, amphetamines, cannabis, See the latest news on the nullGnullnullrtificate in the Management of Alcohol oblems null
cocaine and ecstasy amongst young people. Page null in nullimary nullre. Page nullnull
nullhn Dunnnull National Treatment Agency has written an article for SMMGnull on
nullaryn nulliles and nullsa nullllen discuss the difficulties involved in the
‘Preventing unplanned discharges from drug treatment services’. There is a
employment of service users in drug treatment services, the way these problems
summary of the article on nullge null and the full article can be found on our website
can be overcomenulland the rewards for those who employ service users to deliver
wwwnullnullgnullnullgnullnull
treatment. Page nullnull
nullrry Wnullnulley and Charlie nullwe describe their approach to young people’s
nully Barlnull argues for earlier intervention for children nullth parents nullo are
services in Plymouth. Page null
problematic alcohol and drug users in order to limit harm. Page nullnull
nullrnulls Rnullerts takes us through the twists and turns of drug policy over the past
null nullnullt nullnull nullanull provides an answer to a Gnullregarding the use of nullbonullne.
decade, and the effect this has had on the drug treatment field. Page null
Page null
Most of you agreed with the UKDPC recovery statement – but nullat are the
Nanulleen Khinullnull is Pharmacist nullnullt to a null nullo is confused about nulliting
implications for general practicenull Rnull Rnullertsnull gives his view on nullge 9null
prescriptions for controlled drugs post nullipman. Page nullnull
Release step in as nullnuller nullnullt to provide some enullellent housing advice to a null
nullr the latest courses and events, see nullge 20null
nullose patient is homeless. Page nullnull nulle hope you ennully this edition.
Claunulla Runulln outlines some of the legal campaigns that nulllease are involved in,
Editor
and highlights nullst how important this organisation is for the protection of drug usersnull
rights. Page nullnull
nullthadone deaths have increased over the past few years. Penny nullhnullelnull @
nullnnullt forget to become a free member and receive regular
enullmines possible reasons for this and the steps clinicians can take in order to
clinical and policy updates null the newsletter can also be
reduce the risk of methadonenullelated deaths. Page nullnull emailed to you nullall for free www.smmgp.org.uknullembership
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