We have received a report of a serious adverse reaction linked to the use of ketamine and cocaine.

What has been reported?

An individual became very unwell after using ketamine and cocaine together. They experienced:

Extreme sedation
Inability to move or speak
Very dry mouth
Glazed eyes that were wide open

An ambulance was required, and the person was taken to hospital for treatment.

When did this happen?

Within the last week

Where did this occur?

In a home setting in Birkenhead

What we know

A person became seriously unwell after using ketamine and cocaine together
The person experienced extreme sedation, was unable to move or speak, and had a very dry mouth with glazed, wide-open eyes
An ambulance was called, and the person was taken to hospital
The incident happened within the last week
It occurred in a home setting
At this stage, we do not know whether the substances were stronger than expected or contaminated, but the effects reported directly by the user are concerning

Why is this concerning?

Ketamine is a depressant and cocaine is a stimulant. When used together, the effects can be unpredictable and dangerous. One drug can mask the effects of the other, increasing the risk of:

Severe sedation or loss of consciousness
Breathing problems
Heart complications
Overdose

There is also an ongoing risk of unexpected strength or contamination in the drug supply.

Harm Reduction Advice

Drug supplies change, best test first

What you buy is not always what it’s sold as, and strength varies a lot.
Start with a small test dose first.

Naloxone: get it, carry it, use it

Naloxone does not work on ketamine or cocaine, but it does work if opioids are also involved.
As the drug supply is unpredictable, it is still vital to carry it.
If someone collapses, give naloxone and call an ambulance.

Do not use alone

Always try to use with people you trust. If something goes wrong, someone needs to spot the signs and call for help.

Recovery position saves lives

While waiting for help:

Check they are breathing
Clear their airway
Put them in the recovery position

Look out for your mates

Signs of overdose include:

Loss of consciousness
Snoring, gurgling, or raspy breathing
Very slow, shallow, or stopped breathing
Blue or pale lips or fingertips

If in doubt, call 999 immediately.

Consider drug support

Being in treatment reduces the risk of overdose and gives you access to ongoing health support.

Drug checking and testing strips

Wirral Ways offers free drug checking resources, including:

Medetomidine and xylazine testing strips
These detect powerful sedatives increasingly found in the drug supply. They can cause profound sedation, slowed breathing, and loss of consciousness, particularly when mixed with other substances.
Nitazene testing strips
Nitazenes are extremely strong synthetic opioids. Even very small amounts can significantly increase the risk of overdose and may be present without a person’s knowledge.

Testing strips cannot make drug use safe, but they can support informed decision-making and harm reduction.

For professionals, partners and people supporting those who use drugs

Please be alert to:

Reports of unusual or excessive sedation
Reduced responsiveness, immobility, or difficulty speaking
Shallow or slowed breathing
Effects that appear stronger or last longer than expected

We encourage you to:

Share this alert with colleagues, teams, and service users where appropriate
Promote drug checking and harm-reduction advice
Encourage people not to use alone and to avoid mixing substances
Reinforce that seeking medical help will not get someone in trouble

Please continue to anonymously report any concerns, unusual reactions, or suspected contamination to help identify emerging risks and protect others.

For people who use drugs

We have had a report of someone becoming seriously unwell after using ketamine and cocaine together.

To reduce risk:

Avoid mixing drugs, especially stimulants and depressants
Use a much smaller amount than usual
Do not use alone
Take breaks and pace yourself
Stay hydrated, without overdoing fluids

If someone becomes very drowsy, unresponsive, or has trouble breathing, call 999 immediately.

You will not get into trouble for seeking medical help. Paramedics and hospital staff are there to help keep people safe and save lives.

You can also access free testing strips through Wirral Ways to check for strong sedatives or synthetic opioids that may be present without your knowledge.

Key Reminders

If someone becomes very drowsy, unresponsive, or has trouble breathing, call 999 immediately
You will not get into trouble for seeking medical help
Acting quickly can save a life

If you hear of contaminated drugs, bad reactions, or positive test strip results

Please report this to Wirral Ways as soon as possible so we can help keep people safe.

Make an anonymous report

Over 18s Support

Click here to make a referral

Under 18s Support