KASPR is implemented as an integrated four-tier treatment pathway, designed to respond to ketamine-related harm as it develops and progresses.

 

It provides a structured and coherent system of care, allowing intervention to be aligned with both the level and nature of need.

 

The pathway reflects the way ketamine-related harm emerges — often progressively, unevenly, and without clear dependence.

 

A Continuum of Care

 

The KASPR pathway spans four tiers of intervention, each representing increasing levels of complexity and clinical need.

 

These tiers form a connected system, allowing movement between levels as presentations change over time.

 

This supports continuity of care and ensures that intervention remains aligned with the individual’s needs.

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Tier 1 — Early Recognition and Low-Intensity Intervention

 

Focus: emerging risk and early change

 

Tier 1 supports the identification and response to sentinel symptoms, including early changes in use, cognition, behaviour, and physical functioning.

 

Intervention at this level focuses on:

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• recognising emerging patterns of use and risk

• identifying early indicators of harm

• supporting initial behaviour change

• preventing escalation

 

This work is typically delivered within routine contacts and existing service provision.

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Tier 2 — Structured Psychological Intervention

 

Focus: patterns of use and underlying drivers

 

Tier 2 addresses the psychological and behavioural processes associated with ketamine use.

 

This includes:

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• dissociative and regulatory processes influencing use

• reinforcement patterns and behavioural cycles

• changes in functioning associated with ongoing use

 

Intervention at this level is more structured and sustained, while remaining within standard service settings.

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Tier 3 — Integrated Psychological and Medical Response

 

Focus: complex presentations and emerging harm

 

Tier 3 supports individuals experiencing more significant and established harm.

 

This includes:

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• coordination between psychological and medical responses

• emerging physical, cognitive, and psychological impact

• increased complexity in presentation and risk

 

Intervention reflects the interaction between ongoing use and developing harm, requiring a more integrated and multi-disciplinary approach.

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Tier 4 — Specialist and Inpatient Provision

 

Focus: high complexity and acute need

 

Tier 4 supports individuals requiring specialist or intensive intervention.

 

This may include:

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• inpatient or residential provision

• specialist medical input

• complex care coordination

 

This level reflects severe or advanced presentations requiring intensive and specialist response.

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A Connected System of Care

 

The strength of the KASPR pathway lies in its integration.

 

The four tiers operate as a single, coherent system, allowing services to:

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• respond early and prevent escalation

• adjust intervention as needs change

• maintain continuity across different levels of care

 

KASPR provides the structure that links assessment, interpretation, and intervention across all tiers.

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Linking Understanding to Action

 

The pathway is informed by KASPR’s core framework.

 

By identifying sentinel symptoms and interpreting them across Exposure, Drivers, and Harm, practitioners can determine:

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• the appropriate level of response

• the focus of intervention

• when movement between tiers may be required

 

This ensures that intervention remains proportionate and aligned with how ketamine-related harm is developing.

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A System Designed for Practice

 

The KASPR pathway is designed for use within real-world service settings.

 

It supports:

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• integration with existing provision

• consistency across practitioners and teams

• delivery across a range of service intensities

 

Providing a structured and practical response to a complex and evolving clinical need.