By the time Beth was going to the toilet 30 times a day, she knew something had gone badly wrong.
Then 19, the student had started taking ketamine casually at parties in Bristol, where she had arrived from her home in Lancashire two years earlier to study English at university.
Cheap and widely used, the drug had seemed – initially at least – practically harmless.
‘It was about £10 – and it felt brilliant,’ she says. ‘It just stopped all the noise in my head.’
Yet within a year, Beth’s outlook was very different. She was constantly craving a hit and in permanent pain.
Only after being left in such agony that she had to go to A&E did Beth learn the grim truth – that ketamine had damaged her bladder.
Her story is not an isolated one in a city where ketamine use has become so embedded in the culture that it has earned the nickname ‘Bristol Crystal’. This epithet is likely to be reinforced by startling new research suggesting usage of the drug in the city may be the highest in Europe.
An analysis of wastewater in 130 cities, published last week by the European Union Drugs Agency, found that Bristol recorded a peak weekend average of 350.18 micrograms of ketamine residue per 1,000 people – far outstripping traditional party capitals such as Amsterdam and Barcelona.
Another famously hedonistic capital, Berlin, registered less than half Bristol’s levels.
And while researchers caution that this is not a definitive measure of how many people are using the drug, taken alongside a surge in hospital admissions, police seizures and addiction cases, it paints a stark picture: a city where ketamine use is no longer a subculture but a norm.
Bristol of course is not the only UK city with a ketamine problem. The use of ketamine – originally a horse tranquiliser which is still used in medical settings but which was made an illegal Class B drug in January 2005 – has surged to record levels across the UK in recent years, particularly among young people.
When it was first criminalised 21 years ago, only a recorded two per cent of 16 to 24-year-olds had tried it, a figure that had tripled by 2020.
Overall, Home Office figures show that an estimated 299,000 people aged 16 to 59 reported using ketamine in the year ending March 2023 – the highest number ever recorded.
Border Force seizures have also climbed dramatically, with quantities rising by more than 50 per cent year on year, while deaths linked to the drug are also increasing sharply: a study by King’s College London found that fatalities involving illicit ketamine have increased twentyfold since 2014.
Behind those numbers lies a growing strain on health services. NHS data shows that admissions for ketamine addiction have roughly doubled in recent years, with 3,609 people starting treatment for misuse in 2023-24.
The trend is noticeable enough for the government to have launched a multi–million campaign last October to highlight the dangers of ketamine, targeting 16 to 24-year-olds in particular.
As a historic port city, Bristol has long been identified by law enforcement as a critical gateway for illegal substances entering the UK.
Alongside other major UK cities, ketamine gained traction here during the rave explosion of the 1990s, when its dissociative effects made it popular in club environments.
Additionally, Bristol has long held a reputation as a ‘party university’ with high levels of drug use among students.
A decade ago, when student newspaper Epigram undertook an anonymous survey of 300 University of Bristol students, it revealed that 77 per cent had taken illicit drugs recreationally.
Fast forward ten years, and last year another student newspaper, The Tab, surveyed 6,000 students nationwide and found that Bristol University ranked among the highest in the country for ketamine use, with around 19 per cent reporting they had tried the drug, and 22 per cent saying they used it regularly.
A dramatic price drop has also played its part in the drug’s popularity among students.
Wholesale costs have fallen from around £8,000 per kilogram to just £5,000 – meaning it can be sold on the street for as little as £10 a gram. Far cheaper than cocaine or MDMA, it has become one of the most accessible drugs available.
‘It has become ubiquitous for a number of reasons, including pricing and availability… but it also has a short half-life of a couple of hours, which makes it attractive on a night out as you feel back to normal quickly,’ says Lydia Plant, CEO of the Bristol Drugs Project, a highly respected independent charity which has supported people in the city with drug and alcohol use for more than 40 years.
‘It is also common in friendship groups, which means it can be difficult to detach yourself socially from the people you take it with and the places where you take it.’
She believes lockdown, too, has played its part.
‘Most young people missed out on a formative part of their adolescence and, as a result, there is a lot of anxiety around social connection. Ketamine takes away that anxiety,’ Lydia says.
‘We provide a lot of help and support around how to stop, how to detox.
‘We can signpost people to specialist nurses, support groups and psychosocial work. We also have sober club nights with DJs we have helped train, because it can be difficult rebuilding a drug-free circle.’
Even so, according to a recent blog by a third-year dentistry student, ‘drug culture is definitely normalised’ at the university.
One student told me that she ‘wouldn’t bat an eyelid if someone whipped out a class A [drug] at the pub’.
As former student Beth, now 22, testifies, ketamine is particularly popular because, aside from being cheap, it is seen as ‘softer than cocaine, safer than heroin and less risky than a synthetic pill’.
She now knows how dangerously misleading that belief can be, recalling how swiftly that first ‘bump’ at a crowded student party spiralled into something darker.
At first, she used ketamine only at weekend get-togethers. Then midweek, as her rapidly growing tolerance to the drug meant she needed more to achieve the same effect, fuelling a cycle of escalating use.
Increasingly, she took it alone in her room and, within a year, Beth was using ketamine every day – spending up to £50 daily, skipping meals to afford it and slipping into debt as what had begun as a social lubricant became a private dependency.
It was the physical changes that were most damaging. While Beth had noticed she needed the toilet more often, within 18 months she was going up to 30 times a day, wracked with severe pain.
Still, she continued to use ketamine – often to numb the very pain it was causing – a problem familiar to Lydia Plant.
‘Ironically, first and foremost among the problems people report is pain… and ketamine is a painkiller which is affordable, easy to get hold of, so you can become stuck in a vicious cycle of use,’ she says.
Intervention only came when Beth collapsed one night, unable to stand upright, and her friends called an ambulance.
In A&E, doctors told her she had symptoms consistent with ketamine-induced bladder damage – a condition so severe it is sometimes referred to as ‘ketamine bladder’. Chronic use of the drug can erode the lining of the bladder, causing it to shrink.
The result is a debilitating condition marked by constant urination, infections, bleeding and, in severe cases, incontinence.
Had Beth continued as she was, she could have faced permanent damage, and even the removal of her bladder altogether.
‘I genuinely had no idea that something like this could ever happen to me,’ she says now.
Beth was treated at Bristol’s Southmead Hospital, where medics are seeing a growing number of young patients suffering from severe complications linked to ketamine use.
Partly in response, it has developed one of the most specialised urology units in the country.
‘We see new referrals every couple of weeks,’ reveals Jasmine King, a urology nurse at the Bristol Urological Institute, based at Southmead, where she has worked for three years.
‘Sadly, stopping seems to be difficult and the relapse rate among patients is high. We are currently treating between 60 and 70 patients with varying degrees of problems.’
Many patients are still in the throes of addiction, but they must commit to stopping ketamine in order to receive proper treatment.
‘If people are still using when they are referred, there is little we can do beyond pain relief,’ says Jasmine. ‘But after stopping for a month, we can consider bladder instillations [where medication is delivered directly to the bladder via a catheter] to calm inflammation and build up a tolerance to holding urine.’
Sadly, for some, it is too late.
‘If the damage is too great, then the treatment is major surgery where the bladder is removed and a urostomy – a stoma bag for urine – is put in its place,’ she adds.
Law enforcement is also on the ketamine frontline, grappling with the surge in use.
Figures from Avon and Somerset Police show that ketamine-related crime is rising sharply.
In the year to March 2025, there were 99 arrests linked specifically to the drug – a 70 per cent increase compared to four years earlier.
The South West now tops the national list for ketamine seizures, accounting for nearly a quarter of England’s total.
In tandem, Avon and Somerset Police have also secured a number of high–profile convictions.
Last year, Alex Kousiounis, 32, was sentenced to 49 months in prison after being found in possession of 5kg of ketamine with intent to supply at his Bristol home, while in January this year, Gary Browne, from Paulton, near Bristol, was jailed for five years after more than 1.6kg of ketamine, together with 1.6kg of cocaine and 887 grams of heroin, were seized at two addresses to which he was linked.
‘A number of arrests have been made in recent years of people being found in possession of ketamine,’ Superintendent Steph McKenna, Avon and Somerset’s drugs lead, told the Daily Mail.
‘In many cases those individuals have been charged and brought before the courts, but in some instances for lower-level offences it’s felt a more productive way forward is an educational one as that can lead to better long–term outcomes.
‘Ultimately, our main focus is about stopping ketamine reaching people in the first place, which is why we would place greater emphasis on targeting drug suppliers who are profiteering from the misery drugs cause.
‘We have successfully been able to bring a number of such offenders to justice in recent years and will continue to do so.
‘A lot of that work is only possible because of the support of the public providing us with information around suspected drug activity.’
The region has also seen its share of ketamine-related deaths.
In 2017, the lifeless body of Callum Mays, 27, a papermaker from Wells in Somerset, was found in a caravan where he had stayed overnight with friends. He had taken excessive amounts of ketamine.
And in April 2021, 20-year-old Bristol-based James Diss suffered an extreme reaction to ketamine and also ecstasy during a gig in Manchester and died, just two days before he was due to enrol on a music course in the city.
There is also a grim irony at the heart of the city’s relationship with the drug.
Ketamine has been used as a treatment for severe depression, PTSD and addiction – and, for a time, Bristol was at the forefront of that research.
Between 2021 and 2024, it hosted one of the UK’s first psychedelic-assisted therapy clinics, offering controlled ketamine treatments for patients with ‘treatment-resistant’ conditions.
Supporters hailed it as a glimpse of the future of psychiatry – a substance capable of healing as well as harming.
But the clinic ultimately closed, amid controversy and a lack of uptake.
Today Beth has no doubt about a drug that nearly ruined her life. Now working in a graduate job after managing to complete her degree, she has stopped using ‘Bristol crystal’, but the damage has not entirely healed.
‘I would do anything to turn the clock back,’ she says. ‘Now I would say to anyone that however easy it seems, don’t do it. The price you could pay is too high.’
*Beth is a pseudonym
