those getting addicted... we've seen so many patients, and it feels like we're getting more and more and more. ..but is it enough, and what more can be done to help those young and addicted to ket? ketamine is a very effective medical drug used as an anaesthetic since the 1970s and, more recently, to treat some mental health conditions. but its use as a recreational drug is on the rise, partly because it's cheap and because more of it is being made in parts of asia. hey, i got you a present! oh, my goodness! where did you hide it? in october 2023, 54—year—old actor matthew perry, best known for playing chandler in the us sitcom friends, was found dead at his home in la. i'm in control of the first drink.

he'd openly struggled with drug and alcohol addiction and a toxicology report concluded he died as a result of the acute effects of ketamine. deaths from ketamine are rare but for people who take the drug recreationally, around one in four will experience urinary problems as a result. in the last few weeks, i have been speaking to loads of ketamine users and people that are addicted on an online forum which has basically been set up for people to support each other, ask questions and just share advice as well. on it, there are quite graphic descriptions of the physical impacts it can cause — cramps, needing to urinate frequently or not being able to, passing blood and clots are just a few of them. ketamine is also used by vets as a tranquilliser and injecting just one gram is enough to knock a horse out. i chat to dozens of people, most in their late teens and early 20s.

a lot of them are taking at least a few grams a day and tell me they had no idea of the issues it can cause when they first started using. from the minute you wake up... beth and her mate, who wants to be anonymous, are keen to share their story. we're calling him �*jay�*. we catch up with them on a saturday night as they prepare to buy ketamine from a dealer they found online. i was hoping to pick up a minute ago. the guy has seen a police car where i am and just, cos i'm not from the area, driven off. and how did you find that dealer? so, it was just as easy as messaging a friend on facebook, saying, "hey, do you know anyone with k "in bristol area?" and then, yeah, i was sent the menu and a number and it'sjust a case of messaging. it's, "what do you want? "where do you want to meet?" as easy as that. it runs through snapchat as well, facebook messenger. from the minute you wake up,

all through the night, i get messages. active till liam, active till 5am. and people arejust serving all the time. it is literally everywhere you go. both beth and jay are in their 20s and have been using ketamine for quite a few years after first trying it as teenagers. yeah, the first time i ever had a line of ketamine was at a free party. yeah, same. a little shindig happening out in a barn somewhere. i was 14 years old and somebody had some in the classroom and i had a little bit in the back of the classroom — that was the first time i had it. and then from then, it was in the party — party scene from about the age of 17. so, yeah... can you remember what it was like the first time you tried it? not really, no. no, i was out of this world. i remember being in a house once and i had some k and i completely forgot who i was and who i was with and it was really scary. but then, you get used to that feeling and you sort of break a barrier almost and it becomes not scary any more and it becomes quite a therapeutic drug.

and you can then become fully functional on it and then, you can find yourself going to work on it. it's become a way for beth and jay to cope with things that have happened in their lives, and they're using every day. it's just that little bit of escapism and that reality. unfortunately, i have had a few things that have gone on in my life that have led me to make these decisions. post—traumatic stress disorder. i do suffer mental health as well. and so, that's kind of been my turn—to. it starts off with you're at a party, you're having a bit of fun and then, it starts to become something that masks how you're really feeling and that's — that's what i've turned to. but i love that escapism. i absolutely love the feeling of when i have it. i feel great. i feel normal — i feel me. with a justin bieber haircut. i used to have to straighten his hair for him before he went to school. so, rian, when he was growing up, was very cheeky — very cheeky chappy, he was.

he was — he was such a lovely boy. on every single parents' evening i went to, he was the class clown but he was the glue that brought all of his friends together. he was a really sociable, loving boy. clare's son rian first tried ketamine at a festival but got addicted after his best friend fraser died in a car crash in 2018. that really hit him hard. that was, you know, the grief — i don't think he could deal with it and i think at that point then, that's when he started doing ketamine a little bit more. he used to see fraser when he was under the influence of ketamine. i think it was his way of trying to get close to his best friend again. during the pandemic, rian�*s use started to escalate while he was off work. he was doing it every day. he didn't look like the son that i had. he went from being such a happy confident, clever boy to this shell of a person.

i didn't know who he was any more. it must have been incredibly difficult to see him like that, knowing that wasn't really rian. no. it wasn't him. it wasn't him — it was the drugs talking. but i couldn't get through to him. no matter what i said to him, i literally could not get through to him. and we tried everything that we could to try and, you know, stop him from doing what he was doing. rian started to struggle with bladder issues as a result of his prolonged ketamine use and ended up going to rehab. he was walking into rehab like he was a 90—year—old man, like on a — with a walking stick or hunched over, and his legs were bowed. he looked really, really poorly. government figures show ketamine addiction has more than quadrupled since 2016 in england and wales and use is estimated to have more than doubled in that time. and with those under 25, it's more than tripled — a growing concern for the british association

of urological surgeons. i think we've seen a huge explosion of young people taking ketamine, and that means that they come to see us with significant urinary symptoms. and these symptoms can include going to the toilet every hour or every half an hour. and what the ketamine does is it destroys the lining of the bladder, and that can have very serious consequences. we've noticed throughout the whole country — we always have discussions amongst other urologists — that there's a huge explosion. all of us have seen pockets in certain places, some very high use of ketamine, and lots of young patients with severe bladder problems that we would not see until patients are much older. as a result, they're now putting together a document to help other health professionals spot the signs of ketamine bladder. ketamine is really popular in bristol — so much so, there's even

a term, bristol bladder, to refer to the impact ketamine can have on the bladder if you take a lot of it. do you have anything to hand over from this morning? we've got quite a big nightlife scene and festival scene in bristol, and i know that's commonly where people would take drugs. why ketamine seems to be the drug of choice — it's cheap to buy. i think people don't realise that it has detrimental effects to the bladder, and i think it's viewed as sort of a safe drug by people, which evidence doesn't show it is. some hospitals are also setting up specialist clinics in urology departments. so, this will be a normal bladder size. a normal bladder could be a capacity of about 500ml. this is an example of a bladder in a ketamine patient. that's a very small bladder. i will say that capacity

could be around 20ml. the hospital can offer a range of treatment and support but, in the most extreme cases, patients will have to have their bladders removed and reconstructed using part of their bowel. probably the youngest that comes here could be i9 and onwards, so very, very young patients. so, 19 and they're already having severe bladder issues? problems with ketamine, yeah. if we are offering major surgery to a person who's 2i, then the likelihood of having any sort of complications after that surgery is enormous. the treatments are life—changing. since we've started doing this a year ago, we've seen so many patients, and it feels like we're getting more and more and more. one thing i want to make people aware of is if they do come and see us, we're

notjudging them. we're here to support them and help them with their problems. we're notjudging them for drug—taking. we're not, you know, reporting them to anyone. we just want to help. the uk is not the only country which is seeing an increase in ketamine use. the european monitoring centre for drugs and drug addiction analyses waste water from a number of cities across the continent. i would say that the levels of ketamine use in the uk are similar to those observed in the netherlands, spain, france, where we are seeing an increase in the data coming from the most recent surveys. we now also have data on ketamine use coming from wastewater samples. for the cities that have comparable data between �*22 and �*23, we saw, in the majority of the cities, an increase in ketamine use. we always get the questions, if we are sure it's non—medical use of ketamine or if it's ketamine as a medicine. wastewater allows us to have data on a daily basis,

so we can see that the use is higher during weekends — on fridays, saturdays and sundays — which probably points to the use of ketamine in recreational settings. try them both, mate. it's now later in the night and we're back with chronic ket users beth and jay. what is the physical impact for you now of taking ketamine? i can't walk down the street. i can't walk 50m without either needing to sit down or needing to run to the toilet. when i first went to the doctors in urology, they had no idea. they said, "we don't know what's going on. "all we can tell you is that your bladder has shrunk." you could see on the camera screen ketamine floating amongst my urine. it did also cause a big growth, where they had to burn that away immediately. when it's sort of at its peak as well, i can't engage in any conversation.

i struggle to focus on anything. i can't work, i can't, um, yeah, i can't — i can't do anything. i can't feed myself or go and get a drink. yeah, it really disables you completely. this is what was coming out, these blood clots, after i had to have, like, an operation. but yet, it's still not enough to be able to stop you from using it, right? it does make you think. it does make you really consider it more. you think, "right, i do need help with this now. "and i do want to stop now." but then, a part of me thinks, what's — when i do stop ketamine, what have i got? my life's been about ketamine for the last nine years now. so, once that's gone, i feel like what do i really have left? you feel sort of lost, yeah. is that how you feel, then? that's how i can feel, and that's where my depression comes and that's when i start to think, well, i might as welljust keep on using, keep on using. and if i lose my bladder, i lose my bladder. if i lose my life, i lose my life. if i lose myself, i lose myself. and that's what makes me

want to take more k, cos then i stop thinking about stuff like that, and that's the vicious circle. to escape from that vicious circle, james dear left the uk and moved to australia, and later new zealand, when he was addicted to ketamine. since getting clean, james has been sharing his story through his youtube channel and podcast break the chain. i shared my insights about my life and my regrets and what i felt guilty, i felt about what i'd done to my mum and put her through, and my family, and ijust got completely positive feedback from doing this. in that time, he's noticed an increase in ketamine in australasia. when i first went to australia, i went there because i didn't think i was going to be able to get ketamine — and that was fundamentally more or less true. when i first went to brisbane, for example, it was a smaller city. i think i came into contact with it twice. people knew what it was but it was just this unusual, rare thing that every now and then would appear

and it would usually come from some european traveller who was bringing it in because other people didn't know what on earth it was, you know? and now it's readily available in — you know, in melbourne, it was quite big there where all the techno and the music scene was. in sydney, it was much more available. and, you know, up in brisbane, i think it's spreading up there now. in new zealand, it was absolutely, really unheard of. but with this influx of travellers, it's becoming more popular and it definitely is spreading. the production of illegal ketamine has been increasing across the world — something the united nations office on drugs and crime has been looking into. we are seeing more and more in southeast asia, where the clan labs for ketamine have moved out of china into the golden triangle and into some countries in the mekong area — like cambodia, for that matter.

and we've seen clandestine laboratories of an industrial scale in those countries. there is definitely a push to get more ketamine into the market. the way ketamine is policed totally varies in different countries, which can make it more difficult for authorities to follow its route around the globe. we are talking about international organised crime here, and apart maybe from the question, "would "a higher penalty be a deterrent for an individual "dealer?," i think we need to talk about how can law enforcement get the necessary tools to go after those criminal organisations and dismantle them? in england and wales, the quantity of ketamine seized by police and border force is currently around 1.5 tonnes a year. that compares to an average of around 150kg a year a decade ago — a tenfold increase. and with more of it being produced, it's making it cheaper for dealers to get hold of as well. i speak to a few, who all say that demand is bigger than ever before.

ketamine is currently a class b drug in the uk, which means the maximum penalty for dealing is 1a years in prison. i'd come and see and there would be barrels — like actual, like, steel tank barrels full of ket. it was unbelievable how much ket you could see. an ex—dealer agrees to meet me with herfriend. she says it was during covid that she noticed a huge increase in demand. i never did this to get into like anything gang—related. i never did this to get on anyone's back. i never did it for an ego boost. i did it cos i needed the money and i saw the gap in the market. 0bviously, drug dealing is very illegal. that is a very — like, be all and end all, it is illegal, yeah! but you've got to make it as safe as possible. like, i'd rather teach other people how to do it safely. did you ever worry about the impact that it can have on people? yeah, because it's double reasons —

it's caring for them, for their safety, because i obviously don't want them to overdose or anything like that and two, it's good for me as well — i don't want them overdosing. if they link that back to me, that's a death on my hands and, like, more than i'll just feel bad for it, i'll also go to jail for it. like, there's two wrong things happening there. if i was going too far, she'd always, like, stop. she stopped selling to me a while — quite a while ago. yeah. do you know what i mean? i've had to wee in buckets. i've had to do disgusting, grim things, because it's, like, no—one talks about that. no—one talks about how you're going to end up living like an old man when you're, like, in your early 205. what do you think needs to be done going forward? fear doesn't work, fear doesn't help. like, telling people, "don't do this because it'll "kill you," like, anything can, do you know what i mean? people are going to do things anyway. but i feel like if someone had told me when i first started using it how bad i would feel from using ket, i don't think i would've let it get this far, i really don't. showing how to do

stuff in moderation — that's the key for it to be safer. but there is no way you're ever going to stop a country from doing drugs at all, ever. rian did a stint in rehab but relapsed not long after. he was living in a shared house and, in april 2023, was found dead in his bathroom at the age of 26. they found him in his shower with the water still running. he'd been there potentially three days. there was five bags of ketamine in his room. two were empty. he had pulmonary oedema and cerebral oedema. so, basically, his breathing slowed down so much that he just, you know, just died. i couldn't even see him because the condition of him was — he was unviewable, you know?

and all i wanted to do was go and see him. i couldn't. since rian's death, clare has started a petition to get ketamine reclassified and set up a facebook page with information and support. when rian was addicted to it, i was struggling to find all the information in one place, so that's why i set up a ketamine awareness facebook page so that i could gather all this information and put it into one place, so that if there was somebody like me, you know, who's got a child who's addicted to the substance, they could just click on one facebook group and it's all there. going forward, what do you think is needed to tackle the increasing number of people using and being addicted to ketamine? you know, reclassify it, so that people know how dangerous it is. get a tougher sentence for these dealers, but also support these people who are addicted to this drug, you know? rian's inquest ruled he died from ketamine toxicity. deaths linked to ketamine

are rare, but on the rise. in the uk, the numbers of drug—related deaths following ketamine use have more than doubled in the last ten years. so, this is our drug—testing room. unlike rian, pagan managed to get help and has recovered after a 12—year addiction to ketamine. at her worst, she was taking more than 10g a day. it wasn't a nice experience. i was sick, dizzy and, like, kind of blacked out, so it wasn't very nice. i don't know why i carried on, but i did. and then, i started injecting it into my muscles and then, that's when my bladder started to get bad. what's it like to look back now and think about your addiction when it was at its worst? i wanted to die, yeah. ijust didn't want to be alive any more. ididn't want to be in the world, in that pain, completely reliant on ketamine. i spent eight weeks in hospital and i kind of felt

like i tempted fate too many times, so i needed to give it up, otherwise, i would have ended up dead. as a result of her addiction, pagan's daughter was adopted. she had bladder surgery and then, ended up going to rehab for the third time in 2022. the beginning was really hard but i was determined this time to stay clean. ketamine took too much from me, so i wasn't going to let it take my life as well. how are you going? hey! you all right? how are you? yeah, i'm all right. turning point was a massive help with me — i couldn't have done it without them, really — so, i wanted to give back and help other people. i feel guilty that i let it take control of me again. i guess that's what addiction does, doesn't it? yeah, it takes everything. it has no mercy. pagan volunteers at drug and alcohol charity turning point each week,

working with other people trying to get clean. you've got it. you're doing it. one of the key bits we do here, we have lots of people doing really well in treatment, and pagan is one of those people who can make a real impact. well done. so, if you can imagine today someone walking through our door who is in the gutter, who feels at rock—bottom, meeting someone like pagan — we have lots of peer mentors here who can talk about their experiences and give them a ray of hope, really, to say "i've done it and, actually, you can do it. "give it time." so, as production and use across the globe continues to rise, what more can be done to help those young and addicted to ketamine? our main message with ketamine is stop taking it. but we understand how difficult that is, so i think it's engaging with mental health services, drug charities. if people are worried about their friends or family who are taking ketamine, i thinkjust trying to have a conversation with them and be a bit more open about it.

in a statement, the uk government told us it's committed to offering support in tackling the supply of illegal drugs. it also says there are currently no plans to change the law, but drug control and harms from ketamine are under constant review. social media platforms say they do everything they can to prevent the sale of drugs. so, this is rian's room? yeah, yeah. rian's mum clare recently met with a government representative to discuss her petition to get ketamine reclassified from a b to an a. i won't stop until it's reclassified. i've got to keep going. if i can helpjust one person, rian's death wasn't in vain, you know? since filming, beth and jay have been trying to get off ketamine and hope sharing their stories might help others. i hope people wake up to ketamine is a horrible drug and it does destroy your body.

it does destroy your organs. it does destroy your bladder. we wasn't taught about it in school. i kind of wish in uk schools that they would teach children from a young age that this stuff — you stay away from these kind of chemicals. my hope now is to engage in some support groups. i have support workers now and doing something different, going to the gym, making my life better and that's the steps — the next steps for me. i'm hoping that, you know, i'll get back into work, get back into my career path, and one day being the person that has recovered from this really rubbish journey that i've been on. but the hope is there and it is going to happen. lam determined. i don't want this life for myself any more. you're doing it this time. yeah. no matter how much you think it's taken your life, how much you think you've got nothing left, you can always gain that back, so it's never too late to reach out for help.

hello there. northern ireland was the place to be. light wind and sunny skies and it turned out to be the warmest day country so far. much further east across the uk, it remains cold, particularly across north—eastern parts of england with cloud in the breeze coming off the north sea. high pressure is close by but it is tending to edge away and that is allowing these weather fronts to bring cloud and even some rain southwards overnight. but ahead of that, we've got clear skies for east anglia and the southeast, so temperatures could be close

to freezing first thing in the morning before that cloud comes in, and there will be a lot of cloud on monday. we've got this light rain and drizzle affecting northern england, the midlands, wales heading towards the southwest. there could be a few spots of rain moving down across scotland before northern areas see the sunshine returning in the afternoon. but there won't be as much sunshine in northern ireland, it's not going to be as warm on monday. may make 16 degrees in glasgow, but it's going to be particularly chilly for the midlands and eastern parts of england. that area of high pressure continues to just get pushed away and these weather fronts move southwards overnight. with clearer skies, though, following into scotland, there could be an early frost around here. most of the cloud will be affecting some eastern parts of england heading to the southeast. a northerly wind then follows and the odd light shower around north sea coasts. cloud will tend to build up, the sunnier skies western scotland, northern ireland and wales. and here, temperatures will be 13 or 1a degrees. but, again, it's going to be colder further east, and generally over the next few

days, west is going to be best. but high pressure is no longer with us by wednesday, but we're still in that colder air stream with a northerly wind, bringing the odd shower down some of those north sea coasts where it will feel particularly cold. we may well see a touch of frost here and there if the cloud breaks, but the cloud will tend to build up through the day on wednesday and that could lead to a few showers mainly for england and wales. looking a bit sunnier perhaps for western scotland and northern ireland, but temperatures are 11 degrees in belfast, and that's going to be a typical best number on wednesday. it is going to be a chilly week ahead. temperatures dropping across northern areas and there's even the risk of frost overnight before lower pressure maybe brings some rain by the end of the week.

live from washington, this is bbc news. israel continues air strikes on gaza's southern city of rafah — more than a dozen people from one family alone are killed in one raid. palestinian officials say teams have recovered more bodies from a hospital in southern gaza, weeks after israeli forces pulled back from the medical complex. president zelenskyy calls on the us senate to swiftly take up a $61 billion aid package destined for ukraine. hello, i'm helena humphrey.

at least 15 people have been killed in israeli air strikes on rafah in southern gaza. israel is continuing air raids on the city, where 1.5 million displaced palestinians are sheltering. prime minister benjamin netanyahu said on sunday that israel "will deliver additional and painful blows" aimed at hamas. he has for weeks threatened to start a ground offensive on rafah, claiming hamas members are hiding there. gaza's health ministry, which is run by hamas, says more than 35,000 people have been killed by israeli military action since the start of the war in october. as fergal keane now reports, while there are concerns about a wider war between israel and iran, the suffering in gaza continues. a warning, this report contains distressing scenes. air-raid sirens blaring the eyes of the world were on a bigger drama, played out in the skies above israel. but in gaza, nothing changed.