{"id":26668,"date":"2022-12-30T12:59:10","date_gmt":"2022-12-30T12:59:10","guid":{"rendered":"https:\/\/mailinvest.blog\/index.php\/2022\/12\/30\/this-doctor-prescribes-ketamine-to-thousands-online-its-all-legal\/"},"modified":"2022-12-30T12:59:10","modified_gmt":"2022-12-30T12:59:10","slug":"this-doctor-prescribes-ketamine-to-thousands-online-its-all-legal","status":"publish","type":"post","link":"https:\/\/mailinvest.blog\/index.php\/2022\/12\/30\/this-doctor-prescribes-ketamine-to-thousands-online-its-all-legal\/","title":{"rendered":"This doctor prescribes ketamine to thousands online. It\u2019s all legal."},"content":{"rendered":"<p> <a href=\"https:\/\/go.fiverr.com\/visit\/?bta=1052423&nci=17043\" Target=\"_Top\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" src=\"https:\/\/mailinvest.blog\/wp-content\/themes\/breek\/assets\/images\/transparent.gif\" data-lazy=\"true\" data-src=\"https:\/\/fiverr.ck-cdn.com\/tn\/serve\/?cid=40081059\"  width=\"601\" height=\"201\"><\/a>\n<\/p>\n<div>\n<div class=\"wpds-c-grBDNq hide-for-print mb-sm undefined\">\n<div class=\"PJLV PJLV-iAjpuP-css flex items-center\" config=\"[object Object]\" data-qa=\"article-actions\">\n<div class=\"wpds-c-fLphcs\">\n<div class=\"wpds-c-jmLDag wpds-c-jmLDag-bywHgD-variant-primary wpds-c-jmLDag-biynoz-density-compact wpds-c-jmLDag-hZSyid-isOutline-true wpds-c-jmLDag-ejCoEP-icon-left wpds-c-jmLDag-futxca-cv wpds-c-jmLDag-iknmtxO-css\"><button aria-label=\"Comment\" class=\"PJLV PJLV-iPnDcc-css\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewbox=\"0 0 16 16\" fill=\"currentColor\" aria-hidden=\"true\" focusable=\"false\" role=\"img\" class=\"wpds-c-kKAfCG wpds-c-efqEZa focus-highlight flex items-center justify-center brad-lg pointer transition-400 ease-in-out transition-colors\" aria-label=\"Comment on this story\"><title>Comment on this story<\/title><path d=\"M14 14V2H2v9.47h8.18L12.43 13ZM3 10.52V3h10v9.23l-2.5-1.66Z\"\/><\/svg><\/button><\/p>\n<p>Comment<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"teaser-content grid-center\">\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">In the past two years, Scott Smith has become licensed to practice medicine in almost every U.S. state for a singular purpose: treating depressed patients online and prescribing them ketamine.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The sedative, which is sometimes abused as a street drug, has shown promise in treating depression and anxiety. But instead of dispensing it in a clinic or under the strict protocols endorsed by the Food and Drug Administration, the South Carolina physician<b> <\/b>orders generic lozenges online for patients to take at home. He says this practice, though controversial, has benefited more than half of his 3,000 patients. \u201cPeople are beating a path to my door,\u201d he said in an interview.<\/p>\n<\/div>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith is part of a wave of doctors and telehealth start-ups capitalizing on<b> <\/b>the pandemic-inspired federal public health emergency <a href=\"https:\/\/aspr.hhs.gov\/legal\/PHE\/Pages\/covid19-13Oct2022.aspx\" target=\"_blank\" rel=\"noopener\">declaration<\/a>, which waived a requirement for health-care providers to see patients in person to prescribe controlled substances. The waiver<b> <\/b>has enabled Smith to build a national ketamine practice from his home outside Charleston \u2014 and fueled a boom among telehealth companies that have raised millions from investors.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">As the urgency around covid-19 subsides, many expect the waiver to expire this spring. Companies are lobbying to extend it, and patients are bracing for a disruption to purely virtual care.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cI would not have wanted to do this if I had to go to a clinic,\u201d said Steve, a Chicago resident who works in public relations and who spoke on the condition that<b> <\/b>his last name be withheld<b> <\/b>because of the stigma around<b> <\/b>the drug. Ketamine has helped his bipolar disorder more than any other medication, he said, and he wants to continue taking it. \u201cIt\u2019s just not going to happen, if that regulation changes.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p><span class=\"font--article-body font-copy hide-for-print ma-0 pb-md db italic interstitial\"><a data-qa=\"interstitial-link\" href=\"https:\/\/www.washingtonpost.com\/wellness\/2022\/09\/12\/ketamine-therapy-explained\/?itid=lk_interstitial_manual_10\">Ketamine for depression: What it feels like and who it can help<\/a><\/span><\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The Drug Enforcement Administration in 2020 <a href=\"https:\/\/www.deadiversion.usdoj.gov\/coronavirus.html\" target=\"_blank\" rel=\"noopener\">temporarily waived<\/a> the requirement that prescribers meet patients in person before treating them with several classes of drugs, from opioids to antidepressants. A DEA spokesperson said the agency is working on regulations to allow this permanently, but declined to provide details or a timeline.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">At least eight<b> <\/b>companies have begun providing ketamine by telehealth since the start of the pandemic. Between just Smith and two of the better known companies, Nue Life and Mindbloom, more than 10,000 patients have been treated at home. Virtual ketamine start-ups say they\u2019re making the treatment vastly more accessible and improving patients\u2019 lives. But many psychiatrists \u2014 including those who believe in ketamine\u2019s promise for treating mental illness \u2014 worry that having patients taking it outside a doctor\u2019s direct supervision is a step too far, too soon.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith, who thinks the federal waiver should be made permanent,<b> <\/b>is unbothered by critics who question the wisdom of mailing ketamine to patients at home. \u201cI\u2019m like a medic running around on the battlefield taking care of wounded people, and ketamine helps the people I\u2019m taking care of,\u201d he said.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Ketamine has long been <a href=\"https:\/\/pubs.asahq.org\/anesthesiology\/article\/113\/3\/678\/10426\/Taming-the-Ketamine-Tiger\" target=\"_blank\" rel=\"noopener\">used in hospitals<\/a> for anesthesia and <a href=\"https:\/\/www.dea.gov\/sites\/default\/files\/2020-06\/Ketamine-2020.pdf\" target=\"_blank\" rel=\"noopener\">abused recreationally<\/a> for its mind-altering properties. But in recent years, it\u2019s shown promise for delivering rapid relief to patients with mental health conditions who\u2019ve tried conventional antidepressants without success.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p><span class=\"font--article-body font-copy hide-for-print ma-0 pb-md db italic interstitial\"><a data-qa=\"interstitial-link\" href=\"https:\/\/www.washingtonpost.com\/wellness\/2022\/09\/12\/ketamine-depression-treatment-research\/?itid=lk_interstitial_manual_17\">Nothing seemed to treat their depression. Then they tried ketamine.<\/a><\/span><\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The FDA <a href=\"https:\/\/www.washingtonpost.com\/health\/2019\/03\/06\/biggest-advance-depression-years-fda-approves-novel-treatment-hardest-cases\/?itid=lk_inline_manual_18\" target=\"_blank\" rel=\"noopener\">approved a nasal spray<\/a> derived from ketamine, Spravato, in 2019 to treat severe depression. But that approval came with <a href=\"https:\/\/www.spravatorems.com\/\" target=\"_blank\" rel=\"noopener\">strict guardrails<\/a> to ensure patient safety, a nod to known side effects such as altered consciousness and increases in blood pressure.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The FDA requires that patients be monitored by health-care professionals for two hours after they take Spravato, in addition to mandating certain steps for clinics and pharmacies.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Those safety measures may have an unintended consequence, some ketamine scholars say: Rather than go through the extensive FDA requirements, more patients and doctors may turn to what is known as \u201coff-label\u201d ketamine, ordering the generic variety the FDA has approved for anesthesia to instead treat depression. Ketamine clinics have opened up across the nation to provide the generic version through an IV infusion.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Now, with the federal waiver of requirements to treat patients in person, more health-care professionals \u2014 and venture capital-backed start-ups \u2014 are prescribing ketamine in the form of dissolving tablets that patients can take at home.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The growing use of off-label ketamine outside direct medical supervision has <a href=\"https:\/\/ajp.psychiatryonline.org\/doi\/10.1176\/appi.ajp.2020.20101480\" target=\"_blank\" rel=\"noopener\">aroused concern<\/a> among some psychiatrists who worry there isn\u2019t enough evidence to show it\u2019s safe.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cI\u2019m very concerned about treatments that deviate too far from the standard recommendations given by the FDA,\u201d said Gerard Sanacora, director of the Yale Depression Research Program who led a team that pioneered ketamine to treat depression. \u201cI really do believe that it is one of the major advances of psychiatry in the past half-century,\u201d he said of ketamine, \u201cbut we have to be very careful to continue to develop this responsibly.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cI understand the concern,\u201d said Juan Pablo Cappello, chief executive of Miami-based Nue Life, launched in 2021 to provide virtual ketamine therapy. \u201cBut what I really spend my time thinking about is suffering that\u2019s going on today and how to alleviate it,\u201d he said.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Among telehealth ketamine companies, the details vary but the model is similar: Patients meet with a doctor virtually to determine whether ketamine therapy is appropriate. If so, a provider orders generic ketamine lozenges from a pharmacy. The patient is mailed a dose, with instructions to have a \u201csitter\u201d present while they take the ketamine and how to follow up after the experience. Prescribing practitioners work with patients to adjust the dose and monitor their symptoms.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The telehealth model allows ketamine providers to offer the treatment at a lower cost than infusion clinics, which can run hundreds of dollars per session.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p><span class=\"font--article-body font-copy hide-for-print ma-0 pb-md db italic interstitial\"><a data-qa=\"interstitial-link\" href=\"https:\/\/www.washingtonpost.com\/wellness\/2022\/10\/10\/how-to-know-depression-from-sadness\/?itid=lk_interstitial_manual_35\">How to know if it\u2019s depression or just \u2018normal\u2019 sadness<\/a><\/span><\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cAt-home ketamine has increased accessibility for those who may not have access to ketamine clinics due to physical location, cost and time commitments,\u201d Ryan Magnussen, chief executive of ketamine provider Wondermed, said in a statement.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Beyond pitching their affordability, telehealth providers are trying to translate their patients\u2019 experiences into scientifically rigorous proof that ketamine is safe and effective to take at home. Company websites highlight research findings alongside images of blissful-looking people in warm hues, though the scientific claims at times lack context.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Nue Life, for instance, cites an American Psychiatric Association <a href=\"https:\/\/adaa.org\/sites\/default\/files\/Ketamine%20JAMA%20Journal%20Article%20-%20Charlie%20Nemeroff.pdf\" target=\"_blank\" rel=\"noopener\">publication <\/a>that ketamine\u2019s effects are \u201c<a href=\"https:\/\/web.archive.org\/web\/20221223165714\/https:\/\/intercom.help\/nuelife\/en\/articles\/6783303-is-ketamine-legal\" target=\"_blank\" rel=\"noopener\">rapid and robust<\/a>\u201d without mentioning another passage in the same paper: \u201cwe strongly advise against the prescription of at-home self-administration of ketamine.\u201d The association still maintains this view.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Wondermed proclaims that \u201c<a href=\"https:\/\/web.archive.org\/web\/20221215231002\/https:\/\/www.wondermed.com\/\" target=\"_blank\" rel=\"noopener\">over 90%<\/a>\u201d of patients see an improvement in anxiety and depression \u2014 but that is among those who have reported on their well-being, and some 40 percent have not.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Mindbloom similarly touts that <a href=\"https:\/\/web.archive.org\/web\/20221220175537\/https:\/\/www.mindbloom.com\/\" target=\"_blank\" rel=\"noopener\">89 percent of its clients<\/a> report improvement for these conditions, but that figure comes from a study where more than half of participants didn\u2019t report any follow-up data.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Despite the incomplete data, the <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0165032722007625\" target=\"_blank\" rel=\"noopener\">study <\/a>is a point of pride for Mindbloom. Dylan Beynon, Mindbloom\u2019s chief executive<b> <\/b>and a ketamine patient himself, said it is the largest-ever peer-reviewed study on ketamine therapy, showing that 63 percent of 1,247 patients had a clinically significant improvement in their anxiety and depression and fewer than 5 percent reported side effects.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The study had<b> <\/b>significant limitations. It didn\u2019t compare ketamine treatment with a control group receiving a placebo, the gold standard for gauging a drug\u2019s safety and impact.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Sanacora, the ketamine specialist at Yale, objected to the conclusions of the Mindbloom study, which described<b> <\/b>ketamine by telehealth as \u201csafe and effective.\u201d<b> <\/b>In a <a href=\"https:\/\/docs-cdn-prod.news-engineering.aws.wapo.pub\/publish_document\/ffc60069-e959-433d-9a9f-c69a7a582a19\/published\/ffc60069-e959-433d-9a9f-c69a7a582a19.pdf\" target=\"_blank\" rel=\"noopener\">letter <\/a>to the journal that published the study, he and a colleague wrote,<b> <\/b>\u201cWe think the authors\u2019 conclusions go well beyond the data.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Mindbloom said the study was open about its limitations. \u201cIt\u2019s also important to understand how well a treatment works for people in the real world,\u201d the company said in a statement attributed to Thomas Hull, the paper\u2019s lead author.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">The company CEOs uniformly believe that telemedicine is here to stay but are preparing for the expiration of the federal waiver, including making plans to open physical clinics.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Mindbloom, one of the more established ketamine telehealth firms, reports operating in 35 states and Washington, D.C. But even that reach doesn\u2019t match one doctor in South Carolina.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">As a doctor working in an emergency room in the early 1990s, Scott Smith knew ketamine as a drug he used to sedate patients. His understanding began to shift with the experience of his wife, who after  suffering from depression tried ketamine infusions.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cI had lost the person I had married,\u201d he said. After her ketamine treatment, \u201cI got my college girlfriend back. That was a life-changing event.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith describes himself as a \u201cperson who gets obsessed with things.\u201d He took up quilting after watching \u201cProject Runway\u201d and acquired five sewing machines. When he got into gardening, he threw himself into researching plants that could thrive in his completely shaded yard. He bought a fixer-upper house and did the electrical and plumbing work himself, he said. Ketamine is his latest fixation.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith closed his brick-and-mortar family practice during the pandemic to focus on ketamine by telemedicine, where patient demand was higher. People began reaching out to him on Reddit, where he posts under the handle <a href=\"https:\/\/www.reddit.com\/user\/KetamineDrSmith\/\" target=\"_blank\" rel=\"noopener\">KetamineDrSmith<\/a>, to see if he could treat them.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">With the federal public health emergency declaration, he could. It just took getting licensed in states where patients lived, he said. He went all in, obtaining licenses in 45 states in addition to South Carolina, according to a Washington Post review of state licensing databases. His Louisiana license expired in May. In July, an <a href=\"https:\/\/arc-sos.state.al.us\/ucp\/L0929893.AI1.pdf\" target=\"_blank\" rel=\"noopener\">Alabama law<\/a> required telehealth providers to meet patients in person to prescribe a controlled substance like ketamine.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Initially, \u201cit was like building a bridge while you\u2019re driving across it,\u201d Smith said. Catherine Smith, his wife and medical assistant, added, \u201cWe\u2019re really saving more lives than we ever did in our primary care practice.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith estimates that about 5 percent of patients who come to him aren\u2019t good candidates for ketamine therapy, and he declines to treat them. Occasionally, younger patients will ask for a prescription simply because they want to try the drug.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cThey think it\u2019s like an internet service,\u201d he said, \u201clike there\u2019s a drive-through window at McDonald\u2019s for ketamine.\u201d Smith only treats patients for a legitimate medical purpose, he said, usually for depression, anxiety or post-traumatic stress disorder.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">His patients generally pay $250 a month, which includes a supply of ketamine \u2014 10 tablets at a time \u2014 and follow-up visits with a nurse practitioner, medical assistant or other members of his eight-person practice. More than half respond well, he said, and he will prescribe ketamine for six months and then encourage them to stop taking it.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Ketamine doesn\u2019t carry the same risk of addiction or overdose as opioids, but side effects can range from unpleasant, disorienting sensations \u2014 what some might call a \u201cbad trip\u201d \u2014 to being temporarily immobilized.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cSo if somebody took a dose of ketamine that was way too high and their house caught on fire, they wouldn\u2019t be able to leave the house,\u201d Smith said.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">At first, Smith scheduled virtual appointments with patients in the evening and would stay by his computer for 90 minutes. \u201cIt was so incredibly uneventful and such a poor use of my time,\u201d he said. \u201cIf a competent adult has somebody to sit with them, that\u2019s adequate.\u201d<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">By taking ketamine orally, patients absorb less of the drug, and more slowly, than they do when it is administered through an IV. Smith believes this reduces the risk of side effects, citing the <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0165032722007625\" target=\"_blank\" rel=\"noopener\">Mindbloom study<\/a> and another <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.992624\/full\" target=\"_blank\" rel=\"noopener\">study by Nue Life<\/a>.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Because he doesn\u2019t physically watch patients take ketamine, Smith acknowledges it is possible for them to use the drug inappropriately \u2014 taking multiple doses at once to get a high, for instance, or selling the ketamine to others. Still, he says, he has ways of holding patients accountable, such as having them do a \u201cpill count\u2019 on screen to see if they are taking the doses as directed.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cThis is a part of my job I take very seriously,\u201d he said. \u201cI can have my medical license taken away. I can be fined, can do jail time for continuing to treat people\u201d who are abusing ketamine, he said. Of some 3,000 patients, he said there have only been two who wanted to abuse the drug, and he stopped prescribing and arranged follow-up care for them.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">Smith knows his practice is controversial but isn\u2019t concerned. \u201cWhat is the risk versus benefit, is the question society needs to ask,\u201d he said. Rather than returning to pre-pandemic regulations where he would have to consult patients in person, Smith says the key to making ketamine therapy safer is for the DEA to create a registry and closely monitor the drug\u2019s prescribers.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cPut everybody under a microscope,\u201d he said.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">But should the waiver that has allowed him to practice nationally expire, he has a plan: hit the road.<\/p>\n<\/div>\n<div class=\"article-body\" data-qa=\"article-body\">\n<p data-qa=\"drop-cap-letter\" data-el=\"text\" class=\"wpds-c-cYdRxM wpds-c-cYdRxM-iPJLV-css font-copy\">\u201cI would buy an RV,\u201d he said, comparing the prospect of meeting his virtual patients to reunions with people he\u2019s come to know through internet games. \u201cNothing would thrill me more than to meet these people in person,\u201d he said.<\/p>\n<\/div>\n<section class=\"dn-ns hide-for-print\" data-testid=\"mostRead\" subscriptions-section=\"content\"\/><\/div>\n<iframe data-lazy=\"true\" data-src=\"https:\/\/www.fiverr.com\/gig_widgets?id=U2FsdGVkX18x7XQvttUTrv1oEqmGNGTgvvCUiUoJ\/AP4z\/UyMz8lXGOLpu15jIMxBbTR0gmD5uBoFvhC4KWeALQRp3h\/X\/AwcVD0K8Wj9H\/ZzYKzcCNHosB9oS4SCJJFWiN85P9ICAc4OgCoE\/wHKIY7CDkf2\/DQ1vqGvk4smVe5cRDEmrLPCWi4FC8p40VUhSmWQ5udCm0zoJtorgWv3vbDQw0kKYkwn39ozAnQXDe+YvWMxkLFWA+O3TFwkJvdkIK+\/AUSnRssPKt5WHY0FhNOxnSPcLslEL4G4\/RfP95ve99U+kRnDy3X+KtzdQLY+u935ghON\/o3UE4IMv9oN6JX9RnxzL\/LRcOgnHigxStSGPKsZYtnz8RWNVT\/rOLAibqiWJadC5MYHRbekF3eg6FOGrQGkXYbsn0+a5aovnlLCbLwIqY9fcS17UX8J235iQ6cdmHNbrPeS84CMm34RA==&affiliate_id=1052423&strip_google_tagmanager=true\" loading=\"lazy\" data-with-title=\"true\" class=\"fiverr_nga_frame\" frameborder=\"0\" height=\"350\" width=\"100%\" referrerpolicy=\"no-referrer-when-downgrade\" data-mode=\"random_gigs\" onload=\" var frame = this; var script = document.createElement('script'); script.addEventListener('load', function() { window.FW_SDK.register(frame); }); script.setAttribute('src', 'https:\/\/www.fiverr.com\/gig_widgets\/sdk'); document.body.appendChild(script); \" ><\/iframe>\n<br \/><a href=\"https:\/\/www.washingtonpost.com\/business\/2022\/12\/30\/ketamine-telemedicine-covid-emergency\/?utm_source=rss&#038;utm_medium=referral&#038;utm_campaign=wp_business-technology\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Comment on this story Comment In the past two years, Scott Smith has become licensed to practice medicine in almost every U.S. state for a&#8230;<\/p>\n","protected":false},"author":1,"featured_media":26669,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-26668","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tech-universe"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>This doctor prescribes ketamine to thousands online. 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