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Ketamine Use Case Expands, But Concerns Persist

Mental health professionals turn to ketamine for treatment-resistant conditions.
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Ketamine’s use cases continue to grow across the country, from clinics treating mental health to law enforcement using it to subdue suspects (albeit with sometimes tragic results), making it appear to be a new wonder drug. It’s also effectively help drive the whole psychedelics industry forward.

Ketamine in low doses is an anesthetic used to sedate both humans and pets. It’s also been, and continues to be, a favorite of partygoers seeking a psychedelic high, called K, special K, super-acid, or cat valium.

It is also reportedly very hallucinogenic. People can experience unpleasant flashbacks even weeks after the drug has been eliminated from the body, according to one study.

But beyond anesthetic and recreational use, other indications include using ketamine as a regular treatment option for adult pain conditions such as complex regional pain syndrome (CRPS). It can be used for CPRS in young children as well, according to a study, and even to treat severe epilepsy for neonatal patients.

Recent clinical trials are looking at ketamine to treat alcoholism and other addictions. “In many cases, the use of ketamine has been shown to relieve symptoms of depression and PTSD so the effect of ketamine on pain relief, mental health benefits, and the social effects, such as improvement of quality of life, are all potential areas of study,” the CPRS study concluded.

The drug’s growing popularity for treating depression in particular is partly a result of it being listed as a Schedule III substance by the Drug Enforcement Administration (DEA) in 1999, and the approval of the prescription nasal spray Spravato (to be taken with an oral antidepressant) made with a nonhallucinogenic formulation of ketamine. It’s expensive – Spravato costs $729 for a two-spray dose.

Research demonstrates the benefits of ketamine over standard pharmaceutical methods of treating depression. One study found that standard antidepressants often take weeks to months to achieve their full effects, commonly resulting in increased risk for suicidal behavior.

But a single infusion of ketamine induced a rapid (within two hours) and sustained (1-2 weeks) effect in patients with treatment-resistant depression.

The legalities of using ketamine and doing ketamine therapy are still complex and vary state by state. For example, possession of ketamine (or any other Schedule III controlled substance) can get you one year in the county jail in California. Possession of 1,000 milligrams or more of ketamine in New York is a felony.

So for now, ketamine remains illegal to use without a prescription or during a surgical procedure under the care of a licensed professional.

There are loopholes being explored. Ketamine intravenous infusion therapy falls into a legitimate off-label use for mental health conditions not effectively treated by what’s on the pharmaceutical market today. As long as the health care provider in charge judges the infusion therapy to be ethical and not violative of safety standards, they may prescribe it accordingly.

There are more than 100 ketamine clinics and treatment centers in the U.S., with some estimates reporting even higher, clustered mainly on the coasts. Cost per infusion general ranges from $200 to $800, but costs can go as high as $2,000. The longer the duration for the infusion and the higher the dose, the more the infusion costs. Some patients reportedly go through dozens of infusions.

More research about the drug is encouraging to researchers, but it’s also sounding the alarm as sometimes contradictory results continue to roll in. Ketamine offers a “higher level of consciousness,” similar to LSD and psilocybin, according to one study.

But ketamine has been found in another study to be less efficacious than both LSD and psilocybin, because it doesn’t offer the same sort of therapeutic psychedelic experience as those substances do.

Bottom line: The mental health world is witnessing ketamine becoming a psychedelics phenomenon, and that’s not necessarily a good thing, according Dr. Jeffrey Lieberman, psychiatrist-in-chief of Columbia University Medical Center.

“Ketamine has proven a real boon to those with treatment-resistant depression,” he wrote in a 2017 commentary. “However, things have moved along at such an accelerated pace as to pose a concern – and, frankly, a real danger – to the field of psychiatry. This is a work in progress, and for clinicians to engage in this kind of reckless application and leaping ahead of evidence is very, very dangerous, in my opinion. I’m very sorry to have to say that it’s not just that people are being overzealous in their application of what they think might be a panacea, but it’s driven by the profit motive.”

Other psychiatrists and medical doctors also urge caution. A group wrote in a “consensus statement” published by the Journal of the American Medical Association: “While ketamine may be beneficial to some patients with mood disorders, it is important to consider the limitations of the available data and the potential risk associated with the drug when considering the treatment option.”

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