Mind-altering ketamine becomes latest pain treatment, despite little research or regulation

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As U.S. doctors scale back their use of opioid painkillers, a new option for hard-to-treat pain is taking root: ketamine, the decades-old surgical drug that is now a trendy psychedelic therapy.

Dr. Padma Gulur, a Duke University pain specialist, stands for a portrait on Friday, Oct. 27, 2023, in Durham, N.C. Prescriptions for ketamine have soared in recent years as doctors adopt the mind-altering drug as an alternative pain treatment. Gulur and other specialists see potential for ketamine as a pain therapy, but warn it also carries risks of safety and abuse. WASHINGTON —

When Gulur and her colleagues tracked 300 patients receiving ketamine at Duke, more than a third of them reported significant side effects that required professional attention, such as hallucinations, troubling thoughts and visual disturbances. “No matter how horrific an experience is, if it allows me to be more functional, I will do it,” Bass said.

Patients pay cash because most insurers don’t cover non-surgical uses of ketamine, none of which are approved by the Food and Drug Administration. Mahjoubi’s background is in anesthesiology, not psychiatry or addiction. The prescribing boom has led to shortages of manufactured ketamine, driving up sales of compounded versions.

A blog post from one, Ketamine Startup, lists “Five reasons you should open a ketamine clinic,” including: “You want to be your own boss” and “You want to take control of your money-making ability.” Last month, the FDA warned doctors and patients against compounded versions of ketamine, including lozenges and pills, saying the agency does not regulate their contents and cannot assure their safety. The warning followed a similar advisory last year about nasal spray versions of ketamine.

 

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