Dangerous ketamine clinics

The clinics we need to worry about aren’t necessarily dirty back-room operations. They have nice-looking websites, use all the right buzzwords, and offer convenient services in comfortable offices at reasonable prices.

Consider the following quotes from a website advertising a new clinic:

The (clinic name) offers exciting and cutting-edge IV infusions for the treatment of Depression, Bipolar Disorder…. administered by .…a highly experienced ….anesthesia provider that holds a national board certification in anesthesia by the NBCRNA.

Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression…..We are Now Accepting Appointments. We welcome same day appointments, call us today to schedule…. Introducing our NEW Membership pricing option. Buy a membership for $(price) per month and receive discounted infusions…. If you are currently suffering from suicidal thoughts, please contact your local crisis center or call 911.

When the provider from this clinic advertised their services on a ketamine-related message board, I replied with the following question:

Please explain how a clinic can claim to ‘treat’ psychiatric disorders without requiring that their patients be properly diagnosed and monitored by a qualified mental health professional. I mean, if your patients are self-medicating a condition they self-diagnosed, how is that different from recreational drug use? And if your patients really have serious psychiatric disorders, wouldn’t they actually need mental health services, and not just whatever you’re offering?

I’m not saying this just to be obnoxious — I would really like to understand the logic behind a clinic like this. And I’d also like you to understand my serious reservations about it as a patient who is doing well receiving ketamine for severe, treatment-resistant depression.

I want the treatment that saved my life, and the lives of so many others, to be given safely and taken seriously. I don’t want psychiatrists to continue to refuse to work with patients who are benefiting from this treatment. I want the treatment to someday be covered by insurance, and I want people to stop acting as if patients like us are just taking stupid risks to get high. For these reasons I am concerned that clinics like yours are hurting people like us.

The provider quickly answered:

We understand your concern….Here, we do not diagnose mental illnesses and we make that very clear to all of our patients. We require that every mental health patient is diagnosed by and remains under the care of a mental health professional. In fact, we mandate that they provide us with the name, address and phone number of their mental health provider.

…we aim to offer an ancillary ketamine infusion service that most mental health providers support but are not willing to provide themselves. We are able to confidently administer a GENERAL ANESTHETIC in any setting and we are trained to manage any and all possible serious life threatening complications including acute tachycardia, severe hypertension, cardiac dysrhythmias and loss of patient airway… 

I answered:

I completely understand that mental health professionals rarely administer ketamine themselves (for good reasons) and think it is great that specialists are stepping up to provide ketamine to psychiatric patients on a consultant basis.

But given that this treatment is for patients at high risk for suicide, psychosis, mania, and other dangerous/severe symptoms, I do have an issue with advertising same-day service with no referrals required, even if you do ask for an address/phone number. There is a difference:

– A referral indicates that a mental health professional who has thoroughly evaluated the patient agrees that ketamine is appropriate for their diagnosis and treatment history, knows the patient will be receiving ketamine, and is on board to monitor the patient’s mental health and coordinate their care throughout this process.

– An address and phone number indicates that the patient has a mental health professional’s address and phone number.

The provider replied:

Thank you for your response. I would like to respond to your comments above which are based on assumptions and not on our current policies or procedures. Let me clarify, at (clinic name) we only treat uncomplicated unipolar and depressive phase of bipolar disorders without referral. We do NOT treat patients that are actively suicidal nor do we treat any patients without referral if we feel we may be putting them at risk of further mental health complications. We perform mania, psychosis and suicidal ideation screenings on all patients prior to Ketamine therapy. These type of screenings do not require mental health certifications or degrees to conduct. Patient safety is our priority and we are extremely confident that our current policies and procedures that are in place ensure the safety and continuity of care for all of our patients.

I was speechless. But here’s what goes unsaid:

No, I’ve thoroughly read your website and what you’ve said right here about your policies and procedures.  My concerns aren’t just “based on assumptions.”

 You said: “Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression,” which implies that you consider “most cases” of unipolar or bipolar depression to be “uncomplicated.” But patients with these disorders ARE at high risk for mental health complications by definition. Just because someone denies manic, psychotic and suicidal symptoms before their infusion doesn’t mean they won’t encounter these or other serious mental health symptoms before or after they leave your office. And why would someone with truly “uncomplicated” depression require an experimental treatment like ketamine infusions anyway?

That you are “extremely confident” making complex clinical decisions based on a few screening questions shows a profound lack of judgment. Mental health screening questions are just tools, and how much training is required to use them depends on what you’re using them for.  People don’t need specialized training to use a knife as a tool for spreading butter, but they sure better have that training if they want to use that tool to perform brain surgery! While you say you will not treat patients if you “feel” you may be putting them at risk, you are making this decision with neither the necessary patient assessment data nor the necessary expertise to able to use your feelings as a gauge of mental health risk.

A clinic like this is a tragedy waiting to happen.

4 thoughts on “Dangerous ketamine clinics

  1. Ketamine saved my life.

    This issue is about the tragedies that will occur, if not in this centre, in another one, for desperate people seeking help where Ketamine is not being administered safely.

    It’s also about the tragedy of people like me who could have their lives returned to them, but who are likely to be casualties of a backlash that turns back the clock to the time when there was no hope.

    Thank you for writing this.

    Liked by 2 people

  2. I fully agree with the content of this post, but wanted to provide another perspective. For the last ten years, at least, I have suffered from depression. Though this is not the correct definition, to me it was “treatment resistant” because I refused (likely as a symptom) to seek treatment. I had been formally diagnosed a few times, but I just refused to do therapy or take medication. I saw my depression as a weakness in my character, and refused to accept that taking a pill or speaking to someone who is paid to listen could help. Instead, at one point I burned through all my savings and spent 2 years in bed. The rest of the time I just suffered. I think my story is reasonably typical.

    Recently, it got so bad that I couldn’t take it anymore. Despite being highly skeptical of the ketamine reports I had read, I had nothing left to lose. I contacted a local clinic, run by a seemingly legit doctor. I was blown away at how easily they accepted me for treatment. They asked for my doctors contact info, which I provided (to learn later he had retired 3 years prior). I was honest in that I had never tried anti depressants. It was very clear to me that this place was more interested in injecting me than anything else, but I went for it. They were professionally staffed and I did feel like it was a safe medical facility, but I was very aware that they were not going to do any more than run the IV. The checklist surveys and follow up mood monitoring seemed like an attempt to “tick the boxes” to appear as a mental health provider.

    Had there been any more barriers to entry at this clinic, I may not be here to write this now. The fact that this treatment was available to me so easily is the only reason I did it. As a result, a window opened that has allowed me to evaluate myself from a different perspective. I can best describe it as wearing dirty glasses. I could still see enough to scrape by in life, but until ketamine cleaned them I had no idea just how dirty they were. The filter that my thoughts were running through became so normal to me that I did not even realize it was there. I have introduced new healthy behaviors that I have always known were needed but were impossible to sustain. I am seriously considering seeking professional help, voluntarily. When the direct results of my infusion wear off (I am 9 days from the last treatment) I expect the realizations to persist, which should at least provide me with some tools to cope. Knowing that I can go get a booster or lozenges is a great comfort.

    So, while I fully agree that clinics practicing in an unsafe manner is unacceptable, I probably owe my life to the minimal acceptance criteria of the clinic I visited.

    I know this post is quite old, but I am leaving this comment in the hopes that someone in my situation, doing research as I did (and continue to do) may find it and relate. If that person is reading this, please be careful, do your homework, and use your best judgement. I am also quite interested in the blog author’s thoughts.

    Liked by 1 person

    • Thank you for this response, which is so well-explained. I’m also really glad the clinic was able to help you. Your story highlights that there remain so many obstacles to people getting the help they need, and that in addition to making ketamine safer as an option, the mental health field and the rest of society need to make it less hard for people to pursue treatment.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s