**6.1 Abstinence and a multidisciplinary approach**

The management of ketamine cystitis aims at abating the debilitating urinary symptoms and preventing further damage to the urinary tract. The most important components of the management plan therefore lie in early diagnosis and early abstinence, as this aims to effectively remove ketamine and its metabolites from the urinary system before irreparable damage to the urinary system sets in. A large-scale study involving more than 1000 ketamine users reported that up to 50% of users report symptomatic improvement after cessation of use. Urinary frequency has been shown to be the first symptom to improve [8]. That said, as with any detoxification program, psychosocial challenges pose a big barrier to long-term abstinence. It is therefore imperative that the clinician solicits help from relevant parties such as social workers, clinical psychologists, or even psychiatrists to form a multidisciplinary approach in managing these patients [22]. This process involves first identifying those suffering from ketamine cystitis, then explaining the relationship between ketamine use and cystitis, and finally embarking on the detoxification journey. As mentioned earlier in the chapter, the PUF scale serves as a standardised and validated means of identifying ketamine users suffering from cystitis. Success in multidisciplinary management has been demonstrated by outreach teams comprising urologists, psychiatrists, social workers, and nurses in Hong Kong [23].
