DR MAX PEMBERTON: What to do in case your baby is in a ketamine ‘Ok-Hole’

Over the past few years working shifts in A&E dealing with patients with mental health problems, I’ve been struck by the growing number who have come in under the influence of the illegal ‘rave drug’ ketamine.

From something I hardly ever saw when I first started working as a doctor, it has become, in the past decade or so, a regular occurrence. I was working last weekend and saw three patients in one single night shift. All of them were students and all of them had been brought in after they took too much ketamine and became unresponsive – in effect, passed out.

It’s shocking how quickly it has become the drug of choice among young people, yet most of the older generation know very little about it.

Indeed, the latest figures, put out last week, show ketamine use among 16 to 24-year-olds was at record levels last year, with almost one in 25 in this group in England having taken it. This is a jump of a fifth on 2020’s figure, and also stands four times higher than the levels of a decade ago.

Ketamine – also called ‘ket’ or ‘special K’ on the streets – is sometimes referred to as a horse tranquilliser, and when taken in small doses is supposed to induce a sense of euphoria in the user and a light, relaxed sensation.

It was first used as an anaesthetic during the Vietnam War, but it’s only been used recreationally since the 1980s. Back then, it was a niche, underground drug mainly used by hardcore clubbers, and thus it remained for decades. When I was at university 25 years ago, I didn’t ever hear of anyone taking it. Now everyone seems to be.

The problem, of course, is that it comes with serious risks. I often see patients in what’s colloquially called a ‘k-hole’, when the drug has the effect of detaching them from reality. They feel trapped inside their body, aware but unable to move or communicate. They dissociate and can hallucinate. It can be a terrifying experience, grossly distorting their sense of time, so hours can pass and yet feel like minutes.

This doesn’t happen to all users, of course, although judging from the numbers I have seen in k-holes in A&E, it clearly happens with startling regularity.

Ketamine has been implicated in the deaths of 41 people since 1991, with seven alone in 2021. Many are students who have taken too much, or mixed it with other drugs, or fallen to their deaths while under its influence. 

However, when I speak to younger people about it, despite its potentially lethal effects, they don’t consider it a serious drug. I think that’s at least in part because it is still categorised as a Class B drug, which gives a false impression of harmlessness.

Even when people are with friends who have fallen into a k‑hole, they often shrug it off, saying they’ll come out of it soon and failing to realise they are comatose and could easily die.

Ketamine can also have a profound and long-term effect on memory and thinking.

It is associated with dreadful bladder problems, too. It can cause open, weeping wounds inside your bladder and urinary tract and make it shrink in size. This can be so bad the bladder has to be removed entirely. The pain from these symptoms can lead some to use more and more ketamine to numb it, creating a devastating downward spiral.

Why has it become so popular? Price, no doubt, plays a large role. At £20 a gram, and with 100 mg enough to send someone into a k-hole, you can see how cheap it is. I wonder whether it’s potential use as an antidepressant, when prescribed properly, is generating interest, too.

Its use for depression is still quite experimental and not mainstream at all, but it helps give it an air of legitimacy, especially among the younger generation who are so obsessed with mental health but fail to realise that getting it prescribed in a clinical setting is a world away from snorting it in a club toilet.

Campaigners are pushing for it to be made a Class A drug in the hope this will clarify how dangerous it is. But in the meantime, what do you do if you find someone who has taken ketamine?

If they are distressed or acting erratically, then move them to a quiet place and get them to sit and sip water while you reassure them. Talk to them about where they are and try to ‘ground them’ in reality by describing their surroundings. If they remain very distressed or are hallucinating they may need to go to hospital to be assessed. Never make them vomit as they can choke.

If someone isn’t moving or able to communicate, they can probably still understand you, so offer lots of reassurance and move them somewhere safe if you can.

If the person has stomach cramps, trouble passing urine or blood in their urine, they need to go to hospital immediately. This is also the case if their breathing becomes shallow or less frequent, or they have chest pain.

If they appear to be fluctuating in and out of consciousness or are unconscious, call an ambulance. Put them in the recovery position to keep their airway open. Stay with them and do not leave them with friends (who might also have taken drugs).

Have a very low threshold for calling an ambulance and don’t be put off by others saying this has happened before and that they haven’t taken very much; neither you, nor they, know exactly what their friend has taken, how much or what it was cut with.

If they have a seizure, move them somewhere safe. Do not put them in the recovery position while they are fitting, but put an item of clothing under their head to act as a cushion. And call an ambulance.

Newly-trained dentists are to be forced to work in the NHS under a plan to tackle the dental care crisis. It costs taxpayers £200,000 to train a dentist, who can then work privately immediately. This plan is sensible. It should apply to doctors, too.

Gio’s mental health will be suffering 

Giovanni Pernice has promised to co-operate fully with the BBC investigation into his conduct on Strictly, and thereby clear his name. But what has he done exactly? 

We know Sherlock star Amanda Abbington has claimed he stamped on her foot, and that he’s alleged to have reduced others to tears. Beyond that, we don’t know. While he is being investigated, his career is in the balance and he may lose his livelihood. 

With accusations of this nature, there’s a tendency to assume there’s no smoke without fire. Of course, I have no idea if they are true or not, but I know everyone’s mental health suffers when caught up in a horrible situation like this. 

It’s easy to see people in the public eye as fair game; we love to pass judgment and gossip, but it’s important to remember that behind the showbiz glamour are real people with real feelings.

Diagnoses of type 2 diabetes before middle age have risen by 40 per cent. The tragedy is people still don’t understand the severity of this disease. The prognosis for those with type 2 is actually much worse than those with HIV, a condition which still strikes fear into people’s hearts. 

Overall, those with diabetes die 12 years sooner than those without. People also think it can be easily fixed with tablets. But this is wrong, too. The public needs to be educated about the reality of diabetes. We don’t want to scare people unduly, but this complacency has to end.

Dr Max prescribes… Matcha Tea  

Yes, I know it’s not as nice as a cup of PG Tips, but this drink, loved by celebrities from actor Zendaya to Kourtney Kardashian and Bella Hadid, contains a compound called L-theanine, which has been shown to help with period cramps as well as fight gum disease. A small study has also shown it boosts memory, attention and reaction time.