Caution Is Warranted in Prescribing Ketamine for Mental Health.
Journal of general internal medicine April 1, 2026 Katherine Drabiak 2 citations
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.