HKU Bulletin November 2005 (Vol. 7 No. 1)

11 Ketamine – Youth in Denial Over Harmful Effects U sers of ketamine tend to think the drug is harmless, but a University study has found they experience physiological, cognitive and psychiatric impairments, even after as little as one month of use. Ketamine is a white powder that produces a hallucinogenic, floating effect in users. It is popular with young people, who tell each other the drug is harmless. But they are deceiving themselves, according to Hon. Clinical Assistant Professor Dr Ronald Chen Yuk Lun, who conducted the study for the Department of Psychiatry. Dr Chen examined 95 admitted users and 26 non-users for signs of physical and psychological dependence on ketamine. Some 76 per cent of users showed symptoms of dependence, such as needing to take more of the drug to get high and suffering fatigue, irritability, aggression, sleeping difficulties and depression when they stopped. These symptoms appeared within an average of one year of starting ketamine use, but as little as one month. “This is contradictory to the common misconception of young people, that the only dependence is psychological,” Dr Chen said. “Actually there is a high potential for physical dependency and there are harmful effects on the brain.” Thirteen per cent of users had a depressive disorder, compared with three to five per cent in the general population. Another six per cent had drug induced psychosis such as hallucinations and delusions. Ketamine users were also more likely to have impairment of fine motor skills and had more difficulty with task organisation and grouping things into categories for memory-based exercises. “They are young, they should have good memories and learn a lot of things easily,” Dr Chen said. He admitted the group of users was ’fairly severe’ as they had an average of only nine years of education, 33 per cent were unemployed and half of them had a criminal record. The average age was 20 and they had taken the drug an average 366 times, from as low as 15 times to 2,000. “The thing is, we wanted to demonstrate that ketamine has some effect on the mind. Some people had only taken it several times and still they had problems,” he said. The two-year study was funded by the Narcotics Division of the Hong Kong SAR Security Bureau and completed last year. The findings formed the basis of a public education campaign on ketamine. Dr Chen is now in private practice. RESEARCH Tracking Illicit Drug Use in Hong Kong I n Lan Kwai Fong, an interior designer special ising in nightclubs has heeded the demands of her clients and installed a ledge in toilets for chopping up cocaine. And just in time, for cocaine is in fashion. That is one of the many findings on local drug use that Dr Karen Joe Laidler, Associate Professor of the Department of Sociology, has gathered in her 10 years of researching the subject. Since her arrival in Hong Kong in 1995, when the stereotypical drug user was a working class male on heroin, manufactured drugs such as ecstasy and ketamine have burst onto the scene and changed the nature of drug use here. More women and young people now take drugs. Instead of meeting in dingy rooms or back alleys, they indulge in drugs in nightclubs and, increasingly, karaoke lounges. Triads are predictably involved. “Hong Kong has always been a heroin society, but in the late l990s ecstasy and other manufactured drugs rapidly became prevalent. The proliferation of these new drugs is a reflection of what has happened globally,” Dr Laidler said. When she f i rst ar r i ved, po l i ce se i zures of i ce (methamphetamine) had increased slightly and she suspected there was more behind the story – a reasonable suspicion given that recreational drug users often fall outside the radar of police, hospitals and social workers. And indeed, the drug scene in Hong Kong changed rapidly by the latter half of the 1990s. Dr Laidler and her researchers have interviewed users and sellers to help profile the drug market, drug use in clubs, women and drug use, and drugs, crime and violence for the United Nations and government, as well as for a long-term University project on violence. Their findings show that ecstasy and ketamine have become popular nightclub drugs, especially in trendy Lan Kwai Fong and Soho, and cocaine use has risen, in part because some users are looking for alternative experiences due to the deteroriating purity level of ecstasy. Ketamine, an hallucinogenic considered to be the ‘poor man’s cocaine’, is the drug of choice in Mongkok and Shenzhen. About one-third of ecstasy and ketamine users are young women, as against 23 per cent of heroin users. For ice, young women represent over 40 per cent of ice users. Drugs like ice, ecstasy and ketamine appeal to women because they appear to lose weight and they are told by their friends that these drugs are not addictive and have no short- or long-term health consequences. (There is competing evidence that ecstasy is harmful and ketamine is still being researched, but long-term use of ice has been associated with paranoia, social isolation and aggressive behaviour.) Other motivating factors include hearing friends talk about the positive attributes of the drug, as well as curiosity and boredom and the fact the drugs are cheap. “The increase in the number of women and young users has not yet resulted in extensive social problems, but it has raised health questions about whether young people understand how to minimise the potential harm to themselves from using drugs,” Dr Laidler said. There are reasons for concern. About 21 per cent of users of ice – which has serious long-term effects – are aged 21 and under. Young people are also starting to report that they use ketamine in school because they are bored. This mirrors trends in other societies, where a drug initially taken in leisure is brought into other areas of people’s lives, she said. “The broader context for drug use is that globally, the life course has changed for people and adolescence is prolonged,” Dr Laidler said. “A lot of research shows that young people live at home longer because they can’t afford to live on their own, they’re expected to be a young person for longer and their schooling is prolonged. They’re uncertain about their future so they say to themselves, I may as well enjoy myself now because who knows what the future holds.” 10 Nightclubs and karaoke lounges can be appealing settings for women and young people to test out drugs. Recently, club ‘hosts’ have been visiting tables asking if patrons want to supplement their beverages with drugs. Dealers either tend to work for club doormen or act as ‘freelancer’ who give the doormen a cut. Although the clubs are often managed by people with triad links, violence is not a problem as ecstasy and ketamine users do not tend to get involved in crime or violent behaviour.