10 ms·
Ketamine: From Party Drug to Prescription Medicine
- thinkingkong 8y agoThe suggested price of these treatments is absurd. “And then there is the cost. It is unclear what insurance companies will cover and treatment estimates are in the vicinity of $7,000 per month.” Its been awhile but Im fairly confident this drug doesnt cost anywhere near that price.
- civilian 8y agoKetamine is also available for use as an anesthetic. (It used to be used for most heart surgeries.) It's like $10 a shot when used as an anesthetic. Some insightful background: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...
- Scoundreller 8y agoIt’s still used. Moreso in animals, but still in humans, but usually with another sedative. Also used in palliative care when opiates aren’t working or causing too many side effects.
- civilian 8y agoRight, my comment about "was used" was for heart surgery. The story I heard was that the patients were complaining about the psychedelic effects :D It was really interesting to watch "Combat Medics", a show about med-evac choppers for the US armed forces in afghanistan. One of the first things they do with bad cases is give them a shot of ketamine. So in addition to calling K disparagingly "cat tranquilizer" and "horse tranquilizer", we should call it "marine tranquilizer".
- Scoundreller 8y agoThe big advantage of it is that it works and it doesn’t mess with heart rate or breathing. Safe to give without having to monitor much, nor carry other items because it has few contraindications.
- jfk13 8y agoSomeone I used to know was a ketamine user for a while -- when she wasn't busy with cocaine. (The impact was pretty drastic, so I'm guessing she was using rather more than might be recommended...) What I came to say, though, was that I'm quite sure she wasn't paying anything like that much for it.
- str33t_punk 8y agoIn my experience a gram of K in the US costs around $100 In the UK it is more like $20-$40
- glerk 8y agoThis is a bit like comparing street amphetamine powder with prescription adderall. People are willing to pay for a pure product measured precisely in laboratory, not cut with other dangerous chemicals delivered as a pill.
- akvadrako 8y agoI’m not an expert but I’ve heard that K is so easy to make and cheap, it’s rarely cut.
- cwkoss 8y agoFrom what I remember from the Hamilton's Pharmacopeia episode on Ketamine, this synthesis is actually quite complex and a high-yield synthesis (which is presumably being used currently by manufacturers) is not published in publicly available literature. However, ketamine is widely used as an anesthetic, so I think the "cheap to make" refers to Ketamine redirected from the pharma market to illicit channels, in which case "making" ketamine is just drying the solution to crystalize the sole ingredient.
- empath75 8y agoStreet ketamine is almost always redirected pharmaceuticals. We used to buy cases of bottles unopened back in the 90s
- devoply 8y agoBut research, development, and marketing cost.
- Symmetry 8y agoIIRC most of the money spent on the development of a successful drug comes from the phase 3 clinical trial. R&D does make up a lot of a drug company's budget but that's because you do the R&D for the 10 drugs you start with, not just the 1 that makes it to market.
- Scoundreller 8y agoIt should be a joke for a generic drug company to take generic S-Ketamine and put it in another insufflation device and show bio equivalency. You don’t patent indications.
- Symmetry 8y agoI don't think it's a joke that they could patent their special version of ketamine, I think it's a joke that despite the fact that we've been using ketatmine for generations and despite the fact that it's anti-depressant qualities are well attested to in the literature this brand of s-ketamine is the only one doctors are allowed to use. And there's research[1] showing that most of racemic ketamine's effect is from the r-ketamine, not the s-ketamine. [1]https://www.sciencedirect.com/science/article/pii/S0091305713003328?via%3Dihub https://www.sciencedirect.com/science/article/pii/S009130571...
- Scoundreller 8y agoThere’s no way they were the first to synthesize the S énantiomor. Usually doctors can still prescribe the compounded forms as long as they’re not duplicating something commercially available.
- refurb 8y agoYou don’t patent them, but you do get exclusivity with the FDA approval. FDA won’t approve another drug for 3-7 years.
- mrkurt 8y agoKetamine infusions for depression are pretty expensive, but not $7000/mo. They seem to run about $400-600 per treatment.
- penagwin 8y agoGiven that patients require constant treatment to benefit from ketamine I'm not sure that helps a ton.
- Scoundreller 8y agoI couldn’t imagine it being that expensive to have a home care nurse set up a peripheral line, mix up the bag and run the infusion (or IV push it). The drug in vials is generic. No different than IV antibiotics at home. Not much clinical monitoring required when you’re on a stable dose.
- penagwin 8y agoWe're comparing this to the 20$ for a months worth of antidepressants though. It's 1000x more convenient (and cheaper) to take a single pill a day vs setting up an IV.
- dawhizkid 8y agoJohnson & Johnson patented and got Esketamine FDA-approved specifically for the treatment of depression, which is literally just the active part of Ketamine, which is otherwise a very cheap generic drug but not approved for the treatment of depression. And with the patent raised prices at least 300x over what Ketamine costs. And we wonder why drug prices are so high.
- bentona 8y agoEsketamine is just an enantiomer. Both enantiomers are similarly active, and to me it's not 100% clear to me why Esketamine was the enantiomer chosen.
- dawhizkid 8y agoThere is no rhyme or reason other than the fact that one or the other could be patented by a private co unlike Ketamine. I assume trying to patent both would've doubled their costs, so why bother, especially if it's highly probable both do the same thing.
- mveety 8y agoEsketamine doesn’t have the same activity as racemic or Arketamine (S- hits some of the dopamine receptors harder and doesn’t bind with the sigma ones iirc). Patients seem to find esketamine more pleasant because of this and it’s eliminated faster than R- so patients can (probably) get back to normal faster. (Edit: had my right from left mixed up. It’s been a while)
- dawhizkid 8y agoSo maybe it makes you a little less groggy but at 300x the price? Don't think anyone can say that justifies the price multiple.
- xkcd-sucks 8y agoNow r-ket can be developed as a patentable improvement over the state of the art :)
- cgb223 8y agoI feel like the street price for a months worth of Ketamine would be way less than $7000...
- ada1981 8y agoYou could get a couple first class flights and VIP tickets to EDM festivals to go with it :p
- SpikeDad 8y agoEven worse is are the conditions for being prescribed. First you have to have failed 5 previous medications but still be taking one. The dosages are delivered only to your psychiatrist. You have to have it injected there and then you have to wait 2 hours and are not permitted to drive for 24 hours. And that's for the several injections per week... So not only will the drug be expensive but you're going to be charged a doctors visit every time AND you'll have to figure out how to get off from work for hours each week. Seems a lot easier to go down to the local high school and buy a bag of K.
- Zircom 8y agoMy girlfriend did ketamine treatments and her's were once a week for four weeks with a break period in between(don't remember the exact length of the break), where are you seeing the several injections per week number?
- starpilot 8y agoSpravato is 2x a week for nasal administration for the first 4 weeks, then weekly or less thereafter. http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf http://www.janssenlabels.com/package-insert/product-monograp... page 2 upper right. Still it's constraining.
- deleted 8y ago[deleted]
- jokowueu 8y agoThats not the case for people I know . I know a place that don't need a history of failed AD treatments and each session costs 400$ . After 5 sessions u get a one month supply of oral or intranasal ket for daily use 20mg .
- perfmode 8y agoUntil I see a detailed cost breakdown, I am going to assume this is just more of the same graft that has infected the rest of the US healthcare system.
- vilifiedtwin 8y agoBig pharma and their dubious ties to politicians should be put to an end. I am so sick of this injustice. If it wasn't possible to hike the price, the drug would have remained illegal. The same is with cannabis although some countries have politicians with a spine and managed to legalise. The most dumbfounding situation is in the UK, where doctors have been told to not prescribe cannabis for chronic pain, as supposedly there is no evidence it works (!).
- hndamien 8y agoI wonder if just giving some people $7,000 a month would help with depression?
- cwkoss 8y agoOoh, this would be a really interesting 'placebo' control. Literally hand the patient the cost of providing the treatment as an alternative condition.
- internet_user 8y agoI like the active placebo in cash idea.
- escherplex 8y agoFunny, a physician friend once commented that the effectiveness of a placebo seems to be directly proportional to its cost :-)
- deleted 8y ago[deleted]
- mirimir 8y agoWell, I find this.[0] > Drug maker Johnson & Johnson has stated that the Average Wholesale Price (AWP) for each treatment of esketamine would range from $590 to $885, depending on dosage and excluding administration and observation costs. This implies a twice-weekly treatment during the first month would cost medical treatment centers offering the drug at least $4,720 to $6,785. Subsequent weekly treatments would cost about half as much. Purchasers and payers with market power will get discounts and/or rebates, of course. But that's still a damn expensive drug. Also, do note that it's the "cost [to] medical treatment centers". Not what they'd charge patients and third-party payers. 0) https://www.coventrywcs.com/content/dam/pdf_assets/first_script_bulletins/2019/CLINICAL_BULLETIN-FDA-Approves-Spravato-20190314.pdf https://www.coventrywcs.com/content/dam/pdf_assets/first_scr...
- Lazare 8y agoDriving it through FDA trials does though. We've set up a system where we don't let new drugs hit the market unless someone spends billions on testing. That's...mostly good? I guess? But there's no way ketamine will ever be approved in the US unless someone finds a way to charge $7k a dose for it, because otherwise nobody is going to spend the money for approval. I mean, nothing is stopping you, RIGHT NOW, from crowdfunding a campaign to get the normal version of ketamine through trials, and once you did, it'd be legal to prescribe the "normal" version, and it'd cost a few dollars a dose. Which would (it seem) be a big net benefit to humanity! It's just, you know...how would you make that work? The cost structure is not favourable.
- BurningFrog 8y agoKetamine is practically free to manufacture. What you're paying for is the FDA approval process for this condition.
- rjurney 8y agoI use 10% Ketamine topical cream for nerve pain. It's the business. Irritating it isn't covered by insurance as the research is favorable.
- long 8y agoI've got some nerve issues and would be interested in trying this -- how did you get a hold of the cream?
- refurb 8y agoThere is very little evidence that these creams work.[1] Just one example... CONCLUSIONS: This study suggests that KA cream does not decrease CIPN symptoms in cancer survivors. [1]https://www.ncbi.nlm.nih.gov/m/pubmed/24531792/ https://www.ncbi.nlm.nih.gov/m/pubmed/24531792/
- long 8y agoInteresting. GP seems to say that it worked wonders for them, so I'm still interested in trying it.
- dandigangi 8y agoI was considering this to aid my depression/bipolar but the prices just don't make it worth it if it only provides up to months of benefit. I could see doing it at around $800-1200 total for the 6 shots, not per shot.
- mrkurt 8y agoI have a fair amount of familiarity with Ketamine infusion clinics in the Chicago area. Prices seem to be $400-600 per treatment. They like people to go 3-6 times in the first two weeks, and then way less frequently after that. It has been a godsend for my family.
- dandigangi 8y agoWhat places? I am going to a clinic out in NW burbs called Chicago Pain and Wellness. (If I do it that is)
- mrkurt 8y agoWe tried that one and didn't really like it, this one has been excellent: https://www.optketamine.com/ https://www.optketamine.com/
- starpilot 8y agoThis is supposed to be covered by insurance.
- dandigangi 8y agoDefinitely not.
- starpilot 8y agoSpravato will be covered by at least some insurance plans, that was the point of FDA approval. Kaiser is already running ketamine clinics in California.
- rconti 8y ago... and people wonder why users turn to black markets. It costs, what, $40 on the street for a bunch?
- patorjk 8y agoReminds me of the research now starting around MDMA as a cure for tinnitus (ringing in the ears) [1]. Lots of people who use the drug have self reported a reduction in the ringing they hear. It'd be real interesting if this eventually led to it being a prescription medicine too. [1] http://www.stuff.co.nz/national/9806851/Party-drug-link-to-tinnitus-cure http://www.stuff.co.nz/national/9806851/Party-drug-link-to-t...
- simonsaidit 8y agoI cured my stress and tinnitus so loud I could hardly hear and sleep with my own homemade Changa (dmt+hamalas) with one trip. Most amazing drug ever... and I did them all ;)
- akvadrako 8y agoI’m pretty sure DMT gave me tinnitus, so I guess it affects people in different ways.
- simonsaidit 8y agoYes I read that happening too temporarily but I was kinda desperate and it got me out of a bad loop and into healthier living and better sleep which took the stress and the tinnitus with it.
- fokinsean 8y agoOh man I have mild tinnitus and wish for a cure, but psychedelics are intimidating to me. I feel like if I was 5 years younger I would dive right in but I don't know if I could do it now a days.
- ada1981 8y agoAs someone who used psychedelics as a teenager and later as an adult cured myself of schizo/bipolar using MDMA and mushrooms, I’d say that being older is nothing to fear. You are wiser, more mature and the smartest you’ve ever been. Psychedelics as an adult is so much more enjoyable when done responsibily.
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- reneberlin 8y agoAI is on the way to create cheaper alternatives for medication. Recreational or therapeutic use? It'll take the middleman out of the price. it'll be cheap as chewing gum. My guess.
- k_sh 8y agoAI doesn't solve the underlying issue that made ketamine depression treatment expensive: intellectual property rights on a particular molecule. If a company achieved AI that can identify effective alternatives, why wouldn't they just acquire the patents for all of those alternatives and prop up all the prices?
- kkarakk 8y agoThere will be AIs to obscure other AIs work and AIs to clarify the obscured work. The rat race will never end
- perfmode 8y ago<God> is on the way to <solve problem>.
- mito88 8y agothen there was MXE...
- ozzyman700 8y ago2f-dck is my grail currently for a ket-a-like
- stiGGG 8y agoIs Ketamine really a party drug? I've no experience but i thought the effect is more like you sit somewhere and won't stand up for a while...
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- thatswrong0 8y agoIn my scene, it’s the drug of choice. I’ve never really understand why but so it goes
- Scoundreller 8y agoPsy-trance?
- cc81 8y agoSeems to be incredibly popular in UK and just like MDMA they are taking pretty high doses in general so you have teens needing their bladder removed due to abuse.
- perardi 8y agoYes. It's big in the gay circuit party scene. Along with GHB.
- dustindiamond 8y agoWhy is it called a ‘circuit party’?
- f0under 8y agogay circuit, party scene
- starpilot 8y agoPlug: new subreddit for this, https://www.reddit.com/r/spravato https://www.reddit.com/r/spravato. Has an AMA from someone who was part of the trial. Right now it's hard to find a treatment center participating in the REMS, but spravato.com should have a locator tool up later this month.
- hello_tyler 8y agoThis is something that I'd try if it wasn't cost prohibited. But no, I'm stuck on benzos forever. At least they are cheap and they work OK I suppose.
- linuxdude314 8y agoAs someone who has gone down that road (and managed to get off), I can't emphasize enough how important it is to not take those drugs forever. It simply isn't possible, at some point your tolerance will become so high you will be forced to find something else. The withdrawals from benzodiazapenes are some of the worst of any drug and will require medical intervention in order to keep your seizure threshold properly regulated. The Ashton Method has worked miracles for many including myself. https://www.benzo.org.uk/manual/bzcha02.htm https://www.benzo.org.uk/manual/bzcha02.htm It is hard to find a doctor who will support you with that treatment, but I went through it and am successfully benzo free now.
- mnm1 8y agoCouldn't agree more. The withdrawl severity very much depends on the person and if tapered slowly, it's not bad (it wasn't for me). Cannabis can help there temporarily also. Benzos are awful after awhile due to tolerance and mostly the negative effects persisting.
- stordoff 8y agoI don't want to downplay it too much (I've seen my grandmother go through benzodiazapine withdrawal, and it took the best part of a year IIRC), but I would add withdrawal is highly personal. I've quit drugs that I was told (by my consultant) that would be "worse than quitting heroin" and stopped cold turkey, and didn't feel a thing. I also now take regularly take benzodiazapines, and can stop taking them during good periods without any noticeable effects (which has the bonus of limiting my tolerance increase).
- Uhhrrr 8y ago"cost prohibitive"
- skybrian 8y agoSlate Star Codex had a good post about this: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...
- KaiserPro 8y agohmm, it'll be interesting to see the prescribing guidelines for this. Ketamine is not really designed for long term repeated use, mainly because it shrinks your bladder.(https://www.nhs.uk/news/mental-health/experts-call-for-ketamine-to-be-upgraded-to-class-b/ https://www.nhs.uk/news/mental-health/experts-call-for-ketam...) The NHS has been doing basic research since at least 2014: https://www.nhs.uk/news/mental-health/ketamine-tested-as-severe-depression-treatment/ https://www.nhs.uk/news/mental-health/ketamine-tested-as-sev... If it is approved, it certainly won't be Esketamine thats used.
- starpilot 8y agoEsketamine was approved by the FDA two weeks ago, here are the prescribing guidelines: http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf http://www.janssenlabels.com/package-insert/product-monograp...
- random878 8y agoOh look, the perennial 'ketamine as a novel treatment for depression' article.