The use of ketamine in psychiatric treatment is generally unapproved and unregulated, with the exception of esketamine, an FDA-approved ketamine nasal spray for treatment-resistant depression. According to a recent New York Times article, the FDA has raised concerns about the misuse of ketamine in treating psychiatric disorder. The warning stems from reported adverse incidents, stressing that unsupervised use of ketamine elevates the risk of negative psychiatric reactions, heightened blood pressure, respiratory depression, and urinary tract problems, potentially leading to incontinence.
While off-label use of ketamine is not illegal, the regulatory ambiguity has created opportunities for misuse, as ketamine can be addictive. The growth of telehealth during the pandemic has led to an increase of online prescribers providing inexpensive ketamine in various forms. The FDA aims to differentiate between supervised ketamine therapy provided in clinics or wellness centers and online marketers who prescribe it remotely, where important risk information might be lacking or absent.