Approved and non-approved uses of ketamine
Approved uses of ketamine by the U.S. Food and Drug Administration (FDA)
Ketamine is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents. Ketamine is also indicated to supplement low-potency agents, such as nitrous oxide. Medicare does not have a National Coverage Determination for the use of Ketamine Injection in treatment of depression or pain management. Local Coverage Articles (LCDs) do not exist at this time.
Off-label uses of ketamine
Ketamine is investigational, and therefore not covered by insurance companies for:
I. Psychiatric disorders (including, but not limited to major depression, bipolar depression, OCD, and posttraumatic stress disorder)
II. Chronic pain (including but not limited to fibromyalgia, neuropathic pain, Complex Regional Pain Syndrome, Reflex Sympathetic Dystrophy
III. Migraine Headaches
What is ketamine?
Ketamine is a medicine developed more than 50 years ago for anesthesia during surgery, and has been used for that purpose since that time in children, adults, and animals. More recently, Ketamine has been found to be a valuable and highly effective treatment for depression, anxiety, and certain pain disorders.
Is ketamine a street drug?
Ketamine has been used at very high doses, illegally obtained for recreational use. It is abused on the streets and called “Special K” that sends it’s users into a psychedelic “K-hole”. The doses used for depression and pain treatments, however, are much lower. At doses used in our clinic, the abuse potential of ketamine is minimal. There is virtually no potential for addiction or abuse. In fact, IV ketamine can be used to treat opiate cravings.
Can ketamine be used for heroin cravings?
Yes, two published studies have demonstrated that ketamine is effective in treating opioid use disorder. Krupitsky et al. conducted a randomized controlled trial of 70 heroin-dependent participants in which they compared the efficacy of high dose ketamine (2 mg/kg IM) vs. low dose ketamine (0.2 mg/kg IM) in conjunction with psychotherapy. Abstinence rates at 1 month approached 85% in the 2 mg/kg group and were 24% at 1 year in the 2 mg/kg group. Craving was also notably reduced. They noted significantly greater reductions in heroin craving in the repeated treatment group as compared to the single treatment group.
Is nasal ketmine as good as IV ketamine?
No. Intranasal ketamine does not get absorbed into the body as efficiently as IV ketamine, and thus has a weaker effect at the same doses
as IV ketamine. Why use something that is not as effective when we know what is most effective?
What are the possible side effects of ketamine?
Ketamine is a dissociative anesthetic associated with significant neuropsychiatric, gastrointestinal, cardiovascular, and respiratory adverse effects that can vary depending on the dose and subject. Neuropsychiatric adverse events include sedation, vivid dreams or nightmares, hallucinations, out-of-body experiences, headache, dizziness, fatigue, changes in mood, altered vision and hearing, light-headedness, paresthesias, changes in taste, dysarthria, euphoria, and inebriation. Hemodynamic adverse effects include tachycardia, arrhythmias, and hypertension, whereas possible respiratory events include hypoventilation or hyperventilation, oxygen desaturation, and hypoxia. The majority of these adverse effects are transient and can be treated by lowering the rate of infusion or stopping it.
Can I stay on my home medications while receiving ketmine?
Most medications can be continued. There are very few medicines that can not be taken in combination with ketamine. For treatment planning purposes, please contact us with any questions regarding interactions between your current medications and ketamine.
Does insurance pay for IV ketamine treatment?
Insurance companies do not generally cover IV ketamine treatment. We do, however, provide you a free psychiatric evaluation and many insurance companies reimburse for this kind of service. We give you a receipt for services at the time of your appointment. While we can not guarantee any reimbursement, some of our patients with “out of network” benefits have been able to recoup a portion of their out of pocket costs. Call 949-549-9010 or email us at into@ketamineofsoutherncalifornia to discuss this further.
Does insurance pay for intranasal ketamine treatment?
With the arrival of intranasal ketamine, Spravato, there is a large push on behalf of Janssen Pharmaceuticals to have insurance companies cover the intranasal form of ketamine delivery. Insurance companies are starting to cover a portion of the treatments with Spravato. However, we do not find intranasal ketamine to be as effective as IV ketamine, so we are not offering Spravato at our clinic at this time.