Death of Matthew Perry: Insights into Hollywood's ketamine obsession

Even a simple Google search for “ketamine prescription” yields a handful of ads from online companies touting the benefits of “psychedelic therapy” for treating conditions such as depression and anxiety, Lyme disease and chronic pain. Some offer the drug by subscription for as little as $100 a month.

One problem: The drug is not approved for the treatment of these diseases.

The U.S. Food and Drug Administration—the regulatory agency responsible for approving drugs and ensuring their safety, effectiveness, and proper labeling—has approved ketamine only for general anesthesia under medical supervision.

In 2019, the FDA approved a ketamine-based nasal spray and allowed its use to treat depression as long as the drug is combined with additional therapy and administered under the direct supervision of a physician. The physician must also monitor the patient for two hours after taking the dose for possible side effects, which include hallucinations, loss of reality and increased blood pressure.

But these online clinics have exploited a gray area in the regulations to market ketamine prescriptions directly to consumers outside of the approved scope of use, experts say.

While FDA advertising regulations restrict pharmaceutical companies that “manufacture, distribute, or package,” these rules do not apply to start-up businesses such as online wellness clinics.

“It's a very delicate matter – almost a loophole,” Dr Sanacora told the BBC.

Two weeks before Perry’s death, the FDA warned consumers about the off-label use of ketamine, externaland noted that “the lack of monitoring for adverse events such as sedation and dissociation by an on-site healthcare professional can put patients at risk.”

Doctors and experts say the market seemed to boom during the pandemic, as online telemedicine services, clinics and home care proliferated.

The pain management specialist, who spoke to the BBC on condition of anonymity, said some of these companies are structured in such a way that they “don't want people to get well” but instead want to hold on to prescription subscriptions to keep bringing in money.

“It’s out of control,” he said.

Dr. Sanacora has studied and researched the use of ketamine to treat depression and said there is a lot of evidence supporting the drug's effectiveness. , externalDrug trials are currently underway, external To examine the benefits of ketamine treatment for treatment-resistant depression.

However, much is still unclear about the effects of this substance and it carries risks such as seizures and death.

Dr. Sanacora said it's unclear whether overdoses have increased because the federal government doesn't log ketamine-related deaths, unlike cocaine, heroin and opioid overdoses, and sometimes autopsies don't even test for the drug.

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

DEA chief Anne Milgram said the agency is targeting doctors who prescribe these drugs too frequently or unnecessarily.

Speaking to CBS News, the BBC's US news partner, she compared ketamine and its use in the Perry case to the beginning of the opioid epidemic in the US.

“Unfortunately, this is a tragic trend that we have seen since the beginning of the opioid epidemic, when many Americans became addicted to substances in doctors' offices and among medical professionals, which then led to addiction on the streets.”