This article was originally published on Microdose and appears here with permission.
Ketamine telehealth is a bit of an enigma — an off-label drug combined with at-home treatment, allowed because of originally temporary Public Health Emergency legislation put in place for Covid-19.
Within this short window, telehealth has turned into a very lucrative business model that has been well received by many who want to try psychedelics in the comfort of their own homes.
Yet, now that the pandemic has been declared over will psychedelic telehealth stick around?
Origins of Ketamine Teletherapy
Usually, doctors (in most states) cannot prescribe controlled substances without an in-person examination. Ketamine is Schedule III and thus can only be administered by those with the required credentials.
These laws were established to combat online drug trafficking by the Ryan Haight Act in 2008. Additionally, in some States, practitioners must have an office in the State to prescribe medications, meaning a mail-order ketamine service would be suspect.
When the pandemic took hold, Covid became classified as a Public Health Emergency in January 2020. Following the declaration of PHE requirement for in-person consultation was waived in March 2020, with the only requirement being for practitioners to communicate with audio and visual tools. In the same period, the DEA also gave an exemption to the restrictions on prescribing medication out of state.
The door to ketamine telehealth was suddenly open. Companies like Mindbloom, which had already been operating before Covid-19, were extremely well-placed to tackle exasperated mental health concerns in the face of lockdowns. Mindbloom had already conducted virtual sessions, but the pandemic blew the business model wide open.
Since Covid, others have followed suit, like Field Trip’s partnership with Nu Life and a growing list of startups appearing in a casual Google.
Is Ketamine Telehealth Safe?
It’s easy to understand why there are safety concerns about giving someone a powerful conscious-altering drug without being in-person to monitor and take care of them. Health evaluations are a big part of telehealth, even when in-person visits aren’t conducted. But if you have ever gotten stuck looking in the bathroom mirror on mushrooms, you might understand why psychedelics, in particular, present challenges.
A study has been published stating ketamine therapy is safe and effective at home. However, reports in the field have been mixed. Shayla Love and Vice published a provocative piece that undermines the study mentioned above. Issues like training of psychedelic guides, follow-up care, and potentially misleading pricing have also echoed around the internet.
Also, a thorn in the side of ketamine is that it is prescribed off-label to treat mental health disorders. Ketamine is approved for use as an anesthetic, but exactly how ketamine works on, for example, depression, is something researchers are now trying to figure out after the fact.
The exact mechanisms of ketamine in the brain are promising areas of study, like its actions on the glutamate pathways, yet still being researched and debated for its actions on opioid receptors.
While companies providing telehealth provide limited quantities of ketamine, there are rumblings of its addiction potential, which is well established from its popularity as a recreational drug.
Will Telemedicine Stick Around?
Due to the positive press about psychedelics and the success of telehealth companies, it’s easy to miss that legislation to secure a permanent ketamine telehealth model isn’t yet in place.
In March of 2022, Congress, with the Consolidated Appropriations Act, extended measures that would allow teletherapy to continue for five months, ending in July 2022. The Advancing Telehealth Beyond Covid-19 Act was sent to the Senate, where it remains at the time of writing.
The Act, if approved, would extend telehealth benefits until December 31, 2024. After that point, the practice of prescribing ketamine remotely is uncertain.
However, there is bipartisan support for telehealth measures. While the conversation isn’t centred around ketamine, another bill, the Telehealth Extension and Evaluation Act, was introduced in February 2022, looking to extend telehealth measures, including the exemptions the DEA granted on prescribing drugs out of state.
With two bills in the Senate, ketamine teletherapy advocates are hopeful the issue will be taken seriously. Research around ketamine’s potential for mental health treatment is positive, yet there are still questions around addiction potential and risk of abuse — so how this information will make the cards fall for ketamine’s future is still difficult to predict.
