Prescriptions for ketamine have soared in recent years, driven by for-profit clinics and telehealth services offering the medication as a treatment for pain, depression, anxiety and other conditions. The generic drug can be purchased cheaply and prescribed by most physicians and some nurses, regardless of their training.
With limited research on its effectiveness against pain, some experts worry the U.S. may be repeating mistakes that gave rise to the opioid crisis: overprescribing a questionable drug that carries significant safety and abuse risks.
"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," said Dr. Padma Gulur, a Duke University pain specialist who is studying ketamine's use. "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."
When Gulur and her colleagues tracked 300 patients receiving ketamine at Duke, more than a third of them reported significant side effects that required professional attention, such as hallucinations, troubling thoughts and visual disturbances.
Ketamine also didn't result in lower rates of opioid prescribing in the months following treatment, a common goal of therapy, according to Gulur. Her research is under review for medical journal publication.
PSYCHEDELIC EXPERIENCE
Ketamine was approved more than 50 years ago as a powerful anesthetic for patients undergoing surgery. At lower doses, it can produce psychedelic, out-of-body experiences, which made it a popular club drug in the 1990s. With its recent adoption for pain, patients are increasingly encountering those same effects..
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