A novel treatment option for difficult-to-treat pain is emerging as American physicians reduce their usage of opiate painkillers: ketamine, a decades-old surgical medication that is currently a popular psychedelic therapy.

Ketamine prescriptions have skyrocketed in recent years due to the proliferation of for-profit clinics and telemedicine services that provide drugs for the treatment of pain, depression, anxiety, and other ailments.

(Photo: by SAI AUNG MAIN/AFP via Getty Images) Packs of illegal ketamine are seen before a destruction ceremony to mark the "International Day against Drug Abuse and Illicit Trafficking" in Yangon on June 26, 2023. Myanmar junta authorities said they torched almost half a billion dollars worth of illegal drugs on June 26, 2023, but warned they were failing to stop a surge in the production and trafficking of narcotics.

Regardless of training, the majority of doctors and nurses can prescribe generic medication because it is inexpensive to buy.

Could It Lead to An Epidemic?

Some experts fear the United States may be repeating the mistakes that led to the opioid epidemic by overprescribing a dubious medication that contains substantial safety and misuse concerns, despite the paucity of studies on its usefulness in treating pain.

More than a third of the 300 patients Gulur and her colleagues monitored while on ketamine at Duke had serious side effects that needed medical treatment, including hallucinations, unsettling thoughts, and visual abnormalities.

According to Gulur, ketamine also did not lead to decreased rates of opioid prescribing in the months after treatment, which is a typical therapeutic objective. Her work is being considered for publication in a medical journal.

Ketamine And Its Uses

Over fifty years ago, ketamine was authorized as a potent anesthetic for surgical patients. Due to its ability to provide psychedelic, out-of-body experiences at lower dosages, it was a common party drug in the 1990s. Patients are seeing the same symptoms more frequently now that it has been used to treat pain.

Ketamine acts on glutamate, a neurotransmitter that is hypothesized to be involved in pain and sadness. Some medical professionals believe that the psychedelic experience is crucial, although it's unclear if this contributes to the drug's therapeutic effects.

For the treatment of anxiety, PTSD, chronic pain, and alcoholism, intravenous ketamine is available. While the ketamine dosages for such indications are far lower than those used for surgery, some people choose greater doses for pain management over mental health issues.

Patients pay cash since the majority of insurance does not cover ketamine used for purposes other than surgery, which the FDA has not approved.

In-between-infusion ketamine nasal sprays and tablets are available for an additional fee to patients. These formulations are produced by specialized pharmacies and are not authorized by the FDA either.

Mail-order ketamine delivery has grown to be a lucrative industry for telehealth providers like MindBloom, who entered the market after authorities loosened regulations on internet prescription under COVID-19.

According to pain experts who research ketamine, there isn't much proof for such formulations.

A Growing Demand for Ketamine

Over 125 million patients' records were studied by Epic Research, which found that since 2017, the demand for ketamine has caused prescriptions to surge by more than 500%. Although depression has been rapidly increasing, pain remained the most common reason for which ketamine was administered each year.

Sales of compounded ketamine have increased due to shortages of produced ketamine caused by the surge in prescriptions.

The case for using ketamine to treat depression is stronger than the one for treating pain. A Johnson & Johnson-developed substance similar to ketamine was authorized by the FDA in 2019 for the treatment of severe depression. Strict FDA safety regulations govern where and how physicians can deliver the medication, Spravato.

According to Pain Society guidelines, there is some evidence supporting the use of ketamine for complex regional pain, a chronic pain syndrome that typically affects the limbs. However, the specialists discovered "weak or no evidence" for ketamine in a wide range of additional ailments, including cancer pain, fibromyalgia, migraines, and back pain.