Ketamine in a vial (© kittisak - stock.adobe.com)
Matthew Perry’s death was attributed to the acute effects of ketamine. However, his is not the only death tied to this substance, it may just be the highest-profile death at this point. So, is it also a herald of greater ketamine problems and more deaths to come?
Ketamine, a drug developed for use as an anesthetic during surgery involving animals, is now approved for use among human patients. There is growing interest in ketamine as a treatment for depression, anxiety, and other mental health problems. It isn’t yet approved for this purpose.
Ketamine is a Schedule III controlled drug – less restricted than oxycodone or heroin but more restricted than alprazolam (Xanax) and zolpidem (Ambien).
The total number of prescriptions has increased steadily over the last two years, although it appears that the number of new prescriptions for ketamine has decreased. Experts say that the increasing use of telehealth during the COVID-19 pandemic contributed to the rise in the number of prescriptions. These online services started distributing ketamine lozenges from compounding pharmacies.
There are multiple communities on Reddit with information about online distributors of ketamine, along with stories of abuse and addiction to the legally obtained lozenges. There are also stories like Perry’s — patients who first received ketamine infusions, possibly for depression, then later sought out dangerous quantities. After building a tolerance to the drug, some patients have gone from referral clinic to referral clinic, receiving multiple doses for depression. Later, they obtained it illegally and inadvisably.
Experts liken the pattern to that of oxycodone. It was first prescribed for legitimate use, then became a club drug, which was increasingly commercialized. Ketamine is both similar to and different from other drugs of abuse. Although less habit-forming than drugs like oxycodone or alcohol, once it is available to more people, it can be misused and abused.
People use ketamine despite adverse consequences – one of the definitions of addiction. Tolerance builds over time. In withdrawal, users have muscle aches and so-called “zaps” – a feeling of electricity down the back.
Ketamine causes death because of its anesthetic effect. It also puts people at risk for motor vehicle accidents.
Currently, there is no national drug database, making ketamine misuse difficult to track. Although states have prescription drug monitoring databases, prescribers don’t always check them. There is also no policy specific to telemedicine prescribing.
There is no regulatory agency for off-label prescribing, although the FDA has issued a warning about the potential risk of compounded products. That warning, however, is all the FDA can do. Right now, the only way to regulate excessive prescribing is through state practice boards, which are not really part of the Drug Enforcement Agency (DEA).
There are some counties in the U.S. that are designated as local High Intensity Drug Trafficking Areas, making up the Office of National Drug Control Policy. It has detection response strategies but has no regulatory power.
The attention of regulatory agencies is currently focused on fentanyl.
