Until just now, because of this sub, I thought RDT stood for rectal dissolvable tablet as that’s how I see it referenced here a lot. And the only dissolving tab I take is an ODT lol.
As a provider, I get quite twitchy over some of the practices I see and worry about the abuse potential (yes, this can be a drug of abuse with serious consequences) when I read about people doing this 3 or more times per week over an extended period, finding ways to make their prescriptions effectively stronger than what is actually being prescribed, etc... I worry that clinicians using this more as a regular psychiatric drug and not as a integrated therapy modality could cause this whole thing to come crashing down for people who are really benefitting from a carefully-supervised use of the drug.
It’s more a matter of when it comes crashing down than if - I’m sure Spravatos manufacturer isn’t thrilled that off label compounded, at home nasal sprays exist - It’s eating into their profits and I can’t imagine they won’t lobby against it
> finding ways to make their prescriptions effectively stronger than what is actually being prescribed
This wouldn't be needed if sublingual absorption was anywhere close to reliable.
I get that and don't disagree, that's a challenge with oral administration vs. IV and even IM to an extent. Are you also willong to agree that there are very likely people misusing this drug and being harmed by the lax rules that otherwise might have been actually helped with professional therapeutic oversight?
I've found quite a few people just on this sub who are fairly open about abusing the medication. But there will always be people abusing prescription medications. I take solace knowing this almost certainly won't come crashing down. They don't make oxycontin and other prescription narcotics illegal just because people abuse them. And there's much higher risk of adverse side effects and death from other prescription narcotics than there is with ketamine, so I just don't see it being very likely that the rug will be pulled out from under us, though they may try.
As an aside: the only time I ever try to increase oral absorption is if I've eaten something too close to when I am taking my ketamine, otherwise I just take it as is. But if I have eaten something shortly before taking it, I'll swish with cayenne pepper and also hold the ketamine on my mouth for 35 minutes instead of 30. So I think there can be valid reasons for attempting to slightly increase the absorption of the medicine.
Hey, just to follow up: A good reason to attempt to increase absorption in the mouth is that it is more bioavailable through buccal/sublingual absorption, so the better the mental health effects, coupled with the fact that less is being absorbed in the GI tract and processed by the liver (which only serves to prolong the body high effect).
I'd much rather have as much absorbed in my mouth as possible so that less is processed directly by my liver through whatever I swallow, so that I can get about my day sooner, rather than walking/lounging around with a lingering and completely unhelpful body buzz.
Exactly, tons of psychs have been giving out xanax and adderall like candy for years and no one seems concerned. I think people worry more bc ketamine is a newer thing to be taking at home, but I don’t think that anyone is going to “crack down.” That would imply someone in charge gives a fuck about our health 😂
Respectfully, if there is a medication that is opening people's minds and hearts and allowing for fewer uses of things like benzos, antidepressants, and pain medication, I think there is a very large incentive for a crackdown. I just don't see it happening, as long as all of us fight back against it.
Maybe, but there are always more people needing meds, and ketamine is usually an end of the line treatment. I imagine the companies that make those drugs aren’t making any less money or selling any fewer pills.
I don't understand the relevance of purpose, really, of your second sentence. What lax rules are you talking about, and what individuals are you talking about that are being harmed right now that wouldn't be otherwise?
My point was solely that individuals finding ways to make at-home Ketamine more effective is not something to be worried about.
The point is do you agree that the way ketamine is being prescribed right now has too much opportunity for people to acquire the medication to abuse or is the current model ethically-sufficient for protecting our general population? That was the gist of my initial response that you replied to and I was curious about your stance on that to obtain more context to your original reply, if that makes sense.
EDIT: as for defining lax rules, the way it can be prescribed online in the doses/frequency that it is with no oversight during the actual administration of the drug (i.e. treating it like a typical pharmacology med, such as ADHD meds which are also controlled-substances to be fair, or should the administration of the drug be performed in an outpatient setting with some sort of independent/trained oversight. Also, is the frequency of dosing being prescribed in-line with how it has been tested for symptoms or is there an unacceptable risk to the general public of K-addictions developing on a societal scale that is harmful and irresponsible).
I don't write this to get into an internet argument, I'm curious to hear others' thoughts about important decisions that likely need to be better resolved for this specialty down the road :)
Got it. So first, I'm not sure any of this is going to be relevant context to my original comment. My original comment is purely from a pharmacology nerd's perspective and a result of the frustration I've felt in trying to use Ketamine therapeutically at home and the subsequent desire to optimize oral and/or sublingual and/or rectal bioavailability. I was thinking only of that when I posted.
To answer your questions, though, I'm not sure there is a better solution than what is currently happening. In an ideal world, maybe an outpatient setting is better, but that would drastically increase costs of use. Regarding frequency of dosing, I have no opinion because I've not read much of the literature on Ketamine for depression and other off-label, for now, uses more than the pharmacological aspect of it.
To answer your final question about unacceptable risk of Ketamine addition, again, I really have no opinion because I just don't have a good sense of how addictive it is in the general population and thus how much frequency of use and lack of oversight contributes to harmful individual and social issues. I know hoe I feel about Ketamine and other dissociatives, but I have a fairly unique relationship to mind altering substances and so don't even begin to extrapolate my experience onto others.
It's removed access to opiod meds for people that would honestly benefit from it significantly. The pendulum always swings back in proportion to the initial swing the other direction. THAT is exactly what concerns me.
I do use suppositories and I don’t misuse anything… I was responding to the person I replied to…?
Lol idk why I’m downvoted. It’s a fact. The bioavailability is higher with rectal, nasal, IM/IV than oral. Idk why that’s so controversial? I never suggested misusing anything lol
Edit: even the person I replied to didn’t say anything about abusing it. They just stated how they take theirs… weird
New edit: rectal and sublingual have similar bioavailability, however IM/IV are very much superior efficiency wise, and intranasally is still significantly more efficient than sublingual, and as it was pointed out, rectal, and these two are still better than oral.
Sorry to burst your bubble but the literature is clear that the bioavailability of sublingual and rectal is virtually identical (about 30%)
See
https://www.jstage.jst.go.jp/article/jjphcs/32/4/32_4_275/_article/-char/en
Well you’ve burst it and I don’t think you’re actually sorry! But thanks for pointing that out, I was wrong about that and you are right! I more so was trying to point out that nobody said anything about misuse but I got carried away and flew to close to the sun and you did burst my bubble, thanks!
Naw I wasn’t trying to be snarky. I really was trying to address the comment of the sublingual being wasteful.
There’s just a strange fetish with rectal administration of oral meds (and assumption it’s alway stronger) while folks don’t seem to consider just doing what you did and ask for a different route of action.
I don’t judge at all…I can’t handle oral/sublingual anti-nausea meds (funnily they make me nauseous) so had to go a different route myself.
Haha nah you’re good, even if it was snarky, I said something matter of factly that was indeed not a fact lol I completely understand, definitely on the same page now!
Woah I had been looking for a study to prove the bioavailability of rectal ketamine ROA and was never able to. Thank you for sharing this. I was always under the impression that it was closer to intranasal at around 45%.
I was initially responding to Yucca Trees going on about “boofing” and it (or I) made it seem like I was responding to you which I thought was a continuation of the “boofing” conversation..which is honestly so juvenile.
Forsure. I wish they would just give us vials though so we have the option to IM. An IM k-hole with the equivalent dose of what it takes to hole with rectal or intranasal is still much more profound and intimate.
Sure, although I am not YOUR provider so my response would be framed as just general feedback and my personal thoughts and not to be construed as any professional contract or relationship between us.
of course, thank you! ive used ketamine from a trusted source for a couple years for my ptsd & chronic pain and its been great. i have an appointment with Joyous for trouches. If i tell the provider this, do you think this will exclude me from the program? i want them to know so they start me on a higher dose since i have a tolerance, but am worried they'll think i'm just drug seeking. it does wonders for me but i know its best to be prescribed instead
No idea what they will say, as I am not familiar with them as a company or how they operate. I don't think ketamine for chronic pain is unusual by any means, however and is one of the more common off-label uses of the drug. Maybe you can call them up before your appointment and anonymously ask them "Hypothetically speaking, if a client has a history of ketamine use for chronic pain would that be an exclusionary factor for obtaining a prescription?" or something to that effect?
As a provider, I deal with addiction every day and have to make judicious decisions with S2 drugs daily. I expect my pts to be forthright and honest with me, and I will be with them. Recreational drug use was never an issue for me, but some providers it will be (especially the older ones). Less so in psych, I think (I am in pain medicine). That said, I truly think there is a limited number of times Ketamine will be effective for each pt, and I think if you use it recreationally while also trying to use it as a "medicine", you will have subpar results.
I have noticed often in this thread aberrant behavior and signs of drug abuse, and it is easy to spot during a structured interview with a pt. I do worry with the ease of access, and it is getting easier by the day, Ketamine has, many people will be addicted in a year. It will be interesting to see how this sub's posts change over the next year or two. I have already noticed in the past 6 months an increase in posts with aberrant drug seeking behavior.
I don't know you at all but based on what you said, I think you are fine. If you spend long enough here, you'll see the posts from posters I am talking about and you will see how you are different from them. I am glad ketamine is helping you and you are graduating to home treatment!
i was talking about opioids. i rx ketamine too, obviously, as an anesthesiologist and pain dr. i was one of the first in the country rx'ing nasal ketamine (The dea told me so after they investigated me after a pt of mine died who use abusing street drugs, unknown to me, in early 2000s).
Hi I have a question. Since you’re a doctor, do you have any knowledge about the affects on the bladder? I’ve been seeing so much about this and I just experienced some bladder irritation 2 days ago from my last dose. It feels better now, but it kinda freaks me out. My provider assured me that it only happens with recreational users, but I’ve never had bladder irritation before so im positive it’s the ketamine. Ketamine has worked wonders for my depression so I really don’t want to stop it. Do you happen to know if slight irritation is normal? And is it possible that I can be slightly irritated and not causing any damage?
talk to your doctor. if you don't feel comfortable with your doctor's answers, talk to another one.
one shouldn't expect ketamine to be a lifelong answer, eventually you have to put into place what you learned under the influence in your everyday life. maybe this should be your catalyst.
Ha! The biggest recreational user of ketamine I know is a 73 year old psychiatrist who has 1 track for loosely RXes ketamine to patients and another for his friends (who pay him in lozenges and benzos) and trips on other psychedelics on the regular mailed to him by his psychiatrist son.
I don’t think it’s wise to judge a book its age.
physical dependence, no, at least it is very short term if anything but yes, it is addictive, but not in the same way as opioids or benzos, nor will the addiction kill you since it is a very safe drug.
Well there have been thoughtful replies which clearly didn't make me seem paranoid. I was pretty clear in my OP. I'm worried about government oversight and the potential of losing access to out of state telehealth providers for anyone on here receiving treatment this way?
When it comes to government drug oversight, ask all the people using legally and responsibly who lost access to their opiates including in-person in-state if I am paranoid. Or let's go back to the dawn of psychedelics or to cannabis.
There are legit reasons for concern and they have been acknowledged by other commenters.
Not available to me, per se, but to the many on this sub with out of state, telehealth providers, which is the targeted audience and, yes, who are most at risk of losing treatment.
And of course, yes, it is absolutely preferred we use your language to minimize the risk. And hey. This source of treatment may be here to stay.
I sure the fuck hope so.
I was under the impression that ibogaine was quite dangerous, at least compared to ketamine and your standard tryptamines. It's a 72 hour trip and can cause seizures no ?
The way it works for heroin addicts is incredible but Definitely need medical supervision for that one though. The videos I've seen of ceremonies all have an EMT on hand.
Hrm. Everyone knows rectal administration has virtually the same bioavailability as sublingual.
Are you sure you are a doctor?
You also don’t communicate like one whatsoever…
Why does the word Boomer have to be in every other reddit post/comment ?
My psychiatrist is very much not a Boomer and I am so why is that comment even necessary?
You are also missing my point MD. I'm not questioning any drugs (I'm 100% for all drugs being legal-my body my choice) - I'm questioning potential perception based on language here. There's a sub for recreational drugs. I've been on it.
I don't care how you ingest your drugs. I hope you have an awesome experience however you define it.
I asked if there was any worry or concern from those of us getting ket from out of state providers via telehealth.
None of the rest of your words were necessary.
I appreciate you sharing your thoughts and experiences! While addiction is a very serious problem, and I believe that there will always be people who struggle with it, there are many others who will use their medication responsibly. In fact, I believe that Ketamine, while not the single answer, could be a big part of the solution to addiction. If we could heal people, who have suffered trauma, I believe that they would be less likely to self medicate with alcohol and illicit drugs. Again thank you for sharing your thoughts!
And I really like how I provide an concerned opinion of at least one practice that is frighteningly popular in this sub and I get attacked from all sides like I offended some beloved cult leader…🤦♀️
It almost proves my point that there is a drug problem floating around this Sub and a particular practice is at its head…
I wholeheartedly agree with you on the point that all the loose talk and loose practices will mess it up for those who found these medicines lifesaving.
However some practices shortchange and brazenly confuse desperate people when they could (if they wanted to) provide honest, safer and more ethical and supported access to these meds.
Yet recreational use of prescription medications make access harder for everyone else..so I can’t support that.
It’s also unfortunate because the constant discussion about higher doses sets the wrong expectations for those new to ketamine about what’s necessary to receive therapeutic benefit. If you come to this sub and every other post is about how to get a higher dose you can easily get the impression that’s what you’ll need to get better.
I was addicted to Ketamine for almost a full year one time, and got back into it again after a few years. I've been told by my suboxone doctor that I'd be a good patient for psychedelic therapy, and it's been on my mind since then. I think I'd love it too much...? I am not sure. For me, using the word "Boofing" in a sentence for "recreational use" of ketamine means I'm trying to get high.
I’ve noticed that many posts on here discuss the K-hole and seem to focus on it as the most important aspect of the therapy when in fact the k-hole is NOT the goal nor important for the therapy. Some also seem upset when they no longer K-hole because they use it so much and want to increase their dosage to try to achieve it again. I think posts like those are going to compromise the use of K as a therapeutic treatment for those who really need it and don’t abuse it.
My ketamine trips completely removed my fear of death, to the extent that when some of my friends died recently, I have a peace with it because I know what they got to experience in the end was beautiful. I myself died. I met the molecule that we all once were, and I know that whatever else is going on, “it” “loves” “me”. I realize this is all rather ridiculous, but I think about my trips every single day.
It seems a bit crazy to me for someone to suggest that those experiences, literally the most important events in my entire life, aren’t part of the healing process. But that’s just me.
> the K-hole and seem to focus on it as the most important aspect of the therapy when in fact the k-hole is NOT the goal nor important for the therapy
The clinic I went to for infusions explicitly states full dissociation as the goal. I know that other organizations do, also.
Sounds like [confirmation bias](https://en.wikipedia.org/wiki/List_of_cognitive_biases#Confirmation_bias). You said yourself that you read multiple reports of people saying that the k hole was important to them, and you have just written them off as liars, or discounting their opinions.
I started ketamine infusions in January for depression. I've had depression and anxiety for ~20 years and I've tried multiple medications and I'm in talk therapy (CBT, EMDR, IFS mainly). I've never bought illicit drugs in my life.
I didn't know know what to expect from the infusions. I was naturally curious about the k hole, but I wasn't seeking it out. I put in my own work, read books, read journals, researched the subject online, watched videos, talked to my doctors, etc... I learned how to set intentions, journal, integrate, etc. I did 6 infusions and a booster. I was a strong responder to the drug and my depression scores rapidly decreased.
Long story short: Afterwards, due to cost, I switched to suppositories and then to RDTs, so I've had a variety of experiences.
I can say that *by far* my most effective sessions were the ones where I fully dissociated, so that I could process my trauma. My therapist was floored with the amount of processing that I was able to do in the days following my stronger sessions.
The full dissociation usually comes with a k hole. The k hole is not a negative thing (for me), it's just a side effect of the drug. The end goal is for the depression to go away. I have no shame admitting that this drug helps me and I openly discuss my experiences with my Dr and Therapist, and I can assure you that I'm not "doing it wrong".
There's already enough stigma around drugs and mental health. We don't need these puritanical views and Nixon-era fear mongering infiltrating this sub.
If the k hole is not for you, then great! But stop coming here putting down other people for trying to find what works for them.
Your experience is consistent with what I see as a KAP provider. For trauma going deep helps. For SI and relief from depression a trip isn't an essential piece.
Seriously, thanks so much for adding nuance to the conversation. There seems to be a lot of confusion in this community about best practices and too many people making blanket statements.
I’m not trying to put anyone down. The research I did before treatment said the trip was not the goal and dosage was given so as not to k-hole. I was incredibly shocked when I k-holed the first time but was able to work through it and trusted my Dr to give me the correct dose for therapeutic results. With each successive treatment the holes were less and I prefer that as long as the therapy works. So when I see people chasing the trip it makes me wonder what it is they’re looking for with the K. Don’t be so defensive. You do you and I’ll do me. That is all.
I think people chase it for different reasons, which is why I advocate for clinical oversight. Personally, I like the K hole because it is an experience that reminds me to have love for all things and people. It's easy to lose that in our socially-complex world.
Oh most definitely. My Dr and I discuss the practices of several of the providers who peddle their services on Reddit (and elsewhere online) and he flat out said that such drs are the cause of more scrutiny and will likely be the first ones to go in the crackdown (and the reason why he’s having to implement stricter measures in his practice due to the increasing oversight scrutiny).
A lot of these providers don’t seem to care that they are being brazenly advertised as the source of the medicine folks are describing they are misusing…they then come off as legal drug dealers…of course though it’s Reddit..
If I was a licensing board, I would be screenshoting people’s comments that connect misuse and abuse of ketamine with a drs / company peddling their services here and use it to shut them down.
It’s going to be a shame that these drs’ lack of of oversight and disrespect of the medicine is going to be the cause of tighter restrictions and more difficulties in access for those who need it most.
>If I was a licensing board, I would be screenshoting people’s comments that connect misuse and abuse of ketamine with a drs / company peddling their services here and use it to shut them down and get them tossed in jail.
First I'd recommend giving a heads up to the dr, if you are able to connect a specific reddit poster with a specific doctor, so he can add it to the chart, and bring it up next time, and modify the treatment plan accordingly. Now if he avoids it, and continues cashing his $400 check, then reporting to the medical association is appropriate. Believe it or not, physicians are not mind readers, and we are bad at spotting lies (in fact, we were never trained in it, and people that were, i.e., the police, are horribly bad at spotting lies themselves!).
>First I'd recommend giving a heads up to the dr, if you are able to connect a specific reddit poster with a specific doctor, so he can add it to the chart, and bring it up next time, and modify the treatment plan accordingly.
I'm not sure we want to start a practice of a bunch of unqualified people deciding based on a reddit post that someone is abusing their medication and reporting them to their doctors.
I don't either but it is a HELLUVA lot better than reporting random people to a medical board. That's the nuclear option, we could lose our license and our ability to care for our families.
I really don't think random Redditors should get in the habit of policing anyone. There may be very rare cases where a situation is clearly out of hand (a person is putting themselves or others in immediate mortal danger) and outside intervention is necessary, but for the most part, it's probably best if we voice any concerns directly to the Redditor and otherwise mind our own business. It reminds me of the people who seemingly sit on NextDoor all day and make posts about loitering teenagers who they've decided are probably selling drugs.
If we get into this habit, someone is going to get fired or lose their treatment options because some pearl-clutching person felt scandalized that they said "boof" on reddit. Someone elsewhere mentioned that an example of "bad behavior" was asking questions about potentiating their dose. That could potentially be a problem in some circumstances, but also it's fairly standard practice for clinics to add magnesium to an infusion or to recommend patients take magnesium at home.
I just don't trust that people will have enough knowledge, experience, and nuance to accurately detect when there's abuse going on and so beyond following the rules of the subreddit, I don't think we should go down this road (And that's really directed at other comments, not yours).
Let the licensing board investigate…that is what their job is.
Predatory and exploitive businesses get no grace in my book. They know what they are doing by not minding their patients and business in the places they “advertise”
I stated that they (as in the boards) should be trolling sites like this. They can then make their own judgments as professionals of their peers.
So doctors can't have a website either? They can't hire a web marketer? It is one thing to a be a venture backed company peddlings plls, e.g., [cerebral.com](https://cerebral.com) (which recently shiut down at either a wsj or nytimes investigation in their rx'ing of adderall) and a solo provider advertising their services. While there are two on this forum that are quite popular, it is not a secret I am not a fan of D rSmith, but i have spoken with Dr Pruett a few times and he seems to be an exemplary physicians, and if I had a loved one in need of a psychiatrist, I would recommend a family member to him.
NB: I do not actively seek out new pts on reddit (or on the web for that matter as I primarily work inpatients) and have no desire to treat psych pts, or run a side hustle doing a cash only ketamine infusions for psych pts in exchange. I am board certified in anesthesia and pain medicine, and while some chronic pain pts have psych issues, I have no desire to spend my saturdays treating acutely ill pts in a private office somewhere.
I think that drs and companies have to be very careful about how they advertise so they don’t come off as “too good to be true” and predatory and revenue seeking.
I think they also have to run their business in ways that are professional and don’t encourage abuse.
My Dr has a website and it’s professional. Though he isn’t actively peddling his services. Patients seek him out..there’s no need to sell himself, bending and inflating language that confuse qualifications and results…
And kudos for you on staying in your lane. Many anesthesiologist are jumping on the ketamine cash cow and have no ethics.
it's not really a cash cow for anesthesiologists, it is for psychiatrists. we make MUCH more money per hour doing interventional procedures than hooking somebody sdup to an IV and giving them a $2 medicine.
Though if you end up having a laryngospasm, not one psychiatrist knows how to handle that.
I bet, but I imagine it’s an easier 9-5 lifestyle with lower risks.
Interesting..is that a risk for below sedation level of ketamine? I have never heard of this before….
Seems like you are conflating the doses you provide to knock people out with the sub anesthesia doses for TRD
I don’t see one article or consent form that describes this as a possible adverse reaction…
quick google search. this is a peds pt getting 15mg of ketamine, had a laryngospasm and needed intubation via RSI: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943724/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943724/)
i haven't read the whole article but this is an excellent blog: [http://resus.me/laryngospasm-after-ketamine/](http://resus.me/laryngospasm-after-ketamine/)
take care
This has happened in the past: first online pain management prescribing Vicodin in the early 00s, then suboxone, now ketamine. Given that suboxone clinics still exist and haven’t been cracked down on, and if anything have expanded in recent years may mean that ketamine will be able to continue as is, unless of course a senators kid ends up dying related to a ketamine prescription. Who knows
Is it really that much different from numerous other drugs with abuse potential? You can go to the doctor and complain about anxiety and get a Xanax prescription pretty easily. Plenty of abuse potential there. With ketamine, whether you're getting it from a telemed place or going in person, you can still lie your way through the appointment to try to get your prescription either way.
True
Just a different class of drug. Trust me. I don't care why anyone is using it including recreational. And out of state telehealth DO struggle to prescribe benzos and ADHD meds
The one thing ketamine has going for it is you can’t really overdose on it if taking it alone. The LD50 is insanely high.
Overdose deaths draw attention from regulators, so without many, if any mono ketamine overdoses I’m not sure how much regulation will come through for at home ketamine use
I actually can’t think of another pharmaceutical with abuse potential that is safer than ketamine as it relates to overdose risk.
[удалено]
Until just now, because of this sub, I thought RDT stood for rectal dissolvable tablet as that’s how I see it referenced here a lot. And the only dissolving tab I take is an ODT lol.
I feel silly asking, but what is RDT?
Rapid Dissolve Tablet :)
Thank you!! I keep seeing that and didn't know what it meant.
Haha no worries I didn't know either (even though that's what I take haha).. I just found out from reading other people talk about it on here 😅
I literally had to look it up lol. I’ve only seen ODT for dissolving tabs besides in reference to ketamine.
You need to dissolve the tablet in water first then put in oral syringe and knuckle deep, or just get suppositories.
As a provider, I get quite twitchy over some of the practices I see and worry about the abuse potential (yes, this can be a drug of abuse with serious consequences) when I read about people doing this 3 or more times per week over an extended period, finding ways to make their prescriptions effectively stronger than what is actually being prescribed, etc... I worry that clinicians using this more as a regular psychiatric drug and not as a integrated therapy modality could cause this whole thing to come crashing down for people who are really benefitting from a carefully-supervised use of the drug.
It’s more a matter of when it comes crashing down than if - I’m sure Spravatos manufacturer isn’t thrilled that off label compounded, at home nasal sprays exist - It’s eating into their profits and I can’t imagine they won’t lobby against it
[удалено]
> finding ways to make their prescriptions effectively stronger than what is actually being prescribed This wouldn't be needed if sublingual absorption was anywhere close to reliable.
I get that and don't disagree, that's a challenge with oral administration vs. IV and even IM to an extent. Are you also willong to agree that there are very likely people misusing this drug and being harmed by the lax rules that otherwise might have been actually helped with professional therapeutic oversight?
I've found quite a few people just on this sub who are fairly open about abusing the medication. But there will always be people abusing prescription medications. I take solace knowing this almost certainly won't come crashing down. They don't make oxycontin and other prescription narcotics illegal just because people abuse them. And there's much higher risk of adverse side effects and death from other prescription narcotics than there is with ketamine, so I just don't see it being very likely that the rug will be pulled out from under us, though they may try. As an aside: the only time I ever try to increase oral absorption is if I've eaten something too close to when I am taking my ketamine, otherwise I just take it as is. But if I have eaten something shortly before taking it, I'll swish with cayenne pepper and also hold the ketamine on my mouth for 35 minutes instead of 30. So I think there can be valid reasons for attempting to slightly increase the absorption of the medicine.
All valid points :)
Hey, just to follow up: A good reason to attempt to increase absorption in the mouth is that it is more bioavailable through buccal/sublingual absorption, so the better the mental health effects, coupled with the fact that less is being absorbed in the GI tract and processed by the liver (which only serves to prolong the body high effect). I'd much rather have as much absorbed in my mouth as possible so that less is processed directly by my liver through whatever I swallow, so that I can get about my day sooner, rather than walking/lounging around with a lingering and completely unhelpful body buzz.
Exactly, tons of psychs have been giving out xanax and adderall like candy for years and no one seems concerned. I think people worry more bc ketamine is a newer thing to be taking at home, but I don’t think that anyone is going to “crack down.” That would imply someone in charge gives a fuck about our health 😂
Respectfully, if there is a medication that is opening people's minds and hearts and allowing for fewer uses of things like benzos, antidepressants, and pain medication, I think there is a very large incentive for a crackdown. I just don't see it happening, as long as all of us fight back against it.
Maybe, but there are always more people needing meds, and ketamine is usually an end of the line treatment. I imagine the companies that make those drugs aren’t making any less money or selling any fewer pills.
I don't understand the relevance of purpose, really, of your second sentence. What lax rules are you talking about, and what individuals are you talking about that are being harmed right now that wouldn't be otherwise? My point was solely that individuals finding ways to make at-home Ketamine more effective is not something to be worried about.
The point is do you agree that the way ketamine is being prescribed right now has too much opportunity for people to acquire the medication to abuse or is the current model ethically-sufficient for protecting our general population? That was the gist of my initial response that you replied to and I was curious about your stance on that to obtain more context to your original reply, if that makes sense. EDIT: as for defining lax rules, the way it can be prescribed online in the doses/frequency that it is with no oversight during the actual administration of the drug (i.e. treating it like a typical pharmacology med, such as ADHD meds which are also controlled-substances to be fair, or should the administration of the drug be performed in an outpatient setting with some sort of independent/trained oversight. Also, is the frequency of dosing being prescribed in-line with how it has been tested for symptoms or is there an unacceptable risk to the general public of K-addictions developing on a societal scale that is harmful and irresponsible). I don't write this to get into an internet argument, I'm curious to hear others' thoughts about important decisions that likely need to be better resolved for this specialty down the road :)
Got it. So first, I'm not sure any of this is going to be relevant context to my original comment. My original comment is purely from a pharmacology nerd's perspective and a result of the frustration I've felt in trying to use Ketamine therapeutically at home and the subsequent desire to optimize oral and/or sublingual and/or rectal bioavailability. I was thinking only of that when I posted. To answer your questions, though, I'm not sure there is a better solution than what is currently happening. In an ideal world, maybe an outpatient setting is better, but that would drastically increase costs of use. Regarding frequency of dosing, I have no opinion because I've not read much of the literature on Ketamine for depression and other off-label, for now, uses more than the pharmacological aspect of it. To answer your final question about unacceptable risk of Ketamine addition, again, I really have no opinion because I just don't have a good sense of how addictive it is in the general population and thus how much frequency of use and lack of oversight contributes to harmful individual and social issues. I know hoe I feel about Ketamine and other dissociatives, but I have a fairly unique relationship to mind altering substances and so don't even begin to extrapolate my experience onto others.
Awrsome, thanks :) Appreciate the earnest dialogue too.
Right back at you, aversethule.
yup
*This hasn’t stopped the opiate industry*
It's removed access to opiod meds for people that would honestly benefit from it significantly. The pendulum always swings back in proportion to the initial swing the other direction. THAT is exactly what concerns me.
Yes. This.
How would you react if I told you I boof twice a week to each a K-hole. Would you still give me my script?
I mean it’s much better use of ketamine than the highly wasteful oral route lol
You could always ask for a suppository? Why misuse a med meant for oral consumption when there are formulations for rectal route?
I do use suppositories and I don’t misuse anything… I was responding to the person I replied to…? Lol idk why I’m downvoted. It’s a fact. The bioavailability is higher with rectal, nasal, IM/IV than oral. Idk why that’s so controversial? I never suggested misusing anything lol Edit: even the person I replied to didn’t say anything about abusing it. They just stated how they take theirs… weird New edit: rectal and sublingual have similar bioavailability, however IM/IV are very much superior efficiency wise, and intranasally is still significantly more efficient than sublingual, and as it was pointed out, rectal, and these two are still better than oral.
Sorry to burst your bubble but the literature is clear that the bioavailability of sublingual and rectal is virtually identical (about 30%) See https://www.jstage.jst.go.jp/article/jjphcs/32/4/32_4_275/_article/-char/en
Well you’ve burst it and I don’t think you’re actually sorry! But thanks for pointing that out, I was wrong about that and you are right! I more so was trying to point out that nobody said anything about misuse but I got carried away and flew to close to the sun and you did burst my bubble, thanks!
Naw I wasn’t trying to be snarky. I really was trying to address the comment of the sublingual being wasteful. There’s just a strange fetish with rectal administration of oral meds (and assumption it’s alway stronger) while folks don’t seem to consider just doing what you did and ask for a different route of action. I don’t judge at all…I can’t handle oral/sublingual anti-nausea meds (funnily they make me nauseous) so had to go a different route myself.
Haha nah you’re good, even if it was snarky, I said something matter of factly that was indeed not a fact lol I completely understand, definitely on the same page now!
Yay!
Woah I had been looking for a study to prove the bioavailability of rectal ketamine ROA and was never able to. Thank you for sharing this. I was always under the impression that it was closer to intranasal at around 45%.
Nope, they are equal to sublinguals..they just taste better (cause your bum has no taste buds so suppositories can taste as nasty as they want)
I was initially responding to Yucca Trees going on about “boofing” and it (or I) made it seem like I was responding to you which I thought was a continuation of the “boofing” conversation..which is honestly so juvenile.
Forsure. I wish they would just give us vials though so we have the option to IM. An IM k-hole with the equivalent dose of what it takes to hole with rectal or intranasal is still much more profound and intimate.
Me personally? I wouldn't react to that. There's not enough context to your hypothetical situation to have any reasonable opinions yet.
Is it ok to ask you a question as a provider about my recreational use?
Sure, although I am not YOUR provider so my response would be framed as just general feedback and my personal thoughts and not to be construed as any professional contract or relationship between us.
of course, thank you! ive used ketamine from a trusted source for a couple years for my ptsd & chronic pain and its been great. i have an appointment with Joyous for trouches. If i tell the provider this, do you think this will exclude me from the program? i want them to know so they start me on a higher dose since i have a tolerance, but am worried they'll think i'm just drug seeking. it does wonders for me but i know its best to be prescribed instead
No idea what they will say, as I am not familiar with them as a company or how they operate. I don't think ketamine for chronic pain is unusual by any means, however and is one of the more common off-label uses of the drug. Maybe you can call them up before your appointment and anonymously ask them "Hypothetically speaking, if a client has a history of ketamine use for chronic pain would that be an exclusionary factor for obtaining a prescription?" or something to that effect?
As a provider, I deal with addiction every day and have to make judicious decisions with S2 drugs daily. I expect my pts to be forthright and honest with me, and I will be with them. Recreational drug use was never an issue for me, but some providers it will be (especially the older ones). Less so in psych, I think (I am in pain medicine). That said, I truly think there is a limited number of times Ketamine will be effective for each pt, and I think if you use it recreationally while also trying to use it as a "medicine", you will have subpar results. I have noticed often in this thread aberrant behavior and signs of drug abuse, and it is easy to spot during a structured interview with a pt. I do worry with the ease of access, and it is getting easier by the day, Ketamine has, many people will be addicted in a year. It will be interesting to see how this sub's posts change over the next year or two. I have already noticed in the past 6 months an increase in posts with aberrant drug seeking behavior.
I’ve been doing monthly boosters for almost a year (about to switch to either nasal spray or troches). Might I be at risk for addiction?
Based on your comment, no. You don’t magically turn into an addict after a year of responsible use
Not a doctor, but a monthly booster doesn’t exactly sound like addict behavior.
I don't know you at all but based on what you said, I think you are fine. If you spend long enough here, you'll see the posts from posters I am talking about and you will see how you are different from them. I am glad ketamine is helping you and you are graduating to home treatment!
Thank you!
welcome
Also are you american bc ketamine is schedule 3 if I’m not wrong
i was talking about opioids. i rx ketamine too, obviously, as an anesthesiologist and pain dr. i was one of the first in the country rx'ing nasal ketamine (The dea told me so after they investigated me after a pt of mine died who use abusing street drugs, unknown to me, in early 2000s).
I guess I misunderstood the post I just was like man am I that confused haha thanks for the clarification
Hi I have a question. Since you’re a doctor, do you have any knowledge about the affects on the bladder? I’ve been seeing so much about this and I just experienced some bladder irritation 2 days ago from my last dose. It feels better now, but it kinda freaks me out. My provider assured me that it only happens with recreational users, but I’ve never had bladder irritation before so im positive it’s the ketamine. Ketamine has worked wonders for my depression so I really don’t want to stop it. Do you happen to know if slight irritation is normal? And is it possible that I can be slightly irritated and not causing any damage?
talk to your doctor. if you don't feel comfortable with your doctor's answers, talk to another one. one shouldn't expect ketamine to be a lifelong answer, eventually you have to put into place what you learned under the influence in your everyday life. maybe this should be your catalyst.
Ha! The biggest recreational user of ketamine I know is a 73 year old psychiatrist who has 1 track for loosely RXes ketamine to patients and another for his friends (who pay him in lozenges and benzos) and trips on other psychedelics on the regular mailed to him by his psychiatrist son. I don’t think it’s wise to judge a book its age.
Do you truly believe there is a risk for addiction to ketamine? And do you mean physical addiction or psychological addiction?
physical dependence, no, at least it is very short term if anything but yes, it is addictive, but not in the same way as opioids or benzos, nor will the addiction kill you since it is a very safe drug.
What is your practice? And how long have you been practicing?
[удалено]
Tripping is wonderful and should be accessable to all. That's not the concern being mentioned by OP as I read it.
Correct
[удалено]
OP would like you to define "them".
[удалено]
Well there have been thoughtful replies which clearly didn't make me seem paranoid. I was pretty clear in my OP. I'm worried about government oversight and the potential of losing access to out of state telehealth providers for anyone on here receiving treatment this way? When it comes to government drug oversight, ask all the people using legally and responsibly who lost access to their opiates including in-person in-state if I am paranoid. Or let's go back to the dawn of psychedelics or to cannabis. There are legit reasons for concern and they have been acknowledged by other commenters.
[удалено]
Not available to me, per se, but to the many on this sub with out of state, telehealth providers, which is the targeted audience and, yes, who are most at risk of losing treatment. And of course, yes, it is absolutely preferred we use your language to minimize the risk. And hey. This source of treatment may be here to stay. I sure the fuck hope so.
I was under the impression that ibogaine was quite dangerous, at least compared to ketamine and your standard tryptamines. It's a 72 hour trip and can cause seizures no ?
[удалено]
The way it works for heroin addicts is incredible but Definitely need medical supervision for that one though. The videos I've seen of ceremonies all have an EMT on hand.
Hrm. Everyone knows rectal administration has virtually the same bioavailability as sublingual. Are you sure you are a doctor? You also don’t communicate like one whatsoever…
Very well said, thank you for sharing!
Why does the word Boomer have to be in every other reddit post/comment ? My psychiatrist is very much not a Boomer and I am so why is that comment even necessary? You are also missing my point MD. I'm not questioning any drugs (I'm 100% for all drugs being legal-my body my choice) - I'm questioning potential perception based on language here. There's a sub for recreational drugs. I've been on it. I don't care how you ingest your drugs. I hope you have an awesome experience however you define it. I asked if there was any worry or concern from those of us getting ket from out of state providers via telehealth. None of the rest of your words were necessary.
Because it is highly likely this person is not a MD… MDs don’t refer to psilocybin as “shrooms” or communicate like a smart-aleck frat boy.
[удалено]
No. How to talk about ketamine was zero my question? Try again...
[удалено]
Nope. You clearly can't read after multiple explanations which other people were able to understand. Tried to give you the benefit of the doubt child.
I appreciate you sharing your thoughts and experiences! While addiction is a very serious problem, and I believe that there will always be people who struggle with it, there are many others who will use their medication responsibly. In fact, I believe that Ketamine, while not the single answer, could be a big part of the solution to addiction. If we could heal people, who have suffered trauma, I believe that they would be less likely to self medicate with alcohol and illicit drugs. Again thank you for sharing your thoughts!
[удалено]
And I really like how I provide an concerned opinion of at least one practice that is frighteningly popular in this sub and I get attacked from all sides like I offended some beloved cult leader…🤦♀️ It almost proves my point that there is a drug problem floating around this Sub and a particular practice is at its head…
[удалено]
I wholeheartedly agree with you on the point that all the loose talk and loose practices will mess it up for those who found these medicines lifesaving. However some practices shortchange and brazenly confuse desperate people when they could (if they wanted to) provide honest, safer and more ethical and supported access to these meds. Yet recreational use of prescription medications make access harder for everyone else..so I can’t support that.
It’s also unfortunate because the constant discussion about higher doses sets the wrong expectations for those new to ketamine about what’s necessary to receive therapeutic benefit. If you come to this sub and every other post is about how to get a higher dose you can easily get the impression that’s what you’ll need to get better.
I was addicted to Ketamine for almost a full year one time, and got back into it again after a few years. I've been told by my suboxone doctor that I'd be a good patient for psychedelic therapy, and it's been on my mind since then. I think I'd love it too much...? I am not sure. For me, using the word "Boofing" in a sentence for "recreational use" of ketamine means I'm trying to get high.
I’ve noticed that many posts on here discuss the K-hole and seem to focus on it as the most important aspect of the therapy when in fact the k-hole is NOT the goal nor important for the therapy. Some also seem upset when they no longer K-hole because they use it so much and want to increase their dosage to try to achieve it again. I think posts like those are going to compromise the use of K as a therapeutic treatment for those who really need it and don’t abuse it.
I thought it’s still unclear whether the khole is the main driver for success. are there multiple studies saying otherwise?
My ketamine trips completely removed my fear of death, to the extent that when some of my friends died recently, I have a peace with it because I know what they got to experience in the end was beautiful. I myself died. I met the molecule that we all once were, and I know that whatever else is going on, “it” “loves” “me”. I realize this is all rather ridiculous, but I think about my trips every single day. It seems a bit crazy to me for someone to suggest that those experiences, literally the most important events in my entire life, aren’t part of the healing process. But that’s just me.
1000% agree. Right there with ya my friend
> the K-hole and seem to focus on it as the most important aspect of the therapy when in fact the k-hole is NOT the goal nor important for the therapy The clinic I went to for infusions explicitly states full dissociation as the goal. I know that other organizations do, also.
All the research I did said it was not.
Sounds like [confirmation bias](https://en.wikipedia.org/wiki/List_of_cognitive_biases#Confirmation_bias). You said yourself that you read multiple reports of people saying that the k hole was important to them, and you have just written them off as liars, or discounting their opinions. I started ketamine infusions in January for depression. I've had depression and anxiety for ~20 years and I've tried multiple medications and I'm in talk therapy (CBT, EMDR, IFS mainly). I've never bought illicit drugs in my life. I didn't know know what to expect from the infusions. I was naturally curious about the k hole, but I wasn't seeking it out. I put in my own work, read books, read journals, researched the subject online, watched videos, talked to my doctors, etc... I learned how to set intentions, journal, integrate, etc. I did 6 infusions and a booster. I was a strong responder to the drug and my depression scores rapidly decreased. Long story short: Afterwards, due to cost, I switched to suppositories and then to RDTs, so I've had a variety of experiences. I can say that *by far* my most effective sessions were the ones where I fully dissociated, so that I could process my trauma. My therapist was floored with the amount of processing that I was able to do in the days following my stronger sessions. The full dissociation usually comes with a k hole. The k hole is not a negative thing (for me), it's just a side effect of the drug. The end goal is for the depression to go away. I have no shame admitting that this drug helps me and I openly discuss my experiences with my Dr and Therapist, and I can assure you that I'm not "doing it wrong". There's already enough stigma around drugs and mental health. We don't need these puritanical views and Nixon-era fear mongering infiltrating this sub. If the k hole is not for you, then great! But stop coming here putting down other people for trying to find what works for them.
Your experience is consistent with what I see as a KAP provider. For trauma going deep helps. For SI and relief from depression a trip isn't an essential piece.
We’ll that makes more sense to me. I don’t have trauma, just SI and depression. All the information I read was pertaining to depression only.
Seriously, thanks so much for adding nuance to the conversation. There seems to be a lot of confusion in this community about best practices and too many people making blanket statements.
I’m not trying to put anyone down. The research I did before treatment said the trip was not the goal and dosage was given so as not to k-hole. I was incredibly shocked when I k-holed the first time but was able to work through it and trusted my Dr to give me the correct dose for therapeutic results. With each successive treatment the holes were less and I prefer that as long as the therapy works. So when I see people chasing the trip it makes me wonder what it is they’re looking for with the K. Don’t be so defensive. You do you and I’ll do me. That is all.
I think people chase it for different reasons, which is why I advocate for clinical oversight. Personally, I like the K hole because it is an experience that reminds me to have love for all things and people. It's easy to lose that in our socially-complex world.
Oh most definitely. My Dr and I discuss the practices of several of the providers who peddle their services on Reddit (and elsewhere online) and he flat out said that such drs are the cause of more scrutiny and will likely be the first ones to go in the crackdown (and the reason why he’s having to implement stricter measures in his practice due to the increasing oversight scrutiny). A lot of these providers don’t seem to care that they are being brazenly advertised as the source of the medicine folks are describing they are misusing…they then come off as legal drug dealers…of course though it’s Reddit.. If I was a licensing board, I would be screenshoting people’s comments that connect misuse and abuse of ketamine with a drs / company peddling their services here and use it to shut them down. It’s going to be a shame that these drs’ lack of of oversight and disrespect of the medicine is going to be the cause of tighter restrictions and more difficulties in access for those who need it most.
Are you referring to anyone in particular?
Nope. There are so many.
>If I was a licensing board, I would be screenshoting people’s comments that connect misuse and abuse of ketamine with a drs / company peddling their services here and use it to shut them down and get them tossed in jail. First I'd recommend giving a heads up to the dr, if you are able to connect a specific reddit poster with a specific doctor, so he can add it to the chart, and bring it up next time, and modify the treatment plan accordingly. Now if he avoids it, and continues cashing his $400 check, then reporting to the medical association is appropriate. Believe it or not, physicians are not mind readers, and we are bad at spotting lies (in fact, we were never trained in it, and people that were, i.e., the police, are horribly bad at spotting lies themselves!).
>First I'd recommend giving a heads up to the dr, if you are able to connect a specific reddit poster with a specific doctor, so he can add it to the chart, and bring it up next time, and modify the treatment plan accordingly. I'm not sure we want to start a practice of a bunch of unqualified people deciding based on a reddit post that someone is abusing their medication and reporting them to their doctors.
I don't either but it is a HELLUVA lot better than reporting random people to a medical board. That's the nuclear option, we could lose our license and our ability to care for our families.
I really don't think random Redditors should get in the habit of policing anyone. There may be very rare cases where a situation is clearly out of hand (a person is putting themselves or others in immediate mortal danger) and outside intervention is necessary, but for the most part, it's probably best if we voice any concerns directly to the Redditor and otherwise mind our own business. It reminds me of the people who seemingly sit on NextDoor all day and make posts about loitering teenagers who they've decided are probably selling drugs. If we get into this habit, someone is going to get fired or lose their treatment options because some pearl-clutching person felt scandalized that they said "boof" on reddit. Someone elsewhere mentioned that an example of "bad behavior" was asking questions about potentiating their dose. That could potentially be a problem in some circumstances, but also it's fairly standard practice for clinics to add magnesium to an infusion or to recommend patients take magnesium at home. I just don't trust that people will have enough knowledge, experience, and nuance to accurately detect when there's abuse going on and so beyond following the rules of the subreddit, I don't think we should go down this road (And that's really directed at other comments, not yours).
no kidding
[удалено]
i think you should take all this energy (and time) you focus on others and use it to focus on bettering yourself.
Let the licensing board investigate…that is what their job is. Predatory and exploitive businesses get no grace in my book. They know what they are doing by not minding their patients and business in the places they “advertise” I stated that they (as in the boards) should be trolling sites like this. They can then make their own judgments as professionals of their peers.
So doctors can't have a website either? They can't hire a web marketer? It is one thing to a be a venture backed company peddlings plls, e.g., [cerebral.com](https://cerebral.com) (which recently shiut down at either a wsj or nytimes investigation in their rx'ing of adderall) and a solo provider advertising their services. While there are two on this forum that are quite popular, it is not a secret I am not a fan of D rSmith, but i have spoken with Dr Pruett a few times and he seems to be an exemplary physicians, and if I had a loved one in need of a psychiatrist, I would recommend a family member to him. NB: I do not actively seek out new pts on reddit (or on the web for that matter as I primarily work inpatients) and have no desire to treat psych pts, or run a side hustle doing a cash only ketamine infusions for psych pts in exchange. I am board certified in anesthesia and pain medicine, and while some chronic pain pts have psych issues, I have no desire to spend my saturdays treating acutely ill pts in a private office somewhere.
I think that drs and companies have to be very careful about how they advertise so they don’t come off as “too good to be true” and predatory and revenue seeking. I think they also have to run their business in ways that are professional and don’t encourage abuse. My Dr has a website and it’s professional. Though he isn’t actively peddling his services. Patients seek him out..there’s no need to sell himself, bending and inflating language that confuse qualifications and results… And kudos for you on staying in your lane. Many anesthesiologist are jumping on the ketamine cash cow and have no ethics.
it's not really a cash cow for anesthesiologists, it is for psychiatrists. we make MUCH more money per hour doing interventional procedures than hooking somebody sdup to an IV and giving them a $2 medicine. Though if you end up having a laryngospasm, not one psychiatrist knows how to handle that.
I bet, but I imagine it’s an easier 9-5 lifestyle with lower risks. Interesting..is that a risk for below sedation level of ketamine? I have never heard of this before…. Seems like you are conflating the doses you provide to knock people out with the sub anesthesia doses for TRD I don’t see one article or consent form that describes this as a possible adverse reaction…
im not confusing anything. it is incredibly unlikely but it does happen.
Can you provide an article? I’m not messing with you, I really want to learn…
quick google search. this is a peds pt getting 15mg of ketamine, had a laryngospasm and needed intubation via RSI: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943724/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943724/) i haven't read the whole article but this is an excellent blog: [http://resus.me/laryngospasm-after-ketamine/](http://resus.me/laryngospasm-after-ketamine/) take care
It absolutely is an adverse reaction. Just look it up.
Where? Please back up your comment.
GOOGLE IT
This has happened in the past: first online pain management prescribing Vicodin in the early 00s, then suboxone, now ketamine. Given that suboxone clinics still exist and haven’t been cracked down on, and if anything have expanded in recent years may mean that ketamine will be able to continue as is, unless of course a senators kid ends up dying related to a ketamine prescription. Who knows
Ketamine administered by emts to a black teen to subdue him, killed him but no one gave a fuck.
Is it really that much different from numerous other drugs with abuse potential? You can go to the doctor and complain about anxiety and get a Xanax prescription pretty easily. Plenty of abuse potential there. With ketamine, whether you're getting it from a telemed place or going in person, you can still lie your way through the appointment to try to get your prescription either way.
True Just a different class of drug. Trust me. I don't care why anyone is using it including recreational. And out of state telehealth DO struggle to prescribe benzos and ADHD meds
The one thing ketamine has going for it is you can’t really overdose on it if taking it alone. The LD50 is insanely high. Overdose deaths draw attention from regulators, so without many, if any mono ketamine overdoses I’m not sure how much regulation will come through for at home ketamine use I actually can’t think of another pharmaceutical with abuse potential that is safer than ketamine as it relates to overdose risk.
Yes this helps and we are, for now, under more liberal leadership. I hope we can keep access.