Children as young as thirteen are presenting with severe urinary tract damage after using ketamine, according to doctors running a specialist NHS service at Alder Hey Hospital in Liverpool. Since the clinic opened in May 2026, more than one hundred referrals have been logged, with many patients reporting a “jelly‑like” shedding of the bladder’s protective lining and describing the act of urination as feeling like passing glass shards. Prolonged injury can lead to incontinence, urgent and frequent urination, blood‑stained urine, kidney impairment and, in extreme cases, the need for surgical removal of the bladder. The team notes that some children have been using the drug for a year or more, meaning they may have first exposed themselves before the age of twelve.
A dedicated NHS service emerges
Prof Rachel Isba, who leads the Alder Hey clinic, told the BBC that the unit was set up after a sharp rise in cases throughout 2025. Referrals rose from a single case in 2023 to nine in 2024, prompting an “accelerated” response in 2025 that culminated in the opening of the bespoke centre. The service now receives roughly one new referral each week from general practitioners or emergency departments across Cheshire, Merseyside and surrounding areas. Of the initial sixty patients seen, forty‑three were female, highlighting a pronounced gender pattern among those affected.
Symptoms and severity of the injury
Patients frequently describe a burning, stabbing sensation when they urinate, likening it to “weeing over broken glass.” The condition often includes an urgent need to void, frequent trips to the toilet, and urine that appears tinged with blood. While abstaining from ketamine can halt progression, some injuries are so extensive that they require surgical repair or even bladder excision. In addition to bladder problems, heavy users may experience abdominal cramps, spasms and, in rare instances, liver damage, although separating ketamine’s impact from concurrent alcohol or other substance use is challenging.
Barriers to treatment and wider context
Ketamine is inexpensive, sometimes sold at “pocket‑money” prices, and a very small dose produces a rapid anaesthetic effect. Young people often find it difficult to stop using the drug when their peers continue to take it, especially when use occurs within school environments. Many of the children attending the clinic have pre‑existing conditions such as attention‑deficit/hyperactivity disorder or have been in and out of the care system, adding layers of complexity to their treatment. Moreover, the lack of inpatient detox facilities for those under sixteen creates an unfair barrier for youths who are ready to quit but cannot access the level of care they would receive as adults.
Future directions and policy debate
The British Association of Urological Surgeons estimates that roughly thirty percent of frequent ketamine users develop bladder complications, a figure that underscores the seriousness of the issue. While stopping the drug can allow recovery in some cases, the potential for irreversible damage remains high, prompting calls to reclassify ketamine as a Class A substance, akin to cocaine or heroin. The Advisory Council on the Misuse of Drugs, however, has recommended maintaining its current Class B status, placing it alongside amphetamines and cannabis.
Why it Matters
The rise of ketamine use among children threatens not only individual health but also educational attainment and long‑term social outcomes; untreated bladder damage can lead to chronic incontinence, kidney failure and repeated hospitalisations, placing a heavy burden on families and the National Health Service. Early identification, accessible treatment pathways and a reconsideration of drug classification are essential to curb this emerging public health crisis and protect vulnerable young people.
