As psychedelic medicines, including ketamine, are increasingly recognized for their ability to treat some of the most pernicious and persistent ailments, one of the biggest questions to emerge is how to increase treatment access (affordability) without sacrificing patient safety.
On one hand: At-home ketamine therapy continues to expand with the help from companies like Enthea, Skylight Psychedelics, and Innerwell. By offering a lower cost treatment to patients anywhere with an internet connection, these companies are increasing access to the healing power of ketamine, which is undoubtably a good thing.
On the other hand: We are starting to see some—thankfully, mostly limited for now—instances of misuse. In spite of these negative outcomes, it was surprising that the DEA, with support from the US Department of Health and Human Services, recently extended an exception to the pre-pandemic era rule that controlled substances like ketamine can only be prescribed after at least one in-person visit. Before this second exception was extended through 2024, patients would need to visit a licensed medical provider's physical office before receiving a prescription for ketamine (usually in the oral dissolving tablet form) starting this November 11, 2023.
What makes this even more befuddling is the recent FDA warning and reported on by the NYTimes about compounded ketamine. Unlike the injectable ketamine which we use at Innerbloom Ketamine Therapy, compounded ketamine is developed by various compounding pharmacies which are subject to a different regulations and standards compared to pharmaceuticals like Pfizer. From what I can tell, compounded ketamine is also what most telehealth / at-home ketamine therapy companies rely upon.
I started Innerbloom Ketamine Therapy as a way to help people in our community find relief from mood disorders and chronic pain. Since the beginning, I have focused on injectable ketamine because of its safety, bioavailability, and ability to manage patient outcomes. I also understand that our ketamine therapy may not be an option for many because most health insurance does not cover our treatment yet.
However, I am also hopeful that we can increase access to psychedelic-assisted therapy, including ketamine therapy. To this end, I am a proponent of TREAT California which aims to allow California voters to decide in 2024 on a massive $5 billion increase in research into safe and effective psychedelic medicines. I am also looking forward to joining Enthea which is working to increase access to ketamine therapy through an emerging type of employee benefit.
TREAT stands for Treatments, Research, Education, Access, and Therapies
And while I believe that telehealth ketamine therapy may be a good (or the only) option for some, especially those in rural areas, the risks of misuse may start to outweigh the benefits, unless the most popular online services—who are careful to state that they are not actually medical providers—do more to prevent negative outcomes.
About the Author
Dr. Ray Rivas, a former general and trauma surgeon with over a decade of experience utilizing ketamine, became a ketamine therapy specialist to treat mental health and pain after witnessing its profound impact on his hospital trauma patients and his own mental health. As the founder and medical director of Innerbloom Ketamine Therapy in San Luis Obispo, California, Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
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