Several months ago, I was working with the Palliative Care docs on a patient with incredibly challenging pain control issues. Ultimately we were able to get the patient on ketamine infusions.
Fortunately for me, PallCare had done all the heavy lifting before I ever came on the scene. As I recall, there are potential state and institutional issues. Though ketamine is legal in my state, I guess there was significant pushback from the hospital when this was started. Eventually, a protocol was adopted to allow inpatient ketamine infusions for pain control.
The challenge becomes if you're sending people home on ketamine (e.g. to home hospice). I remember a lot of phone calls being made to area pharmacies to find one willing to work with us. We were eventually successful. I believe there's something about the stability of ketamine, the legality, or maybe both, because I think we needed to arrange frequently home deliveries (like, 3x a week).
Two things I learned:
1) Ketamine worked when nothing else did. This patient was in agony and we were using high doses of everything else with minimal efficacy. It was a drastic improvement.
2) I would start with your local Palliative Care and/or Hospice docs. Even if they don't have avenues in place for you, I imagine you'll find them easy allies down the road.
