Medicine
By Associated Press
Published Nov. 6, 2023, 8:33 p.m. ET
WASHINGTON — As doctors in the United States reduce their reliance on opioid painkillers, the use of a new alternative for treating difficult-to-manage pain is on the rise: ketamine, a psychedelic therapy that has been used as a surgical drug for decades. The popularity of ketamine prescriptions has increased in recent years due to for-profit clinics and telehealth services offering the drug as a treatment for pain, depression, anxiety, and other conditions. Ketamine is a generic drug that is affordable and can be prescribed by most physicians and some nurses, regardless of their training. However, concerns have been raised about the limited research on the drug’s effectiveness in treating pain, which has led some experts to worry that the overprescription of ketamine may lead to safety and abuse issues, similar to those seen with opioids.
Dr. Padma Gulur, a pain specialist at Duke University, expressed concern over the lack of options for pain management, which often leads to the adoption of new drugs without sufficient scientific evidence. She found that more than a third of the 300 patients receiving ketamine at Duke reported significant side effects, such as hallucinations, troubling thoughts, and visual disturbances. Additionally, ketamine did not result in a decrease in opioid prescribing following treatment, which is a common goal of therapy. Dr. Gulur’s research is currently under review for publication in a medical journal.
Ketamine was originally approved as a powerful anesthetic for surgical patients over 50 years ago. At lower doses, it can produce psychedelic experiences, making it popular as a club drug in the 1990s. With its recent use for pain management, patients are now experiencing these same effects. Although the therapeutic effect of ketamine is still unclear, some practitioners believe that the psychedelic experience is essential for its efficacy.
Dr. David Mahjoubi, the owner of the Ketamine Healing Clinic in Los Angeles, explained that the goal of ketamine treatment is to help patients dissociate from their pain, depression, or anxiety. Higher doses of ketamine are often favored for pain management compared to psychiatric conditions. However, the use of ketamine for non-surgical purposes is not covered by most insurance plans, so patients usually have to pay out of pocket. Ketamine nasal sprays and tablets are also available, but they are not FDA-approved and are compounded by specialty pharmacies. Telehealth services, such as MindBloom, have profited by delivering ketamine through the mail, but the evidence for the effectiveness of these versions is limited.
The demand for ketamine has led to a 500% increase in prescriptions since 2017, with pain being the most common condition for which ketamine is prescribed. However, there is more evidence supporting its use for depression than for pain. Ketamine shortages have resulted from the increased demand, leading to the rise in sales of compounded versions. While venture capital investors have contributed to the growth of ketamine clinics, telehealth services are also gaining traction, connecting patients with physicians who can prescribe ketamine remotely.
The prescribing of ketamine is currently unregulated, allowing physicians to have freedom in prescribing the drug for off-label uses. However, high doses of ketamine can cause bladder damage and the long-term neurological effects are still largely unknown. The FDA issued warnings against compounded versions of ketamine and nasal spray versions due to safety concerns, but most compounding pharmacies are overseen by state officials rather than the FDA. Moreover, physicians promoting ketamine are not subject to the same strict FDA regulations as drug manufacturers.
In conclusion, the use of ketamine as an alternative to opioids for pain management is increasing in the United States. Although there are concerns about the lack of research on its effectiveness and the potential for abuse and safety issues, ketamine continues to be prescribed for a variety of conditions. The growth of the ketamine industry has attracted venture capital investors and led to the rise of telehealth services offering remote prescribing and delivery of the drug. While the FDA has issued warnings about the safety of compounded ketamine products, the regulation of ketamine prescribing remains limited.
