Ketamine gains favor to treat chronic pain, depression
The 1990s-era club drug nicknamed “Special K,” or ketamine, is gaining interest in Michigan and across the country as a potent treatment for chronic pain and severe depression, spurring calls for standards to regulate its use.
Michigan Progressive Health Inc. in Royal Oak is among the first clinics nationally to offer ketamine infusion therapy for patients whose conditions have not responded to traditional therapies. Since opening in April, the clinic has attracted patients from as far as the Upper Peninsula and Florida.
The therapy is also available from a small number of doctors who administer intravenous ketamine at their offices alongside more traditional treatments. One Dearborn anesthesiologist uses ketamine to treat complex regional pain syndrome, an excruciating and often intractable condition.
A University of Michigan psychiatrist has used ketamine to treat major depressive disorder and is set to begin clinical trials to study how it works.
“For many conditions, it works in half to two-thirds of patients,” said Dr. Sagar Parikh, the John F. Greden professor of depression and clinical neuroscience at the University of Michigan.
Despite its controversial past, law enforcement agencies have not objected to ketamine treatment.
Tuscola County Prosecutor Mark Reene, president of the Prosecuting Attorneys Association of Michigan, said “we expect and trust the medical community prescribes a substance such as ketamine appropriately.”
Studies have shown that low doses of ketamine, given intravenously over several hours, can bring nearly immediate relief to patients with severe depression and some forms of chronic pain. But the treatments are not approved by the federal Food and Drug Administration or covered by health insurance.
Supporters say most doctors who offer ketamine therapy are following protocols that have been tested in clinical trials and published in respected scientific journals. But a few bad actors have exploited the growing demand for the drug, said Dennis Hartman, executive director and founder of the Seattle-based Ketamine Advocacy Network that lists 19 sites across the country, mostly in major cities such as Boston and Los Angeles.
“(Some doctors) are doing it in ways that are easy and fast for them but not necessarily best for the patient,” Hartman said, adding that some psychiatrists have administered ketamine by intramuscular injection rather than intravenously — a method of delivery that has not been vetted in clinical trials.
The Ketamine Advocacy Network was formed by four patients with depression who benefited from ketamine as participants in a clinical trial funded by the National Institute of Mental Health in Bethesda, Maryland.
“To have experienced such sudden, profound relief, we couldn’t ignore the need to increase access (to ketamine treatment),” Hartman said.
The network soon will roll out standards developed with leading research institutions, including Yale University.
“We need to validate a standard of care,” Hartman said. “There is no professional organization made up of trained medical professionals who have set standards. We’re patients, we’re not experts. ... But since they’re not doing it we will do it.”
Standards are needed not only to protect patients’ safety but to satisfy insurance carriers that consider the treatments experimental.
The vast majority of health insurers do not cover the treatment, but resistance may be softening. California-based Kaiser Permanente has launched a pilot project offering ketamine coverage to some members.
“The pilot program is in Northern California at a few sites at this point in time,” Kaiser spokeswoman Diana Yee said, noting the company doesn’t operate in Michigan.
Treatments typically cost $400 to $1,500 per treatment out of pocket, depending on the patient’s condition. Infusions can take from one hour to six hours and should be supervised by a physician.
An initial treatment can involve twice weekly infusions for as many as six weeks. Once in remission, patients need to return for a booster every six weeks to two months to maintain relief from their symptoms.
For Troy McLaughlin, 40, of Adrian, it was a worthwhile expense. His severe depression was triggered by his brother’s death in a 2013 plane crash. His first ketamine treatment at Michigan Progressive Health in Royal Oak brought nearly immediate relief, McLaughlin said. He recently completed an initial course of six treatments and says “it saved my life.”
“The final decision for me was ‘this course of treatment is about $4,000 and a funeral’s about $4,000’— that’s honestly how bad I felt,” McLaughlin said.
“With the depression, the mind is just beating you up all the time. It’s impending doom. (Ketamine) stops all that. The sad thoughts or depressive thoughts go away.”
Ketamine is an anesthetic that’s a staple in hospital emergency departments, on battlefields and in veterinary offices, said Dr. Megan Oxley, an emergency physician and founder of Michigan Progressive Health.
It’s a Schedule III drug, meaning ketamine’s potential for abuse is lower than than drugs like heroin or cocaine. It’s classified as a “dissociative anesthetic” because it makes people feel disconnected from their environment. It can also cause hallucinations.
Illicit users take ketamine in massive doses to get very high and then pass out, Oxley said. Therapeutic doses are extremely small and administered slowly.
During a recent treatment, Oxley checked on her patient every five to 10 minutes. She said she checks their vital signs, makes sure they’re comfortable and not experiencing anxiety, which can be a side effect.
McLaughlin, the patient from Adrian, said his treatments initially caused anxiety, so Oxley reduced his dose slightly and added more time between treatments.
“You feel dissociated from your body, (but) I know I’m in a safe environment,” McLaughlin said. “By the time you’re home you can function, but you’re tired for the rest of the day.”
Break the cycle
Wesley Cooper, 31, of Royal Oak, has suffered from severe chronic pain since breaking his back in a snowboarding accident at the age of 21.
He’s taken medication for depression, a common problem for chronic pain patients. And he said he’s tried “every narcotic known to man” to cope with his unrelenting pain.
Cooper gave up both the antidepressants and the opioids after ketamine treatments from his pain doctor, Dearborn anesthesiologist Dr. Hussein Huraibi.
“I did six to eight treatments over a two-week period and then I came off my pain meds altogether,” Cooper said. “My nerve pain was gone.”
Huraibi said he began offering ketamine treatments about three years ago. About two-thirds of patients benefit from the treatment, said Huraibi, who added he first learned about it during residency training at Yale University.
“If we can break the cycle in some way,” he said, “it would help get these people back on their feet.”
UM’s Parikh is months away from starting a large, multi-site clinical trial of ketamine.
Funded with $1 million from a private donor, Parikh’s team will search for biomarkers or indicators to show when patients are responding to ketamine treatment for depression.
Such discoveries could lead to the development of a blood test that could predict who will benefit from ketamine treatment.
The lack of FDA approval, usually a prerequisite for insurance coverage, is “the elephant in the room,” he said.
Getting FDA approval can cost millions of dollars, typically paid by a pharmaceutical company that holds a patent on a drug. Ketamine is generic, so no drug company stands to benefit from FDA approval of ketamine infusion. Efforts are underway to develop other forms of ketamine, such as a nasal spray, that could be proprietary.
“If a new use of (ketamine) comes along and it enters into standard treatments, than insurance companies should be willing to pay for it,” Parikh said.