Startups are prescribing ketamine online to treat serious mental health conditions, raising concerns among psychiatrists about the safety of taking the mind-altering anesthetic without medical supervision, sometimes at high doses that increase the risk of side effects.
Ketamine is approved by the Food and Drug Administration to anesthetize humans and animals and has been used safely in hospitals for decades. The out-of-body, hallucinogenic sensations it produced made it popular as a party drug known as Special K. Some doctors prescribe ketamine off-label to treat patients with conditions such as severe depression, suicidal thoughts, and post-traumatic stress disorder.
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Generic ketamine is not approved for these conditions. Studies have shown that it can rapidly relieve symptoms of severe depression when other treatments have failed.
Less is known about the effectiveness of ketamine for other conditions, including anxiety and PTSD, and less is known about its long-term use.
The FDA has approved a chemically related version of a drug called esketamine from Johnson & Johnson for treatment-resistant depression with suicidal thoughts.
Clinics certified to administer J&J’s nasal spray prescribe doses based on patient weight. After that, patients should be monitored for two hours.
People who take generic ketamine at home are not subject to the same controls.
Mindbloom Inc., Nue Life Health PBC and Wondermed LLC are among about a dozen companies selling ketamine tablets or lozenges online, taking advantage of relaxed prescription restrictions for controlled substances during the pandemic.
Companies work with clinicians who prescribe ketamine to patients based on survey and virtual assessment. Generic ketamine pills or lozenges are mailed to patients’ homes. The companies say that, among other safety measures, they instruct people to take the drug with someone nearby.
Taking ketamine at home without a doctor’s supervision increases the risk of patients falling and harming themselves or taking more than prescribed, doctors said. Psychiatrists say ketamine can be addictive, and patients may not get the help they need if they experience pain while taking the drug.
Medical director of the ketamine and esketamine program at Brigham and Women’s Faulkner Hospital in Boston, Dr. “Virtual ketamine venues negotiate a trade-off between accessibility and safety,” said Benjamin Yudkoff.
Ketamine increases heart rate and blood pressure, increasing the risk of rare complications including stroke or heart attack in high doses prescribed to some telehealth patients, medical experts said.
President of the American Society of Anesthesiologists Dr. “Giving any such drug can lead to general anesthesia in a completely uncontrolled environment at home,” said Michael Champeau.
Prescribing ketamine treatment at home can help meet the needs of people who don’t respond to existing medications or who can’t afford or receive in-person treatment, the companies said. Ketamine blocks a receptor on brain cells that is important for brain adaptation, which researchers say can help facilitate changes in mood and thinking.
Mindbloom and Nue Life, citing published research, report that many patients feel better after taking ketamine, and that a few have problems taking the drug.
Mindbloom, Nue Life and Wondermed said they refuse to treat people with extremely severe symptoms or conditions such as substance use disorders, psychosis or uncontrolled hypertension. Nue Life said it sometimes consults with a patient’s doctor before prescribing ketamine, and Mindbloom said it often requests medical records. Wondermed said patients can choose to have their doctor work with the company during treatment.
““Virtual ketamine venues negotiate a trade-off between accessibility and safety.”“
Nue Life said it starts patients at about 125 milligrams and prescribes a maximum of 750 milligrams per dose. Wondermed said it prescribes patients between 100 milligrams and 400 milligrams per dose. Mindbloom said he starts patients on about 400 milligrams, and some patients reach doses of about 1,000 milligrams.
Ari Aal, a psychiatrist in Boulder, Colo., who prescribes lower doses of ketamine to patients taking ketamine under supervision at his clinic, said doses closer to 1,000 milligrams increase the risk of serious side effects, including rare seizures, bleeding or strokes.
“It’s too much to do at home and probably in no way, and it’s too big without a practitioner watching you,” said Dr. Aal.
Mindbloom and Wondermed said they provide blood pressure monitors for patients to use before and during treatment. Nue Life said it instructs patients with controlled hypertension to monitor their blood pressure.
Patient advocate Timothy Mitchell, 40, of Ballston Lake, N.Y., said Mindbloom was started on him last year at a dose of 800 milligrams. He said he was on his third course of a six-dose regimen with Mindbloom at a dosage of 1,200 milligrams. He said the treatment helped calm suicidal thoughts.
Wondermed said it charges $399 for a month of ketamine tablets or lozenges and telemedicine treatment. Mindbloom said he charges about $1,000 for about three months of ketamine and telemedicine care. Nue Life said it charges $2,999 for four months for ketamine tablets and telemedicine treatment. Health insurers typically don’t pay people for off-label treatments.
Amanda Itzkoff, CEO of Curated Mental Health, which administers ketamine to psychiatrists and clinics, said she declined to be on Mindbloom’s advisory board in part because she was concerned that home use might not include enough patient supervision.
Drawing comparisons to the fight against psychedelic drug research decades ago, he said companies could be blocking the uptake of a valuable treatment if they recklessly prescribe ketamine for home use. “We can blow it up again,” said Dr. Itzkoff.
A spokesperson for Mindbloom’s Dr. He said he had lost contact with Itzkoff and had not raised security concerns. Mindbloom’s medical director, Dr. Striking the right balance between expanding access to ketamine and safe prescription apps is critical to Mindbloom, Leonardo Vando said.
Courtney Gable, 47, said her husband checked on her while she was taking ketamine, which Mindbloom prescribed to her this year to treat chronic pain and depression. He said the 400-milligram dose was higher than the initial doses prescribed at a clinic where he worked in Philadelphia.
“There is a safety net, but the gaps between the nets are a little wider,” Ms. Gable said.
Leon New Valentine, a 32-year-old actor and video game model based in Los Angeles, founded Peak Health Global Inc. last year. prescribed 100 milligrams of ketamine online by and took the medication with someone nearby. Mx. Using them as a pronoun, Valentine said they finished the 150-milligram doses and took it alone. Ketamine alleviated symptoms of treatment-resistant depression and PTSD, Mx. Valentine said.
“Even though I’m in pain, things are happy again” Mx. Valentine said. Peak said it will close in November as it anticipates the soon tightening of rules that allow remote prescribing of controlled substances.
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