Prescriptions for ketamine have soared in recent years, driven by for-profit clinics and telehealth services offering the medication as a treatment for pain, depression, anxiety and other conditions. The generic drug can be purchased cheaply and prescribed by most physicians and some nurses, regardless of their training.
Daniel Bass, of Southgate, Kentucky, found the visual disturbances “horrifying.” His doctors prescribed four- to six-hour IV infusions of ketamine for pain related to a rare bone and joint disorder. Seated in a bare hospital room with no stimulation or guidance on the drug's psychological effects, Bass says he felt "like a lab rat.”Still, he credits ketamine with reducing his pain during the year that he received twice-a-month infusions.
Mahjoubi’s practice is typical of the burgeoning industry: He offers IV ketamine for alcohol addiction, chronic pain, anxiety and post-traumatic stress disorder. The ketamine doses for those indications are well below those used for surgery, but Mahjoubi favors higher doses for pain than for psychiatric conditions.
Demand for ketamine has sent prescriptions soaring more than 500% since 2017, according to Epic Research, which analyzed the trend using a database of more than 125 million patients. In each year, pain was the No. 1 condition for which ketamine was prescribed, though depression has been rising quickly.developed by Johnson & Johnson for severe depression. The drug, Spravato, is subject to strict FDA safety rules on where and how it can be administered by doctors.
The clinics are facing increasing competition from telehealth services like MindBloom and Joyous, which connect potential patients with physicians who can prescribe ketamine remotely and send it through the mail.of high-risk drugs like ketamine and opioids. But the Drug Enforcement Administration, facing backlash for telehealth companies and physicians, agreed to extend the flexible approach through 2024.
“There’s an element of whack-a-mole and it’s essentially beyond their regulatory purview,” said Dr. Caleb Alexander, a drug safety researcher at Johns Hopkins University. “These clinics would represent yet another front that they would be hard pressed to manage and address.”