The guidance warns that ketamine should only be prescribed and administered by trained healthcare professionals. While it is a dangerous controlled substance, some states allow patients to procure ketamine via mail.
The ASA warns patients against receiving ketamine at home or at nonaccredited outpatient clinics, due to improper monitoring, rescue personnel or emergency resuscitation equipment available.
Ketamine can cause high blood pressure and slowed breathing, respiratory failure, cardiac issues and seizures, if issued improperly.
Ronald Harter, MD, professor of anesthesiology at The Ohio State University Wexner Medical Center in Columbus and past president of the America Society of Anesthesiologists, spoke with Becker’s about the new ASA guidelines and effective pain management alternatives.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Why did the ASA feel it important to put out a notice on ketamine at this time?
Dr. Ronald Harter: I think following Matthew Perry’s unfortunate passing, when it was evident that ketamine was one of the main drugs in his system, that led to a lot of coverage in the media from various sources talking about ketamine. Some of those comments were very much in line with what ASA would say was appropriate and reasonable, but I personally saw a comment from someone who was a supposed expert saying you can’t overdose on ketamine. That’s absolutely not right and a very dangerous statement.
The other thing we became aware of was that there are some places in the country where people can get ketamine delivered to their homes, with directions that someone has to monitor you. Anesthesiologists have been using ketamine for decades. I’ve been in anesthesia for over 30 years and it was a tried and true drug when I started. We have been using it for various sedative indications for years and so we have the greatest level of understanding of the potential risk and side effects of it. We thought it would be a good service to the public to increase awareness if someone is saying, “It’s ketamine, it’s safe, take it in your home.” This, hopefully, will be something patients can do some research on and run across our statement and look at the proper settings.
Q: What other pain alternatives is ASA eyeing right now?
RH: Certainly, we have been at the forefront of multimodal opioid sparing, analgesics for chronic pain, acute pain post operatively, so with things like regional nerve blocks before surgery before or after surgery, they can facilitate that. There is a new non-opioid analgesic that Vertex Pharma came out with that appears to have a role in being another non-opioid option for treatment of pain. Opioids have their niche, but there’s also appropriate concern about adverse effects. Having options for treating pain that don’t rely on opioids is an important part of that. Any other tools in the toolbox for treating pain is something we are very interested in and very much want to incorporate.
