Is Ketamine A Miracle Medicine or Misused Molecule?

With great reward comes great risk. -Thomas Jefferson

Photo by Micah & Sammie Chaffin on Unsplash

In recent years, ketamine has taken center stage as one of the most promising treatments for individuals suffering from treatment-resistant depression (TRD). As an addiction psychiatrist, I’ve seen the way it transforms lives—quickly lifting people out of a suicidal spiral when nothing else works. Administered in carefully controlled settings like IV infusion clinics, Spravato observation clinics, and evidence-based outpatient lozenge/troche protocols, ketamine has helped many patients regain hope, restore functionality, and reconnect with life. For many, it’s a lifeline.

But ketamine also has a darker legacy-one that many clinicians and patients alike are all too aware of. Known on the street as “Special K,” ketamine has long been associated with illicit recreational use and dissociative highs. In higher doses or unsupervised environments, it can be dangerous—causing hallucinations, cognitive disturbances, and even addiction in vulnerable individuals. Emergency rooms have witnessed a surge in ketamine-related complications and overdoses as underground use continues to rise.

With unfettered access to ketamine for sedative anesthetic treatment purposes, healthcare professionals like doctors and nurses are uniquely vulnerable to develop ketamine misuse and abuse.

While I’m in awe of how quickly ketamine can positively transform the lives of those with severe depression, I’m also equally uneasy about how rapidly it can destroy those who are vulnerable to addiction and misuse.

This is the paradox we now face: a powerful drug with nearly unrivaled therapeutic potential… that also carries significant risk for misuse. As healthcare professionals, how do we harness the treatment benefits while minimizing abuse potential?

As access to ketamine increases—via intravenous infusions, lozenges, lollipops, nasal sprays, and even at-home telehealth models—we must contend with growing questions of oversight, ethics, and safety to best protect patients and providers. Are all prescribers equally equipped to screen for patient addiction risk? Are all patients being adequately monitored? How do we best protect healthcare professionals who have larger occupational exposure (and risk) to the drug? Should high exposure physicians like surgeons, ER docs, and anesthesiologists be required to take additional, proactive training on the risks of ketamine abuse and prevention tips? (I would say yes.) And how do we ensure that patients most in need can access ketamine safely, while minimizing opportunities for diversion and self-medication?

Ketamine may be one of the most revolutionary psychiatric tools of our time. And the genie is now out of the bottle. But like any powerful tool, it demands careful stewardship. I don’t have all the answers, but asking the right questions is a good start.

-Lauren Grawert

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