Substance abuse in adolescence in Taiwan Focus on ketamine

Ketamine is an anesthetic and analgesic agent but has been identified to have abuse potential in recent years. Ketamine abuse is found to be rapidly increasing especially among adolescents and early adults for its relative low cost and lack of immediate severe side effects. Ketamine is a NMDA antagonist and has acute antidepressant effects from recent pharmacological research. The association between abuse potential and antidepressant effects is still uncertain. Though there are no obvious physical withdrawal symptoms of ketamine, strong cravings were noted from chronic ketamine abusers. On the other hand, ketamine can cause severe damage to the urinary system. “Ketamine-induced uropathy” was proposed in recent years, with presentation of severe lower tract urinary symptoms (LUTS; including frequency, urgency, dysuria and hematuria) and urinary system damage. Similar to patients with other substance abuse, ketamine abusers have higher incidence of co-morbid psychiatric diseases. Currently there is still lack of specific medical treatment for managing ketamine abuse, but psychosocial intervention plays an important role especially for adolescents. In this brief review, we hope to call more attention to this emerging problem