Non-Hispanic Black, Hispanic, and Asian patients with moderate-to-severe recurrent major depressive disorder received ketamine at lower rates than non-Hispanic White patients. Esketamine was used less often among Black patients, more often among Hispanic patients, and at similar rates among Asian patients compared with White patients. Black and White patients who received either treatment had more co-occurring medical and psychiatric conditions than those who did not. The findings indicate significant racial-ethnic disparities in access to these advanced therapies, especially for Black patients.
Racial-ethnic diversity is lacking in psychedelic science. Efforts to increase representation among clinical trial participants have been made but remain insufficient. This column describes the disparity, outlines potential benefits of eliminating it, and provides recommendations for achieving equity and justice in psychedelic treatment research for mental disorders.
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.