Ketamine Bladder and Getting High Off Metal Cleaner: Let's Talk About London's Club Drug Problem

Photo by Chris Bethell

Dr. Owen Bowden-Jones is the founder of London's Club Drug Clinic, started in 2011, which aims to provide aid to people who have "begun to experience problems with their use of recreational drugs." After they were overwhelmed with users of ketamine, cocaine, ecstasy, and legal substances who wanted help, a second clinic was opened earlier this year.

Unlike heroin and crack, for which many rehabilitation and counselling services exist, party drugs often aren't associated with bad things like addiction, losing your job, losing your mind, and ruining your life. Owen hopes that in addition to helping individual users, his clinics will spread understanding of the dangers of these relatively new drugs through the medical world.

I gave Owen a call to find out what he's discovered from treating people.

VICE: Has drug use changed much in the UK in the past ten to 15 years?
Owen Bowden-Jones: What we’ve seen are relatively major reductions in heroin and crack use and an increase in a new group of drugs called "club drugs"—things like ketamine, MDMA, and mephedrone.

I'm familiar with the category. What about the ways in which people take them?
Actually, we’re finding that quite a few of these people are beginning to inject their drugs, especially mephedrone and ketamine. So all of the very real dangers that we used to see with heroin injecting, we’re now beginning to see with these newer club drugs.

Oh, dear. What are the drugs that cause the most problems?
Here at the Club Drug Clinic, the four main drugs we’ve seen have been ketamine, GBL or GHB, crystal meth, and mephedrone. You can often determine the drug someone’s using [when they come in]. It seems to split along the lines of sexuality. We’re seeing a lot of gay men using crystal meth and GBL—for sex—while we’re seeing a lot of straight clubbers and students using ketamine and mephedrone. Interestingly, we've hardly seen anybody come into the clinic saying they’ve got a problem with MDMA or ecstasy—that just hasn’t happened.

Have you seen problems with many of the newer, more underreported drugs?
PMA is the one that seems to have caught the media's attention, and we are certainly seeing plenty of it. We are also seeing people who use poppers developing "cartoon vision" [when people's field of vision appears to be two-dimensional] and a range of other visual disturbances. The visuals may also be happening with nitrous oxide, of which we have also seen many more cases.

A load of vials of ketamine. Photo via

OK, let's go over the main four drugs people use. What does ketamine do to people?
Seventy-five percent of ketamine users who see us have bladder problems, and we're seeing many more cases related to the squat scene in East London since opening our second clinic off Tottenham Court Road. "Ketamine bladder" is an ulceration of the inside lining of the bladder. First, people get a discomfort over their bladder and then, as the ulceration develops, they start peeing more often, sometimes every five or ten minutes. When it gets really bad they sometimes get pain when they pee as well. As the ulceration develops, they start peeing blood and, of course, that’s an incredibly distressing symptom for people. It’s been such a problem that we’ve had a urologist join the team to try to help us deal with all the ketamine bladder we’re seeing.

Is it common to get so serious?
Well, we’ve got one person in the clinic who’s had their bladder replaced with an artificial bladder because they’d damaged their bladder so, so badly. And, for some people, when they stop it seems to get completely better.

That sounds pretty awful. Is there anything else in regards to K?
The K-cramps is a really intense spasm on the muscles in the abdomen, which can last for sometimes just 30 seconds, but sometimes up to ten minutes. It puts people in excruciating pain and then it will just wear off. We don’t really understand why it happens but it’s definitely associated with the ketamine use.

Shit.
And the final thing we’re seeing—which we didn’t really expect to see—is people getting really addicted to ketamine. We’re seeing people use it every day, escalating amounts, grams and grams a day and really getting into terrible trouble in a way that we didn’t really think would happen with ketamine. There’s no doubt in my mind that ketamine is dependence-forming.

Anything else of note?
It's used by men and women, but we see a disproportionate number of women using it as an emotional anesthetic.

A baggie of mephedrone.

Next up: mephedrone.
Mephedrone is a synthetic amphetamine and it works on the dopamine system in the brain, giving people a euphoric high. Now, in terms of the negative effects we’ve seen here, I have to say, it’s estimated that 300,000 people a year are using mephedrone. We’re not seeing 300,000 people a year here, so there are lots of people out there using mephedrone who may not be having any problems at all. But we’re seeing a lot of paranoia—increasing amounts. Often this will actually tip over into brief periods of psychosis where people get convinced that they’re under surveillance or start hearing voices. People become very distressed and agitated. We’ve seen it particularly when people inject mephedrone.

Is it addictive?
Mephedrone hasn’t particularly been considered an addictive drug, but we’re definitely seeing people addicted to it here at the clinic who are using every day and are saying, "Well, I used to use a gram a day and now it’s crept up and I’m using grams and grams a day and it’s going up all the time." You can see that typical experience of tolerance, which is one of the really important features of dependence.

Crystal meth has a pretty bad reputation for being addictive. Why do people take it here?
It's an amphetamine-based drug. It gives people an intense high, a euphoria, and makes people very disinhibited. Typically what we’re seeing in the Club Drug Clinic is a lot of sexual disinhibition. The negative effects are, again, lots of paranoia with brief episodes of psychosis. We also see something called rebound anxiety, where after a crystal binge people will be in the grip of this very intense anxiety that they just can't find a way of stopping other than using other drugs to bring them down. The typical [drug to use] with crystal is GBL.

That's probably not a great idea in the long run, is it?
We see very severe dependence where people escalate to grams and grams a day and, you know, being really very sick with it. Of all the drugs we see here in the clinic, I think crystal meth and GBL are the two most addictive.

A rock of crystal meth. Photo via

How do people normally start taking them?
We’re seeing a lot of people who binge on crystal who would use it Friday, Saturday, Sunday, Monday and then go back to working through the week—then Friday they’ll start the crystal binge again. Often those people will tip into daily use over time; it might be six months, it might be a year, it might even be a couple of years. But then, as they develop a tolerance to crystal, what happens is their weekend goes from a Friday to a Monday to a Thursday to a Tuesday and then the negative consequences of the use kick in so they get fired from work, their social relationships break down. Before they know it, all they do all week is take crystal. So it’s a really dangerous drug.

What is GBL? It's not as common as the others.
It’s an industrial solvent—an alloy cleaner—used to clean metals.

So what's so bad about it?
It gives people a sense of slight euphoria but generally it’s also a sedative. It’s what we call pro-sexual, so it makes people horny and it’s usually pipetted, one or two milliliters, into a drink. There are some real dangers here. The first is that the difference between the recreational dose and the toxic overdose amount is very small. Also, because people measure it in milliliters, the difference between one or two milliliters means the difference between getting the effects you want and going into a coma. So it’s a very dangerous drug in terms of what we call a "narrow therapeutic range."

Yeah, that does sound pretty bad.
The other thing about it is it’s highly addictive, so we see people setting their alarm clocks at night to wake up and dose themselves, so they dose right through a 24-hour cycle—sometimes every hour. And they walk around with little bottles—pipettes in their pockets—to make sure they’re not caught without the G. The reason for that is that once someone’s dependent, the withdrawal symptoms are really horrendous. They come on very rapidly, they’re very distressing.

What are they?
Intense anxiety, agitation, rapidly going into a delirium. One of the things we’ve been doing here is detoxifications for people who get dependent on G, and it’s a really tricky medical detox to do because if it goes wrong people get sick very quickly. It has to be managed very carefully.

So you can't just stop taking it, then?
In fact, a number of people who’ve been detoxed off G have ended up in intensive care if they’ve not been managed properly, so it’s really important if any services out there are thinking of doing GBL detoxes—or if anyone’s wanting to go and get a GBL detox—that they go and get it from somewhere that does it regularly. It would be a bad idea to go somewhere that’s never done it before.

What's next for the clinic?
There’s no doubt that lots of people out there are using club drugs with no problem whatsoever and, you know, that’s fine. As a clinic, we are making no judgement on people’s drug use. We’re here to offer help to the proportion of people for whom it goes from being something that’s recreational and fun into something that actually starts causing them harm. We need to get to a point where, if a 17-year-old using a new drug walks into their doctor's office and asks for help, their general practitioner knows how to respond to that. I think that’s the next step—trying to get the knowledge out of specialist services and into more general services.

Great. Best of luck!

Follow Chris on Twitter: @chrisoreal

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