When Off-Label Ketamine Meets Direct-to-Consumer Telehealth: Liability Risks and Ethical Responsibilities.
Psychiatric services (Washington, D.C.) July 1, 2026 Joshua Mitchell, Benjamin Bregman, Renuka Surujnarain et al.
Telehealth platforms expanded access to mental health care during the COVID-19 pandemic, including online prescribing of ketamine for off-label psychiatric use. A wrongful death lawsuit against a telehealth ketamine provider illustrates how combining off-label prescribing with on-demand delivery can weaken clinical safeguards. With limited oversight of many telehealth platforms and the drugs they prescribe, responsibility for patient safety falls heavily on clinicians. To sustain responsible care, structures must support robust clinical relationships, monitoring, and accountability.