ketamine clinic

[gomavs]

Alright, seeing more and more of these not run by psychiatrists. Have seen some ABEM folks running them. Some of them claim to have some advance training in addiction/psych..... most don't. Not sure how I feel about it. On one hand, it seems ripe for easy money and you may be able to benefit some folks. Most of us feel pretty safe with ketamine given how frequently we use it in the ED. I can't get past a few things though.

1)Scope of practice
- Are we qualified to treat people with a psychoactive drug for mental health disorders? Sure, it's generally safe but...

2)Safety
-The drug isn't without risk. Most hospital policies still require an anesthesiologist or ED MD and RT to be in the room to administer more than a sub dissociative dose. I can't really find much info on what kind of dosing these folks are doing but, in a pay to play environment I'd guess they are being heavy handed.

3)Future ramifications
-If any of ya'll are younger out there or have friends that are in other fields...ketamine is getting pretty popular as a recreational drug. While it isn't known to be harmful outside of rare instances like laryngospasm etc, I feel like this could be a ticking time bomb effect if **** goes sideways and the public comes after these after some bad outcomes. That being said, we are in a time of increasing deregulation for psychedelic therapeutics with mushrooms etc.

---

Members don't see this ad.

 

[Apollyon]

"Getting"? It's been a popular party drug for many years.

 

[bky3c]

"Getting"? It's been a popular party drug for many years.

Yep, we had a nurse who was found down in the ED bathroom after stealing some and using it during her shift about 10 years ago, and I assume she wasn't blazing new trails as far as recreational drugs go.

 

[jwk]

Doesn't have to be docs in a lot of states to open up these clinics. CRNAs and NPs are opening them right and left, frequently along with IV hydration, semaglutide, vitamin infusions, etc.

 

[sloh]

Doesn't have to be docs in a lot of states to open up these clinics. CRNAs and NPs are opening them right and left, frequently along with IV hydration, semaglutide, vitamin infusions, etc.

Semaglutide drives the effect of weight loss. Hitched on with a bunch of other shenanigans “you definitely need for the perfect cocktail.”

Cha-Ching.

 

[beebermd]

Ive been doing them in my office for about 2 years now. Its really not that big of a deal, assuming you are set up to handle any complications. It is only done while I am in office (not in the ER), I have a full crash cart and intubation/airway mgmt capability in my operating room. Ive never had to use them, as we are only using sub anesthetic doses, but its almost mandatory from a liability perspective. The more important part is using it in a way that is benefecial to the patient. There is a lot of information and studies out there. Its not a huge part of my practice as its really only indicated for like 5 condtions, so its really limited pool of patients. But ive had some great results in the patients that have undergone treatment. I see a lot of places that are dedicated ketamine ONLY clinics.........dunno about that. In order to sustain a buisness on ketamine alone, my first thought its they are treating everyone that comes through the door. Sketchy at best

 

[dozitgetchahi]

Note that nasal esketamine (Spravato) is now officially FDA approved for treatment resistant depression. It has a REMS and is administered in psych offices. I’m not sure what the advantage is of continuing with off label IV ketamine infusions for this, other than to generate $$$.

 

[VA Hopeful Dr]

Note that nasal esketamine (Spravato) is now officially FDA approved for treatment resistant depression. It has a REMS and is administered in psych offices. I’m not sure what the advantage is of continuing with off label IV ketamine infusions for this, other than to generate $$$.

Because not every psychiatrist does those.

 

[pazzer2]

Eskatamine (Spravato) is administered intranasally. It does have a 2 hour monitoring period (BP and respirations). Plus a lot of insurance providers will now pay for it. A lot easier than IV ketamine. I imagine that a lot of psych offices are not setup to handle the 2 hour monitoring so there seems to be a gap needing to fill.

 

[thegenius]

Eskatamine (Spravato) is administered intranasally. It does have a 2 hour monitoring period (BP and respirations). Plus a lot of insurance providers will now pay for it. A lot easier than IV ketamine. I imagine that a lot of psych offices are not setup to handle the 2 hour monitoring so there seems to be a gap needing to fill.

What is a standard, or range, of intranasal ketamine dosing? How many mg?

 

[pazzer2]

What is a standard, or range, of intranasal ketamine dosing? How many mg?

Not sure you can directly compare IV and intranasal dosing. The kinetics are a little different. But the Spravato label says that induction phase dosing is 56 mg on day 1, followed by 56-84 mg. Then either once weekly or every 2 weeks during maintenance phase.

 

[thegenius]

Not sure you can directly compare IV and intranasal dosing. The kinetics are a little different. But the Spravato label says that induction phase dosing is 56 mg on day 1, followed by 56-84 mg. Then either once weekly or every 2 weeks during maintenance phase.

Yea I figured there is no direct comparison. But there's about a 2:1 ratio between strength of IV vs IM, roughly speaking. That is...full induction dose of ketamine IV is 2 mg/kg vs 4 mg/kg IM. So giving basically 0.7 - 1 mg / kg IN...frankly...is higher than I expected.

What I was questioning is whether people need to have vitals monitored for 2 hours after getting the IN dose. that was the reason for my comment.

 

[pazzer2]

Yea I figured there is no direct comparison. But there's about a 2:1 ratio between strength of IV vs IM, roughly speaking. That is...full induction dose of ketamine IV is 2 mg/kg vs 4 mg/kg. So giving basically 0.7 - 1 mg / kg IN...frankly...is higher than I expected.

What I was questioning is whether people need to have vitals monitored for 2 hours after getting the IN dose. that was the reason for my comment.

Ok gotcha. Yes monitoring for 2 hours is required, even after a IN dose.