Glastonbury, 2013. Photo: Ian Gavan/Getty Images
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Ketamine users, beware: your trip might end on an operating table

The drug can cause symptoms akin to a UTI – recurrant use may lead to severe bladdar damage.

Poppy came to see me, suffering from yet another bout of cystitis (an inflamed bladder). The likeliest culprit was a urinary tract infection (UTI), which would respond to antibiotics. Men rarely get UTIs but the tube – the urethra – draining the female bladder is very short, rendering it susceptible to invasion by bacteria. This was Poppy’s fourth presentation over the course of the summer, so it was starting to look as if she would be one of the group with recurrent problems.

A student in her early twenties, Poppy has a cheerful approach to life and seemed to view these episodes as no more than mildly irritating interruptions to her general mission to party, travel and attend as many festivals as possible. Although her symptoms were typical – frequent and urgent calls to the loo, with a nasty, burning, cramping pain when she passed urine – I was starting to wonder whether a UTI was the correct diagnosis. I sent urine samples to the lab on two occasions and neither of them yielded a positive bacterial growth.

I made some tactful inquiries about any link to sex. “Honeymoon cystitis” is a term belonging firmly to another era, yet it’s still widely used as a euphemism for the association between intercourse and cystitis-like symptoms, which probably arise as a result of frictional microtrauma to the urethral opening. Although Poppy said she was intermittently sexually active, there was no clear relationship to any of her episodes of symptoms.

Another possibility was chlamydia, one of the commonest sexually transmitted infections. Many people carry it without symptoms but one of the ways it can present in a woman is with recurring bouts of what seem to be UTIs, yet return negative laboratory cultures. Poppy proved to be clear. An ultrasound scan excluded a bladder stone.

I’d investigated all the causes I could think of and had drawn a blank, so I left her with advice to ensure a good daily water intake, avoid drinking too much coffee and not to use bubble baths or other potentially irritant chemicals. Time passed and she receded in my mind, the absence of any new presentation suggesting that these simple lifestyle measures may have been all that had been required.

A couple of months later, I attended an educational event convened by our local drugs team. It was arranged because over the past few years our locality had become a national hot spot for the illicit use of ketamine. While the dangers associated with common street drugs such as heroin are well described, ketamine use is a relatively new phenomenon and some serious problems were starting to come to light.

In the UK, ketamine serves as a veterinary anaesthetic. Taken in smallish doses by human beings, it produces a hallucinatory trip (“going in the K-hole”). It seems that ketamine also provokes an intense inflammation of the bladder and, sometimes, the bowel. The latter causes abdominal pains (“K-cramps”), while the former causes symptoms indistinguishable from a UTI. With regular use, this chemical cystitis results in scarring and intractable irritability in the bladder. There is a small but growing cohort of young people facing a life blighted by incurable urinary symptoms, the only remedy being the surgical removal of the damaged bladder and the diversion of urine drainage through a stoma.

The drugs team urged us to consider ketamine use in any young person presenting with recurrent cystitis without proven infection. Poppy immediately came to mind. Before I had a chance to contact her, however, she’d made an appointment with another bout of symptoms. Now I knew the question to ask. Sure enough, it transpired that she had been dabbling with ketamine and we were able to link each of her cystitis episodes to an instance of drug use. She was shocked by the connection and sufficiently alarmed by the prospect of permanent bladder damage to forswear any future trips through the K-hole.

This article first appeared in the 30 January 2015 issue of the New Statesman, The Class Ceiling

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I'm far from convinced by Cameron's plans for Syria

The Prime Minister has a plan for when the bombs drop. But what about after?

In the House of Commons today, the Prime Minister set out a powerful case for Britain to join air strikes against Isil in Syria.  Isil, he argued, poses a direct threat to Britain and its people, and Britain should not be in the business of “outsourcing our security to our allies”. And while he conceded that further airstrikes alone would not be sufficient to beat Isil, he made the case for an “Isil first” strategy – attacking Isil now, while continuing to do what we can diplomatically to help secure a lasting settlement for Syria in which Assad (eventually) plays no part.

I agreed with much of David Cameron’s analysis. And no-one should doubt either the murderous barbarism of Isil in the region, or the barbarism they foment and inspire in others across the world.  But at the end of his lengthy Q&A session with MPs, I remained unconvinced that UK involvement in airstrikes in Syria was the right option. Because the case for action has to be a case for action that has a chance of succeeding.  And David Cameron’s case contained neither a plan for winning the war, nor a plan for winning the peace.

The Prime Minister, along with military experts and analysts across the world, concedes that air strikes alone will not defeat Isil, and that (as in Iraq) ground forces are essential if we want to rid Syria of Isil. But what is the plan to assemble these ground forces so necessary for a successful mission?  David Cameron’s answer today was more a hope than a plan. He referred to “70,000 Syrian opposition fighters - principally the Free Syrian Army (FSA) – with whom we can co-ordinate attacks on Isil”.

But it is an illusion to think that these fighters can provide the ground forces needed to complement aerial bombardment of Isil.  Many commentators have begun to doubt whether the FSA continues to exist as a coherent operational entity over the past few months. Coralling the myriad rebel groups into a disciplined force capable of fighting and occupying Isil territory is a heroic ambition, not a plan. And previous efforts to mobilize the rebels against Isil have been utter failures. Last month the Americans abandoned a $500m programme to train and turn 5,400 rebel fighters into a disciplined force to fight Isil. They succeeded in training just 60 fighters. And there have been incidents of American-trained fighters giving some of their US-provided equipment to the Nusra Front, an affiliate of Al Qaeda.

Why has it proven so hard to co-opt rebel forces in the fight against Isil? Because most of the various rebel groups are fighting a war against Assad, not against Isil.  Syria’s civil war is gruesome and complex, but it is fundamentally a Civil War between Assad’s forces and a variety of opponents of Assad’s regime. It would be a mistake for Britain to base a case for military action against Isil on the hope that thousands of disparate rebel forces can be persuaded to change their enemy – especially when the evidence so far is that they won’t.

This is a plan for military action that, at present, looks highly unlikely to succeed.  But what of the plan for peace? David Cameron today argued for the separation of the immediate task at hand - to strike against Isil in Syria – from the longer-term ambition of achieving a settlement in Syria and removing Assad.  But for Isil to be beaten, the two cannot be separated. Because it is only by making progress in developing a credible and internationally-backed plan for a post-Assad Syria that we will persuade Syrian Sunnis that fighting Isil will not end up helping Assad win the Civil War.  If we want not only to rely on rebel Sunnis to provide ground troops against Isil, but also provide stable governance in Isil-occupied areas when the bombing stops, progress on a settlement to Syria’s Civil War is more not less urgent.  Without it, the reluctance of Syrian Sunnis to think that our fight is their fight will undermine the chances of military efforts to beat Isil and bring basic order to the regions they control. 

This points us towards doubling down on the progress that has already been made in Vienna: working with the USA, France, Syria’s neighbours and the Gulf states, as well as Russia and Iran. We need not just a combined approach to ending the conflict, but the prospect of a post-war Syria that offers a place for those whose cooperation we seek to defeat Isil. No doubt this will strike some as insufficient in the face of the horrors perpetrated by Isil. But I fear that if we want not just to take action against Isil but to defeat them and prevent their return, it offers a better chance of succeeding than David Cameron’s proposal today. 

Stewart Wood is a former Shadow Cabinet minister and adviser to Ed Miliband. He tweets as @StewartWood.