At-home ketamine therapy is a growing (and highly profitable) trend. But many clinicians, including Ketamine Wellness Centers, say that using remote care to administer a class III drug poses a number of unique safety concerns—regardless of how appealing or profitable it may be.
In early 2020, the United States Department of Health and Human Services (DHHS) declared a public health emergency due to the COVID-19 pandemic. This paved the way for the ketamine telehealth industry as it exists today by suspending certain federal laws designed to prevent online drug trafficking and removing many requirements for in-person medical evaluation/supervision.
In some cases, access to remote medical care during the pandemic was (literally) a lifesaver. For certain treatments, however, standard clinical procedures can’t be easily recreated at home. In the case of ketamine, these rushed legal changes made a potentially dangerous at-home medical treatment more accessible than ever.
Why is At-Home Ketamine Dangerous?
Before COVID, controlled substances like ketamine could not be prescribed without an in-person evaluation from a healthcare provider. While ketamine can be a life-changing treatment, it isn’t for everyone—and certain health conditions can significantly increase the risk of medical complications. Because of this, in-person appointments can play an important part in assessing whether or not someone is mentally and physically suited for ketamine therapy.
When telehealth laws changed to better accommodate virtual care during the pandemic, some companies leapt at the opportunity to take advantage of newly lifted regulations. Not every at-home ketamine company sets out to put money over safety considerations and patient needs. However, even with a well-intentioned provider, remote ketamine treatment can hinder quality of care. Basic considerations like assessing treatment complications, preventing accidental injury, and ensuring patient safety and comfort are all severely limited by a virtual setting.
Also of concern is that many remote ketamine companies fail to hire qualified practitioners, perform basic health screenings, or follow the same standards of care that are required of in-person clinics. In some cases, a company with just a handful of staff members could have thousands of patients.
Complications from dangerous care are not only harmful to patients, but also threaten the future of ketamine therapy itself by fueling a misguided belief that all ketamine treatment is always dangerous. Irresponsible ketamine care can cause serious harm not only to patients, but to the decades of scientific, social, and legal progress that have brought ketamine therapy into modern medicine.
When used in a clinical setting, ketamine is widely regarded as a safe and effective medication. At home, however, risk factors that would be minor under medical supervision can quickly escalate into more serious complications. These safety risks include:
At a reliable ketamine clinic, staff will have experience in recognizing and treating potential side effects of ketamine. This means that, for example, someone experiencing anxiety can be offered calming medication for a more comfortable treatment.
Without appropriate medical monitoring, any at-home treatment is at risk of side effects escalating into an out-of-control situation. Even in the absence of major side effects, negative experiences in an uncontrolled setting can cause ketamine therapy to be unsuccessful.
Other side effects, like elevated blood pressure or nausea, can also pose increased risks at home. Many of us know what medications help us when we feel unwell, and it’s easy to reach for them when side effects set in. However, some standard medications can become dangerous when combined with ketamine. Drug interactions are always a risk when taking more than one medication—even something as simple as taking aspirin with a prescription blood thinner is potentially harmful. Certain medications shouldn’t be used at the same time as ketamine, which makes self-medicating at home a potentially disastrous situation.
Because of how potent ketamine’s effects can be, even mild side effects can make the difference between successful treatment and an uncomfortable, unwanted experience. These effects can usually be controlled under medical supervision, but become much more unpredictable at home.
Potential for Injury
Ketamine is in a class of medicine known as “dissociatives,” which means it can temporarily cause a feeling of being far away (or “dissociated”) from one’s body. This can lead to impaired coordination, loss of balance, and reduced sensation from physical touch.
When experienced under medical supervision, dissociation is often considered a beneficial and even pleasant part of the ketamine “experience.” Medical professionals can help guide the experience by keeping the patient comfortable, making sure they stay sitting or laying down, and helping them walk if they need to get up at any point.
In an unsupervised environment, dissociation is less safe. For someone who has never experienced it before, dissociation can be an uncomfortable and scary experience to go through without a source of support to help keep the experience positive. Someone taking ketamine at home might try to “walk it off,” which can be extremely dangerous when combined with normal tasks like using stairs, preparing food, and driving.
If a patient does fall or otherwise get injured, the pain-relieving effects of ketamine mean that they may not notice something is wrong. The possibility of getting seriously hurt while using ketamine at home is a major reason to opt for clinical supervision in a controlled environment.
Lack of medical oversight
While someone may be present over video call, few (if any) at-home ketamine companies require supervision from a trained medical professional. Serious complications from ketamine treatment are rare, but if problems arise without the presence of someone trained in medicine, it can be very difficult to provide help.
One issue is that it’s almost impossible to provide appropriate medical monitoring over video. Because the person monitoring you is unlikely to be a medical professional, they may struggle to tell the difference between a medical emergency and a minor side effect. For example, elevated blood pressure sometimes signifies a serious issue, but it can also be a harmless and temporary reaction the body has to ketamine. It’s easy to tell the difference in a clinical setting, but remote ketamine treatment means that there is little to no medical equipment or medication available if it feels like something might be wrong. If something does go wrong, it may not be possible to receive medical help in a timely manner.
Some at-home ketamine providers require a “chaperone” to be physically present with the person undergoing treatment, but this person is not required to have medical training or basic knowledge about ketamine. In some cases, this can do more harm than good: someone who is unfamiliar with ketamine therapy might overreact to normal treatment effects, causing stress and discomfort to the patient, or they might underreact to serious symptoms, potentially putting the patient in danger.
At a trustworthy ketamine clinic, you will be allowed to bring a supportive loved one and have continuous medical monitoring from a professional. Having a trusted source of support can go a long way, but safe, high-quality ketamine care also requires the presence of trained staff in a controlled environment.
Quality of Care
Another concern for ketamine-by-mail companies is the quality of services provided. Poor regulation means that you may be paired with an unlicensed “therapist,” given a dose that isn’t right for you, or overcharged for inadequate treatment. Some major issues patients of these programs have reported are:
Limited Support Options
Having access to qualified support throughout the treatment process is one of the most important contributors to a successful recovery. When someone undergoes ketamine therapy without sufficient support, they may find it difficult to process their experiences and struggle to reap lasting benefits from treatment.
Some remote ketamine companies may seem to address this problem by charging a fee for a “guide” to monitor you through video chat throughout your ketamine experience. (They are called guides or coaches because often, company-provided “guides” are not licensed therapists or medical professionals.) In reviews for certain ketamine-by-mail companies, patients have noted that they were paired with a different “guide” for each treatment, and sometimes did not know who it would be until they logged in for their session.
If you’ve ever seen a therapist or counselor, you’ll probably agree that a trusting relationship built over multiple sessions is a key component of successful recovery. Being paired with a stranger each time means that the patient-therapist bond—one of the most important predictors of successful treatment—will be completely absent.
Unsurprisingly, hiring less experienced staff is a safe bet to save money and boost profit. For the patient, though, inadequate care rolls the dice on successful treatment outcomes.
Less Room for Personalized Care
One of the most important features of in-person IV ketamine therapy is that treatment can be adjusted to suit your individual needs.
In a clinical setting, your care team will continuously monitor your comfort and offer support as-needed. For example, if you don’t notice the effects from an infusion, your dose can be raised until it feels right. Similarly, if you start to feel uncomfortable, your dose can be lowered immediately. This is not possible with ketamine-by-mail, both because there is no provider present and because ketamine-by-mail uses ketamine in a lozenge form. Unlike infusion therapy, if you take too high of a dose of ketamine lozenges, you cannot lower it.
Shady Advertising and Hidden Expenses
It’s important to know that online ketamine providers often use advertising that makes their services appear more affordable than they really are. An ad might promise low-cost ketamine therapy, but fail to mention hidden costs like pre-treatment consultations, post-treatment counseling, and a minimum number of required sessions. By the time you’ve completed the treatment, your final bill may be equivalent to the cost of in-person infusion therapy—even when you haven’t received the additional services and safeguards that come with it.
There is also concern that fully remote ketamine companies could soon be illegal. Earlier this year, psychedelic law specialist Griffen Thorne warned that the state of emergency that launched the remote ketamine trend is likely to end soon. A return to pre-COVID telehealth policies will likely criminalize fully remote ketamine therapy, but most companies providing this service have failed to disclose this risk to clients or offer a plan for continuing care under new regulations.
This is a major problem with relying on less regulated medicine: if an online medical company shuts down (as at least one has already done), thousands of patients could be left stranded with disrupted and incomplete treatments.
Ketamine and Safe Patient Care
When practiced responsibly, ketamine therapy can be a truly remarkable medical intervention. Its long-lasting effects, success rate for treatment-resistant conditions, and fast-acting symptom relief may well change the future of mental health treatment.
When practiced irresponsibly, though, this therapy is not just less effective—it can be downright dangerous. For this reason, KWC does not provide or condone in-home ketamine therapy with a virtual provider.
While it may seem convenient short-term, the model of remote ketamine care can’t guarantee the presence of licensed support during treatment sessions, offer clinical-quality care, or adequately provide in-person support in the event of an emergency. Prescribing ketamine for use outside of a controlled clinical environment doesn’t just pose risks to the patients who use it at home—it threatens the future of ketamine access for every patient who needs it.