Fears grow over ketamine use in wake of five deaths

Ketamine, the drug that led to Friends star Matthew Perry’s death, has been implicated in five recent deaths in Ireland and rising year-on-year admissions to treatment facilities.

Ketamine is a powerful anaesthetic, a horse tranquilliser and more recently has been used to treat depression.

However, a sharp rise in its popularity in Irish drug youth culture since the return of post-pandemic nightlife is causing concern in the HSE.

Last December, when the Los Angeles county medical examiner said Perry died from the “acute effects of ketamine” there was an outpouring of concern.

Contributing factors included “drowning, coronary artery disease and the effects of buprenorphine” — used to treat opioid use disorder — but it was also reported that he was receiving ketamine infusion for depression and anxiety in the days before his death.

While there is renewed debate about its efficacy for treatment-resistant depression — mainly in the US — there is concern in the HSE that it has become a leading recreational drug among those aged between 18 and 24.

The latest figures recorded by the National Drug-Related Deaths Index in Ireland show eight poisoning deaths where ketamine was implicated between 2011 and 2020. Five of these deaths were recorded between 2018 and 2020.

Meanwhile, ketamine-linked admissions to Irish drug-treatment facilities have also been rising year on year, with 500 cases over the past five years.

The figures show seven cases where ketamine was the main problem drug in 2018 compared to 17 in 2022, and while treatment cases where ketamine was an additional problem numbered 67 in 2018, it rose to 122 cases in 2022.

The street drug can result in horrific side effects from hallucinations and seizures in the short-term to bladder issues, memory loss and neuropsychiatric disorders with long-term use.

Nicki Killeen, co-ordinator of the HSE Safer Nightlife Programme — which operates a back-of-house drug-checking service aiming to identify drug market trends at festivals — said there is a worry over the sudden increase in ketamine use.

“Similar to drugs like MDMA, it’s moving from what would have been considered the cultural margins to more popular use, particularly in nightlife settings with younger people,” she said.

“We’re basing this on our work in festivals. In advance of Covid, we did see ketamine beginning to become a trend.

“But the past few years what we have noticed is more concern and more young people talking to us about their use of ketamine,” she added.

​Findings from the programme show that across four events in 2022 and 2023, 266 substances were surrendered to the HSE as part of the back-of-house drug-checking programme. One hundred and seventeen substances were MDMA, 40 were ketamine and 34 were cocaine.

There were medical concerns related to ketamine observed across events last summer, in particular ketamine-related seizure activity.

“What is concerning is the pattern of use, they’re using it with other substances and they’re using large volumes of it,” said Ms Killeen. “The young people we’re speaking to are often unaware of what ketamine is.

“They think of it as a club drug. They would compare it to something like MDMA or cocaine that will give a stimulating effect. What we’re seeing with them is that they don’t realise that it has a dissociative effect.”

While at lower doses it can be a stimulant with euphoric or trippy effects, higher doses can result in hallucinations or delusions, or dissociative out-of-body experiences where people cannot move their arms or legs.

In the European Web Survey for Drugs 2021, 23pc of respondents from Ireland reported using ketamine, considerably higher than the overall proportion of ketamine use from the other 30 participating countries, which was 13pc.

Ms Killeen, project manager with the HSE National Social Inclusion Office, also highlighted the trend observed in Ireland of the intentional mixing of cocaine and ketamine known as Ck or Calvin Klein. This can have an impact on the heart and cause palpitations.

Unlike the drug used in clinical settings, the drug used in nightlife settings is often illicitly produced in clandestine laboratories.

The HSE expert also warned about the trend of mixing alcohol with ketamine.

“Ketamine used with any type of depressant drug is extra risky. It can lead to increases in accidents, drowsiness, passing out,” she said.

The HSE has listed the long-term ill effects of ketamine-use. They are stomach cramps, known as K cramps, psychological dependence, urological disorders and impairment of memory.

Other chronic effects include neuropsychiatric disorders, typically a schizophrenia-like syndrome associated with long-term and frequent use.

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