Ketamine harm reduction: Collaborative development of a prevention ecosystem using data from the northwest of England

Heavy ketamine use among young people in Northwest UK is driven by trauma, vulnerability, social deprivation, and easy access through digital drug markets. Clinical responses are often reactive and late, with service gaps and workforce training deficits. A participatory action research approach involving young people and professionals identified three themes: drivers of use, systemic failures in harm reduction, and the value of co-production. A conceptual model proposes that harm arises from interactions between social determinants, and that community-based collaborative approaches could improve public health messaging.

Study at a glance

Abstract

Abstract Background Despite legitimate, evidence-based use in clinical settings, an increase in ketamine misuse has in recent years resulted in substantial adverse effects on young populations across the UK. Urological symptoms and psychological effects are among the most common side effects, often irreversible and taking place within months of regular ketamine use. The Northwest UK includes areas of high deprivation and drug use; in recent years the number of paediatric ketamine related referrals to urology services has warranted the opening of a specialist unit within one children’s hospital. This study aimed to map out the service use, social determinants and needs of individuals who were engaged in heavy ketamine use, to understand how public health messaging could be complemented with collaborative approaches from community organisations. Methods This research adopts a participatory action research approach where young people, practitioners, and professionals worked together as co-researchers across the research cycle. Co-production workshops and interviews were conducted, alongside gathering contextual data. Results Using reflexive analysis, three interrelated themes were found, divided into eight subthemes: The drivers of ketamine use (trauma, vulnerability and social determinants; drug market, accessibility and digital supply); systemic responses to emerging public health concerns (service gaps; harms reduction; reactive clinical responses and late identification; systemic failures; workforce and training gaps); coproduction (trust building and lived experience). Conclusions Interpreting these results, a conceptual model is proposed here, where ketamine-related harm is seen as emerging from the interaction between social determinants, with a community and systemic response to emerging public health concerns as a proposed solution.