The ketamine crisis has crept up on British youth

Our hearts and gratitude go to "Nick" and Jack Curran for so bravely sharing the devastating impact ketamine has had on their lives ( The agony of ketamine addiction: 'I felt like I was peeing glass', 5 November ). Their stories starkly illustrate the unexpected crisis unfolding in urology clinics nationwide as more young adults present with bladder issues tied to their recreational use of the drug.

Last month, Jasmine King, a urology specialist nurse practitioner with North Bristol NHS trust, discussed this growing problem at an insights webinar held by the Urostomy Association to mark World Ostomy Day. She pointed out that not only do we have to raise awareness among younger people, as Elle Hunt's explores, but among health professionals too, as the symptoms of recreational ketamine use are not always recognised by GPs and nurses.

In younger patients, symptoms such as needing to wee more often are frequently misinterpreted as an infection or interstitial cystitis. They are subsequently treated with numerous courses of antibiotics before being referred to urology specialists. But by that point, many will have crossed a threshold and caused themselves significant and irreversible damage. At this stage, life-changing surgery becomes the last option and young patients face life with a urostomy bag (not a colostomy bag as your said; colostomy bags collect poo).

The multi-disciplinary team in Bristol is doing some exemplary collaborative work to support young drug users to reduce bladder damage. But a national approach is needed so best practice can be shared to ensure more young lives aren't devastated just as their adult selves begin to unfold. Thank you, Elle Hunt and the Guardian, for helping to propel that dialogue.

You can see a blog by Jasmine King on the Urostomy Association website precising her presentation at urostomyassociation.org.uk/blog . Samantha Sherratt Transformation director, Urostomy Association

As a specialist nurse in an adolescent drug and alcohol service, I am not surprised by your . When I was working in the home counties a decade ago, ketamine was becoming a major problem in the under-18s. Its use was becoming commonplace, with bladder problems even appearing in our client group. At that time, its use was becoming predominantly popular in more affluent areas, where drug use apart from cannabis was generally less common than large urban areas. Our users saw it as a recreational drug for weekend use.

An opportunity was missed as ketamine was seen as less dangerous than heroin or cocaine by Public Health England, which seemed to ignore our concerns and ultimately closed our specialist service down, transferring it to adult services, whose way of working was heavily influenced by heroin and crack users. Name and address supplied

My daughter took her life after several years of ketamine addiction, and I recognise the picture painted by the young man in your . The drug and alcohol services are not equipped to manage this relatively new addiction. For young people with depression, autism and eating disorder conditions, it is the perfect drug, offering dissociation, trippiness and calmness in a cheap drug with no hangover. While our young people wait months for support with mental health, this is becoming their "little helper", and they are addicted by the time mental health services pick them up. Name and address supplied

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