Caution Is Warranted in Prescribing Ketamine for Mental Health.
Journal of general internal medicine April 1, 2026 DOI: 10.1007/s11606-025-10024-8 via PubMed
Summary
Ketamine has become a multibillion-dollar industry for mental health treatment in the USA, with three delivery models: in-person clinics offering off-label racemic ketamine, clinic visits for esketamine (Spravato), and telehealth services prescribing off-label racemic ketamine, the latter accounting for about half the market. The article describes legal changes enabling telehealth-only providers, differences in patient monitoring requirements, and implications for patient safety. Providers should evaluate whether sound evidence exists for off-label prescribing, whether benefits outweigh risks, and whether it serves the patient's best interests, noting that ketamine's dissociative properties raise concerns about appropriate prescribing under controlled substance laws.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Citations | 2 |
| Key finding | Telehealth services prescribing off-label racemic ketamine account for about half the ketamine market, and providers should evaluate evidence, risk-benefit, and patient best interests when considering off-label prescribing. |
Abstract
Clinics across the USA advertise ketamine as an alternative solution for mental health conditions. Ketamine has expanded into a multibillion-dollar industry, with three delivery models: (1) in-person clinics offering off-label racemic ketamine; (2) clinic visits for esketamine (Spravato); and (3) telehealth services prescribing off-label racemic ketamine. About half of the market encompasses telehealth using off-label prescribing. This article describes the legal changes behind the growth of telehealth-only providers, differences in patient monitoring requirements, and implications for patient safety. While providers can legally prescribe medications off-label, providers should consider three questions to determine whether off-label prescribing is clinically and ethically appropriate. Providers should evaluate: (1) whether sound evidence exists to prescribe; (2) whether drug benefits outweigh the risks; (3) and whether prescribing serves the patient's best interests. As a dissociative anesthetic, ketamine raises significant concerns regarding whether the purpose and function of the drug meet legal requirements for appropriate prescribing of controlled substances.