Where Is Ketamine Legal In 2024
The hype around ketamine, a very promising psychedelic, is real. So where is ketamine legal, exactly? We explain everything that you need to know.
The U.S. alone has seen a proliferation of ketamine clinics in the last five years, with very big jumps in numbers happening month after month. Not only are people becoming more interested in learning about ketamine and how it can help them with their long-term issues, but the health care provider community seems to be keen on exploring various alternative therapies and emerging medicines to improve quality of care.
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With two existing ketamine treatment options (ketamine as a nasal spray, esketamine, and IV therapy), the FDA has different approaches. They approved the nasal spray (although it’s only available through a restricted distribution system, under a Risk Evaluation and Mitigation Strategy (REMS), but decided against doing so for ketamine IV therapy. That said, is ketamine legal as IV therapy then?
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Where Is Ketamine Legal?
Is ketamine legal? Well, the answer depends on how a person plans on using the drug.
Here is a Breakdown of Countries Where Ketamine is Legal in Various Forms
| Country | Legal Status of Ketamine |
| United States | At a federal level, ketamine is a Schedule III Substance but FDA-approved for anesthesia and depression (in the form of esketamine). Ketamine therapy and infusions are legal in every state through off-label prescriptions for a range of mental health conditions. There are now around 2,500 legal ketamine clinics in the United States. Spravato (esketamine), a ketamine nasal spray, is prescribed for depressive disorders in supervised clinics. Non-medical use is prohibited. |
| Canada | Legal for therapeutic use, with clinics in Toronto and other cities Non-medical use is strictly prohibited: ketamine is a Schedule I drug under the Controlled Drugs and Substances Act |
| United Kingdom | Ketamine infusions are legal for off-label use as a treatment for depression. Spravato is licensed for the treatment of treatment-resistant depression.In 2014, the UK government reclassified ketamine from a Class C to a Class B drug under the Misuse of Drugs Act 1971. It is illegal to use the drug for recreational purposes. |
| Czech Republic | Only legal for medicinal use. It is available as part of ketamine-assisted psychotherapy for patients who have depression Possession of personal quantities has been decriminalized |
| Germany | Legal for off-label use for the treatment of certain mental health conditions (e.g. depression and PTSD) in the form of ketamine-assisted psychotherapy Illegal for recreational uses |
| Portugal | Possession of small quantities of ketamine (along with all other drugs) has been decriminalized since 2000 following passage of Law 30/2000. This means you won’t face prosecution or any legal penalties if you have an amount of ketamine intended for personal use and not for selling. However, it is still a controlled substance, so it is not commercially available or regulated. |
| Spain | Ketamine is only legal for medicinal use. While personal use and possession are decriminalized, its use in public is considered an administrative infraction and may result in a hefty fine (between 601 and 30,000 euros). |
| Australia | It is illegal to use, possess, supply, or manufacture ketamine in Australia. It is a Schedule 8 controlled substance, which puts it in the same legal category as opioid painkillers (e.g. oxycodone and methadone), which can be legally prescribed. It is legal to use ketamine for therapeutic purposes if administered by medical practitioners who are authorized to do so. The off-label use of ketamine to treat depression, for instance, is not as widespread as in the US – there are fewer ketamine clinics. |
| New Zealand | It is illegal to use ketamine recreationally. It is a Class C drug, the same as cannabis Ketamine is only approved for use as an anesthetic agent. One clinic – the Dunedin ketamine clinic – did provide the drug as an off-label treatment for depression, but it closed in 2018. |
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Detailed Risk and Side Effects Therapeutic Use
Ketamine, when used in a controlled, therapeutic setting, can offer significant benefits for certain mental health conditions. However, it is crucial to be aware of the potential risks and side effects. Common side effects during or shortly after ketamine infusion therapy include nausea, dizziness, disorientation, and elevated blood pressure.
Some patients may experience dissociative symptoms or hallucinations during the treatment, which typically subside quickly. Long-term side effects are less well-documented, but there is concern about the potential for cognitive impairment, bladder issues, and dependency with prolonged or frequent use. It’s important to note that these risks are generally associated with higher doses than those used in therapeutic settings.
Recreational Use
Recreational use of ketamine carries significantly higher risks. It can lead to severe cognitive and memory impairments, urinary tract and bladder problems, and a high potential for abuse and addiction. Recreational users are also at risk of overdosing, which can lead to severe respiratory issues, coma, and even death. The illegal status of recreational use in many countries adds the risk of legal consequences.
Comparison with Other Treatments Effectiveness in Mental Health Treatment
Ketamine has shown promise in treating depression, particularly in cases resistant to other treatments. Studies suggest that ketamine can rapidly reduce symptoms of depression and suicidal thoughts, often within hours of administration. This is a notable advantage over traditional antidepressants, which typically take weeks to become effective.
Safety Profile
Compared to traditional antidepressants, ketamine’s safety profile is somewhat different. While antidepressants have their own side effects (like weight gain, sexual dysfunction, and emotional blunting), they generally lack the acute risks of ketamine such as dissociation and short-term cognitive impairment. However, ketamine’s rapid action can be crucial in acute cases of severe depression or suicidal ideation, where immediate symptom relief is paramount.
Use in Conjunction with Other Therapies
Ketamine is often considered as an adjunct to other forms of therapy, rather than a standalone treatment. This is especially true in cases of treatment-resistant depression, where ketamine can be used to provide rapid symptom relief, while other treatments (like psychotherapy or standard antidepressants) work on longer-term management.
Off-label Use Of Ketamine
Ketamine therapy falls under “off-label use”. This means a person is using it for a condition without approval. This often happens with chemotherapy while treating different types of cancer.
Ketamine infusions are only OK to use as a sole anesthetic agent for diagnostic and surgical procedures. This does not mean they cannot be used for other indications. Off-label ketamine for the treatment of mental health issues, mood disorders, and pain has medical support. Plus, research is constantly growing and is receiving funding.
Therefore, ketamine can be administered for indications outside of its FDA-approved indications — but only if it’s consistent with medical standards and regulations. More specifically, careful practice of evidence-based medicine by appropriately-trained physicians.
So what does this exactly mean for ketamine clinics?
Are they doing something wrong by administering infusions, or should they stick to esketamine? The Drug Enforcement Agency (DEA) has five categories or schedules for all medicine: Schedule I, Schedule II, Schedule III, Schedule IV, and Schedule V.
Drugs are scattered amongst various categories based on medical uses and dependency potential. Schedule I drugs have high dependency potential (developing addiction), with no current medical use. Schedule II drugs often have some medically accepted uses, with a progressively decreasing potential for developing addiction.
Ketamine falls under Schedule III, which means that it has a moderate potential for physical and psychological dependence. For reference, Tylenol with Codeine, buprenorphine, and testosterone are also Schedule III drugs.
Is ketamine legal to obtain from a pharmacy? Yes, so long as anyone administering it all have a DEA license. Since the treatment is from an outpatient clinic, it has standard outpatient requirements. These are below.
- State medical board licenses
- Insurance coverage
- OSHA standards
- The ability to store and take care of controlled substances
- Must obtain county/city licensing
Beyond that, there are no other regulations for ketamine infusions clinics. That’s why, over the years, those working with ketamine have come up with some suggested guidelines, like the consensus statements in JAMA Psychiatry and Regional Anesthesia and Pain Medicine, and organizations such as Kriya Ketamine Research Institute and the American Society of Ketamine Practitioners which are working hard on bringing together like-minded doctors, psychologists, and nurses to share experience, information, and provide education on the latest evidence-based research, studies, and treatments.
Is Ketamine Legal Outside Of The U.S.?
Ketamine clinics in the U.S. aren’t the only places administering ketamine. There are plenty of countries worldwide which are trying to get the best out of this psychedelic.
- Dr. Scheib’s clinic operates in both Germany and Spain. Each offers ketamine for depression, using repetitive transcranial magnetic stimulation (rTMS), neurofeedback, hypnosis and psychotherapy.
- The UK offers ketamine treatment for depression, but only for those who don’t respond to other treatments with a paid-for service.
- Ketamine has even become available in Czech Republic in a health center that focuses primarily on psychedelic-assisted psychotherapy and psychotherapeutic counseling.
Many health care providers see ketamine as a new, non-invasive and alternative treatment. This may help patients after attempting all evidence-based options without yielding results.
Is ketamine legal? At its core, yes. However, ketamine infusions are still awaiting full approval. With a plethora of studies ongoing, the possibilities are endless for the near future. Should more positive results return, the legalities around the psychedelic treatment will shift.
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Robert
November 27, 2022 at 7:51 pmKetamine is the only drug that works for my pain management. I require less than the minimum dosage to manage my pain. More than 4 mg and I start spinning into a k hole. I can’t take oral meds or opioids. So my doctors have given up on treating my incredible pain. For context, my intestines are falling out of a hole in my chest which isn’t being treated by my doctors. So I’m in a fair chunk of pain. They won’t even try to find a way to treat me. I think I’ll be dead before I can get it legally.
Debvin
April 1, 2024 at 6:03 amKetamine IV saved my life. I was severely clinically depressed with suicidal ideation. It should be easier to get everywhere in the world IF used for medicinal purposes (depression, PTSD, pain) and administered by medical professionals.