Ketamine’s Rising Prescription Spark Concerns a Crisis in US

As doctors in the United States reduce opioid prescriptions, ketamine, once a surgical drug, is gaining popularity as a treatment for pain, anxiety, and depression. However, the surge in ketamine prescriptions is raising concerns about a potential repeat of the opioid crisis. The generic drug, easily accessible and inexpensive, is being offered by for-profit clinics and telehealth services, often without clear scientific evidence supporting its efficacy.

Padma Gulur, a pain specialist at Duke University, notes the risks associated with the rapid adoption of ketamine. She highlights the lack of research on its effectiveness against pain, emphasizing a potential parallel with the opioid crisis, where questionable drugs were overprescribed.

Gulur’s study on 300 patients receiving ketamine at Duke revealed that over a third reported significant side effects, including hallucinations and visual disturbances. Moreover, the use of ketamine did not result in lower rates of opioid prescription in the months following treatment, raising concerns about its long-term implications.

Ketamine, initially approved as an anesthetic, has seen a resurgence as a psychedelic therapy, targeting the brain chemical messenger glutamate, linked to pain and depression. The drug’s psychedelic experiences are considered by some practitioners as an essential part of its therapeutic effect.

Despite its resurgence, concerns about ketamine’s safety persist. High doses have been linked to bladder damage and potential neurological effects. The lack of clear guidelines and the rapid expansion of ketamine clinics, both physical and online, contribute to a regulatory “wild west,” according to Dr. Samuel Wilkinson of Yale University.

The business model surrounding ketamine is straightforward – clinics can purchase it inexpensively and charge substantial fees for infusions. Telehealth services, such as MindBloom and Joyous, have entered the market, connecting patients with physicians who can prescribe ketamine remotely, adding to the complexity of the current landscape.

The rise in ketamine prescriptions has been dramatic, with a more than 500% increase since 2017, according to Epic Research. Pain remains the primary condition for which ketamine is prescribed, though depression rates are on the rise. While there is more evidence supporting ketamine’s use in treating depression, concerns about its overall efficacy and safety persist.

The “wild west” of ketamine prescriptions extends to various formulations, including nasal sprays and tablets, often compounded by specialist pharmacies. However, these formulations lack FDA approval, and warnings have been issued against compounded versions due to safety concerns.

The FDA’s recent warnings about off-label ketamine use, including compounded versions, indicate a growing need for regulatory attention. However, the decentralized nature of compounding pharmacies, overseen by state officials rather than the FDA, complicates regulatory efforts.

Despite the concerns and warnings, it remains uncertain whether regulators will take more decisive action. The rapidly expanding ketamine market, coupled with the challenges of overseeing clinics and telehealth services, poses a significant regulatory challenge for health authorities. As the use of ketamine for non-surgical purposes continues to rise, careful monitoring and clear guidelines are essential to prevent a potential crisis reminiscent of the opioid epidemic.

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