The Rise of Ketamine: A Controversial Solution to Hard to Treat Pain

With U.S. doctors reducing their use of opioid painkillers, a new alternative for treating challenging pain has emerged: ketamine, a decades-old surgical drug now gaining popularity as a psychedelic therapy. The surge in prescriptions for ketamine in recent years is being driven by for-profit clinics and telehealth services that offer this medication as a treatment for various conditions, including pain, depression, and anxiety. Unlike opioids, ketamine can be easily obtained and prescribed by many healthcare professionals, irrespective of their specific training. However, this growing trend raises concerns among experts, who fear that the U.S. may be heading down a path similar to the opioid crisis, with overprescribing a potentially risky drug.

Lack of Research and Concerns about Safety

One significant issue surrounding the increasing use of ketamine is the limited research available on its effectiveness against pain. Some experts worry that the rush to adopt ketamine without sufficient scientific evidence may lead to unintended consequences. Dr. Padma Gulur, a pain specialist at Duke University, has been studying ketamine’s usage and found that over a third of the 300 patients receiving ketamine reported significant side effects that required professional attention, such as hallucinations, troubling thoughts, and visual disturbances.

Moreover, Dr. Gulur’s research did not find a decrease in opioid prescriptions following ketamine treatment, which is often a desired outcome of therapy. This casts doubts on ketamine’s potential as a substitute for opioids in pain management.

The Psychedelic Experience

Ketamine, originally approved as a powerful anesthetic for surgical procedures, is known for its potential to induce psychedelic, out-of-body experiences at lower doses. While these effects may be integral to its therapeutic value, they can also be unsettling for patients. Some individuals describe experiencing visual disturbances and other disorienting sensations during ketamine treatment.

Demand and Profitability

The rising demand for ketamine has resulted in a more than 500% increase in prescriptions since 2017. Pain has consistently been the leading condition for which ketamine is prescribed, although prescriptions for depression have been on the rise. The surge in demand has led to shortages of manufactured ketamine, driving up sales of compounded versions.

Ketamine’s use against depression has more supporting evidence than its use for pain. In 2019, the FDA approved a ketamine-related chemical for severe depression. This drug, known as Spravato, is subject to strict FDA regulations regarding its administration by doctors.

Challenges in Regulating Ketamine

Despite the unclear scientific basis for ketamine’s efficacy, the business model has become evident. Physicians can purchase ketamine inexpensively and charge a significant markup for its administration. The recent boom has also attracted venture capital investment, and consulting businesses have emerged to help doctors establish ketamine clinics.

Additionally, the rise of telehealth services like MindBloom and Joyous, which enable remote prescribing and mail delivery of ketamine, has introduced competition to traditional clinics. While online prescribing rules for high-risk drugs like ketamine and opioids were initially set to be tightened, the extension of these flexible policies through 2024 has created a regulatory “wild west.”

The Future of Ketamine Use

Despite concerns and warnings from the FDA about compounded versions of ketamine, as well as a lack of comprehensive evidence for its usage, it appears that regulators may be limited in their ability to curb the proliferation of ketamine clinics and remote prescribing. For now, the U.S. medical landscape remains in a state of flux, with patients and healthcare professionals navigating the uncharted territory of ketamine treatment for a range of conditions. As this trend continues to evolve, it raises important questions about the balance between patient access to innovative therapies and the need for regulatory oversight to ensure safety and effectiveness.

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