Matthew Perry death: Inside Hollywood’s ketamine obsession

A simple Google search for “ketamine prescription” reveals a handful of advertisements for online companies touting the benefits of “psychedelic therapy” to treat illnesses from depression and anxiety to Lyme disease and chronic pain, some offering a subscription for just $100 a month to get the drug.

One problem: The drug isn’t approved to treat those conditions.

The US Food and Drug Administration – the regulatory agency responsible for approving drugs and ensuring they’re safe, work and labelled properly – has only approved ketamine for general anaesthesia used under the care of a physician.

In 2019, the FDA approved a nasal-spray drug that is made from ketamine and okayed its use to treat depression, so long as the drug is coupled with additional therapy and administered under the direct supervision of a doctor. The doctor must also monitor the patient for two hours after the dose has been taken for potential side effects, which include hallucination, feeling disconnected from reality and increased blood pressure.

But these online clinics have exploited a grey area in the regulations to market off-label ketamine prescriptions directly to consumers, experts say.

While FDA advertising regulations restrict pharmaceutical companies that “manufacture, distribute, or pack”, they do not restrict new start-ups, like online “wellness” clinics.

“It’s a very tricky thing – it’s a loophole almost,” Dr Sanacora told the BBC.

Two weeks before Perry’s death, the FDA warned consumers about ketamine’s off-label use, external, noting “the lack of monitoring for adverse events, such as sedation and dissociation, by an onsite health care provider may put patients at risk”.

Doctors and experts say the market seemed to boom during the pandemic, when online telehealth services, clinics and at-home care proliferated.

The pain management doctor, who had spoken to the BBC on condition of anonymity, said some of these companies are structured in ways that “don’t want people to get better” but rather, to keep them on prescription subscriptions that keep money pouring in.

“It’s gotten out of hand,” he said.

Dr Sanacora, who has studied and researched how ketamine can be used to treat depression, said there is a lot of evidence of the drug’s efficacy. , externalDrug trials are currently underway, external testing the merits of ketamine treatment for treatment-resistant depression.

But much is still not known about why it works, and it does come with risks, such as seizures and death.

Dr Sanacora said it’s unclear whether overdoses have increased, because the federal government does not track ketamine-related deaths, which it does for cocaine, heroin and opioid overdoes. Sometimes the drug is not even tested for during autopsies.

“There’s a lot we really don’t know,” he said.

The DEA’s chief Anne Milgram said the agency is targeting doctors who are over prescribing these drugs or prescribing it when it is not necessary.

Speaking with CBS News, the BBC’s US news partner, she compared ketamine and its use in the Perry case with the start of the opioid epidemic in the US.

“This, unfortunately, is a tragic arc that we have seen thinking back to the beginning of the opioid epidemic, where many Americans became addicted to controlled substances in doctors’ offices and through medical practitioners that then turned into street addiction as well.”