The American Society of Anesthesiologists is calling for stronger oversight of ketamine prescribing and administration as use of the drug expands for depression, post-traumatic stress disorder and other mental health conditions.
The organization said the rapid growth of ketamine clinics and at-home telehealth prescribing has outpaced patient safety standards. The U.S. ketamine market has surpassed $5 billion and is projected to exceed $14 billion by 2035, according to a June 22 news release.
Ketamine is increasingly prescribed off-label for behavioral health conditions, sometimes through telehealth platforms that deliver the medication directly to patients’ homes. ASA said some patients receive ketamine without an in-person evaluation or direct medical supervision.
The organization pointed to the death of a 41-year-old New York woman who was prescribed at-home ketamine through a telehealth company while seeking treatment for depression. According to ASA, the patient had reported taking Xanax, a combination the FDA warns can increase the risk of fatal breathing complications.
The Texas Medical Board recently proposed rules that would increase oversight of ketamine administration in medical facilities and clinics. Similar legislation aimed at strengthening patient protections has been introduced in Georgia, Missouri and Utah.
“We have grave concerns about the home delivery and use of ketamine,” Patrick Giam, MD, president of theASA, said in a statement. “Without proper monitoring and supervision, this can become dangerous.”
The safety concerns are not new. In 2023, the FDA warned that unsupervised use of compounded ketamine heightened the risk of dangerous psychiatric reactions, high blood pressure, respiratory depression and urinary tract issues — and drew a distinction between clinic-supervised administration and telehealth prescribers marketing the drug online.
Regulatory enforcement has also already reached at least one major telehealth prescriber. In 2023, the Drug Enforcement Administration shut down a South Carolina physician who had built a nationwide ketamine prescribing practice by capitalizing on pandemic-era telehealth flexibilities, obtaining medical licenses in nearly every state to prescribe the drug remotely.
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