More than 15 years ago, during one of my first shifts as a junior doctor covering child and adolescent mental health in A&E, I was called to assess a 14-year-old girl who had arrived by ambulance.
She had taken ketamine with friends while sitting on a bench and was unconscious. Fortunately, one of them realised the seriousness of the situation and dialled 999.
What stayed with me was her age. At that point, ketamine was still regarded as a niche substance, associated mainly with clubbers and university students — not children barely out of primary school.
Since then, I have written repeatedly about ketamine as its use among teenagers and young people has grown dramatically.
I have described the “k-holes” seen in A&E, when people become detached from their bodies and surroundings, remaining conscious but unable to move or speak.
I have also examined why ketamine has become so attractive: it is inexpensive, simple to take and carries a misleading sense of legitimacy because doctors use it as an anaesthetic and, in some circumstances, to treat depression.
But research published last week brought that first patient vividly back to mind. Alder Hey Children’s Hospital in Liverpool launched the UK’s first service for children suffering bladder damage linked to ketamine last year. Researchers have now reviewed the first 60 patients, who were aged between 13 and 15.
Some had begun taking the drug soon after turning 13, and on average had used it for one or two years before being referred for specialist care.
Ketamine damages the bladder lining, causing the organ to contract to a fraction of its usual size and potentially leaving patients facing lifelong incontinence (picture posed by model)
Just a few years ago, the hospital was seeing only a small number of these cases annually. Now, children with severe ketamine-related bladder problems are arriving with deeply troubling frequency.
Around two-thirds of the patients were girls. Scientists are still investigating why female bladders may be more vulnerable to ketamine damage, although differences in how males and females metabolise the drug in the liver could play a role.
A similar share of the children lived in the most deprived communities. One in five had spent time in care, while almost three-quarters had a history of emotional trauma.
Ketamine is a dissociative drug, separating users from their surroundings, physical sensations and emotions. For a child dealing with fear, loneliness or previous harm, that temporary escape can be powerfully seductive.
Yet the figures also show that this problem is not limited to the most disadvantaged children: a third came from other areas, and more than one in four had no documented history of trauma. Last year, a Merseyside headteacher warned that ketamine use had become almost a rite of passage for some pupils.
The drug is now found in mainstream schools, costs less than a takeaway meal and is shared among children who often have little understanding of its potentially devastating consequences.
I still wonder what became of the girl I treated that night. She was living in a care home and had come to hospital with several men who appeared to be in their twenties.
I was deeply concerned and raised the matter with social services. However, the case was closed after she said the men were friends.
I never learned how her life unfolded. But ketamine-related bladder disease has a devastating impact on anyone it affects. The drug can damage the bladder lining, causing ulcers, scarring and extreme pain. Some users then take more ketamine to dull that pain, trapping themselves in a destructive cycle.
As the condition progresses, the bladder may contract until it is only a fraction of its normal capacity, leaving patients constantly rushing to the toilet and struggling with incontinence.
Clinicians at Alder Hey caution that the damage may be permanent. In the most severe cases, children could require major surgery or even dialysis.
Imagine being 14 and facing a lifetime of incontinence.
So what should parents look out for? Some of the earliest signs are often mistaken for a urine infection: needing the toilet constantly, pain or burning when passing urine, wetting accidents or blood in the urine.If your child keeps getting ‘infections’ that don’t clear with antibiotics, ask the GP whether ketamine could be the cause.
Other warning signs include a sudden change of friends, particularly if they’re hanging around with older ones, money going missing, withdrawing from the family and seeming vague or detached.
None of these proves drug use, but together they warrant a calm, non-judgemental conversation. Talk to your children about ketamine before there’s a problem. Ask what they’ve heard and whether anyone at school uses it, and listen more than you lecture.
And if you’re a teacher, grandparent or youth worker, the same applies because not every child has someone at home looking out for them.
Go to: talktofrank.com
Coleen’s brush with death
Coleen Rooney has spoken up about growing up alongside her disabled sibling in her new Disney+ series, The Real Rooneys
Coleen Rooney’s new Disney+ series, The Real Rooneys, promises a glimpse of family life behind the headlines, and one detail is especially revealing.
Through tears, her mother Colette describes how three-year-old Coleen developed encephalitis, a dangerous swelling of the brain, and fell into a coma. For 24 hours it was touch and go.
Grateful that their daughter had survived, Colette and her husband Tony wanted to give something back, so they began fostering children with disabilities and special needs.
One of them was Rosie, who had Rett syndrome, a rare genetic condition that causes profound disability. She came to them as a toddler, and they went on to adopt her. It’s striking how often families who come close to losing a child respond by turning outwards.
But I was also struck by Coleen’s reflections. She has spoken about trying to be strong for others and not wanting people to worry about her. Growing up alongside a seriously ill or disabled sibling, people often learn that their parents’ attention is needed elsewhere and they become the capable, uncomplaining one.
If that’s you, remember that you need someone to lean on too.
That strength is admirable, but feelings that are put to one side don’t disappear. If you’re the strong one in your family, remember that you need someone to lean on too.
The largest ever map of gene activity in the brain shows that the prefrontal cortex changes rapidly until about the age of 24. It’s then remarkably stable until a second wave of change in our 60s. I find this stability reassuring.
A fascinating study has found that every extra 100g of ultra-processed food eaten a day (roughly two thick slices of supermarket bread, for example) is linked to a 14 per cent higher risk of a heart attack, stroke or other major heart problem. It’s also linked to a 4 per cent higher risk of cancer and a 3 per cent higher risk of dying early.
Researchers pooled the results of 51 studies involving almost nine million adults. What interests me most as a psychiatrist is that those who ate the most ultra-processed food were also more likely to suffer depression and anxiety.
Of course low mood also drives people towards food that is quick, cheap and comforting, and ultra-processed food is all three. Studies like this one can show a link, but they can’t untangle which came first.
For anyone struggling with low mood, guilt won’t help, and neither will aiming for a perfect diet – so start small. Swapping one processed snack a day for a piece of fruit or a handful of nuts is a good first step, and small successes build motivation for bigger changes.
Many people would love a dog but can’t manage one because of work, the cost or their living situation. BorrowMyDoggy matches local dog owners with people who’d like to walk or look after their dog. I’ve seen how much a dog can do for someone who is lonely or low: it gets you out of the house, gives your day structure and, as any dog walker knows, is a great conversation-starter when you’re out and about.
borrowmydoggy.com
