Ketamine, a substance known for its role for quite a long time as an anesthetic, and just more recently as an antidepressant, holds a distinctive position within the US drug classification system. Initially developed as an anesthetic during the 1960s, ketamine has since been utilized in domains, including pain management and mental health therapy.
We get questions regularly here at Nushama about what ketamine’s scheduling/classification means for its legality and use. TLDR: It’s 100% legal – it’s used off-label for depression at this time (2024), which means that insurance doesn’t cover it (except for Spravato, a nasal form of esketamine approved by the FDA for treatment-resistant depression).
Categorization & Scheduling of Ketamine
In the United States, ketamine is categorized as an anesthetic by the FDA. This classification mirrors its function, which involves inducing a feeling of detachment from one’s surroundings and self. Dissociative anesthetics operate by interfering with glutamate’s interaction with the NMDA receptor in the brain resulting in perception and awareness.
As an anesthetic, ketamine bears resemblances to substances within this category like phencyclidine (PCP – which it originally was made to replace) and dextromethorphan (DXM). Ketamine stands out from these compounds due to its characteristics, particularly its rapid-acting antidepressant properties and safety profile (it’s significantly safer in most uses cases in comparison to PCP and DXM).
The Controlled Substances Act of 1970 (by the DEA) established a system for categorizing drugs based on their purposes, safety and potential for misuse. In this framework, ketamine is placed in the Schedule III category, which means it has a risk of physical and psychological dependence. This classification allows for its use under controlled circumstances while also addressing concerns about abuse. Other substances in this group include steroids, testosterone, and codeine preparations.
Ketamine being labeled as a Schedule III substance strikes a balance between recognizing its benefits and acknowledging the risks associated with its misuse. This scheduling permits its prescription by authorized healthcare providers while implementing measures to prevent use or diversion for purposes.
Key implications of ketamine’s Schedule III status include its prescription by medical professionals for various medical applications in settings, like hospitals, clinics, and veterinary practices. Healthcare institutions and pharmacies are required to comply with regulations on how ketamine is stored, distributed, and documented to prevent it from being diverted or misused.
Those who unlawfully possess, distribute, or produce ketamine may face consequences such as fines and imprisonment.
Ketamine’s Evolving Use
Despite being classified as a Schedule III substance, the status of ketamine is evolving due to research findings and its expanding therapeutic uses. The FDA’s recent approval of esketamine nasal spray for the treatment of depression has sparked interest in exploring medical applications of ketamine.
This progress has triggered discussions about changing the scheduling of ketamine or creating categories for its different forms and purposes. Some argue that its proven effectiveness in treating depression with a risk of abuse, in medical settings justifies a reevaluation of its current classification. Educating the public is vital in helping them differentiate between the applications of ketamine and its potential for misuse.
Ketamine’s classification as an anesthetic and its Schedule III status under the Controlled Substances Act reflect its characteristics and the intricate considerations surrounding its usage. As research continues to unveil possibilities for ketamine, discussions regarding its categorization and scheduling are anticipated to endure.
Understanding ketamine’s standing is essential for healthcare professionals, patients, and policymakers as they navigate the ever-evolving realm of mental health treatment and drug regulation in the United States, especially in the context of the psychedelic medicine movement we’ve seen unfold in 2024 as it relates to state-by-state decriminalization/legalization, and federal regulation dynamics with MDMA and Lykos/MAPS.
