In a commentary published in MedPage Today, three psychiatrists argue that ketamine's legitimate promise is undermined by inconsistent standards of care, particularly for off-label prescribing. They point to the cases of Matthew Perry and Presley Gerber, both of whom reportedly received ketamine from doctors aware of their addiction histories. While ketamine is FDA-approved as an anesthetic and esketamine is approved for treatment-resistant depression, off-label ketamine is prescribed for conditions like PTSD and OCD without a comparable safety program.
The authors note that ketamine clinics have become common in U.S. tertiary care centers, and supervised in-person treatment appears to carry a low risk of ketamine use disorder. However, they warn of a shift toward chronic use, whose long-term effects remain largely unknown. They also cite a more than eightfold rise in U.K. patients seeking treatment for ketamine addiction over the past decade.
Existing guidance from the American Psychiatric Association and the esketamine label calls for careful assessment of patients with substance use disorder, but for off-label ketamine, such assessment is not consistently enforced. The commentary describes a "Wild West" terrain that includes at-home use, telehealth prescribing without in-person evaluation, and inadequate monitoring. The authors call for a clear, evidence-based standard of care that protects patients while acknowledging ketamine's efficacy, and they stress that celebrity status should not alter medical decision-making. They also note that the American Society of Anesthesiologists has urged stronger oversight of at-home ketamine delivery and ketamine clinics. The U.S. ketamine market has passed $5 billion and is projected to reach more than $14 billion by 2035, according to the commentary. The authors conclude that competent prescribing requires documented risk-benefit decisions and a willingness to withhold treatment when risks are unmanageable. No official cause of death has been released for Gerber, and the commentary notes his death is being investigated as a suspected overdose. The authors say that regardless of the toxicology report, the question remains what standard should apply to every ketamine prescriber. The source is a single opinion piece, so no differing viewpoints are available for comparison. The article does not present original reporting beyond the authors' clinical experience and cited public cases. It is best understood as a call for regulatory and professional action rather than a news report. The commentary's authors are psychiatrists who work with addiction and have published on ketamine addiction, which remains poorly defined in psychiatric guidelines. They do not provide data on how many off-label prescribers currently follow APA guidance, nor do they specify which telehealth companies have faced lawsuits. Their central claim is that the current patchwork of oversight leaves too much room for unsafe prescribing, especially for patients with addiction histories. The piece does not dispute ketamine's effectiveness for certain conditions, but argues that efficacy and safety must be balanced through enforceable standards. It also does not address potential benefits of at-home ketamine or telehealth models, focusing instead on the risks of inadequate monitoring. The authors' recommendation is that prescribers be trained in ketamine's risks, document risk-benefit discussions, and refuse treatment when risks are unmanageable. They also suggest that the standard of care should not vary by provider or patient status. The commentary is timely given the rapid growth of ketamine clinics and the market projections cited. It does not propose specific regulatory mechanisms, but frames the issue as a patient-safety imperative. The article is written for clinicians and policymakers, and it uses the Perry and Gerber cases as cautionary examples. It does not claim that either death was caused solely by prescribed ketamine; in Perry's case, the fatal dose came from another source, and Gerber's cause of death is pending. The authors' argument is that prescribing to patients with known addiction histories, without adequate safeguards, is a liability risk and a patient-safety concern. They call for a standard of care that is "built on protecting patients." The piece does not mention any opposing views, and it does not cite peer-reviewed studies beyond the authors' own experience and published work. It is an opinion piece, so its claims should be read as the authors' professional judgment rather than established fact. The commentary does note that research and their experience suggest low prevalence of ketamine use disorder in supervised clinic settings, which is a mitigating factor. But the shift toward chronic use and the lack of long-term data remain concerns. The authors also highlight that esketamine is subject to a REMS program, while off-label ketamine is not, creating a disparity in safety oversight. They do not argue that all off-label use is unsafe, but that the absence of consistent standards makes unsafe practice possible. The article's headline and dek should reflect this balanced but cautionary message. The key points should capture the main arguments: the safety gap, the high-profile cases, and the call for standards. The body should summarize the commentary's reasoning and context without overstating its conclusions. The source is a single opinion piece, so the article should note that it reflects the authors' views and that no differing sources were available. The response format requires strict JSON with the specified keys, and the body should be 2-4 short paragraphs of markdown. The headline must be under 80 characters, which the proposed headline satisfies. The dek should be one sentence. The keyPoints array must have exactly three strings. The body should be concise and plain, avoiding editorializing beyond the source. I will now produce the final JSON.```jsonoai-json-response-start{