Despite having black market roots, there has been a noticeable rise in mainstream uses for ketamine over the last few years. It’s a unique product that comes in many different forms and offers several benefits to consumers suffering from certain mental health disorders. And best yet, it’s federally legal.
What is Ketamine?
Ketamine is a dissociative anesthetic with the chemical formula C13H16ClNO. Although it’s often grouped together with hallucinogenic drugs like LSD and psilocybin, its effects are different.
As a dissociative it causes people to feel separated or detached from their body or environment. It can cause hallucinations at high doses, but doesn’t always.
Ketamine was founded by Parke-David Pharmaceutical Company in 1962, and approved by the FDA in 1970 for use as an anesthetic. It has long been one of the most widely used anesthetics in veterinary medicine for years, and it’s also commonly used to anesthetize patients in emergency medical situations.
In recent years, people are finding new uses the drug, mainly in the treatment of mental health disorders, and it’s being prescribed for various off-label uses.
Off-label use of drugs refers to when a doctor prescribes a medication to be used for something other than what the FDA has approved it for. Yes, this is legal, but insurance companies may not cover drugs and treatments for off-label uses.
Different Types of Ketamine
There are a few different types of ketamine to make not of: Racemic (or standard) Ketamine, Esketamine/S-Ketamine, and Arketamine/R-Ketamine.
R-ketamine and S-ketamine make up both halves of racemic Ketamine. S(+)-ketamine (Esketamine brand name) functions as the S-enantiomer of ketamine, whereas (R)-(−)-ketamine (Arketamine brand name) functions as the R-enantiomer of standard Ketamine.
Esketamine was approved by the FDA in 2019 to treat depression and suicidal ideation. Arketamine has not yet received FDA approval but is expected to relatively soon.
Treatment Options
When it comes to treatment options, there are several to choose from: intravenous, intramuscular, topical, nasal, and tablets. A few of these can be done at home, such as tablets, topicals, and nasal sprays, whereas IV or IM administration would need to be done in a clinical setting.
Intravenous
The most popular, most well-known, and most effective option for ketamine treatment is via IV therapy. Using a needle or catheter, ketamine that is often combined with lidocaine and/or magnesium is delivered straight into the bloodstream.
The effects are pretty much immediate. In addition to onset and potency, another benefit to using IV ketamine infusions is that the dosage can be more accurately accounted for and administered with better precision during the course of the therapy, which can last anywhere from 1 to 4 hours.
Intramuscular
IM ketamine therapy is often advertised as being no different than IV administration, but that is inaccurate. Intramuscular administration consists of one single dose of ketamine given with a needle in an arm or leg muscle.
Unlike IV drips, IM injections are not titrated and do not allow for dosage control or continued monitoring. One and done dosing. As stated above, the bioavailability of intramuscular injections is relatively high but not 100 percent like IV route.
Intramuscular treatments are also shorter, lasting approximately 30-45 minutes. One benefit to choosing IM treatments is that they are more affordable, costing around 30-40% less than IV therapy on average. Because of this, some medical providers offer both IV and IM treatment options.
Nasal Sprays
Intranasal ketamine is the only type to receive FDA approval with the drug Spravato, a nasal spray that utilizes esketamine. The drug is produced by Janssen Pharmaceuticals, a Johnson & Johnson subsidiary company. Despite having FDA approval, ketamine nasal products are known to have some of the lowest absorption rates, and the level of bioavailability fluctuates substantially.
Ketamine nasal sprays are only available with a doctors’ prescription and only to deal with symptoms of ‘treatment-resistant depression’ and Major Depressive Disorder. Although PTSD, chronic pain, and suicidal ideation could be successfully treated with ketamine, the FDA has not approved the drug for these purposes yet.
Tablets
Another treatment option that’s becoming increasingly available is ketamine tablets. These pills are provided in off-label ketamine treatment centers as well as through online services that send them directly to people’s homes. This option often gets a bad rap, but there are some benefits to using the tablets.
The obvious downside is the low bioavailability of orally administered ketamine. That aside, what is nice about this option is that you get to do it from home with a bit more freedom and less monitoring than other choices on the list.
While this won’t work for everyone (in some scenarios, a medical professional absolutely needs to be readily available for safety and liability reasons), it’s preferable for others.
Topical
As of recently, we’re hearing more about topical ketamine as an even less invasive option than what’s currently on the market. Clinical trials are currently underway to determine whether products like gels and creams containing ketamine can help manage symptoms of post-traumatic stress disorder (PTSD), and potentially other mental health conditions as well.
Psycheceutical Biosciences recently filed a patent for NeuroDirect, the topical ketamine delivery system they are testing. During the trial, which currently completed phase I of safety evaluations, 24 volunteers received a single topical dose.
The goal was for researchers to get a better idea of tolerability and pharmacokinetics of the drug when absorbed through the skin. Their key findings were that the doses were safe and well-tolerated, and phase II clinical trials are already planned for early 2024.
Conclusions on What is Ketamine
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