Death of Matthew Perry: What is ketamine, the ‘new fentanyl’ against pain?

Matthew Perry, actor recognized for his role as Chandler Bing in the series Friends, died last October 28 at his home; The autopsy, released this Friday, revealed the discovery of ketamine in your body, a surgical drug that is also a dissociative drug.

As American doctors reduce the use of opioid painkillers, a new option for difficult-to-treat pain takes hold: ketaminea decades-old surgical drug that has become a psychedelic therapy Fashion.

Ketamine prescriptions have skyrocketed in recent years, fueled by for-profit clinics and telehealth services that offer the drug as a treatment for pain, depression, anxiety and other conditions. The generic medicine can be purchased at a low price and be prescribed by most doctors and some nurses.

Although there is limited research on its effectiveness against painsome experts fear that the United States is repeating the mistakes that led to the opioid crisis: Overprescribing a questionable medication that has important security risks and abuse.

“There is a shortage of options for pain, so there is a tendency to just choose the next thing that is available that can make a difference,” said Dr. Padma Gulur, a pain specialist at Duke University who studies the use of ketamine. “A medical journal publishes some articles that say, ‘Oh, look: this is doing good things,’ and then there is rampant use to unauthorized useswithout necessarily science being behind it.”

Gulur and his colleagues followed 300 patients receiving ketamine at Duke and more than a third reported side effects that required professional attention, such as hallucinations, disturbing thoughts and visual disturbances.

Ketamine also did not lead to lower rates of opioid prescribing in the months after treatment, a common goal of the therapy, according to Gulur. Her research is under review for publication in a medical journal.

How did Kentamine come about and what is it used for?

Ketamine was approved more than 50 years ago as a powerful anesthetic for patients undergoing surgery. In lower doses, can produce psychedelic experiencesmaking it a popular club drug in the 1990s. With its recent adoption for pain, patients are increasingly experiencing those same effects.

Daniel Bass, of Southgate, Kentucky, found the visual disturbances “horrible.” His doctors prescribed him intravenous infusions four to six hours of ketamine for pain related to a rare bone and joint disorder. Sitting in an empty hospital room, with no stimulation or guidance about the psychological effects of the drug, Bass says he felt “like a lab rat.”

However, he credits ketamine with reducing his pain during the year when he received twice-monthly infusions.

“No matter how horrible an experience is, if it allows me to be more functional, I will do it,” Bass said.

Ketamine targets a brain chemical messenger called glutamate, which is believed to play a role in both pain and depression. It is unclear whether the psychedelic experience is part of the drug’s therapeutic effect, although some professionals consider it essential.

“We want patients to dissociate or feel separated from their pain, depression or anxiety,” said doctor David Mahjoubi, owner of Ketamine Healing Clinic in Los Angeles. “If they feel like they’re just sitting in the chair all the time, we actually give them more.”

The Mahjoubi practice is typical of the burgeoning industry: It offers intravenous ketamine for alcohol addiction, chronic pain, anxiety and post-traumatic stress disorder. Doses of the drug for those indications are well below those used for surgery, but Mahjoubi prefers higher doses for pain than for psychiatric conditions.

Patients pay cash because most insurers don’t cover nonsurgical uses of ketamine, none of which are approved by the Food and Drug Administration (FDA). Mahjoubi’s training is in anesthesiology, not psychiatry or addictions.

Patients may pay more for nasal sprays and ketamine tablets to use between infusions. Those formulations are also not approved by the FDA and they are prepared by specialized pharmacies.

Delivering ketamine by conventional mail has become a profitable business for telehealth services, such as MindBloom, which jumped into the space after regulators relaxed online prescribing rules during the COVID-19 pandemic.

Pain specialists who study ketamine say there is little evidence for those versions.

“Information on nasal and oral formulations is quite scarce,” said Dr. Eric Schwenk of Thomas Jefferson University. “There’s just not a lot of solid evidence to guide you.”

Demand for ketamine has caused prescriptions to skyrocket more than 500 percent since 2017, according to Epic Research. Every year, the pain was the main condition for which ketamine was prescribed, although its use for depression has increased rapidly.

The rise in prescriptions has led to shortages of manufactured ketamine, boosting sales of compounded versions.

There is more evidence for the use of ketamine against depression than against pain. In 2019, the FDA approved a ketamine-related chemical developed by Johnson & Johnson against severe depression. The drug, Spravato, is subject to strict FDA safety rules about where and how doctors can administer it.

Pain society guidelines point to some evidence of ketamine use for complex regional pain syndrome, a chronic condition that typically affects the extremities. But experts found “weak or no evidence” of ketamine in many more conditions, including back pain, migraines, fibromyalgia, and cancer pain.

Why can’t the FDA regulate the use of Kentamine?

While the science behind ketamine is murky, the business model is clear: Doctors can buy ketamine for less than 100 dollars the vial and charge between $500 and $1,500 per infusion.

The recent boom has been fueled, in part, by venture capital investors. Another set of consulting companies offers to help doctors establish new clinics.

A blog post from one—Ketamine Startup—lists “Five reasons why you should open a ketamine clinic,” including: “To be your own boss” and “To take control of your ability to make money.”

Clinics face increasing competition from telehealth services like MindBloom and Joyous, which connect potential patients with doctors who can prescribe ketamine remotely and send it by mail.

The current landscape is “wild territory,” said Dr. Samuel Wilkinson, a psychiatrist at Yale University who prescribes both Spravato as ketamine for depression. American doctors have “plenty of room for maneuver” to prescribe drugs for unapproved or other than approved uses.

“There are good things in that and not so good things,” he added.

In high doses, ketamine can cause bladder damage, which is sometimes seen in people who use the drug recreationally. Much less is known about the neurological effects of long-term use. Ketamine was linked to brain abnormalities in studies with rats, FDA regulators say.

Last month, the FDA issued a warning doctors and patients against compounded versions of ketamine, including tablets and tablets, as the agency does not regulate their contents and cannot guarantee their safety; However, most compounding pharmacies are small operations, overseen by state officials, not the FDA.

Likewise, the FDA has little influence over doctors who promote ketamine, even those who make exaggerated or misleading claims.

Drugmakers are subject to strict FDA regulation of how they promote their drugs — with requirements to balance information about risks and benefits. Those rules don’t apply to doctors.

Even when the FDA has tried to regulate risky in-office procedures, such as scientifically unproven stem cell infusions, the agency has had a mixed record in the courts.