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THERE is growing evidence that chronic use of the recreational drug ketamine is linked with severe bladder problems. The findings may also have implications for the drug’s use as an antidepressant.

Used safely as a medical anaesthetic and analgesic for decades, ketamine has also risen in popularity as a recreational drug. The first case of severe bladder problems linked with ketamine use was documented in 2007, but little is known about the extent or cause of the problem.

Now a group of surgeons and scientists have raised the alarm in a review calling for more investigation (BJU International, DOI: 10.1111/j.1464-410X.2010.10031.x). They highlight effects such as incontinence and bladder shrinkage, as well as damage to the kidneys and ureter in people using ketamine frequently.

“It has a major impact on users such that they can be incontinent or have enormous pain,” says Dan Wood, a consultant urologist at University College London Hospitals, who led the review. He has seen 20 chronic ketamine users with urinary problems in the last three years and had to remove four patients’ bladders.

The review suggests that heavy users are more likely to suffer symptoms, and about 20 per cent of people who have taken high doses of ketamine several times a week over months to years have experienced urinary tract problems.

“[Recreational use] is a growing problem in the UK, Australia and New Zealand, and it’s a huge problem in south-east Asia, especially in Hong Kong,” says Val Curran, a psychopharmacologist at University College London, who is leading a review of ketamine for the UK’s Independent Scientific Committee on Drugs.

Previously, it was thought that bladder problems might have been down to substances combined with the drug for street sale. In an as-yet-unpublished study, Simon Baker and Jennifer Southgate at the University of York, UK, added ketamine to human urothelium cells, which line the bladder. With increasing doses, the cells rapidly became cytostatic – they stopped growing – and then died with further increases.

Ketamine has recently shown promise in treating depression. In a study published this week, Lisa Monteggia and colleagues at the University of Texas Southwestern Medical Center in Dallas show that in mouse models of depression, ketamine promotes the rapid synthesis of a protein known to have antidepressant effects, called brain-derived neurotrophic factor (BDNF). They suggest that this may provide a therapeutic target for developing fast-acting antidepressants, especially important for people at risk of suicide (Nature, DOI: 10.1038/nature10130).

“We are excited that ketamine could be the basis for a whole new generation of drugs, but concerned that these might show similar side effects to ketamine,” says Baker. Understanding more about ketamine’s actions could support the development of antidepressants without these negative effects.

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— The state Senate gave final approval Wednesday to legislation banning so-called bath salts, synthetic marijuana, for example k2 incense, and the hallucinogenic plant known as salvia divinorum.

The 50-member chamber voted unanimously to outlaw the substances, which are now legal and easily available for a cheap high. Gov. Tom Corbett, a former state attorney general, will sign the bill when it reaches his desk, an administration spokesman said.

“We need to get this off the streets and out of our communities,” said Sen. Elisabeth Baker, R-Luzerne, echoing the sentiments of lawmakers on both sides of the aisle as the Senate voted.

Not to be confused with the sweet-smelling concoctions at the mall, the bath salts lawmakers moved to prohibit resemble baking soda and are typically sold at convenience stores, head shops and on the Internet. A single dose can cost as little as $20.

Law enforcement officials and legislators in states from Maryland to Illinois are moving to clamp down on bath salts, which mimic the effects of methamphetamine and cocaine. Several states — including Minnesota, North Dakota, Florida and Louisiana — have banned their sale.

“People don’t initially realize how damaging this drug is. They think of bath salts, they think of something you pour into the tub,” said Sen. Patricia Vance, R-Cumberland, a former nurse. “People’s personalities change. … People don’t realize the horrible things it can do.”

The bill the Senate approved Wednesday bans the substances and the chemical compounds they contain. Penalties for sale and possession will be addressed in separate legislation, said Sen. Elder Vogel, R-Lawrence, who sponsored the bill.

Penalties probably will range from probation for casual users to several years in jail for dealers.

Synthetic marijuana is banned in 17 states, said Rep. Jennifer Mann, D-Lehigh, who shepherded the fake pot bill through the House. The substance, sold under the brand names of “K2 incense” and “Spice,” has also been outlawed by colleges and military organizations, she said.

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Synthetic marijuana is one signature away from being banned in Wisconsin.

A bill banning the substance passed the Wisconsin State Senate and Assembly last week and is now awaiting the signature of Gov. Scott Walker.

The statewide measure came about four months after the city of Reedsburg failed to ban the substance, often called K2 incense, which mimics the effects of marijuana and can be dangerous.

The local Ordinance Committee voted against enacting a local ordinance by 3-2 vote on Feb. 28.

Russ Ziegler, a citizen member of the committee at that time, said in February that he didn’t believe the city should enact an ordinance stricter than state laws concerning controlled substances; he was one of the three who voted against it.

Police Chief Tim Becker wanted the committee to consider the ordinance again at a meeting earlier this week, because two of the five members are new.

But when the Senate and Assembly passed a similar bill last Wednesday, Becker said it made more sense to simply wait for Walker’s signature than to go through the multi-week process locally.

“It’s not as comprehensive as ours, but I think it’ll do the job,” Becker said of the state act.

Alderman Dave Knudsen, who still serves on the Ordinance Committee, argued in February that it would be too difficult to enforce an ordinance that prohibits the possession, sale and use of a substance that it had no way of detecting.

The act would ban the possession of synthetic marijuana, commonly referred to as K-2 incense or spice. Although selling it wouldn’t necessarily be illegal, possession would be, so stores wouldn’t be allowed to carry it.

K-2 incense is currently sold in some novelty stores, including one in Sauk County.

“The big thing is to keep it out of stores,” Becker said. “The less it’s offered, the less we’ll see it.”

Once the act is signed into state law, Becker said, the Reedsburg Ordinance Committee will likely consider adopting it into its own ordinance book so that local police can handle first-time offenders. That state act currently lists a maximum fine of $1,000, up to six months in prison, or both for first-time synthetic marijuana offenders.

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