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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How the Standing Rock fight will continue

Bureaucratic ability to hold corporate interest account will be more necessary now than ever.

Fireworks lit up the sky in rural North Dakota on Sunday night, as protestors celebrated at what is being widely hailed as a major victory for rights activism.

After months spent encamped in tee-pees and tents on the banks of the Canonball river, supporters of the Standing Rock Sioux Tribe finally received the news they’d been waiting for: the US Army Corps has not issued the Dakota Access pipeline with the permit it requires to drill under Lake Oahe.

“We […] commend with the utmost gratitude the courage it took on the part of President Obama, the Army Corps, the Department of Justice and the Department of the Interior to take steps to correct the course of history and to do the right thing" said a statement released by the Standing Rock Sioux tribe’s chairman, Dave Archambault II.

With the camp’s epic setting, social-media fame, and echoes of wider injustice towards Native Americans, the movement has already earned a place in the history books. You can almost hear the Hollywood scriptwriters tapping away.

But as the smoke settles and the snow thickens around the thinning campsite, what will be Standing Rock’s lasting legacy?

I’ve written before about the solidarity, social justice and environmental awareness that I think make this anti-pipeline movement such an important symbol for the world today.

But perhaps its most influential consequence may also be its least glamorous: an insistence on a fully-functioning and accountable bureaucratic process.

According to a statement from the US Army’s Assistant Secretary of Civil Words, the Dakota Access project must “explore alternate routes”, through the aid of “an Environmental Impact Statement with full public input and analysis”.

This emphasis on consultation and review is not big-statement politics from the Obama administration. In fact it is a far cry from his outright rejection of the Keystone Pipeline project in 2015. Yet it may set an even more enduring example.

The use of presidential power to reject Keystone, was justified on the grounds that America needed to maintain its reputation as a “global leader” on climate change. This certainly sent a clear message to the world that support from Canadian tar-sands oil deposits was environmentally unacceptable.

But it also failed to close the issue. TransCanada, the company behind Keystone, has remained “committed” to the project and has embroiled the government in a lengthy legal challenge. Unsurprisingly, they now hope to “convince” Donald Trump to overturn Obama’s position.

In contrast, the apparently modest nature of the government’s response to Dakota Access Pipeline may yet prove environmental justice’s biggest boon. It may even help Trump-proof the environment.

“Although we have had continuing discussion and exchanges of new information with the Standing Rock Sioux and Dakota Access, it’s clear that there’s more work to do”, said the Jo-Ellen Darcy, the Army’s Assistant Secretary for Civil Works.

Back in July, the same Army Corps of Engineers (which has jurisdiction over domestic pipelines crossing major waterways) waved through an environmental assessment prepared by the pipeline’s developer and approved the project. The Standing Rock Sioux Tribe subsequently complained that the threat to its water supply and cultural heritage had not been duly considered. This month’s about-turn is thus vital recognition of the importance of careful and extensive public consultation. And if ever such recognition was needed it is now.

Not only does Donald Trump have a financial tie to the Energy Transfer Partners but the wider oil and gas industry also invested millions into other Republican candidate nominees. On top of this, Trump has already announced that Myron Ebell, a well known climate sceptic, will be in charge of leading the transition team for the Environmental Protection Agency.

Maintaining the level of scrutiny finally granted for Standing Rock may not be easy under the new administration. Jennifer Baker, an attorney who has worked with tribes in South Dakota on pipeline issues for several years, fears that the ground gained may not last long. But while the camp at Standing Rock may be disbanding, the movement is not.

This Friday, the three tribes who have sued the Corps (the Yankont, Cheyenne River, and Standing Rock Sioux Tribes) will head to a hearing before the Inter-American Commission on Human Rights, seeking to increase pressure on the government to comply with both domestic and international law as it pertains to human rights and indigenous soveriegnty. 

What the anti-pipeline struggle has shown - and will continue to show - is that a fully accountable and transparent bureaucratic process could yet become the environment's best line of defence. That – and hope.

India Bourke is an environment writer and editorial assistant at the New Statesman.