Prescriptions for the psychedelic drug ketamine are soaring as doctors become more reluctant to prescribe highly addictive opioids for pain management.
More doctors are prescribing ketamine for pain as well as anxiety and depression, causing demand for the drug to spike more than 500% since 2017, according to Epic Research, which looked at data from more than 125 million patients. Pain was the number one reason ketamine was prescribed for each year since 2017, although ketamine prescriptions for depression have been on the rise as well.
The rise in prescriptions has even caused shortages of manufactured ketamine, leading to higher sales of compounded versions. The Food and Drug Administration (FDA) warned against compounded versions of ketamine last month, saying the agency cannot guarantee their safety.
Ketamine is an attractive alternative to opioids in part because it is cheap and can be prescribed by some nurses as well as doctors. It can also be prescribed over telehealth and sent through the mail. The drug sells for less than $100 a vial, and physicians can charge $500 to $1500 per IV infusion.
However, there is limited research on the drug’s effectiveness for pain management, and experts worry that doctors may overprescribe it in the same way opioids were overprescribed, ultimately leading to the opioid crisis.
“There’s a paucity of options for pain and so there’s a tendency to just grab the next thing that can make a difference,” Dr. Padma Gulur, a Duke University pain specialist who is studying ketamine, told the Associated Press.
“A medical journal will publish a few papers saying, ‘Oh, look, this is doing good things,’ and then there’s rampant off-label use, without necessarily the science behind it,” Gulur said.
Patients on ketamine have reported hallucinations, troubling thoughts, and visual disturbances, according to research by Gulur and her colleagues that looked at 300 patients. One patient said the visual disturbances he experienced were “horrifying” but said he was willing to take ketamine “if it allows me to be more functional.”
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So far, there appears to be more evidence for ketamine’s use for treating depression than for pain. However, the neurological effects of long-term use need much more research as well — ketamine was linked to brain abnormalities in rat studies.
Ketamine was originally approved over half a century ago as a potent surgery anesthetic, and the FDA still has not approved any non-surgical uses of the drug.
Nevertheless, ketamine clinics offer IV ketamine infusions for things like alcohol addiction, chronic pain, anxiety, and post-traumatic stress disorder. Patients can also get ketamine nasal sprays or tablets to take between their IV appointments. Those alternative forms of the drug have little evidence, pain specialists say.
Meanwhile, the clinics compete for business with telehealth services like MindBloom that offer ketamine prescriptions through the mail.