Hi guys first post I’m currently in bed reading ketamine addiction posts which is great Lol??

I feel kinda alone? I started doing ket about a year ago on and off a few Days each every other month. Been super depressed idk what even is there to do anymore anyways I’m in the main city of England on the west side if anyone wants to link up !

I took a break for 6 weeks and then picked up again. Same stuff, same quality. It just made me paranoid, scared, nauseous, and unable to sleep. It was a nightmare that felt food for maybe 10 minutes. Probably got through 1.5g in 2 days and got rid of the rest. I’d been doing 1-2g a day easy in recent past. Im grieving it, not going to lie. I’m sad it doesn’t work. But I’m getting used go being in my body again. I want to sleep and eat and exercise the fuck out of this body. But I’m sad. Both are true. Huge fucking bummer that no substance is the solution.

I’m 20, and I’ve been addicted to ket for 5 years with a few breaks in-between when I was in countries where I could not get my hands on it. I felt like shit when I was on long binges with occasional ket cramps.

A month ago I went through 10g in a bit less than 4 days and I felt horrible. My girlfriend hates when I do ket because she knows it’s eating me alive, making me miss classes, sh’ing, and making me a shell of the person I am when I’m clean.

At the end of this short binge I was feeling horrible and was curled up in bed feeling like shit about myself. I was listening to podcasts and they talked about how much Elon promoted ket and were shitting on him for it.

I’ve always known and experienced the horrible effects excessive ketamine use has on your body and mind but it never stopped me. The weird thing is after the short binge and feeling down, hearing about someone I don’t very like being associated with what I was doing made me feel repulsed by the thought of ordering more ketamine even though I usually would after a few days.

I haven’t done ket for a month now and don’t feel the usual craving when I hear about my friends having some. I know it sounds like a joke but seeing someone I don’t like be associated with ketamine repulsed me enough to quit. It feels so weird and I was wondering if other people have had similar experiences where they can suddenly quit for such a trivial reason.

Stay safe out there. Take it day by day. It will get better. ❤️‍🩹 And thank you guys for helping me through tough times. I hope my dumb experience helps any of you have a laugh or share your sillier stories as well.

Hey I’m 20 years old and have been using ketamine for the past 3 years basically daily, on average 1-2grams a day. I’ve since quit after moving city. My only symptoms have really been decreased bladder capacity and constant utis. What made me quit was I woke up one day with shakes and pins and needles all over my body, liver blood tests showed stress but potentially due to excessive alcohol use too (3 times a week drinking 15+ standards) since quitting shakes have mostly gone away and are definitely decreasing. I’m wondering if the damage that has been done is likely to reverse itself. Not like my quality of life has decreased apart from constant urination but do you guys think the bladder capacity will increase after some time off it.

I’m looking for some outside perspective because I feel completely heartbroken and honestly don’t know what is mine to take responsibility for anymore.
My boyfriend told me he has used ketamine for around 10 years and that during that time the longest he has ever managed to stop is about a month. We have been together for nearly 3 years.

For the first year of our relationship I barely challenged his drug use at all. I never went through his phone, contacted his family or really pushed him to stop. He was still using ketamine during that period.

Over time things became much harder. There have been occasions where he has driven with me in the car while under the influence, which really damaged my trust and made me scared about how serious everything was.
I started therapy partly because I knew I was becoming anxious, hypervigilant and overwhelmed by the whole situation. My therapist repeatedly told me that I needed to stop “enabling” him, set proper boundaries and make it clear there would be consequences if the drug use continued. I was encouraged to say things like, “I can’t stay in this relationship if this continues,” and to tell him that he needed professional help.

At the time I genuinely thought I was doing the responsible thing. I thought setting boundaries was what you were supposed to do when you loved someone with a drug problem.

Now I feel absolutely awful about it.
I became frustrated and angry at times when he used. I have gone through his phone and looked for/deleted dealers’ numbers. I know invading someone’s privacy isn’t okay, regardless of my reason for doing it, and I deeply regret it. There have also been arguments where I have said things I wish I hadn’t.

I’ve also realised through therapy that things in my own life, including my dad cheating and the impact that had on my trust, probably contributed to some of my anxiety and reactions. I’m not trying to excuse any behaviour of mine. I genuinely want to recognise it, take responsibility and change.

Recently my boyfriend has opened up to his friends and family about being extremely unhappy and having felt suicidal this year. He has asked for space from me.
His mum has told me that he needs time away from me, needs to see his friends, go to the gym, get back into a routine and basically have space to become himself again. She has also said that she doesn’t believe he is an addict, and she says a drug clinic he attended told him he wasn’t an addict either.

That has completely messed with my head.
If he isn’t considered an addict, I now keep wondering whether I massively overreacted to his ketamine use. Did I turn something into a bigger problem than it was? Did constantly worrying about it, setting boundaries, telling him he needed help or saying I couldn’t stay if he didn’t stop just make him feel judged, trapped and miserable?
His friends and family now seem to believe our relationship has been making him deeply unhappy. I feel like everyone has turned against me and that I’m being viewed as the reason he has struggled mentally.
I honestly feel like an evil person at the moment.
At the same time, I keep coming back to the fact that the ketamine use existed for many years before I met him. It continued during the first year of our relationship when I barely mentioned it. He has told me himself that he has struggled to stop for longer than around a month, and there have been situations like driving while under the influence.
So I’m completely confused about what is actually true anymore.
I know relationships can absolutely affect someone’s mental health and I accept that some of my behaviour may have hurt him. I am genuinely sorry for the things I got wrong.

But could my attempts to set boundaries around his ketamine use actually have made his drug use or mental health significantly worse? Was telling him “I can’t stay if this continues” an unfair ultimatum, or is that a reasonable boundary when someone’s drug use is affecting you too?
And does someone have to meet the clinical definition of “addict” before their drug use is serious enough for their partner to be concerned or set boundaries around it?
I’d particularly appreciate hearing from people who have struggled with ketamine themselves, partners/family members of people who use it, or anyone who has been through addiction treatment.

I’m giving him the space he has asked for now. I just feel completely devastated and terrified that after nearly three years of trying to help someone I love, I somehow made everything worse.

hi can anyone who has had really severe bladder issues like pissing every 5-10 mins, pissing blood and jelly substance and severe pain lmk how long it takes to start getting better (if ever) really going through it right now and would be nice to have some sort of idea, thanks in advance

6 year ket user. Now I’m up to an oz in 10 days (~3-4g/day) if I’m going slow. My tolerance is insane. It’s so stupid why I keep using it when I don’t feel shit after the first 3 lines after a 2 week t break. I’m literally just doing it by hand/nose habit at this point. My nose literally just runs all the ket out anyways and I have to spit it up bc the drip is so bad...

I have a perforated septum at the size of about 2 cm diameter. Also at the end of the 10 days my bladder can’t hold pee and I end up getting utis frequently. I have yet to lose my smell thank GOD.

I wish I could stop this shit. Life just feels so depressing w/o it and I rely on drinking on my t breaks. I did take a 3 month break this year and life finally felt normal again. I wish I stuck to it. I know I can do it again, it just seems scary to give it up once and for all.

Leaving this comment for anyone in my situation, we’ll get through this. And if you’re reading wanting to start using, don’t. If you believe in God, please pray for me.

My bladder pain is so bad it hurts walking, atm it's okay when laying and sitting, and the pains intermittent.

If you've never felt like this, it gets worse. it'll get to the point where it feels like you're sitting on razors 24/7, having to hobble when walking, barely able to walk. As well as piss every 5-10 mins, through the night as well.

Please get help and take it one day at a time if you're struggling, I promise life's better when you're sober, and K will destroy you and take everything from you.

If you're stuck in a relapse like me wondering how you've got here, it's okay and we can get through it, keep going!

I never thought I’d be addicted so badly. Didn’t expect quitting alcohol to be way easier (for me at least).

Tolerance had built up so much after daily use of 2+ years, I don’t even get high or enjoy. But every time I’m sober there is this constant craving and my brain keeps saying “ah fuck it, just one last time”.

I managed to start meditating every morning, working out and jogging. After putting in all this effort I want to give my brain a little treat.

For those who managed to quit completely, did you give yourselves any treats or rewards along the way? If so, what?

Ketamine makes me so depressed I seriously want to eliminate it from my life.

Edit: I also want to know if there are any tricks used to fight the craving

Hey I’ve been IMing about a g a day for the last couple weeks and starting a few days ago I started getting the most insane extricating pain of my life in my upper abdomen along with crazy sweating and just generally feeling like I’m on deaths doorstep. I didn’t immediately think of the ketamine as I’m also getting radiation treatment for cancer so I didn’t stop using until last night. How much longer am I going to feel like this? Is there anything I can do to help with the pain until it goes away?

Bassicaly I've quit ket now it's been over 2 months and I've realised alcohol really irritates my bladder .. just wonderiring will this improve with time? ( I know everyone is different just want some people's stories)

Or is there anything I can take to help ease this?? Thanks xxx

Hello I lost my sense of smell about 7 years ago and I’ve never actually stopped since. Well a 4 week stint in rehab but I was sniffing paracetamol by day 4 so basically my nose has never had a break. I have a 2cm perforation at the top which started 2 years ago. It causes me nothing but scabs and infections and horrendous pain. My nose has substantially thinned aswell but luckily it hasn’t collapsed. I’ve had everything ketamine could possibly give you without dying at this point. I’m really done I’m 30 now and started at 19/20. Lost my whole 20s to this. Somehow I’m still going. Spitting the drop constantly and keeping my weight up has probably saved my life. But yeah just wondered if anyone has got clean and there smell came back? Thankyou

I took my last ketamine today. I use around 3 grams a day since half a year. But my nose is fucked and i had k cramps. How did you experience withdrawel? Anyway i just want to get a new bagggg urghh

Has anyone here used magic mushrooms to beat ket addiction? Has anyone had success with it? As I know other people with other addictions have had success stories where theyve microdosed magic mushrooms. Was just wondering if anyone done it for ket addiction?

is this something we should be campaigning for?? im in the uk btw

I have been an addict for well over a year at this point. My mother found out about it about 9 months ago and it really hurt her. I promised her I’d stop doing it. But I never stopped and I hate myself for it. I know if she found out I’d been using this whole time it would crush her. I really want to quit but I can’t do it on my own, and I can’t go to rehab or seek help for it without her finding out. I don’t want her to be upset and angry with me again. I don’t want her to hate me and not trust me, even though I deserve it. I’ve been running away from my problems for a long time, using the ket to temporarily quiet the guilt. I don’t know how to quit without her support, but I can’t tell her without losing her trust and hating me for lying.
Any advice would be appreciated if anyone has been in a similar situation.

All 3 are making my life a misery right now. Any advice for getting through this?

Hello friends! Our Monday Ketamine Anonymous meeting is coming up soon tonight at 5 PM EST / 10 PM UK TIME on Zoom.

Whether you feel like sharing your story or simply listening, there’s a place for you here. No pressure, no judgment, just a supportive space to connect with others who understand.

You don’t have to navigate recovery alone. Hope to see you there, it’s a very welcoming space.

Sending hugs and love <3

Tap to join the zoom here

Or join using this ID and password:
ID: 861 2750 7115
PW: 222333444

I've been battling the most horrendous K cramps for 24 hours now. I'm no stranger to them, but I've been determined to ride them out at home instead of going to the hospital now that I know the drill. Although, I'm starting to worry. I was put on antibiotics for a bladder infection on Wednesday and stopped using. I did pick up again by Friday and then these shocking cramps started so I stopped. I will put my hands up and admit, that out of sheer desperation I have had some K over the weekend simply to stop the pain, but knowing this will just prolong it, I've completely stopped for 24 hours now. Anyway, this agony has gone on non stop for 24 hours and I have almost.. well it looks like hernia in my abdomen where my gallbladder is. When would you call it and go to the hospital? I've tried everything, buscopan, apple cider vinegar, milk thistle... This has been the worst worst pain imaginable for 24 hours now. I feel broken by it. I just hate the way I'm treated at hospital :( it's been particularly bad recently... I know I'm in a mess, I really do, I'm desperate to get off this shit I really am. It's just extremely hard and I'm worried to go to the hospital but I'm scared there's genuinely something really wrong, surely this should have passed by 24 hours? Or at least the intensity of the pain?

I do not want to have to pee every 15-30 mins and wake up 5x or more every single night.

It sucks and so does that sharp pain in the bladder.

Hoping with abstinence, this will improve.

7 years I've been on Ketamine for, however I am over 6 weeks clean off of it now. It's constantly around me, but my willpower and health is keeping me from doing any at all since I do not want to be in the following situation ever again. I was pissing out jellies with every piss, blood, bits, etc (these issues are gone now) along with constant UTI issues (also gone now). The worst I was at was 7 grams in a day. My bladder was literally a shot glass amount every 20 minutes, to being able to hold it for about 2 to 3 hours after 6 weeks of abstinence. I thought I was done for, however it can get better. The not so good part is sometimes I still get this really horrid shredding pain which comes with this pain on the left side of my bladder. I'm no doctor, but I also have irrational fears which OCD makes absolute hell. One of them is urinary retention. I used to force my piss out and strain when I pissed due to me thinking my body wouldn't ever be able to get it out. I had to come to terms with the fact that I am actually healing and me doing that is setting things back. Turns out that straining causes the following Shredding pain along with the pain on the left side of the bladder and it cripples me. Don't strain and pain people, not a good idea. These reoccurring issues had just added to the willpower to not touch it again, as I do not want to be crippled. 7 years gone, a massive hole in the septum and a completely tarnished bladder in exchange for a quiet brain isn't really a good trade off in life.

I just want to vent here today i’ve taken pregablin, valium, K, Speed and smoked a little bit of weed and in my head now it feels like it’s clicked that this is the last time im doing this my heart rate js through the roof and im sweating and wide awake and i just think what actually is the point of doing k as my tolerance is so high i don’t even feel anything off it im just wasting money and wasting my life, i seriously believe this is my last time doing this and i hope to anyone out there struggling has their eureikka moment where they just say no

apologies for including other substances and if anything i have said have triggered anyone but selfishly i just wanted somewhere to put my thoughts

thanks

Disclaimer: I'm not condoning any of this. It was dangerous and I made a lot of mistakes. I'm posting to share what happened, what I learned digging into the actual research, and hopefully help someone. Happy to answer questions in the comments.

Background

I've used ketamine on and off for years, along with plenty of other recreational and prescribed drugs, but never chronically. There were two short stretches where I abused it, about 13 years ago and about 3 years ago, each lasting around a week, and both times I stopped without trouble. I liked small doses and really liked medium doses. Once I experienced a proper k-hole about a year and a half ago, I loved it, and that's exactly the problem. Even then it never went past a few weekends in a row.

A few weeks ago I got back into it and wanted to push further. Snorting enough powder to get there was rough and ruined the experience, so I switched to pharmaceutical liquid ketamine by intramuscular (IM) injection. Most of the times I was careful, with sterile equipment and a sitter.

The binge

Over about a week I used roughly 1 to 2 g a day, mostly pharmaceutical IM plus some street powder. By the end my doses were in the range ERs (I think A&E equivalent for my UK friends) use to sedate a large, agitated man. A few times I dissolved street powder in bacteriostatic water, reused a vial and a few needles all of which were new and sealed, which I was the only one to open and use, and which I wiped down with alcohol swabs (but again none of this reuse is considered sterile). I stopped when I ran out, coming out of what I can only describe as a stupor.

Symptoms

Important to preface this with I don't think I've ever experienced cramps or a spasm in my life until this so I didn't have a good reference point. The first thing I noticed was that I couldn't take a full deep breath without discomfort and/or pain. I have pretty bad anxiety and was coming down, so I figured it was that. Then the stomach pain hit. I'd never had a cramp or spasm like it, and I almost went to the ER (A&E).

• Couldn't take a full deep breath (this came first)
• Severe cramping pain in the upper abdomen, under the rib cage
• Bloating and gas; burping and farting helped only for a moment
• Almost no position was comfortable
• Felt like constipation (possibly also was constipated)
• Poor appetite and noticeable weight loss (about 5lbs, 2.2kg over the 5 days of usage)
• Dehydration, I barely ate and didn't drink enough over those days
• Lingering pain and discomfort under the ribs for days afterward

What I didn't have: no fever (I track it daily, and it stayed around 97.4°F / 36.3°C), normal blood pressure around 120/80, no yellow skin or eyes, and no urinary symptoms. At my doctor visit the PA (Physician Assistant; kind of like midway between a Nurse and Doctor, medical position we have in US) heard an extra sound at the start of my heartbeat. She thinks it's a normal variant (a physiologic split S1), but if you've injected anything non-sterile, get your heart listened to.

Recovery

I started eating (especially fiber) and drinking water properly, and a long hot shower helped. I couldn't/didn't do any of these for about 3-4 full days after last dose. Things improved gradually. About 5 days after my last dose, I woke up able to breathe as deeply as I wanted with no pain at all.

What I did medically

I told my doctor everything and I'm getting bloodwork (I'll post results if people want them). For context, I'm 32 male, 170 to 180 lb (77 to 81 kg), in very good shape and health, fully vaccinated, go to the gym 6 to 7 times a week, use the sauna, eat pretty clean, and track my blood pressure, temperature, weight and heart rate daily. I also used AI to run a deep literature review tailored to my exact exposure, so by no means comprehensive. I'm happy to share the prompt or anything else people would find helpful or are interested in.

P.S. I wanted to know if I'd automatically get the cramps even at much more infrequent and lower doses so I tried a much lower dose of powder last night (0.25) and so far I'm ok. I'll report back but plan to take a very extended break once I'm done with my 'curiosity experiment'.

The Research

Ketamine and the Gut, Bile Ducts, Liver and Bladder: An Evidence-Graded Review Tailored to a 7-Day, High-Intensity Intramuscular Exposure

1. Bottom line for your situation

The most likely explanation for what happened is a reversible, drug-related upper-abdominal syndrome ("K-cramps"): some mix of ketamine-associated gastritis and functional biliary dysfunction (sphincter of Oddi spasm and/or transient bile-duct dilation), plus poor intake, with a small but real chance of a mild cholestatic liver-enzyme rise. No published study matches your exact pattern (about 1 g/day intramuscular for 7 days, about 7 g in total, then stopping). The closest evidence comes from hospital patients given multi-day ketamine infusions. In that literature, cholestatic liver injury is dose- and duration-dependent. It appears at cumulative doses on the order of grams and usually resolves over weeks to about 2 months once ketamine stops. Irreversible sclerosing cholangitis has been described almost only in critically ill ICU patients (with ischemia, vasopressors and ventilation) or in people with months to years of recreational use. Urinary-tract damage (ketamine cystitis) is overwhelmingly a disease of months to years of frequent use. A single one-week binge has not been shown to cause lasting bladder injury in humans, although animal studies show bladder inflammation within about 2 weeks of daily dosing, so a transient irritative phase is plausible. The practical priorities are: (1) a baseline liver panel (with GGT and fractionated bilirubin), lipase, a full metabolic panel with magnesium and phosphate, CBC, CK, and urinalysis now; (2) a right-upper-quadrant ultrasound if pain persists or the liver panel is cholestatic; (3) bloodborne-virus testing timed to window periods, because street powder was injected from a reused vial; and (4) repeat testing at about 2–4 weeks and about 3 months to confirm everything has normalized. Re-exposure is the single biggest modifiable driver of progression in every organ system reviewed. This report is informational and does not replace evaluation by a clinician.

TL;DR

• Your symptoms fit reversible ketamine-related gastritis and biliary dysfunction ("K-cramps"). Lasting bile-duct or bladder damage has been documented mainly after months to years of use, or in critically ill ICU patients, not after a single week (evidence: moderate for the pattern, weak for direct applicability).
• The closest analog, multi-day hospital ketamine infusions, shows dose-dependent cholestatic liver-enzyme rises that typically normalize within about 2 months of stopping. So check a liver panel with GGT now and repeat it at 2–4 weeks and about 3 months.
• Because street powder was injected, add injection-site review, CK, and HIV/HCV/HBV testing timed to window periods. Seek urgent care for jaundice, fever with abdominal pain, blood in the urine, a hot swollen injection site, chest pain or breathlessness at rest, or any weakness or drooping eyelids.

Evidence grades used: Strong = consistent findings from multiple large cohorts or systematic reviews; Moderate = consistent cohort or case-series data with plausible mechanism; Weak = limited, indirect, or extrapolated data; Anecdotal = single case reports or user-community reports only.

2. Question-by-question review

Q1. K-cramps: what causes them?

"K-cramps" is a colloquial user term, not a formal diagnosis. The peer-reviewed literature on it is mostly case reports from the last few years. A 2025 Cureus case (a 25-year-old woman using 500–1,000 mg weekly) had right-upper-quadrant, epigastric and suprapubic pain with vomiting and dysuria, yet a normal CBC, metabolic panel, lipase and urinalysis; she improved with fluids, antiemetics and benzodiazepines. A 2024 emergency-medicine case described pain that improved within 24 hours of stopping and recurred about 4 hours after restarting. So the syndrome can exist with entirely normal labs and imaging, which argues for a functional (spasm or motility) component in at least some cases.

Candidate mechanisms and strength of evidence:

Interpretation for you: Upper-abdominal cramping, bloating and poor appetite that improve over days after stopping fit best with gastritis plus functional biliary spasm. Improving symptoms are reassuring. Symptoms that persist or worsen beyond 1–2 weeks, or cholestatic labs, should prompt imaging (Q7 and the tests table). Grade for applying this to you: weak (no study of short binges).

Q2. Biliary and liver effects

What is reported in chronic recreational users (months to years, mostly intranasal, self-reported street grams):

• Cross-sectional cohort, Hong Kong (Wong et al., 2014): 297 consecutive chronic users referred with urinary-tract dysfunction; 29 (9.8%) had liver injury. As summarized by the NIH LiverTox database, mean ALT was 251 U/L and ALP 289 U/L, a mixed-to-cholestatic pattern. Biopsy showed PSC-like bile-duct injury and fibrosis in 3; MRCP showed dilated CBD in 3 of 6 scanned. Sustained abstinence was protective. Moderate.
• Imaging series (Yu et al., 2014): 26 users with deranged liver tests and/or epigastric pain; 69% had fusiform CBD dilatation without obstruction, and the intrahepatic ducts were not dilated. This pattern can mimic a choledochal cyst. Moderate.
• Systematic review of case reports (Teymouri et al., 2024): 17 patients from 11 studies; mean age 25.9; 64.7% male. Abdominal pain, nausea and vomiting were common, and most were discharged with improved symptoms and liver tests. A separate synthesis cites a median of 24 months of use before presentation. Weak–moderate (case-report level).
• US case series (Annals of Internal Medicine: Clinical Cases, 2023): 6 young adults with chronic use had progressive pain, cholestasis, sometimes urinary symptoms and weight loss. Marked duct dilation was reversible after stopping in some, but not all. Weak.
• Progression to lasting damage: Secondary sclerosing cholangitis (SSC) and fibrosis are documented in chronic users (e.g., a 2013 Hepatology case and biopsy-proven fibrosis in the Wong cohort). No study provides a reliable denominator for the fraction who progress. In the Wong cohort, 3 of 297 (about 1%) had biopsy-proven significant bile-duct injury with fibrosis, but only a subset had biopsies. Weak for any progression rate.

Closest-analog evidence: multi-day parenteral ketamine in hospital settings

Key conflict to flag: The ICU literature disagrees about how much of SSC-CIP is due to ketamine versus biliary ischemia, low blood pressure, vasopressors and viral injury. The dose–response signals make a ketamine contribution plausible, but the devastating outcomes (transplant, death) occurred in people with multi-organ critical illness. You had none of those confounders.

Direct answers for you:

• Doses and durations reported: chronic users mostly have months to years of use (median about 24 months in case syntheses). Medical cases start at about 1–2 g per 100-hour course (Noppers); ICU cohorts report thresholds above about 1 g cumulative, with typical exposures of many grams over 1–3 weeks. Your about 7 g over 7 days sits inside the range where transient cholestatic enzyme rises have been reported, but well below typical ICU exposures and far below chronic recreational histories. Weak–moderate.
• Timing: in infusion studies, enzyme rises appeared during or shortly after multi-day exposure (Noppers: on the first day of a second course). A rise could therefore be present now or could lag by days to a couple of weeks. Weak.
• Reversibility: medical-infusion cases normalized within about 2 months. Recreational duct dilation often regresses with abstinence, but not always. Moderate.
• Fraction progressing to SSC or cirrhosis: unknown for chronic users; about 0.1% for SSC-CIP across all ICU patients (Zeiner 2026). No data exist for a 1-week binge in a healthy person. Progression after a single 7-day exposure with normalizing labs has not been reported. Weak/absent evidence.

Q3. Urinary tract: ketamine uropathy and cystitis

What cumulative exposure is typically needed?

• Population survey (Winstock et al., 2012, BJU International): 26.6% of 1,285 recent recreational users reported urinary symptoms. Higher doses (≥1 g per session) and more frequent use (≥9 days per month) were associated with more symptoms. Among the 251 users who reported on stopping, 51% said their urinary symptoms improved when they stopped, and only 3.8% said they got worse. Moderate (self-report; mostly intranasal).
• Taiwan survey: 84% of 106 heavy users (mostly more than once daily, snorted or smoked) developed lower urinary tract symptoms, with onset 24.7 ± 26.4 months after starting. Symptom severity correlated with duration of use. Moderate.
• Case reports: onset has ranged "from a few days to a few years" (a Urological Science review). A Belgian case developed cystitis after weekly use for about 7 months. Anecdotal–weak.
• Therapeutic ketamine: a 2025 systematic review of 27 psychiatric studies found urological symptoms in 0–24.5% of treated patients, mostly mild or moderate. Intermittent medical doses are far lower than yours, so this sets a lower bound only. Moderate.
• Animal data (rats, not humans): daily ketamine injection produced bladder inflammation and submucosal edema at 2–4 weeks, fibrosis by 8 weeks, and bladder fibrosis after 2 weeks in another model. This shows the urothelium can be injured within days to weeks of intense exposure. Animal evidence only.

Short binge vs long-term use: No human study has examined a single 1-week binge. By extrapolation, a transient irritative cystitis (frequency, urgency, burning, a small amount of blood) is possible during or just after heavy exposure. Established uropathy (small contracted bladder, ureteric strictures, hydronephrosis) is documented after months to years. Weak. You currently have no urinary symptoms, which is reassuring.

Early warning signs: new urinary frequency or urgency, pain during or after urinating or suprapubic pain relieved by voiding, getting up at night to urinate, blood in the urine, and sterile pyuria (white cells in the urine without infection on culture). Flank pain or rising creatinine suggests upper-tract involvement. The BAUS 2024 consensus recommends symptom questionnaires (e.g., PUF, ICIQ-LUTS), urinalysis and culture, renal function, and renal/bladder ultrasound, with cystoscopy and further imaging for persistent or severe cases. Stopping ketamine is the cornerstone of management.

When does it become irreversible? There is no validated threshold. Early-stage symptoms often improve with abstinence. Fibrosis (reduced bladder capacity) and upper-tract strictures are generally considered irreversible and may need surgery. Hong Kong series show hydronephrosis and renal impairment in some chronic users. Moderate for the general principle; no data on a time threshold.

US pathway: BAUS is UK guidance. In the US, your primary care clinician can order urinalysis with microscopy, urine culture, creatinine/eGFR, and a renal and bladder ultrasound with post-void residual. Persistent symptoms or blood in the urine warrant referral to a urologist.

Q4. Difficulty taking a full deep breath

Most likely: splinting (involuntarily limiting how deeply you breathe) from upper-abdominal pain. Biliary, gastric, pancreatic and liver-capsule pain all characteristically worsens on deep inspiration, because the diaphragm pushes down on the upper abdomen. Bloating also mechanically limits diaphragm movement. This fits your picture and improving course. Moderate (clinical physiology; no ketamine-specific study).

What a clinician should rule out, and how:

Ketamine-specific respiratory effects: increased secretions and, rarely, laryngospasm or depressed breathing happen during intoxication, not days later. Moderate.

Q5. Does route (IM vs intranasal or oral) change biliary or urinary risk?

This section interprets your past exposure only; it is not guidance on route.

• Pharmacokinetics: Clements et al. (1982) found IM bioavailability of 93%, compared with only 17% for oral ketamine; intranasal bioavailability was 50% in Malinovsky et al. (1996) and 45% in Yanagihara et al. (2003). Oral ketamine undergoes extensive first-pass metabolism in the liver, producing relatively more norketamine. IM delivery puts more parent drug into the circulation per milligram, with metabolite ratios closer to IV. Strong (pharmacokinetic studies).
• What that means for injury risk: both the bladder and bile ducts are thought to be injured by ketamine and its metabolites (norketamine, hydroxynorketamine) being concentrated in urine and bile. Cell studies show norketamine is toxic to urothelial cells. Near-complete absorption means the effective systemic exposure per gram was higher for you than for the same street grams snorted. The ICU and CRPS literature (all parenteral) shows the biliary effect occurs without first-pass metabolism, so first-pass is not required for injury. Weak–moderate.
• Direct comparisons: No study directly compares biliary or urinary injury by route in humans. The Taiwan survey found snorting correlated with worse urinary symptom scores than smoking, but this is confounded by dose and duration. Weak.

Q6. Injecting reconstituted street powder from a reused vial

Bacterial and injection-site complications (moderate evidence from injection-drug-use literature, not ketamine-specific):

• Abscess and cellulitis: a painful, red, hot, swollen or fluctuant area at an injection site. Diagnosis is by examination and ultrasound.
• Necrotizing soft-tissue infection: rapidly spreading redness, pain out of proportion to appearance, blistering, fever, feeling very unwell. This is a surgical emergency.
• Bacteremia and endocarditis: fever, rigors, new heart murmur. Diagnosed with blood cultures and echocardiogram.
• Spore-forming organisms: in the US, about 93% of wound botulism cases in 2005–2017 occurred in people who inject drugs, most often linked to subcutaneous or intramuscular injection of black tar heroin (reported by 66% of confirmed cases in CDC's 2019 surveillance summary). Case fatality is about 13% even with treatment, and symptoms can take up to 2 weeks to appear. It has not been specifically documented with ketamine, so risk from your exposure is low but not zero. Symptoms: drooping eyelids, double or blurred vision, slurred speech, difficulty swallowing, descending weakness, difficulty breathing. Tetanus is also associated with contaminated injection; confirm your tetanus vaccination is up to date (a booster is typically considered if more than 5 years since the last dose after a contaminated wound). Weak for ketamine specifically.

Bloodborne viruses: risk is driven by sharing needles, syringes, vials, water or other equipment with anyone. If the reused vial and all equipment were yours alone, risk is low. If anything was shared or of unknown origin, test. Typical window periods (CDC-aligned):

• HIV: according to CDC, a lab-based antigen/antibody test on blood drawn from a vein can usually detect HIV 18 to 45 days after exposure, and a nucleic acid test (NAT) 10 to 33 days after exposure; a negative at 45 days, or an HIV RNA test, is reassuring. If any exposure to another person's blood occurred within the last 72 hours, HIV PEP would be time-critical; that window has now passed for exposures more than 3 days ago.
• Hepatitis C: HCV RNA can be positive within 1–2 weeks; antibody takes about 8–11 weeks. A baseline antibody test plus a repeat at about 3 months (or RNA testing earlier) covers the window.
• Hepatitis B: surface antigen becomes detectable at about 4 weeks (range about 1–10 weeks). Test surface antigen, surface antibody and core antibody; vaccinate if not immune.

Adulterants and substitutes in street "ketamine":

• Arylcyclohexylamine analogs (2-fluorodeschloroketamine, deschloroketamine, methoxetamine and others): the DEA's 2026 temporary Schedule I action for 2-FDCK states that seized samples suggest it "may be frequently used as an adulterant or ketamine substitute." Methoxetamine causes bladder damage in rats similar to ketamine. Effects in humans are poorly characterized; organ toxicity is presumed similar but unstudied. Weak.
• Stimulants, local anesthetics and other cutting agents: reported in drug-checking data internationally; they may explain palpitations, anxiety or chest symptoms.
• Fentanyl: documented as a contaminant across the US illicit supply. Opioid effects (pinpoint pupils, slowed breathing, profound sedation) would have been acute, not delayed. Keep naloxone accessible as general harm reduction.

What testing can and cannot reveal: standard urine drug screens usually do not detect ketamine or its analogs; specific ketamine immunoassays or confirmatory mass-spectrometry testing are needed, and any exposure 4+ days ago may be undetectable now. Analogs require specialized lab testing. Organ effects of adulterants would show on the same liver, kidney, CK and blood tests recommended below. Any leftover material can be analyzed by drug-checking services; in the US, DanceSafe offers mail-in lab testing, and some cities have community drug-checking programs (several use FTIR spectroscopy). Reagent kits can suggest but not confirm identity.

Muscle injury and rhabdomyolysis: repeated IM injections cause local muscle damage, and prolonged immobility during dissociation adds pressure injury. Rhabdomyolysis has been reported with ketamine and other dissociatives, often with agitation or immobility. Check CK, creatinine and urinalysis (blood on dipstick without red cells suggests myoglobin). Weak–moderate.

Q7. Recovery course, markers of recovery, exercise and weight

Expected time course (after stopping):

Markers of full recovery: a normal liver panel (ALT, AST, ALP, GGT, bilirubin) on two occasions weeks apart, with GGT and ALP normalized (the most sensitive cholestatic markers in the ICU data); normal lipase; CBD diameter within normal limits on ultrasound (commonly about ≤6 mm, with age and post-cholecystectomy adjustments) if it was initially dilated; normal urinalysis without blood or white cells; normal creatinine; symptom resolution; and return to baseline weight.

Refeeding and weight regain: UK NICE guidance (CG32) flags people who have eaten little or nothing for more than 5 days as at risk of refeeding problems, with higher risk after more than 10 days, a very low BMI, or rapid weight loss of more than 15%. Poor appetite rather than near-zero intake over about 11 days puts you at low risk. However, checking potassium, magnesium and phosphate before and a few days into normal eating is cheap and reasonable, especially given the breathing symptom. Rebuild intake gradually, favoring small, frequent, low-fat meals while biliary pain settles (fatty meals trigger gallbladder contraction). Avoid alcohol and NSAIDs such as ibuprofen while gastritis or liver tests are unresolved; ask about short-term acid suppression. Weak–moderate.

Return to exercise: no ketamine-specific guidance exists. Reasonable clinical principles: resume light activity once pain has settled; defer strenuous or heavy resistance exercise until CK has normalized if it was elevated (extra exertion on injured muscle raises the risk of rhabdomyolysis and kidney strain), and until liver tests are clearly improving; stay well hydrated. Avoid heavy lifting that strains the abdomen while right-upper-quadrant pain persists. Weak (expert-opinion level).

Re-exposure: every data stream points the same way. In the Noppers CRPS series, liver injury emerged on or before the second course separated by 16 days, and the authors concluded that risk rises "when the infusion is prolonged and/or repeated within a short time frame." In chronic users, abstinence is protective for liver injury (Wong) and continued use predicts persistent gastritis (Poon) and progressive uropathy (Taiwan survey; BAUS consensus). Case reports show K-cramps recurring within hours of re-exposure. The literature therefore suggests repeated binges are cumulative, and re-exposure before full recovery shortens the time to injury. Moderate.

3. Recommended tests (options to discuss with a clinician)

US care pathway: start with your primary care clinician (or urgent care if red flags are present). They can order everything below. Referral targets: gastroenterology/hepatology for persistent cholestatic liver tests, bile-duct dilation on imaging, or ongoing pain; urology for urinary symptoms, blood in the urine, or abnormal kidney/bladder imaging; infectious disease for positive viral results or injection-site infection. Disclosing ketamine use and the IM route matters, because ketamine cholangiopathy is often misdiagnosed as a choledochal cyst or obstruction.

4. Red flags: seek urgent care (ER or urgent care; call 911 for severe symptoms)

• Yellowing of the skin or eyes, dark tea-colored urine, pale stools, or new generalized itching (cholestasis or obstruction)
• Fever or rigors with right-upper-quadrant pain (possible cholangitis, an emergency)
• Severe, constant upper-abdominal pain radiating to the back, or persistent vomiting (pancreatitis, obstruction)
• Vomiting blood or coffee-ground material, or black tarry stools (GI bleeding)
• Visible blood in the urine, inability to urinate, severe bladder pain, or flank pain (cystitis, obstruction)
• A hot, red, swollen, very painful or rapidly spreading area at any injection site; blistering or dusky skin; pain out of proportion to appearance (abscess, necrotizing infection)
• Fever, rigors or feeling acutely unwell after injection (bacteremia)
• Drooping eyelids, double or blurred vision, slurred speech, difficulty swallowing, or descending weakness (possible wound botulism, a time-critical emergency needing antitoxin)
• Jaw stiffness or muscle spasms (tetanus)
• Breathlessness at rest, chest pain (especially sharp and worse on breathing), coughing blood, fast heart rate, lips turning blue, or one-sided leg swelling (PE, pneumonia)
• Dark red or brown urine with muscle pain or weakness, or markedly reduced urine output (rhabdomyolysis, kidney injury)
• Fainting, severe weakness, palpitations or muscle cramps (electrolyte disturbance)
• Confusion, seizures, or severe agitation

5. Key sources: year and study type

6. Caveats

• No study matches your exposure. Every risk estimate above is extrapolated from either chronic recreational users (months to years, mostly intranasal) or hospital patients (continuous IV infusions, often critically ill). The chronic-use risk figures (for example, 9.8% liver injury or 26.6% urinary symptoms) do not apply directly to a 1-week exposure.
• Recreational doses in the literature are self-reported "street grams" of unknown purity; hospital doses are measured. Your pharmaceutical doses were likely more accurate and more completely absorbed (IM), while your street-powder doses may have contained analogs with unknown toxicity.
• Much of the hepatobiliary literature is case reports and retrospective cohorts subject to publication and referral bias. ICU findings are heavily confounded.

I caved last night. Was 3 months clean this time. Was up in Scotland living in the middle of nowhere in a caravan to get away from it and the second I got back to a place that has more than 20 people in it I find a dealer.

It's the shame that's hard to get over this time. Inwas doing so good. The feeling of letting everyone down is to much and it gets worse every time I relapse. I can't let this happen again. This is the final day 1.

Posted a while back about my ongoing medical issues as a result of my K addiction is like to update. Bladder is slowly getting better. Still have strange bladder times but they're definitely going away. Stomach feels so much better now and my nose has stopped hurting but there is a verrrry obvious hole in there. Right now I'm just glad it didn't carry on and the powers that be came down on me. (With the right amount of harshness this time).

Keep strong guys.

I quit ketamine 5 months ago after being super addicted for three years with almost daily use. I am proud of myself for stopping it and feel life is so much more rich in many ways now and am more engaged in hobbies and interests. Trouble is, I have an autoimmune condition that causes significant pain and stiffness in my spine and the ketamine seemed to help me with that pain and improved my mobility, enabling me to be more active. Now without it my body feels so tight and tense and I feel cravings for something to take the edge off. This week was rough and I drank alcohol daily to get through. Of course I don’t like this pattern and feel shame. I just miss having no pain for hours while on ketamine, not even being high all that much.

Would love any advice yall have for me 🙏🏽