7 ms·

I've heard that Ketamine treatments cost something like between $400 to $1000 per treatment, and insurance often doesn't cover it (as it's off-label use), so it

I've heard that Ketamine treatments cost something like between $400 to $1000 per treatment, and insurance often doesn't cover it (as it's off-label use), so it has to come out of pocket for patients. This seems completely insane, especially as the cost of ketamine itself is supposed to be negligible, and what you're paying for is the therapy.. but the therapists role in the treatment is itself virtually nonexistant.. they just hang out and let the medicine do the work (or, in the case of lozenges that patients take a home all they do is write a prescription). When you factor in that most people who treat their depression with ketamine have to come back again and again every week or two (possibly for the rest of their life), this is a HUGE money maker for ketamine clinics and I don't see how it wouldn't send any but the richest among us in to the poor house. I've heard some psychiatrists and psychedlic therapy advocates express concern about this and say they want to find some way of making sure that everyone who needs help gets it, regardless of their financial situation, but I don't know if anything ever came of that. AFAIK ketamine treatment is still not covered by insurance. All the ketamine clinics springing up like mushrooms after the rain seem like a big money grab, and I can't believe they couldn't make the treatments orders of magnitude cheaper.

perardi 5y ago
I won’t pretend there isn’t big fat profit in there, but I have to think the cost has more to do with this being an IV infusion. You’re more paying for the medical care, including being under observation.
pamplemoose 5y ago
Ketamine should be a fairly cheap treatment, but there are lots of ways that many involved will try to extract money out of 'doing good'. Check out this take [1] by Slate star codex. [1] https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...
- Turing_Machine 5y ago
  Scott Alexander (the SSC guy) has recently said some cautiously positive things about Zembrin for depression and social anxiety. It is OTC, and apparently quite safe.
  - matttb 5y ago
    Do you have a link to this? I haven't been able to find it
    - Turing_Machine 5y ago
      Most recently at https://astralcodexten.substack.com/p/nootropics-survey-2020-results https://astralcodexten.substack.com/p/nootropics-survey-2020... Note that he's switched to a different URL for his blog; that may be why you couldn't find it -- although I'm pretty sure he mentioned it on the old site several times as well.
ghotli 5y ago
Would love to see a source on the every other week for their life. That's not at all my understanding of the method of action. Overall though, I agree with the sentiment of the post. I think the answer is it's expensive for no other reason than they can.
- after_care 5y ago
  > Would love to see a source on the every other week for their life. There is no standard maintenance treatment interval, but maintenance treatments are commonly practiced. I can’t find anyone recommending 26 treatments of ketamine a year for depression.
seattle_spring 5y ago
Fwiw insurance is covering my compounded Ketamine nasal spray 50%. Ends up being $30 for 1.2 grams (100mg/1mL). AMA, I guess. It was prescribed to me primarily for nerve pain.
- pmoriarty 5y ago
  Could you go in to detail on the exact symptoms of this nerve pain? Also, did you have to nudge-nudge-wink-wink at the doctor to get this prescription or did they actually believe that you had real nerve pain and that ketamine was the best treatment for it? This is the first time I've heard of ketamine being used for nerve pain. AFAIK it's mostly used as an anesthetic during surgery.
  - seattle_spring 5y ago
    > did they actually believe that you had real nerve pain The way you phrase this makes me think you've already assumed a whole lot about me. The worst part about chronic pain is all of the doctors and other people assuming you're just faking symptoms for a quick fix. Hoping that I've misinterpreted your intention, I'll answer honestly: > did you have to nudge-nudge-wink-wink at the doctor to get this prescription The complete opposite: It was suggested by my pain specialist. I had not heard of it being used to treat pain before meeting him. And he's not a "Ketamine practitioner" or an "alternative healer" or whatever, it was a from an MD specializing in pain management within a reputable hospital in Seattle. > Could you go in to detail on the exact symptoms of this nerve pain? Bi-lateral burning arm and hand pain and numbness. Severe headaches and neck pain. The symptoms are consistent with conditions such as thoracic outlet, cervical radiculopothy, and median/ulnar/radial nerve compression. However, tests always come back showing completely normal nerve and muscle function, and radiology imaging always shows perfectly normal everything. It's been a multi-decade journey and I'm really coming to terms with the idea that my brain is just signaling pain even when there's no actual problem or damage. That's the idea behind the Ketamine trial. Edit: I should add that this was more like a 3rd or 4th line medicinal treatment. All of the typical nerve pain medicines like Amitryptaline, Gaba, Pregabalin, Noortyptaline, etc have responded very poorly in my body and brain.
Apocryphon 5y ago
Maybe it’s available via clinical trials?
rsj_hn 5y ago
You can't ask insurance to pay for it unless there is evidence of effectiveness. That requires trials and lots of time, and there is also the issue of heavy regulations and insane costs as soon as the word "treatment" is dropped into the mix. Then there is an extra hurdle for coverage of psychiatric treatments. Assuming this is a real thing and not anecdata, expect ketamine to be covered in Europe long before it's covered in the U.S. Unfortunately our system is a huge mess and incredibly slow and expensive compared to Europe when it comes to approving new treatments.
- ghotli 5y ago
  https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified https://www.fda.gov/news-events/press-announcements/fda-appr... I think it might be further along than your comment suggests. "site:nih.gov esketamine" if you want to peruse what's been done
  - rsj_hn 5y ago
    Thanks for this info. Yes, this is farther along than I expected!
  - goatsi 5y ago
    That's only for one of the isomers of ketamine (rather than the mixture of two used in ketamine clinics), and only for using a nasal spray. That is because the drug company has a patent for using that specific isomer in a nasal spray. None of the esketamine research can be used as evidence for regular (off patent) ketamine. It will need it's own studies. https://qz.com/1889308/why-isnt-ketamine-approved-as-an-antidepressant/ https://qz.com/1889308/why-isnt-ketamine-approved-as-an-anti...
spaetzleesser 5y ago
That's the sad thing in the US. Everything medical is obscenely expensive. Just wait until psychedelics become accepted for therapy. they will probably also charge thousands for a trip.
neurot 5y ago
This is largely a function of Anesthesiologists making a cash grab out of vulnerable populations. This is the same medical specialty that brought you: Pain pill clinics (opiates) Interventional pain clinics (scams) And now ketamine for rip-off prices.
smabie 5y ago
If someone finds ketamine helpful for depression, I'd just recommend they buy it on the street themselves. Of course this isn't the best solution (the best solution would be for drugs to be legalized), but if you're strapped for cash and ketamine is having a seriously positive impact on your life, then I think it probably makes sense.
- pmoriarty 5y ago
  How would you know if you're getting real ketamine?
  - akiselev 5y ago
    Reagent testing [1]. Dance Safe sells a kit that would last a heavy drug user years [2]. It's not fool-proof by any means and it does require some practice when reactions overlap. Ketamine is a relative easy one to test for though, since most of the reagents should not produce a visible reaction. [1] https://en.wikipedia.org/wiki/Reagent_testing https://en.wikipedia.org/wiki/Reagent_testing [2] https://dancesafe.org/product/complete-set-of-all-8-testing-kits/ https://dancesafe.org/product/complete-set-of-all-8-testing-...
    - smabie 5y ago
      +1 to dance safe, those guys are awesome. Probably saved more than a handful of lives over the course of their existence. Great product too
- coef2 5y ago
  I'm not familiar with ketamine at all, but it just feels unsafe to decide by ourselves. Do psychiatrists have to monitor patients closely and determine the amount and frequency of doses? I wouldn't mind taking medicine for a cold or other common diseases. but could this be a lot risker?
- sneak 5y ago
  This is also a halfway decent way to become addicted to ketamine, a fate that has befallen many of my close friends, as well as a former partner. A perfect, near-instantaneous solution to depression button is a compelling button indeed. Take care.
sshumaker 5y ago
Check out mindbloom.com. About 150$/treatment, is done virtually (they mail you the medication). Multiple friends have used and have had great results.
- pmoriarty 5y ago
  Thanks for mentioning that. Unfortunately, when searching reddit for it the first result was a pretty negative review: [1], though it seems like it was the result of some miscommunication. That was followed by some positive reports, but without much detail. It was also interesting to learn that there's an r/TherapeuticKetamine [1] - https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w/mindbloom/ https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w...
- bduerst 5y ago
  Is there an equivalent for MDMA therapy in treating social anxiety, or is that still too new yet?
  - sjg007 5y ago
    Exposure therapy but I am not a therapist or doctor.
- sneak 5y ago
  Their survey/acquisition funnel is sketchy as hell. They demand your PII before giving you results, after first asking you a bunch of personal questions, and intersperse marketing spam in the steps. Major turn-off.
cleverpebble 5y ago
Ketamine treatments are meant to be temporary and augmented with proper existing long-term treatments like SSRIs/SNRIs/TCAs/etc. After a few treatments, the long term antidepressants have had time to start working.
- vvanpo 5y ago
  Do you have a source for that? The article seems to contradict this, from what I understand Ketamine is used for cases of treatment-resistant depression, i.e. many kinds of medications have been tried and failed.
- in3d 5y ago
  I’ve been following this very closely and I’m quite sure you’re wrong.
opheliate 5y ago
Jesus, was not aware ketamine treatment was this expensive. In the UK, a ketamine clinic [0] administers 0.5mg/kg, so 35mg for a 70kg person. At UK street prices, that’s less than £1 per dose. Presumably ketamine clinics pay less than street prices, since they don’t have to deal with the losses associated with illegal drugs. 0: https://www.oxfordhealth.nhs.uk/ketamine-service/faq/ https://www.oxfordhealth.nhs.uk/ketamine-service/faq/
- dstick 5y ago
  Would it be the same quality though?
  - opheliate 5y ago
    That's a good point. Anecdotally, street ketamine friends have come across has appeared pretty pure under reagent testing, but that's obviously still nothing like medical quality.
    - verbify 5y ago
      Reagents generally test for presence, not purity, so all you can conclude is that there is some ketamine in there.
      - throwaway13834 5y ago
        You can get your drugs tested for free in many places (at least here in the NL). They test for purity (87% is the maximum), and also for the presence of other things like caffeine that it may have been cut with. Getting the maximum purity is not uncommon, as they basically just source it from the veterinary circuit if I remember correctly. [0] (in Dutch, under "De Markt"): https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2019/10/07/factsheet-over-ketamine/factsheet-over-ketamine.pdf https://www.rijksoverheid.nl/binaries/rijksoverheid/document...
        atkailash 5y ago
jrowley 5y ago
The actual cost of the drug is only part of cost… malpractice insurance, accepting some risk for off label impacts price.
Waterluvian 5y ago
Isn't Ketamine an available street drug? Must be so cheap in comparison to $400-$1000.
- gallexme 5y ago
  Even as medicine it's like 10€/g The price comes monitoring of vitals, talking, the room, the bed, stuff for emergency allocated...
- thatguy0900 5y ago
  Funny enough, one of the places I buy phenibut from sends a decent sized package of ketamine for free with every order as a sample. But it's quite a bit of it.
harry8 5y ago
In the US you're paying for the clinic's insurance premiums against when you or another customer sues them which is a thing that /will/ happen. Reforming medical costs means reforming the legal system and that ain't gonna happen. The lawyers make the laws. In the legislature and in the judiciary. I can't think of a politician in the US who has said so since Carter.
- loceng 5y ago
  In Canada you'd assume insurance is lower because you get basically nothing for emotional damages, whereas in US the vast majority awarded is for emotional, however Canada being relatively rich means we get fleeced more and also the arguable excuse due to economies of scale - being 1/10th the population of the US. If insurance was kept honest, if it was a true free market system where there was an immutable ledger where all insurance companies in real time had to post every action/response they make as to who/what they approve/deny/delay etc, then competitors could come in when they notice how many billions of profits there are each year - meaning that more people or procedures could be covered. But yes, there are multiple industrial complexes playing together to maintain the status quo.
mynameisash 5y ago
When I was first married, we were paying about $350/mo for my wife's antidepressants. With insurance. That made our financial situation extremely difficult. If what you're saying is accurate -- $400-1000/week or two -- then that certainly is expensive. But it's not like mental health treatment is affordable in the first place. (Well, it's better now than in the mid-2000s, possibly due to my better insurance?)

perardi 5y ago

I won’t pretend there isn’t big fat profit in there, but I have to think the cost has more to do with this being an IV infusion. You’re more paying for the medical care, including being under observation.

pamplemoose 5y ago

Ketamine should be a fairly cheap treatment, but there are lots of ways that many involved will try to extract money out of 'doing good'. Check out this take [1] by Slate star codex. [1] https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...

Turing_Machine 5y ago
Scott Alexander (the SSC guy) has recently said some cautiously positive things about Zembrin for depression and social anxiety. It is OTC, and apparently quite safe.
- matttb 5y ago
  Do you have a link to this? I haven't been able to find it
  - Turing_Machine 5y ago
    Most recently at https://astralcodexten.substack.com/p/nootropics-survey-2020-results https://astralcodexten.substack.com/p/nootropics-survey-2020... Note that he's switched to a different URL for his blog; that may be why you couldn't find it -- although I'm pretty sure he mentioned it on the old site several times as well.

ghotli 5y ago

Would love to see a source on the every other week for their life. That's not at all my understanding of the method of action. Overall though, I agree with the sentiment of the post. I think the answer is it's expensive for no other reason than they can.

after_care 5y ago
> Would love to see a source on the every other week for their life. There is no standard maintenance treatment interval, but maintenance treatments are commonly practiced. I can’t find anyone recommending 26 treatments of ketamine a year for depression.

seattle_spring 5y ago

Fwiw insurance is covering my compounded Ketamine nasal spray 50%. Ends up being $30 for 1.2 grams (100mg/1mL). AMA, I guess. It was prescribed to me primarily for nerve pain.

pmoriarty 5y ago
Could you go in to detail on the exact symptoms of this nerve pain? Also, did you have to nudge-nudge-wink-wink at the doctor to get this prescription or did they actually believe that you had real nerve pain and that ketamine was the best treatment for it? This is the first time I've heard of ketamine being used for nerve pain. AFAIK it's mostly used as an anesthetic during surgery.
- seattle_spring 5y ago
  > did they actually believe that you had real nerve pain The way you phrase this makes me think you've already assumed a whole lot about me. The worst part about chronic pain is all of the doctors and other people assuming you're just faking symptoms for a quick fix. Hoping that I've misinterpreted your intention, I'll answer honestly: > did you have to nudge-nudge-wink-wink at the doctor to get this prescription The complete opposite: It was suggested by my pain specialist. I had not heard of it being used to treat pain before meeting him. And he's not a "Ketamine practitioner" or an "alternative healer" or whatever, it was a from an MD specializing in pain management within a reputable hospital in Seattle. > Could you go in to detail on the exact symptoms of this nerve pain? Bi-lateral burning arm and hand pain and numbness. Severe headaches and neck pain. The symptoms are consistent with conditions such as thoracic outlet, cervical radiculopothy, and median/ulnar/radial nerve compression. However, tests always come back showing completely normal nerve and muscle function, and radiology imaging always shows perfectly normal everything. It's been a multi-decade journey and I'm really coming to terms with the idea that my brain is just signaling pain even when there's no actual problem or damage. That's the idea behind the Ketamine trial. Edit: I should add that this was more like a 3rd or 4th line medicinal treatment. All of the typical nerve pain medicines like Amitryptaline, Gaba, Pregabalin, Noortyptaline, etc have responded very poorly in my body and brain.

Apocryphon 5y ago

Maybe it’s available via clinical trials?

rsj_hn 5y ago

You can't ask insurance to pay for it unless there is evidence of effectiveness. That requires trials and lots of time, and there is also the issue of heavy regulations and insane costs as soon as the word "treatment" is dropped into the mix. Then there is an extra hurdle for coverage of psychiatric treatments. Assuming this is a real thing and not anecdata, expect ketamine to be covered in Europe long before it's covered in the U.S. Unfortunately our system is a huge mess and incredibly slow and expensive compared to Europe when it comes to approving new treatments.

ghotli 5y ago
https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified https://www.fda.gov/news-events/press-announcements/fda-appr... I think it might be further along than your comment suggests. "site:nih.gov esketamine" if you want to peruse what's been done
- rsj_hn 5y ago
  Thanks for this info. Yes, this is farther along than I expected!
- goatsi 5y ago
  That's only for one of the isomers of ketamine (rather than the mixture of two used in ketamine clinics), and only for using a nasal spray. That is because the drug company has a patent for using that specific isomer in a nasal spray. None of the esketamine research can be used as evidence for regular (off patent) ketamine. It will need it's own studies. https://qz.com/1889308/why-isnt-ketamine-approved-as-an-antidepressant/ https://qz.com/1889308/why-isnt-ketamine-approved-as-an-anti...

spaetzleesser 5y ago

That's the sad thing in the US. Everything medical is obscenely expensive. Just wait until psychedelics become accepted for therapy. they will probably also charge thousands for a trip.

neurot 5y ago

This is largely a function of Anesthesiologists making a cash grab out of vulnerable populations. This is the same medical specialty that brought you: Pain pill clinics (opiates) Interventional pain clinics (scams) And now ketamine for rip-off prices.

smabie 5y ago

If someone finds ketamine helpful for depression, I'd just recommend they buy it on the street themselves. Of course this isn't the best solution (the best solution would be for drugs to be legalized), but if you're strapped for cash and ketamine is having a seriously positive impact on your life, then I think it probably makes sense.

pmoriarty 5y ago
How would you know if you're getting real ketamine?
- akiselev 5y ago
  Reagent testing [1]. Dance Safe sells a kit that would last a heavy drug user years [2]. It's not fool-proof by any means and it does require some practice when reactions overlap. Ketamine is a relative easy one to test for though, since most of the reagents should not produce a visible reaction. [1] https://en.wikipedia.org/wiki/Reagent_testing https://en.wikipedia.org/wiki/Reagent_testing [2] https://dancesafe.org/product/complete-set-of-all-8-testing-kits/ https://dancesafe.org/product/complete-set-of-all-8-testing-...
  - smabie 5y ago
    +1 to dance safe, those guys are awesome. Probably saved more than a handful of lives over the course of their existence. Great product too
coef2 5y ago
I'm not familiar with ketamine at all, but it just feels unsafe to decide by ourselves. Do psychiatrists have to monitor patients closely and determine the amount and frequency of doses? I wouldn't mind taking medicine for a cold or other common diseases. but could this be a lot risker?
sneak 5y ago
This is also a halfway decent way to become addicted to ketamine, a fate that has befallen many of my close friends, as well as a former partner. A perfect, near-instantaneous solution to depression button is a compelling button indeed. Take care.

sshumaker 5y ago

Check out mindbloom.com. About 150$/treatment, is done virtually (they mail you the medication). Multiple friends have used and have had great results.

pmoriarty 5y ago
Thanks for mentioning that. Unfortunately, when searching reddit for it the first result was a pretty negative review: [1], though it seems like it was the result of some miscommunication. That was followed by some positive reports, but without much detail. It was also interesting to learn that there's an r/TherapeuticKetamine [1] - https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w/mindbloom/ https://www.reddit.com/r/TherapeuticKetamine/comments/hb619w...
bduerst 5y ago
Is there an equivalent for MDMA therapy in treating social anxiety, or is that still too new yet?
- sjg007 5y ago
  Exposure therapy but I am not a therapist or doctor.
sneak 5y ago
Their survey/acquisition funnel is sketchy as hell. They demand your PII before giving you results, after first asking you a bunch of personal questions, and intersperse marketing spam in the steps. Major turn-off.

cleverpebble 5y ago

Ketamine treatments are meant to be temporary and augmented with proper existing long-term treatments like SSRIs/SNRIs/TCAs/etc. After a few treatments, the long term antidepressants have had time to start working.

vvanpo 5y ago
Do you have a source for that? The article seems to contradict this, from what I understand Ketamine is used for cases of treatment-resistant depression, i.e. many kinds of medications have been tried and failed.
in3d 5y ago
I’ve been following this very closely and I’m quite sure you’re wrong.

opheliate 5y ago

Jesus, was not aware ketamine treatment was this expensive. In the UK, a ketamine clinic [0] administers 0.5mg/kg, so 35mg for a 70kg person. At UK street prices, that’s less than £1 per dose. Presumably ketamine clinics pay less than street prices, since they don’t have to deal with the losses associated with illegal drugs. 0: https://www.oxfordhealth.nhs.uk/ketamine-service/faq/ https://www.oxfordhealth.nhs.uk/ketamine-service/faq/

dstick 5y ago
Would it be the same quality though?
- opheliate 5y ago
  That's a good point. Anecdotally, street ketamine friends have come across has appeared pretty pure under reagent testing, but that's obviously still nothing like medical quality.
  - verbify 5y ago
    Reagents generally test for presence, not purity, so all you can conclude is that there is some ketamine in there.
    - throwaway13834 5y ago
      You can get your drugs tested for free in many places (at least here in the NL). They test for purity (87% is the maximum), and also for the presence of other things like caffeine that it may have been cut with. Getting the maximum purity is not uncommon, as they basically just source it from the veterinary circuit if I remember correctly. [0] (in Dutch, under "De Markt"): https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2019/10/07/factsheet-over-ketamine/factsheet-over-ketamine.pdf https://www.rijksoverheid.nl/binaries/rijksoverheid/document...
      - atkailash 5y ago

jrowley 5y ago

The actual cost of the drug is only part of cost… malpractice insurance, accepting some risk for off label impacts price.

Waterluvian 5y ago

Isn't Ketamine an available street drug? Must be so cheap in comparison to $400-$1000.

gallexme 5y ago
Even as medicine it's like 10€/g The price comes monitoring of vitals, talking, the room, the bed, stuff for emergency allocated...
thatguy0900 5y ago
Funny enough, one of the places I buy phenibut from sends a decent sized package of ketamine for free with every order as a sample. But it's quite a bit of it.

harry8 5y ago

In the US you're paying for the clinic's insurance premiums against when you or another customer sues them which is a thing that /will/ happen. Reforming medical costs means reforming the legal system and that ain't gonna happen. The lawyers make the laws. In the legislature and in the judiciary. I can't think of a politician in the US who has said so since Carter.

loceng 5y ago
In Canada you'd assume insurance is lower because you get basically nothing for emotional damages, whereas in US the vast majority awarded is for emotional, however Canada being relatively rich means we get fleeced more and also the arguable excuse due to economies of scale - being 1/10th the population of the US. If insurance was kept honest, if it was a true free market system where there was an immutable ledger where all insurance companies in real time had to post every action/response they make as to who/what they approve/deny/delay etc, then competitors could come in when they notice how many billions of profits there are each year - meaning that more people or procedures could be covered. But yes, there are multiple industrial complexes playing together to maintain the status quo.

mynameisash 5y ago

When I was first married, we were paying about $350/mo for my wife's antidepressants. With insurance. That made our financial situation extremely difficult. If what you're saying is accurate -- $400-1000/week or two -- then that certainly is expensive. But it's not like mental health treatment is affordable in the first place. (Well, it's better now than in the mid-2000s, possibly due to my better insurance?)