As clinicians aim to reduce their reliance on opioid painkillers, prescriptions for ketamine have seen a surge. What’s most worrisome is that many of the prescriptions originate from telehealth services, according to an Associated Press news article. This raises alarm among experts about the risks of writing prescriptions for non-approved uses, overprescribing, and the associated abuse potential—not unlike the factors that contributed to the ongoing opioid crisis. Research led by a Duke University pain specialist showed that in 300 ketamine-treated patients, more than a third reported significant side effects that called for intervention, including hallucinations, troubling thoughts, and visual disturbances. Furthermore, the research did not find a reduction in opioid prescriptions following ketamine treatment, which would have been the more valuable therapeutic goal.
It’s not just off-label: Initially approved over half a century ago for surgical anesthesia, ketamine primarily targets glutamate, a neurotransmitter linked to pain and depression. However, the ways it’s being used for pain by online prescribers are not FDA-approved. Ketamine is available as an inexpensive generic, and no special training is required for prescribers to write it. UC providers could encounter patients who have used ketamine without understanding its risks, and there is little guidance for how to treat its side effects in an outpatient setting.