https://astralcodexten.substack.com/p/drug-users-use-a-lot-of-drugs

 

I.

If you look at any list of side effects for the FDA-approved version of s-ketamine (Spravato), you see things like urinary tract problems, bladder problems, pain on urination, feeling of urgency to urinate. You can find a bunch of papers like Ketamine: An Important Drug With A Serious Adverse Effect, where they say that ketamine is potentially great for depression, but that the risk of bladder injury needs to be taken really seriously.

When I first considered prescribing ketamine, the bladder injury stories scared me so much that I asked a bunch of veteran ketamine prescribers how I should monitor it. They all gave me weird non-commital answers like "I've prescribed ketamine to thousands of patients and never had a problem with this, so I guess don't worry". But why not? There are all these papers saying we should worry, and all these reports in the literature of ketamine-induced bladder injury!