A 31-year-old man with a three-year history of using ketamine by inhalation, injection, and intravenously visited the emergency department twice in one week with severe back and abdominal pain and indigestion. Standard tests and advanced imaging found no clear cause. The patient identified from Reddit that his symptoms likely stemmed from chronic ketamine use; after stopping ketamine, his pain improved within 24 hours. He then sought addiction treatment on his own. Emergency physicians should consider chronic ketamine use as a possible cause for gastrointestinal and urinary symptoms, and offer education, symptom relief, and links to substance use treatment.
A 32-year-old man with ketamine use disorder experienced severe cravings that persisted after residential and intensive outpatient treatment. After resuming use following a period of abstinence, he was started on lamotrigine and naltrexone for depressive symptoms and cravings. This combination caused nausea and reduced hallucinogenic effects while on ketamine and substantially decreased his cravings, helping him achieve longer-term abstinence alongside dialectical behavioral therapy, family support, and 12-step programming. Ketamine use disorder is poorly described but may become more prevalent as US ketamine use increases. Combining treatment of depressive symptoms and cravings with lamotrigine and naltrexone may be a promising pharmacotherapeutic strategy, though more research is needed.