Back in 2020, at the height of the pandemic, the Trump administration made it easier to treat patients by telehealth or telemedicine, including remotely prescribing certain controlled substances. Today, all manner of medical care, from management of chronic diseases like diabetes to substance abuse treatment, have become more accessible and affordable. While many patients have benefited, the rapid growth of remote prescribing and at-home use of various drugs has outpaced the evidence that doing so is safe and effective. As the gap between medical treatment and online shopping has narrowed, already-thorny debates over the proper balance between availability and safety have become increasingly urgent. The introduction of telehealth has created a whole new industry when it comes to providing health care, especially with the provision of drugs used to treat such mental health issues such as depression.
Back in 2017, I read about a new use for the drug ketamine, a long-used anesthetic that was primarily used to sedate patients during surgery but has also been used as a date-rape drug. Ketamine was undergoing studies by several researchers both in Canada and the U.S. for its ability to rapidly stop suicidal thoughts in a high percentage of patients. As far back as 2013, one Canadian researcher, Dr. Pierre Blier, director of the mood disorders research unit at the Royal Ottawa Hospital, called ketamine the biggest breakthrough since the introduction of anti-depressants. For patients resistant to other drug treatments, it is considered an alternative to one of the only remaining treatments — electroconvulsive therapy, which has potential long-lasting side effects and is more invasive and often requires hospitalization. For anyone suffering from clinical depression, ketamine has been shown to be effective and safe if prescribed and closely monitored by an attending physician. Needless-to-say, there are known serious side-effects from the use of ketamine, and there is a potential for addiction and abuse.
The access to cheaper sources of ketamine for at-home treatment has been facilitated by the emergence of telehealth. Marketing to doctors is often done through social media posts and mailers, wherein they extol the benefits of ketamine. Companies that once served primarily local customers now ship their products across the country. The ketamine boom has presented an alluring opportunity. Because ketamine is regulated by the U.S. Drug Enforcement Administration and Health Canada as a controlled substance, provision of the drug still requires a physician’s prescription. Previously, while prescribing ketamine for depression was allowed, patients needed to first meet in person with a doctor, and treatment was mostly limited to infusions in clinics. Now, telehealth providers will accommodate patients by providing online access to a physician. Patients have the option to schedule live telemedicine visits with their providers at any time for no additional cost. Needless-to-say, this isn’t an ideal situation when it comes to providing medical follow-up for monitoring purposes. Some at-home providers simply view ketamine as just another medicine to be taken regularly.
Covid-19 exacerbated the nation’s mental health crisis and underscored the inadequacy of many existing treatments, accelerating a reconsideration of once-stigmatized psychedelics. The sale of ketamine has reportedly grown ten times what it was in 2019. People who are using telehealth to acquire the drug are desperate, but may also be prone to addiction and abuse. Some suffer serious health side-effects but are hesitant to report them for fear of loosing their cheaper access to the drug. One the one hand, the growth of telehealth is yet one more example of reacting to the lack of availability and affordable access to mental health services in many communities. On the other hand, there are those that worry that this potentially lifesaving treatment could become inaccessible if more rigorous intervention by regulators is implemented. In addition, more research on the long-term use of such drugs as ketamine is needed to determine if its continuous medical use might be harmful. Since many online users are reluctant to provide information about its use, such needed research may be more difficult to undertake. Like access to other controlled substances, regulators need to take a closer look at the growth of telemedicine in both countries. After all, if there are profits to be made and drug costs are reduced, one can certainly foresee the continuing growth of this sector.
FROLITICKS 
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