Ketamine Telehealth Raises Difficult Questions
When the pandemic hit, the Trump Administration temporarily waived the 2008 Ryan Haight Act, which requires an in-person medical evaluation before prescribing controlled substances. This led to an uptick in ketamine providers digitally approving patients for ketamine, which can be legally prescribed off label to treat psychiatric conditions like depression and anxiety.
The current flexibility has broadened access to ketamine to patients who don’t live near any ketamine clinics, or can’t afford in-clinic treatment options. It’s also led to a new business model that a number of companies focusing on telehealth, including MindBloom and Nue Life, have been pursuing.
But that might change on May 11, when the Biden administration plans to officially declare the public health emergency over, and the waiver expires. On February 24, the DEA proposed new rules that reinstate the requirement of an in-person exam for the prescription of controlled substances, but with exceptions that keep telehealth treatment more accessible than it was before the waiver, though far less flexible than what ketamine telehealth advocates would like to see.
The rules are open to public comment for 30 days, and once finalized will take effect in May.
Pushback. The proposed rules have received pushback from The American Telemedicine Association, which calls them “overly restrictive” and fears the “potential public health crisis” they may cause. Some drug policy activists within the psychedelic community are concerned about the barriers to access this new rule, if finalized, will pose for those benefiting from ketamine telemedicine, and are calling on their supporters to urge the DEA to reconsider.
In-house ketamine treatments involve infusions, which usually cost between $400 to $800 per treatment for depression. That stands in sharp contrast to the price point of telehealth. Compounding pharmacies began delivering prescription ketamine during the pandemic, some charging between $50 and $100 for a month’s supply of sublingual tablets, reports The New York Times in a recent, widely discussed piece on ketamine telemedicine. One telehealth start-up, Joyous, offers 30 daily doses for a remarkably affordable $129 a month.
Easy access, mail-order ketamine has raised eyebrows about some providers’ motives. “Sending people drugs in the mail in massive doses without screening them correctly and without providing psychological support is not the answer,” ketamine specialist Raquel Bennett told The Microdose. “It’s a way for these companies to make money.”
Safety concerns. And for all the research conducted on ketamine, very little focuses on sublingual or self-administered home treatment. Unlike other psychedelics, ketamine use can lead to dependency, and chronic overuse can damage the bladder.
In the Times article, most of the ketamine telehealth patients report exceeding their daily dosage to counter their growing tolerance, often leading to painful, sometimes debilitating bladder problems – which in some cases can require the use of a catheter, adult diapers, and even Botox. Many don’t disclose this information to their providers for fear of losing access to ketamine. Still, some regard it as the only successful depression treatment they’ve found, while others admit to having developed dependency, and don’t want their prescription cut off.
Notes from underground. Stories like these are unfortunately all too familiar to some. Ketamine’s potentially addictive nature, along with its effects on the bladder when overused, have long been a concern to many who’ve been involved with ketamine, professionally or otherwise.
Those who run in circles where recreational ketamine use occurs tend to know at least one person whose chronic overuse sent them spiraling into a mental health crisis that interfered with their daily functioning. Telehealth may be indirectly feeding the underground market – anecdotal reports suggest that some are capitalizing on the opportunity to resell medical grade ketamine that they can conveniently order at bargain prices online.
Diligent path forward. Ketamine is a potent substance, often inducing uniquely profound states of consciousness that can be deeply mystical, intellectually stirring, and psychologically rich. For many people struggling with mental health issues, it has been a saving grace. Honest investigations into its inherent risks can only advance the field of ketamine-assisted therapy, ensuring that more people receive the safest, most effective treatment possible.
The telehealth debate has highlighted the obstacles people face in accessing this medicine, and they should be addressed in tandem with thorough research on best practices regarding at-home administration.
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