The inside of the nose has a much more delicate structure than we think. Especially when certain substances are frequently used intranasally, they can cause serious damage to this sensitive structure. Although it is now widely known that cocaine can cause holes inside the nose, recently similar problems have also begun to appear with intranasal (nasally administered) ketamine use. Moreover, the fact that ketamine is cheaper and more accessible increases this risk even further.
Why Does Cocaine Cause Nasal Perforation?
When cocaine is snorted, it constricts the blood vessels. This prevents enough blood from reaching the tissues lining the inside of the nose. Over time, these tissues fail to receive nourishment, lose their vitality, and small sores begin to form inside the nose. If use is frequent and prolonged, these sores grow, merge, and eventually create a permanent hole in the middle part of the nose (the septum). This condition is called “nasal septum perforation.”
Is Ketamine Safer? Unfortunately, No.
Some people use ketamine instead of cocaine, believing it to be “safer.” The perception is fueled by the fact that ketamine is more affordable and pharmacy-sourced. However, an increasing number of patients are now presenting with nasal problems after using only ketamine. Ketamine also irritates and dries out the nasal mucosa, causing long-term tissue damage. Thus, it’s not just cocaine — frequent intranasal ketamine use can also cause perforations in the nose.
Who Is at Higher Risk?
- Those who regularly use ketamine or cocaine intranasally
- Those who always use the same nostril
- Those who already have nasal deviations, infections, or dryness
- Those who experience burning or crusting in the nose after use
What Are the Signs of Perforation?
- Whistling sounds coming from the inside of the nose
- Persistent crusting, bleeding, or nasal discharge
- Sensation of nasal congestion
- Cosmetic changes (nasal collapse or shape alteration)
What Should Be Done?
The first thing to do when these symptoms are noticed is to stop using the substances. If stopped early, the inside of the nose may heal to some extent. However, if intervention is delayed and a hole forms, surgical repair is often necessary. Especially if there are aesthetic concerns or breathing problems, surgery becomes inevitable.
Final Word: Being Cheaper Doesn’t Mean Being Less Harmful
Today, intranasal ketamine has started to be used more frequently instead of cocaine. However, this does not mean that ketamine does not harm the nose. On the contrary, with long-term use, it can erode the nasal tissues just like cocaine. Therefore, raising awareness about both substances is crucial. The nose is not only an aesthetic organ but also vital for breathing and quality of life. Protecting it is everyone’s responsibility.
