5 ms·

There's an interesting risk to all of this: legitimizing the illegal drug. Let's say my doctor says to me "you're depressed, I'm prescribing esketamine, go to

by mabbo 8y ago

There's an interesting risk to all of this: legitimizing the illegal drug. Let's say my doctor says to me "you're depressed, I'm prescribing esketamine, go to this clinic and pay them $3000". Well, I do my research and learn that really this stuff has the same antidepressants effect as ketamine. And the same number of doses of ket on the darknet markets are going to cost me a heck of a lot less. Sure, there's the question of legality. But if I can't afford esketamine but can afford dodgy internet ket, and I'm desperate for something, anything, to help with this nagging constant psychic pain weighing down my life... Suddenly I appreciate my Canadian single payer health care system a lot more, even with the small problems it has.

deleted 8y ago
[deleted]
jmcgough 8y ago
Most people probably lack the technical aptitude to use darknet markets, so this is probably more relevant to hacker news readers than the general public.
loeg 8y ago
What's the risk of legitimizing ketamine? The majority of the research and meta-reviews support ketamine as a treatment for depression too. The S-isomer may be better in some ways, but maybe not $3k better if you're poor. On a risk/harm scale, it's comparable to alcohol or cigarettes[1]. [1]: https://en.wikipedia.org/wiki/Drug_harmfulness#/media/File:Development_of_a_rational_scale_to_assess_the_harm_of_drugs_of_potential_misuse_(physical_harm_and_dependence,_NA_free_means).svg https://en.wikipedia.org/wiki/Drug_harmfulness#/media/File:D...
- fucking_tragedy 8y ago
  When you get ketamine from a doctor, it is in metered in sub-psychedelic and sub-anesthetic doses. When you get ketamine from the internet, you're getting a mystery powder that is, at best, a potent form of an addictive drug in quantities that are not metered and are ripe for abuse. At worst, you're getting some form of fentanyl because internet drug dealers are inept.
  - loeg 8y ago
    You have a lot of opinionated adjectives in that second sentence that aren't related to the chemical, which is the same one as in the first sentence. > a potent form of an addictive drug It's literally the same chemical; you didn't use those adjectives when you described it earlier. > quantities that are not metered Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ https://erowid.org/chemicals/ketamine/ketamine_dose.shtml#oral https://erowid.org/chemicals/ketamine/ketamine_dose.shtml#or... > At worst, you're getting some form of fentanyl because internet drug dealers are inept. That's not a ketamine problem; it's a prohibition problem.
    - fucking_tragedy 8y ago
      > It's literally the same chemical; you didn't use those adjectives when you described it earlier. I would talk the same way about treating ADHD with Desoxyn prescribed by a doctor versus buying a pile of methamphetamine online to self-medicate with. > Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ If you're going to make bad choices, volumetric dosing is one of the less bad choices. > That's not a ketamine problem; it's a prohibition problem. It's a regulation problem. The supplement market is full of bunk or outright fake products. It took the FDA to reel actual medicine in.
    - mzybert 8y ago
      > Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ My friend had one like this. It was barely accurate enough for all the funny RCs we had.
Alex3917 8y ago
Ketamine isn't an illegal drug, it's been FDA-approved for decades. They're both schedule III.
- AstralStorm 8y ago
  It was not legal to prescribe as an antidepressant outside experimental setting.
  - Broken_Hippo 8y ago
    Probably not directly, but I'm pretty sure it is legal to prescribe medicines for off-label use as well. Is there some sort of restriction on this particular drug that I'm not aware of?
  - irq 8y ago
    This is completely wrong. For quite a long time it has been legal for doctors to prescribe FDA approved drugs off-label, that is, for reasons other than what they're FDA approved for. But if it's not FDA approved, insurance companies won't pay for it. That's what this ruling changes, for this one form of the drug.
    - vilhelm_s 8y ago
      Although that's not necessarily true either. Insurance contract typically pay for FDA-approved indications, but they also usually have some process where they will pay for off-label use if you can submit evidence that it's scientifically justified and cheaper alternatives would not work. Of course this is pretty stressfull, but it's really necessary in the U.S. because getting FDA to approve a new indication is really expensive for the drug companies, so there are a lot of drugs which are not approved for some of their main uses. For example, SSRIs are commonly used for anxiety even though this is off-label.[1] And monoclonal antibody-based immunosuppressives like adalimumab are often only approved for a few conditions, like Crohn's and arthritis, even though they are useful for auto-immune diseases in general. In the specific case of ketamine for depression, some people do seem to have successfully gotten insurance companies to pay for it.[2] Even without FDA approval, this would probably get easier over time, as more studies show effectiveness. [1] https://www.aafp.org/afp/2003/0801/p498.html https://www.aafp.org/afp/2003/0801/p498.html [2] https://www.ketaminewellnesscenters.com/getting-insurance-to-pay-for-ketamine/ https://www.ketaminewellnesscenters.com/getting-insurance-to...
jokowueu 8y ago
No . It does not have the same anti depressant effects as racemic ketamine .
mikekchar 8y ago
> Suddenly I appreciate my Canadian single payer health care system a lot more, even with the small problems it has. It's been a long time since I lived in Canada, but one of the "small problems" was that prescription medicine wasn't covered. You need private health insurance, or you need to be covered by one of many confusing provincial health care plans. Generally, you can find a way, but at least 15 years ago (when I left) it could be pretty dicey. I remember several of my friends having difficulty affording their insulin when I was in university -- too rich to qualify for aide, too poor to be able to pay for their life saving drugs without hardship. My dad (who still lives there) tells me things have improved, but he still pays more for prescription drugs than I do (living in Japan) I think. The UK's NHS seems to be a better system to compare to ;-) I lived there for 2 years and was really surprised at what the NHS covers. Interestingly they will even pay for emergency treatment for non-residents who happen to be in the country!
- cheerlessbog 8y ago
  As well as emergency care being free for non residents, contraceptives and STI treatment are too [1] [1] https://www.nhs.uk/using-the-nhs/nhs-services/visiting-or-moving-to-england/visitors-from-outside-the-european-economic-area-eea/ https://www.nhs.uk/using-the-nhs/nhs-services/visiting-or-mo...
- jdietrich 8y ago
  >The UK's NHS seems to be a better system to compare to ;-) I lived there for 2 years and was really surprised at what the NHS covers. The caveat is all of the stuff that the NHS won't cover. The service is largely free at the point of use, but there has always been some element of rationing which has drastically increased in recent years due to Conservative government cuts. Mental health gets the short end of the stick in this respect - it represents 23% of the disease burden but only 13% of NHS spending. Most patients with a mental health condition will never see a psychiatrist and receive no more than six half-hour sessions of psychotherapy. If esketamine does prove to be effective, the NHS is exceedingly unlikely to offer it to more than a handful of patients until the patent expires. https://www.nuffieldtrust.org.uk/resource/rationing-in-the-nhs https://www.nuffieldtrust.org.uk/resource/rationing-in-the-n...
bpchaps 8y ago
Interestingly, at least in the US, a take-home prescription for ketamine is already suprisingly cheap - $38 USD for 100ml: https://www.drugs.com/price-guide/ketamine https://www.drugs.com/price-guide/ketamine At least near me, there are "ketamine centers" that already to ketamine clinics - $500 per session, and insurance doesn't cover it. Ends up being around $3000. I haven't done it, so I can't comment on its effectiveness. It's pretty lame that the cost difference is so large. I guess the barrier is a psychiatrist's willingness to prescribe. Maybe all of this research will open up psychiatrists to prescribe take-home ketamine more readily?
- jokowueu 8y ago
  Basically most clinics will give u a month supply after 6 sessions for 80$ a month
  - _acme 8y ago
    No, they won't, because the only form available is the IV form. There are no ketamine pills or tablets. Some doctors will prescribe ketamine nasal spray or lozenges to be made by a compounding pharmacy, but the vast percentage of doctors who are willing to administer ketamine in their offices are not at all willing to prescribe a take home dose, and if they are, it's in a very different form with different effects than the IV session. I get regular IV sessions and have compounded lozenges that I take daily, and in my experience neither the nasal spray (which I hated) nor the lozenges are anything like the infusion, and it was extraordinarily difficult to find a doctor in the Boston area that would write any kind of take home prescription. No clinic anywhere is going to give you a bottle of ketamine and some syringes, and neither is CVS.
    - jokowueu 8y ago
      That's what I meant by maintenance dose . A nasal spray or lozenge. The maintenance doses are great for the vast majority but if you feel that they don't do it for you and able to get a nasal formulation you can do your own IM injection which I know a few people personally that do it once a month
Pristina 8y ago
>single payer health care system is just a system that forces healthy people to pay for unhealthy people.
- iamben 8y ago
  Or, you know, themselves when they get unexpectedly ill.
- danmaz74 8y ago
  Yes, just like we're forced to pay for police even if we've never been robbed...
- Broken_Hippo 8y ago
  This is what insurance and health care does, though. Do you think your premiums are really based on how healthy you are currently? Especially when you have insurance through your employer? In this last case, you might pay more for certain markers (smoking, uncontrolled high blood pressure, and other wellness marks), but not if you have asthma or migraines, for example. Part of your premium is literally paying for folks that are sick. Paying for other people's pregnancies and children and stuff like that.
- empath75 8y ago
  That’s literally what insurance is.
- fucking_tragedy 8y ago
  If you truly care about costs, and not punishing the sick, single-payer systems are cheaper than private insurance by an average factor of 3[1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
empath75 8y ago
I don’t know if it’s changed recently, but back when I was clubbing, street ketamine was mostly just stolen from vets offices and dried into a powder.
pietrovismara 8y ago
I wouldn't call it a risk but rather a benefit, in which it makes impossible to not see the absurdity of prohibition laws.
unparagoned 8y ago
That is exactly why there is a massive h eppidemic in the us. Drug companies lied about oxys , everyone got hooked, couldn't afford it and moved onto h. Now that's laced with fent and everyone is dying

by mabbo 8y ago

deleted 8y ago

[deleted]

jmcgough 8y ago

Most people probably lack the technical aptitude to use darknet markets, so this is probably more relevant to hacker news readers than the general public.

loeg 8y ago

What's the risk of legitimizing ketamine? The majority of the research and meta-reviews support ketamine as a treatment for depression too. The S-isomer may be better in some ways, but maybe not $3k better if you're poor. On a risk/harm scale, it's comparable to alcohol or cigarettes[1]. [1]: https://en.wikipedia.org/wiki/Drug_harmfulness#/media/File:Development_of_a_rational_scale_to_assess_the_harm_of_drugs_of_potential_misuse_(physical_harm_and_dependence,_NA_free_means).svg https://en.wikipedia.org/wiki/Drug_harmfulness#/media/File:D...

fucking_tragedy 8y ago
When you get ketamine from a doctor, it is in metered in sub-psychedelic and sub-anesthetic doses. When you get ketamine from the internet, you're getting a mystery powder that is, at best, a potent form of an addictive drug in quantities that are not metered and are ripe for abuse. At worst, you're getting some form of fentanyl because internet drug dealers are inept.
- loeg 8y ago
  You have a lot of opinionated adjectives in that second sentence that aren't related to the chemical, which is the same one as in the first sentence. > a potent form of an addictive drug It's literally the same chemical; you didn't use those adjectives when you described it earlier. > quantities that are not metered Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ https://erowid.org/chemicals/ketamine/ketamine_dose.shtml#oral https://erowid.org/chemicals/ketamine/ketamine_dose.shtml#or... > At worst, you're getting some form of fentanyl because internet drug dealers are inept. That's not a ketamine problem; it's a prohibition problem.
  - fucking_tragedy 8y ago
    > It's literally the same chemical; you didn't use those adjectives when you described it earlier. I would talk the same way about treating ADHD with Desoxyn prescribed by a doctor versus buying a pile of methamphetamine online to self-medicate with. > Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ If you're going to make bad choices, volumetric dosing is one of the less bad choices. > That's not a ketamine problem; it's a prohibition problem. It's a regulation problem. The supplement market is full of bunk or outright fake products. It took the FDA to reel actual medicine in.
  - mzybert 8y ago
    > Readily fixed for < $20: https://www.amazon.com/dp/B07D1NNGM6/ https://www.amazon.com/dp/B07D1NNGM6/ My friend had one like this. It was barely accurate enough for all the funny RCs we had.

Alex3917 8y ago

Ketamine isn't an illegal drug, it's been FDA-approved for decades. They're both schedule III.

AstralStorm 8y ago
It was not legal to prescribe as an antidepressant outside experimental setting.
- Broken_Hippo 8y ago
  Probably not directly, but I'm pretty sure it is legal to prescribe medicines for off-label use as well. Is there some sort of restriction on this particular drug that I'm not aware of?
- irq 8y ago
  This is completely wrong. For quite a long time it has been legal for doctors to prescribe FDA approved drugs off-label, that is, for reasons other than what they're FDA approved for. But if it's not FDA approved, insurance companies won't pay for it. That's what this ruling changes, for this one form of the drug.
  - vilhelm_s 8y ago
    Although that's not necessarily true either. Insurance contract typically pay for FDA-approved indications, but they also usually have some process where they will pay for off-label use if you can submit evidence that it's scientifically justified and cheaper alternatives would not work. Of course this is pretty stressfull, but it's really necessary in the U.S. because getting FDA to approve a new indication is really expensive for the drug companies, so there are a lot of drugs which are not approved for some of their main uses. For example, SSRIs are commonly used for anxiety even though this is off-label.[1] And monoclonal antibody-based immunosuppressives like adalimumab are often only approved for a few conditions, like Crohn's and arthritis, even though they are useful for auto-immune diseases in general. In the specific case of ketamine for depression, some people do seem to have successfully gotten insurance companies to pay for it.[2] Even without FDA approval, this would probably get easier over time, as more studies show effectiveness. [1] https://www.aafp.org/afp/2003/0801/p498.html https://www.aafp.org/afp/2003/0801/p498.html [2] https://www.ketaminewellnesscenters.com/getting-insurance-to-pay-for-ketamine/ https://www.ketaminewellnesscenters.com/getting-insurance-to...

jokowueu 8y ago

No . It does not have the same anti depressant effects as racemic ketamine .

mikekchar 8y ago

> Suddenly I appreciate my Canadian single payer health care system a lot more, even with the small problems it has. It's been a long time since I lived in Canada, but one of the "small problems" was that prescription medicine wasn't covered. You need private health insurance, or you need to be covered by one of many confusing provincial health care plans. Generally, you can find a way, but at least 15 years ago (when I left) it could be pretty dicey. I remember several of my friends having difficulty affording their insulin when I was in university -- too rich to qualify for aide, too poor to be able to pay for their life saving drugs without hardship. My dad (who still lives there) tells me things have improved, but he still pays more for prescription drugs than I do (living in Japan) I think. The UK's NHS seems to be a better system to compare to ;-) I lived there for 2 years and was really surprised at what the NHS covers. Interestingly they will even pay for emergency treatment for non-residents who happen to be in the country!

cheerlessbog 8y ago
As well as emergency care being free for non residents, contraceptives and STI treatment are too [1] [1] https://www.nhs.uk/using-the-nhs/nhs-services/visiting-or-moving-to-england/visitors-from-outside-the-european-economic-area-eea/ https://www.nhs.uk/using-the-nhs/nhs-services/visiting-or-mo...
jdietrich 8y ago
>The UK's NHS seems to be a better system to compare to ;-) I lived there for 2 years and was really surprised at what the NHS covers. The caveat is all of the stuff that the NHS won't cover. The service is largely free at the point of use, but there has always been some element of rationing which has drastically increased in recent years due to Conservative government cuts. Mental health gets the short end of the stick in this respect - it represents 23% of the disease burden but only 13% of NHS spending. Most patients with a mental health condition will never see a psychiatrist and receive no more than six half-hour sessions of psychotherapy. If esketamine does prove to be effective, the NHS is exceedingly unlikely to offer it to more than a handful of patients until the patent expires. https://www.nuffieldtrust.org.uk/resource/rationing-in-the-nhs https://www.nuffieldtrust.org.uk/resource/rationing-in-the-n...

bpchaps 8y ago

Interestingly, at least in the US, a take-home prescription for ketamine is already suprisingly cheap - $38 USD for 100ml: https://www.drugs.com/price-guide/ketamine https://www.drugs.com/price-guide/ketamine At least near me, there are "ketamine centers" that already to ketamine clinics - $500 per session, and insurance doesn't cover it. Ends up being around $3000. I haven't done it, so I can't comment on its effectiveness. It's pretty lame that the cost difference is so large. I guess the barrier is a psychiatrist's willingness to prescribe. Maybe all of this research will open up psychiatrists to prescribe take-home ketamine more readily?

jokowueu 8y ago
Basically most clinics will give u a month supply after 6 sessions for 80$ a month
- _acme 8y ago
  No, they won't, because the only form available is the IV form. There are no ketamine pills or tablets. Some doctors will prescribe ketamine nasal spray or lozenges to be made by a compounding pharmacy, but the vast percentage of doctors who are willing to administer ketamine in their offices are not at all willing to prescribe a take home dose, and if they are, it's in a very different form with different effects than the IV session. I get regular IV sessions and have compounded lozenges that I take daily, and in my experience neither the nasal spray (which I hated) nor the lozenges are anything like the infusion, and it was extraordinarily difficult to find a doctor in the Boston area that would write any kind of take home prescription. No clinic anywhere is going to give you a bottle of ketamine and some syringes, and neither is CVS.
  - jokowueu 8y ago
    That's what I meant by maintenance dose . A nasal spray or lozenge. The maintenance doses are great for the vast majority but if you feel that they don't do it for you and able to get a nasal formulation you can do your own IM injection which I know a few people personally that do it once a month

Pristina 8y ago

>single payer health care system is just a system that forces healthy people to pay for unhealthy people.

iamben 8y ago
Or, you know, themselves when they get unexpectedly ill.
danmaz74 8y ago
Yes, just like we're forced to pay for police even if we've never been robbed...
Broken_Hippo 8y ago
This is what insurance and health care does, though. Do you think your premiums are really based on how healthy you are currently? Especially when you have insurance through your employer? In this last case, you might pay more for certain markers (smoking, uncontrolled high blood pressure, and other wellness marks), but not if you have asthma or migraines, for example. Part of your premium is literally paying for folks that are sick. Paying for other people's pregnancies and children and stuff like that.
empath75 8y ago
That’s literally what insurance is.
fucking_tragedy 8y ago
If you truly care about costs, and not punishing the sick, single-payer systems are cheaper than private insurance by an average factor of 3[1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

empath75 8y ago

I don’t know if it’s changed recently, but back when I was clubbing, street ketamine was mostly just stolen from vets offices and dried into a powder.

pietrovismara 8y ago

I wouldn't call it a risk but rather a benefit, in which it makes impossible to not see the absurdity of prohibition laws.

unparagoned 8y ago

That is exactly why there is a massive h eppidemic in the us. Drug companies lied about oxys , everyone got hooked, couldn't afford it and moved onto h. Now that's laced with fent and everyone is dying