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Ketamine

The Potential Dangers of Ketamine Telehealth Services

These clinics are providing access to sublingual ketamine at what expense?

Key points

  • Ketamine is a powerful tool used off-label to treat severe depression and PTSD.
  • There are certain safety risks to prescribing ketamine for at-home use.
  • Many ketamine telehealth companies have financial incentives for patients to use more ketamine.
  • Although the addictive potential of low-dose ketamine given infrequently is quite low, it is not zero.
Tima Miroshnichenko/Pexels
Source: Tima Miroshnichenko/Pexels

Ketamine telehealth clinics are popping up everywhere.

As I watch the "ketamine for mental health" market in the United States evolve and grow, I do have some concerns. Being a psychiatrist and founder of the first ketamine-assisted psychotherapy (KAP) clinic in Philadelphia, I am able to witness firsthand both the miracles of ketamine and the potential pitfalls. The concern I’ll focus on today is the lack of regulation among ketamine telehealth companies. Although some companies are trying to be ethical, others seem more interested in making money and are needlessly encouraging patients to take more ketamine more often.

What psychiatric conditions does ketamine treat?

Ketamine is a powerful medicine with psychedelic effects, used off-label to treat severe depression and PTSD. Small studies also point to benefits in treating OCD, anxiety, eating disorders, and addiction. However, the public must be aware of the potential harmful effects of ketamine, many of which seem more likely to occur in the context of unregulated telehealth ketamine clinics.

Are there potential long-term harmful effects of ketamine?

First, there is very little long-term data on patients using low doses of ketamine over a substantial time period. This means that a patient taking ketamine regularly for long periods of time may be opening themselves up to harmful side effects. Although there is little evidence of long-term side effects in patients taking small doses of ketamine for short periods, we do know that people who are addicted to ketamine and using extremely high daily doses for years have a 30 percent rate of bladder damage and are at risk for brain damage.

In contrast to the high daily doses associated with addiction, patients using ketamine for psychiatric conditions are taking much lower doses of ketamine, which is thought to be safer. In fact, studies show that low doses of ketamine result in neuroplasticity and may improve cognition.

My takeaway point is that using ketamine to treat psychiatric conditions is a young science. We are still researching the dose, frequency, and route of administration for optimal benefit with the least harm. Prescribing ketamine in an ongoing fashion, daily or weekly, for years may have risks we do not yet know.

Could we become a nation addicted to ketamine?

Yes! Ketamine is a schedule III drug and can be addictive for certain individuals. Indeed, China has struggled with a tremendous ketamine addiction problem in recent years. In an article outlining bladder damage in Chinese society due to ketamine addiction, Ma and Chu (2015) suggest that legal availability and extremely low market prices helped create a culture where ketamine was the number-one recreational drug of abuse.

My fear is that telehealth ketamine companies, which are decreasing the barriers to obtaining ketamine as well as to using a lot of ketamine in an ongoing fashion, may be laying the groundwork for a ketamine problem, similar to what occurred in China. I’ve heard stories of financial incentives for prescribers who write more ketamine prescriptions. And, looking at advertising in both telehealth ketamine clinics and non-telehealth ketamine clinics, I note with horror that there are financial incentives for patients to use more ketamine, such as “membership” discounts and package deals. Is anyone else feeling nervous?

Advantages to using a ketamine telehealth clinic?

Ketamine can be a lifesaver for many people. My fear is that if we don’t use caution and careful monitoring, our patients will be harmed, and perhaps there will be a backlash where no one will be able to obtain ketamine. Although I personally do not prescribe ketamine for at-home use, I can see how some patients would benefit from this approach, as it is more affordable and, for many, transportation to and from appointments can be difficult. Also, some patients may prefer to be in the comfort of their own homes.

Disadvantages to using ketamine telehealth clinics—who is “sitting” with the patient?

A friend who went through a ketamine telehealth clinic told me she was asked to sign a paper that she agreed to have someone stay with her for the ketamine journey. She noted it would be easy to fool them if no one was available to sit with her. Although, in some cases, a supportive friend or family member may be a wonderful sitter, I’m not sure this is always the case.

What if difficult material arises from the ketamine voyage? For example, what if someone is having thoughts and feelings about early childhood trauma, and they are sitting with a family member who is too close to the issues at hand and also gets triggered? Many times, trauma may be more therapeutic to discuss with a trained therapist than with a family member or friend.

Questionable medical safety of at-home ketamine treatment

Although ketamine is known to be a very safe medicine, some telehealth companies are prescribing very high doses with little medical monitoring. What if someone’s blood pressure spikes to dangerous levels during the ketamine treatment? What if someone is lying down flat and vomits, and the sitter isn’t there? What if someone gets up to urinate, and the sitter isn’t there, and they fall? Caution and careful monitoring are essential to effective ketamine treatment.

Building a psychedelic framework with clinical integrity

I am passionate about the potential for healing using ketamine and other psychedelics. I recently opened a ketamine-assisted psychotherapy clinic in Philadelphia called Voyage Healing; our mission is to offer and develop high-quality treatments for persons looking for healing that they are unable to get within the traditional medical model alone. Let’s work towards building this model in a careful and measured way. Clinical integrity should always come before profit.

References

Wai-Kit Ma, Peggy Sau-Kwan Chu. Burden of ketamine cystitis in Chinese society, Urological Science, Volume 26, Issue 3, 2015, Pages 167-173, ISSN 1879-5226,

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