3 ms·

I think there are some interesting treatment opportunities, but I also really don’t like the direction this is all going. Locally, ketamine treatment clinics a

I think there are some interesting treatment opportunities, but I also really don’t like the direction this is all going. Locally, ketamine treatment clinics are popping up all over the place. We have so many in my city that they’re now competing with each other in radio advertisements, inviting people to come on down and get some ketamine for their depression, anxiety, PTSD, or even vague symptoms like stress. One of them even had a frequent visitor pass - Buy five ketamine sessions and the sixth is free! Another was shut down for a while when they were caught leaving patients unattended and one injured themself while on a high dose of ketamine. They were found to not even be performing screenings of patients - Anyone who showed up with cash got ketamine. But it doesn’t stop there. Internet prescribers are taking advantage of the temporary COVID rules changes for telehealth controlled substance prescribing to give ketamine over the internet. I won’t name the company, but one specific provider is known for providing prescriptions for exorbitantly high doses of ketamine. From what I saw, nobody is turned away. If you’re willing to pay, you get a prescription for a lot of ketamine and you don’t even have to leave your house. What makes this all worse is that ketamine is very much not a cure for depression. The antidepressant effects of ketamine are famously short-lived, so it’s used as a way to jump-start traditional therapy in normal settings. Not so at these ketamine clinics, which prefer you return to them for more and more expensive treatments each time it wears off, at least until you have such a high tolerance that it doesn’t do anything at all for the depression any more. Whatever you think about the substances, I am not excited for a wave of “growth hackers” at psychedelic startups brainstorming ways to get people to pay for more and more ketamine or psychedelic sessions to improve their numbers. I hope the regulatory bodies step in and steer this back to sanity before these startups cause so many problems that these substances become untouchable again.

symlinkk 5y ago
Why not let the free market work its magic? If ketamine doesn’t work, the word will get out and these places will go out of business. People will self medicate with whatever is available to them. If you lock up ketamine, people will reach for alcohol.
- dqpb 5y ago
  Tell that to China’s 100 years of shame.
- hprotagonist 5y ago
  > Why not let the free market work its magic? the literal snake oil market? no thanks.
- klyrs 5y ago
  Look, I think that ketamine has some great potential... but the medical (especially pharmaceutical) industry has shown time and time again that regulation is absolutely necessary. From what I've gleaned, low-dose ketamine is quite effective at reducing treatment-resistant suicidal ideation, which can be a literal life-saver and has very low risk. The alternatives include doing nothing and hoping for the best, and antipsychotics. High-dose ketamine (k-hole) is a significantly riskier proposition: people can grow dependent on it, and it does significant long-term damage to the body (and in the short term, apparently, walking out of the clinic tripping balls and getting injured). As an emergency emergency remedy (treatment-resistant depression), paired with talk therapy, the high-dose treatments may be promising. A real risk is blowback: if the industry is too cavalier, then there will be actually good reason to clamp down on it. If the industry can get their shit together and be careful, then there's no need for strict regulation. If the industry blows its chance with public sentiment now, we won't have a chance to see the positive effects for another few generations.
NotSashaShulgin 5y ago
Sasha and Ann Shulgin famously believed that dissociatives (e.g., ketamine, xenon, phencyclidine) have no safe role in psychedelic therapy: "We are strongly prejudiced against psychedelic drugs which cause such mind-body separation, as we are against any drug which causes separation from feelings and emotions. However, we acknowledge that the ketamine state can be highly instructive for researchers trying to understand the functions of the human mind." Dissociatives are too addictive, too pleasurable, and reliably produce long-lasting delusional states (e.g., as observed in John C. Lilly and Marcia Moore). For example, see D. M. Turner's "The Essential Psychedelic Guide". Before he died in his bathtub (after injecting ketamine), he wrote the following (https://www.ketamine.co.uk/dmturner/index.html https://www.ketamine.co.uk/dmturner/index.html): "A major concern regarding safe use of Ketamine is its very high potential for psychological addiction. A fairly large percentage of those who try Ketamine will consume it non-stop until their supply is exhausted. I've seen this in friends I've known for many years who are regular psychedelic users and have never before had problems controlling their drug consumption. And I've seen the lives of several people who developed an addiction to Ketamine take downward turns." "After about two years of once-per-week Ketamine use I even found that I had developed an addiction. Although it was less severe than what I've described above, it took considerable effort to break the cycle of repeatedly using it, even though I was aware of detrimental effects that it was causing. Since that time I've used Ketamine only occasionally, but find that I must continually exercise a high degree of will power to prevent myself from falling into a pattern of regular use. Amongst those I know who use Ketamine, I've seen very few who can use it in a balanced manner if they have access to it." On the other hand, there are very useful and beneficial tryptamines (e.g., psilocybin) and phenethylamines (e.g., mescaline). These drugs produce informative, useful, introspective, challenging mental states and are NOT prone to abuse. These are the valuable psychedelics.
- crate_barre 5y ago
  Experienced drug users (loosely using that term, don’t want to call them drug addicts :p) will tell you not to even attempt a psychedelic if you are not in the right headspace. You’ll have a bad trip. Is that still not the case? Isn’t depression about as bad a headspace you can be in to try this stuff?

symlinkk 5y ago

Why not let the free market work its magic? If ketamine doesn’t work, the word will get out and these places will go out of business. People will self medicate with whatever is available to them. If you lock up ketamine, people will reach for alcohol.

dqpb 5y ago
Tell that to China’s 100 years of shame.
hprotagonist 5y ago
> Why not let the free market work its magic? the literal snake oil market? no thanks.
klyrs 5y ago
Look, I think that ketamine has some great potential... but the medical (especially pharmaceutical) industry has shown time and time again that regulation is absolutely necessary. From what I've gleaned, low-dose ketamine is quite effective at reducing treatment-resistant suicidal ideation, which can be a literal life-saver and has very low risk. The alternatives include doing nothing and hoping for the best, and antipsychotics. High-dose ketamine (k-hole) is a significantly riskier proposition: people can grow dependent on it, and it does significant long-term damage to the body (and in the short term, apparently, walking out of the clinic tripping balls and getting injured). As an emergency emergency remedy (treatment-resistant depression), paired with talk therapy, the high-dose treatments may be promising. A real risk is blowback: if the industry is too cavalier, then there will be actually good reason to clamp down on it. If the industry can get their shit together and be careful, then there's no need for strict regulation. If the industry blows its chance with public sentiment now, we won't have a chance to see the positive effects for another few generations.

NotSashaShulgin 5y ago

Sasha and Ann Shulgin famously believed that dissociatives (e.g., ketamine, xenon, phencyclidine) have no safe role in psychedelic therapy: "We are strongly prejudiced against psychedelic drugs which cause such mind-body separation, as we are against any drug which causes separation from feelings and emotions. However, we acknowledge that the ketamine state can be highly instructive for researchers trying to understand the functions of the human mind." Dissociatives are too addictive, too pleasurable, and reliably produce long-lasting delusional states (e.g., as observed in John C. Lilly and Marcia Moore). For example, see D. M. Turner's "The Essential Psychedelic Guide". Before he died in his bathtub (after injecting ketamine), he wrote the following (https://www.ketamine.co.uk/dmturner/index.html https://www.ketamine.co.uk/dmturner/index.html): "A major concern regarding safe use of Ketamine is its very high potential for psychological addiction. A fairly large percentage of those who try Ketamine will consume it non-stop until their supply is exhausted. I've seen this in friends I've known for many years who are regular psychedelic users and have never before had problems controlling their drug consumption. And I've seen the lives of several people who developed an addiction to Ketamine take downward turns." "After about two years of once-per-week Ketamine use I even found that I had developed an addiction. Although it was less severe than what I've described above, it took considerable effort to break the cycle of repeatedly using it, even though I was aware of detrimental effects that it was causing. Since that time I've used Ketamine only occasionally, but find that I must continually exercise a high degree of will power to prevent myself from falling into a pattern of regular use. Amongst those I know who use Ketamine, I've seen very few who can use it in a balanced manner if they have access to it." On the other hand, there are very useful and beneficial tryptamines (e.g., psilocybin) and phenethylamines (e.g., mescaline). These drugs produce informative, useful, introspective, challenging mental states and are NOT prone to abuse. These are the valuable psychedelics.

crate_barre 5y ago
Experienced drug users (loosely using that term, don’t want to call them drug addicts :p) will tell you not to even attempt a psychedelic if you are not in the right headspace. You’ll have a bad trip. Is that still not the case? Isn’t depression about as bad a headspace you can be in to try this stuff?