Ketamine represents many patients’ last hope.
The psychoactive drug can be found at more than 570 private clinics across the U.S. as of 2021. It’s mostly marketed as a depression treatment, especially for patients who haven’t responded to other regimens.
“We don’t expect people to go into remission; we hope them to remain alive and not to kill themselves,” said Dr. Cristina Cusin, director of Massachusetts General Hospital’s ketamine clinic in Boston. “I would say 95% of our patients really dislike the experience—they’re terrified of the experience. But when it’s the only thing that keeps you alive, why not?”
Ketamine, first approved by the Food and Drug Administration in 1970 as an anesthetic in operating rooms or emergency departments, is administered at much lower doses in some academic medical center settings, and in investor-owned or independently owned stand-alone clinics.
The proliferation of these clinics, up from 80 in 2016, is concerning to many in the drug safety and mental health fields.
Ketamine is used off-label for depression, meaning there’s no regulatory oversight of doctors’ prescribing patterns, safety protocols or adverse events in patients. The drug is sometimes marketed for a host of other chronic diseases and behavioral diagnoses that have little scientific backing.
But there’s no consensus on who should administer IV ketamine. Mental health practitioners and anesthesiologists are the top providers. Even at sub-anesthetic levels, ketamine can produce intense effects, such as disembodiment, hallucinations and reduced verbal fluency.
Many private clinic providers say ketamine doesn’t need oversight because few to none of their patients have experienced bad outcomes. They say access should be as open as possible. Many patients in studies say the treatment provided euphoria, enlightenment or a new world view that increased insights and growth.
Providers enter the business
Mass General’s Cusin opened the academic medical center’s ketamine clinic in 2015 after years of treatment model development and meetings with insurers to secure coverage. Her program is different from others because of the rigorous data they collect and safety protocols they follow, she said.