As doctors in the United States seek alternatives to opioid painkillers, ketamine is emerging as a popular option. Originally used as a painkiller during surgery, ketamine is now being widely administered by for-profit medical centers and online health services to treat various conditions including pain, depression, and anxiety. However, with limited research on its effectiveness and potential risks, experts express concerns about the increased use of the drug.

Dr. Padma Gulur, a pain specialist at Duke University, acknowledges the scarcity of available pain medications, potentially influencing the surge in ketamine usage. She states that the lack of extensive research supporting its benefits has led to a significant increase in its use. Dr. Gulur, along with her colleagues, conducted a study at Duke involving 300 patients who received ketamine treatment. They discovered that over one-third of the patients reported significant side effects, such as hallucinations, troubling thoughts, and visual problems, requiring professional assistance.

Furthermore, the study revealed that ketamine did not reduce the number of opioid prescriptions in the months following treatment. The research conducted by Dr. Gulur and her team is currently undergoing review for publication.

Ketamine functions by targeting a brain chemical messenger called glutamate, which is known to affect both pain and depression. Even small amounts of ketamine can produce powerful effects on the brain, including hallucinations.

Daniel Bass, residing in Kentucky, was administered ketamine for pain management related to a rare bone and joint disorder. While the drug effectively reduced his pain, Bass describes the visual effects of ketamine as "horrifying."

The business of ketamine has experienced significant growth. The U.S. Food and Drug Administration (FDA) approved ketamine as a painkiller for surgical patients 50 years ago. Today, the drug is readily available and can be prescribed by most doctors, including some healthcare workers with less training. According to Epic Research, a medical data company, prescriptions for ketamine have increased by more than 500 percent since 2017. Initially, pain was the primary condition for which ketamine was prescribed, but there has been a significant rise in its use for depression as well.

Dr. David Mahjoubi, owner of the Ketamine Healing Clinic in Los Angeles, California, offers ketamine treatment for various conditions, including pain, alcohol addiction, and anxiety. He explains that the goal is to help patients feel separate from their pain, depression, or anxiety by inducing dissociation. Dr. Mahjoubi emphasizes that if a patient feels like they are just sitting in a chair throughout the treatment, they will administer more ketamine.

Doctors can purchase ketamine for less than $100 per treatment and charge patients between $500 and $1,500 for the injection. The COVID-19 pandemic has also contributed to the rise of online prescriptions, allowing online health services like MindBloom and Joyous to connect patients with doctors remotely. These services offer various forms of ketamine, including nasal sprays and pills, which are then delivered through the mail.

In May, health officials attempted to restrict online prescriptions for high-risk drugs like ketamine and opioids. However, the policy was extended until 2024 after facing pushback from online health companies and doctors.

Dr. Samuel Wilkinson, a psychiatrist from Yale University who prescribes ketamine and other depression medications, comments on the relatively lenient rules governing the prescription of ketamine. He states that this flexibility has both advantages and disadvantages.

Last month, the FDA issued a warning against mixed versions of ketamine, emphasizing that the agency does not regulate the composition of such mixtures and cannot guarantee their safety. This warning follows a similar one from last year regarding nasal spray versions of ketamine.

At present, it is unlikely that health officials will take further action beyond issuing warnings regarding ketamine mixtures. Dr. Caleb Alexander, a drug safety researcher at Johns Hopkins University, suggests that controlling the practices of health centers is currently beyond the reach of government officials.

As the use of ketamine continues to grow as a pain treatment drug, concerns persist regarding its effectiveness, potential risks, and the need for further research to determine its long-term implications for patients.