The American Society of Anesthesiologists is calling on policymakers to tighten oversight of at-home ketamine prescribing and delivery, warning that patient safety standards have not kept pace with a surging market.
The U.S. ketamine market has surpassed $5 billion, driven by a proliferation of clinics and telehealth companies prescribing the anesthetic off-label for depression, PTSD and other mental health conditions, according to a June 22 ASA news release shared with Becker’s. ASA projects the market will exceed $14 billion by 2035. In some cases, patients receive ketamine at home after only a remote screening — with no in-person evaluation or direct medical supervision.
ASA cited a 2025 death of a 41-year-old New York woman who was prescribed at-home ketamine through a telehealth company despite reporting use of Xanax, a combination the FDA has flagged as potentially fatal due to respiratory risk.
“We have grave concerns about the home delivery and use of ketamine,” said ASA President Patrick Giam, MD. “I’m concerned that without stronger regulation, we risk repeating another opioid-like public health crisis, particularly because many people underestimate the potential dangers of ketamine.” Dr. Giam added that patients can move rapidly from relaxed to deeply sedated, with no trained personnel available to respond.
ASA flagged three specific risks requiring physician supervision: breathing complications, dangerous increases in blood pressure and heart rate, and potential for misuse or diversion. The society responded to proposed Texas Medical Board rules on ketamine clinic oversight by urging even stricter safeguards. Georgia, Missouri and Utah have also introduced protective legislation.
ASA updated its guidance this month to specify that ketamine used for non-anesthetic purposes should meet the same safety and monitoring standards applied in hospital settings.
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