What is Ketamine? 

Finding information online about ketamine can be overwhelming, leaving a lot of patients and their families confused about its approved uses. Simply put, ketamine is an anesthetic with some hallucinogenic properties and is classified as a Schedule III non-narcotic substance under the federal  Controlled Substances Act. It can only be prescribed by a medical practitioner, and is less likely to lead to physical or psychological dependance than Schedule I or II substances, but is still riskier than Schedule IV or V substances. It is medically approved for use in humans and animals for short-term general anesthesia and sedation. Often used in emergency room settings, ketamine can provide fast and effective anesthesia to patients experiencing pain from conditions like burns, joint dislocations, and broken bones. It can also be used as a precursor to longer lasting general anesthesia used in surgical settings.  

Ketamine is commonly used to sedate children during short procedures. It can be a preferred anesthetic for patients with heart problems and asthma because it doesn’t decrease the heart rate or oxygen absorption.  

The drug has been touted as a fast-acting treatment for depression, with many success stories floating around the internet. This can be an attractive solution for patients struggling with treatment resistant depression

Ketamine Infusion Therapy and Treatments for Depression 

Recently, medical professionals and patients have seen potential benefits of ketamine therapy for depression. This includes ketamine infusion and prescription uses.  

Food and Drug Administration (FDA) approved a ketamine nasal spray (in the form of esketamine) for patients with treatment-resistant depression. Because of the potential for misuse of the drug, the nasal spray is only prescribable to patients under a Risk Evaluation and Mitigation Strategy (REMS). The patient takes the nasal spray at a medical center under supervision of a practitioner; it is not approved for home use.  

Ketamine infusion centers have opened across the US, offering off-label treatment for many psychological disorders. Although these infusion centers are legal as long as a Drug Enforcement Administration (DEA) licensed medical practitioner is prescribing the drug, ketamine is not FDA approved to treat psychological disorders. FDA released a warning statement discussing the risks associated with ketamine use. The physical risks of ketamine, especially in repeated use, include chemical dependence, memory loss, psychiatric events, increases in blood pressure, respiratory depression, and lower urinary tract and bladder symptoms. 

Besides the physical risks, another downside for many patients is cost; a single session varies depending on the amount of ketamine prescribed, ranging from $400-$1,300 on average

Illicit Ketamine Use 

The illicit use of ketamine has risen in recent years. It is commonly known as a “club drug,” primarily used by young adults. Its effects include “floating” feelings, euphoria, hallucinations, and out of body experiences. Unfortunately, overdosing is common when taking ketamine, making it an especially dangerous recreational drug, especially when combined with drugs or alcohol. Taking too much ketamine can lead to immobilization in patients, often referred to as a “k-hole,” which have led in certain cases to death by drowning, hypothermia, falling, or other accidental death. No deaths have been recorded from prescribed therapeutic use of the drug.  

In addition to the risks of overdose or accidental death from taking illicit ketamine, there is also risk of the illicit drugs being combined with other substances, like fentanyl. Accidentally taking fentanyl when it’s mixed with other drugs can be especially deadly. Fentanyl test strips are available for patients to test their medications. You can help to remind your patients to never purchase drugs from social media, as these drugs are sold illegally.  

Ketamine Safety 

Although ketamine is legal to use under the care of a physician, prescribed therapeutic use of ketamine for psychological disorders has not been approved by FDA, and illicit use of ketamine is not safe. The recent rise in illicit use of ketamine is concerning to public health. Patients should talk to their health care providers about the risks of ketamine use and make informed decisions about whether to use the drug.