“You cannot hand out prescriptions for ketamine like candy,” said Dr. Gerard Sanacora, director of the Yale Depression Research Program.
Meanwhile, an increasing number of in-person ketamine clinics have opened in the US, research shows, marketing intravenous infusions, injections or even oral forms of ketamine like lozenges for a number of ailments.
Market research firm Grand View Research estimates that the market for ketamine clinics had reached $3.4 billion in 2023 and projects that it will continue to grow about 10% a year through 2030.
Dr. Steven P. Cohen, a professor of anesthesiology at Northwestern University’s Feinberg School of Medicine, says some ketamine clinics are clearly putting profits before patients.
He said he’s also heard of ketamine being used to treat lingering pain after Lyme disease treatment.
Two physicians are among the five individuals charged in relation to actor Matthew Perry’s death. Federal officials claim that one doctor offered to sell ketamine from his previous clinic, while the other provided the drug to Perry and instructed his live-in personal assistant on how to inject it.
Perry’s body contained ketamine at a level equivalent to that of general anesthesia, according to an autopsy conducted by the US Attorney’s Office for the Central District of California. Perry had received multiple injections on the day of his death.
The ketamine case has brought attention to the widespread use of this hallucinogen, which has been licensed for anesthesia use for many years. In recent times, it has been investigated as a potential treatment for depression, chronic pain, and post-traumatic stress disorder. It has a long history of use as a party drug. Since it’s already available, patients in need of relief can obtain versions of it, sometimes through unregulated cash-only clinics.
The US Drug Enforcement Administration has categorized ketamine as a schedule III drug, which indicates that there is a low to moderate risk of physical or psychological dependence. When a drug is scheduled, a patient’s refill frequency is restricted. Prescribers must also comply with specific storage and dispensing guidelines and register with the DEA.
According to Dr. Gerard Sanacora, director of the Yale Depression Research Program, “ketamine prescriptions cannot be given out like candy.”.
Still, there are ways for people to abuse the medication, particularly compounded medications (which are mixed specifically for each pharmacy) and generic versions, as well as to take it outside of authorized medical settings.
A drug’s approval by the FDA grants physicians the authority to prescribe it for purposes other than those for which it was intended. These “off-label” uses of prescription drugs typically account for a small percentage of prescriptions filled for that particular drug.
In the instance of ketamine, the all-cash business model and drug’s rising reputation as a panacea for a wide range of ailments have led to an explosive rise in off-label use of the generic form.
More regulation of medical ketamine, according to Sanacora, is necessary, but there are trade-offs to be taken into account.
We obviously need a registry or something to know when people are using it outside of that situation, but it’s hard to know how much restriction to put on it without making it harder for people to use it as an anesthetic, he said.
“We simply are unaware of the number of individuals receiving this medication. The dosages at which it is used are unknown. The nature of the unfavorable events is unknown. “.
The market for ketamine is expanding.
Ketamine use is still thought to be relatively uncommon, according to estimates from the federal government’s National Survey on Drug Use and Health. In 2023, only about 2% of adults reported having used ketamine at some point in their lives.
The majority of ketamine prescriptions in the US were written to treat pain, according to a 2023 study by the medical records company Epic Research, which found that the drug’s prescription rates had increased by more than 500% since 2017.
According to the company, small, cash-only clinics are not included in Epic’s data because it only covers traditional medical settings that use its medical records systems.
According to research, an increasing number of physical ketamine clinics have opened in the US, offering injections, intravenous infusions, and even oral ketamine products like lozenges for a variety of conditions. Grand View Research, a market research firm, projects that the ketamine clinic market will grow by roughly 10 percent annually through 2030, with an estimated $3 point 4 billion in sales in 2023.
Growing numbers of telehealth companies started prescribing and teaching people how to use ketamine therapy at home during the isolation of the Covid-19 pandemic. According to the Grand View report, online prescribing now makes up nearly half of the market.
The drug’s compounded forms, including lozenges, are becoming increasingly popular, the FDA warned in October. Increased blood pressure, respiratory depression, and mental events are among the risks that the agency has identified.
The statement read, “Ketamine is not FDA approved for the treatment of any psychiatric disorder, and more clinical studies are needed to adequately investigate the benefit-risk profile and safe-use conditions of ketamine in the treatment of psychiatric disorders.”.
Dr. Theo P. Cohen, an anesthesiology professor at Northwestern University’s Feinberg School of Medicine, claims that certain ketamine clinics are obviously prioritizing their bottom line over their clients’ needs.
According to Cohen, a physician does not always assess patients at the clinics. Based on his experience, it takes approximately 400 milligrams administered over a week to effectively treat depression. He has heard of patients receiving 35 to 40 milligrams of ketamine at a time, which may be subtherapeutic. According to him, patients are typically expected to pay cash for each treatment, and clinics may not keep track of their progress. “It is repulsive. The Wild West is here, he remarked.
Requirements regarding esketamine, a ketamine derivative that is prescribed and approved by the FDA for treatment-resistant depression, are noticeably different.
The nasal spray, marketed as Spravato, must adhere to stringent FDA regulations. Because of the possibility of unpleasant side effects like dissociation—a feeling of being cut off from your body—and loss of consciousness or sedation, users need to be closely observed for two hours following each dosage. Breathing problems can also be brought on by the drug.
A “dangerous… in the wrong context” drug.
A patient whose misfiring nerves caused them to itch nonstop for four years was successfully treated, according to Cohen, with ketamine. He added that he had also heard of ketamine being used to treat post-treatment Lyme disease pain that persisted.
However, he claims that ketamine is being sold to treat a variety of conditions, such as generalized anxiety disorder, PTSD, and obsessive-compulsive disorder, sometimes before thorough research has been done to support these claims.
According to the autopsy report, Perry was taking ketamine to treat his depression, but there were hints that the actor may have become increasingly dependent on the medication. According to the US Attorney’s Office for the Central District of California, doctors supplied Perry with the drug even though they had been told at least a week prior that his ketamine addiction was “spiraling out of control.” This information was included in a news release regarding the charges filed in Perry’s death. Perry had been candid in discussing his battles with a drug addiction.
Experts claim that unlike opioid drugs, ketamine doesn’t physically become addictive. Regular users who quit usually don’t experience withdrawal symptoms.
As far as I’m aware, you won’t experience a physical withdrawal because you don’t live in “K lands,” or “ketamine lands,” and returning to reality may be difficult. Thus, some could argue that’s psychologically addictive,” Dr. Joseph Palamar, an associate director at New York University’s Department of Population Health, said.
Because of circumstances similar to Perry’s, who drowned in the heated end of his pool after consuming large doses of the drug, according to the autopsy report, Palamar expresses concern about unsupervised drug use at home.
While not the most dangerous drug by any means, Palamar—who also serves as deputy director of the National Drug Early Warning System, or NDEWS—a body that keeps an eye out for early indicators of drug epidemics—admitted that the drug can be dangerous if used improperly.
Although it’s extremely difficult to find information on ketamine-related deaths, Palamar says he knows of at least two other deaths through websites that are part of the NDEWS network.
“That’s a scheduled drug that could be dangerous, even if you’re the most responsible person,” the man stated.
When taking ketamine unsupervised at home, one may wonder, “What if you think it’s a good idea to cook while you’re using the drug and then you accidentally burn the house down? Or you think it’s a good idea to drive and you take a walk outside and you get hit by a car?”.
“Thus, because it’s unregulated, I worry about all these things, all these behavioral problems associated with it,” he remarked.
