How Ketamine Is Misused Despite Its Medical Roots

In a theatre or an ambulance, ketamine is one of the more dependable tools a doctor can reach for. It eases pain, sedates a frightened patient, and does so without shutting down breathing the way some other anaesthetics can. That same molecule, taken in a club bathroom or measured out at home from a vial bought online, becomes something else entirely. The distance between those two settings, one closely monitored and one completely unregulated, is where most of the harm happens.

South Africa does not yet see ketamine on the scale of alcohol, methamphetamine or nyaope, but it is appearing more often in nightlife and among younger people who treat it as low-risk. Understanding how a genuinely useful medicine became a misused one helps families and individuals recognise trouble early, before the physical and mental toll sets in.

Where ketamine came from and what it does in medicine

Ketamine was developed in the 1960s as a safer surgical anaesthetic. Its great advantage was that patients could stay sedated while keeping their own airway reflexes and a steadier heart rate and blood pressure, which made it valuable where monitoring equipment was scarce. For that reason it became a mainstay in trauma units, rural clinics and field hospitals across the world, and it remains on the World Health Organization’s list of essential medicines.

Its medical story did not stop at surgery. Pain clinics use low-dose ketamine infusions for severe or chronic pain when opioids stop working or cause too many side effects. More recently, a derivative called esketamine has been approved in some countries for treatment-resistant depression, given only under strict clinical supervision. The United States National Institute on Drug Abuse notes that ketamine is FDA-approved as an anaesthetic and that researchers continue to study its dissociative effects in carefully controlled settings, as explained in its overview of ketamine.

The thread running through every legitimate use is supervision. Dose, timing and the patient’s vital signs are watched the whole way through. Strip that away and the same drug behaves very differently.

How a hospital medicine ends up on the street

Diversion from legal supply

Ketamine reaches illicit markets in a few ways. Some is siphoned from medical or veterinary stock, since it is still a common sedative for large animals. Small quantities go missing during routine handling, paperwork gets altered, and the product is repackaged into vials or powder. Because demand is steady, even modest losses are worth diverting.

The scheduling that protects medical supply also has an uncomfortable side. Research published in the National Library of Medicine has documented how tighter international controls on ketamine risk choking off access for anaesthesia in parts of Sub-Saharan Africa, where it is sometimes the only safe option. The challenge for regulators is real: keep the medicine available to clinics that genuinely need it while closing the gaps that feed the street trade.

Marketing it as a party product

In nightlife settings ketamine gets presented less like a controlled drug and more like a branded experience. It turns up at events in small vials and is sold alongside other party substances, which makes it feel familiar and, to many young users, harmless. That framing is the problem. The packaging changes, but the pharmacology does not.

What recreational misuse actually looks like

Used recreationally, ketamine is usually snorted as a powder, sometimes swallowed or injected. The effect comes on quickly: a sense of detachment from the body, distorted perception, and at higher doses a deeply dissociated state that users sometimes call a “k-hole”. Because the effect is short, people often redose repeatedly over a night, losing track of how much they have taken.

That pattern carries immediate dangers. Loss of coordination leads to falls and injuries, especially in a crowded venue. Dehydration and overheating are common when someone stops noticing thirst or time. Mixing ketamine with alcohol or other depressants raises the risk of dangerous sedation. The UK government’s drug information service FRANK is blunt about this, warning in its ketamine information page that the drug’s numbing effect means users can injure themselves badly without realising, and that mixing it with other substances can be especially risky.

Self-medication is another quiet driver. Some people reach for ketamine to dull anxiety, low mood or sleeplessness. The short escape it offers can feel like relief, but chasing that dissociated state again and again is exactly how a casual habit hardens into dependence. If substance use is being used to manage an underlying mental health condition, both need attention together, something we cover in our piece on drug addiction and mental health disorders.

The real harms of unsupervised use

Damage to the bladder and kidneys

The harm most strongly linked to regular ketamine use is to the urinary system. The drug and its breakdown products irritate the bladder lining, causing inflammation, ulceration and scarring. People develop a constant, urgent need to urinate, pain, and sometimes blood in the urine. In advanced cases the bladder shrinks and the damage can reach the kidneys, occasionally requiring surgery. South African urologists have begun reporting these cases in younger patients who would otherwise have no reason for such problems.

One sobering point from clinical reviews: this damage is dose-related, and stopping early can reverse or halt it, while continued use can make it permanent. That is a strong argument for taking the first urinary symptoms seriously rather than waiting.

Effects on the mind

Heavy, prolonged use is also linked to memory problems, difficulty concentrating, and mood instability. Some frequent users experience lingering cognitive fog and emotional volatility that can persist after they stop. A smaller number develop more serious psychiatric symptoms that need professional care. Because ketamine’s pull is largely psychological, the cravings and the urge to recreate that dissociated state are often what make stopping hardest.

How common is ketamine misuse becoming?

The clearest data comes from the United Kingdom, where the trend is well documented and offers a warning for other countries. The Advisory Council on the Misuse of Drugs reported that the estimated number of people in England and Wales using ketamine in the past year rose from about 160,000 in 2014 and 2015 to roughly 299,000 in 2022 and 2023, with about a quarter of regular users reporting at least one urinary symptom. The full picture is set out in the council’s review of ketamine use and harms.

South Africa does not have equivalent national figures for ketamine specifically, and it would be wrong to overstate the local scale. What is fair to say is that the conditions that drove the rise elsewhere, easy online sourcing, low perceived risk, and a strong club and festival scene, are all present here too. Watching the pattern abroad is part of recognising it at home.

Getting help and finding a way back

Coming off ketamine is rarely as physically dramatic as alcohol or opioid withdrawal, but it should still happen with support. Cravings, low mood, disturbed sleep and anxiety are common in the early days, and the psychological pull is real. A monitored setting makes that stretch safer and far less lonely.

What helps most is dealing with the reasons behind the use, not just the drug itself. Individual therapy uncovers the patterns and triggers driving it, while group work reminds people they are not the only ones facing this. Approaches like cognitive behavioural therapy, which we explain in our overview of CBT in the context of rehabilitation, give practical tools for managing cravings and rebuilding healthier routines. For many people a structured inpatient programme provides the focus and distance that early recovery needs, and you can read more about how inpatient rehab addresses severe addiction.

Recovery does not end when treatment does. Ongoing counselling, peer support and a steady routine are what keep progress in place, which is why aftercare in drug rehab matters as much as the first few weeks.

Frequently Asked Questions

Is ketamine addictive?

Ketamine does not cause the same physical dependence as opioids or alcohol, but it can become psychologically habit-forming. Regular users often build tolerance and feel a strong pull to recreate its dissociative effect, which can lead to compulsive use over time.

Can ketamine misuse really damage the bladder?

Yes. Regular use is strongly linked to bladder inflammation, ulceration and scarring, with symptoms like urgency, pain and blood in the urine. The damage is related to how much and how often the drug is used, and stopping early gives the best chance of recovery.

What should I do if a loved one is using ketamine?

Approach it with concern rather than blame, since shame tends to push people further into hiding their use. Encourage them to speak to a professional, and reach out for advice yourself. You may find it helpful to read our thoughts on how to help a loved one who is struggling with addiction.

Where can I get help in South Africa?

The South African Depression and Anxiety Group runs a free Substance Abuse Helpline on 0800 12 13 14. For treatment, you are welcome to phone Freeman House Recovery on +27 12 1111 739 to talk through the options without any pressure.

You don’t have to work this out alone

If ketamine has started to take up more space in someone’s life than it should, that is worth acting on, not because of fear, but because help genuinely works and earlier is easier. Addiction is a treatable health condition, not a character flaw, and reaching out is a sign of strength rather than weakness.

Freeman House Recovery is a private drug and alcohol rehab in Meerhof, Hartbeespoort, set in the quiet of the Magaliesberg. Our team offers medically supported detox, individual and group therapy, and a holistic programme that treats the whole person. If you would like to talk it through, phone us on +27 12 1111 739 or email [email protected]. There is no obligation, just a conversation.