How Ketamine Assisted Therapy Uses Controlled Settings to Avoid Common Issues

Ask any medical provider what ketamine is, and the answer is likely to be surprisingly boring.

Used as a safe and effective anesthetic agent since the 1970s, it's a medication the World Health Organization lists as "essential." It's also, as more and more people are becoming aware of, a promising alternative to first-line treatment options for a wide variety of mental health and chronic pain conditions — known primarily for its potential to relieve the symptoms of treatment-resistant depression in cases where nothing else worked.

As studies investigating the medication's therapeutic potential pile up, however, the dark side of ketamine has also been in the spotlight. That's especially true if you keenly follow (sometimes sensationalized) popular news outlets.

Read all the stories, and an anesthetic approved for use in human and veterinary medicine, as well as an evidence-based mental health and chronic pain treatment, becomes something entirely different. It becomes the Special K or Kit-Kat abused on the streets. It's derided as an ominous-sounding "horse tranquilizer," something you might expect a villain in a superhero movie to wield as a weapon.

There are a lot of myths going around about ketamine and ketamine therapy. Many need to be dispelled, but just as many have a kernel of truth.

If you are exploring the potential of ketamine-assisted therapy for conditions like treatment-resistant depression, PTSD, anxiety, fibromyalgia, or migraines, you'll want to know what's going on here — and if you're looking into ketamine as a treatment for substance abuse disorder, that's doubly true.

Does ketamine therapy, administered in clinical settings, have the potential to be addictive? Let's get your hard questions answered.

The Difference Between Street Use and Clinical Settings

Without question, ketamine has been used as a illegal drug — and research on the topic indeed suggests that larger numbers of people are now using ketamine as a recreational substance. While ketamine remains an uncommon recreational drug, "results suggest that use and availability are increasing," "although seizures are still uncommon relative to other drugs."

How many? Nobody knows precisely, although the study above estimates that "prevalence remained relatively rare, below 1%."

We have more precise information about overdose cases involving ketamine from the CDC. Ketamine was detected in fewer than one percent of drug overdose deaths between 2019 and 2023. Twenty-four people who tragically died from overdose-related cases only had ketamine in their systems. Most cases involved people who combined ketamine with other recreational drugs, most commonly cocaine, methamphetamine, fentanyl, and alcohol.

People who abuse ketamine recreationally may do so simply for "fun," or they may do so to achieve some of the same effects those receiving ketamine therapy for chronic pain or mental health reasons benefit from.

Although abuse rates and overdoses remain rare, it's absolutely essential to be aware of the dangers. Like other medications that are also abused as street drugs (opioids, benzodiazepines, and Ritalin immediately come to mind), unprescribed ketamine has serious risks.

It's not just used in much higher doses than ketamine therapy prescribed for chronic pain or mental health conditions, but sometimes even in doses higher than those used for general anesthesia. What's more, nobody seeking to use ketamine recreationally can be sure that's what they're actually getting. Ketamine for recreational use is illegal, has addictive potential, and can, in the worst-case scenario, be deadly.

The news stories you may have come across are right to warn about these risks. Illegal drugs are always a bad idea, and if one of those news stories can save just one person from heading down a very dark path, their existence is a net positive.

In that sense, what's true about fentanyl or benzodiazepines also applies to ketamine. A medication that can save lives or radically transform someone's quality of life in the hands of a qualified medical provider can become a recipe for chaos and destruction on the streets.

How Does That Relate to Therapeutic Ketamine?

Are you considering whether ketamine therapy at home or at a clinic may be a good fit for your healing? You're probably in the "research phase" right now. After learning that ketamine has a track record of success in helping people with your condition heal, you're busy finding out all about it.

You may have struggled with addiction in the past (or, indeed, you may be seeking ketamine-assisted therapy to treat a substance use disorder), and have information about addictive potential as one of your top priorities. Or, you could simply want to know everything there is to know about a treatment course you're looking into.

You may even talk to your partner, relatives, or friends about the potential for ketamine therapy to treat conditions like depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, fibromyalgia, neuropathic pain, and more. At that point, there's a non-zero possibility that one of them will have read scary stories about ketamine, and tell you all about them.

The most important facts, summed up quickly?

• Research to date has found that therapeutic ketamine has a low addictive potential and a low potential for dependence.
• Ketamine therapy administered for mental health or chronic pain is prescribed in very low doses — far below the doses given for anesthesia or abused by recreational users.
• That's true whether we're talking about IV ketamine, esketamine nasal spray, or oral sublingual ketamine.
• By now, ketamine therapy is an established (although still not first-line) treatment for a variety of conditions. They include mental health disorders like (treatment-resistant) depression, anxiety, PTSD, OCD, and bipolar disorder as well as chronic pain caused by fibromyalgia, migraines, neuropathic conditions, and cancer.
• At home ketamine therapy plans, like we offer at Mind Clinic, unfold under the careful supervision of a team of experts. We'll follow your progress, work with you to make your treatment as effective as possible, and design a dosing protocol designed for your specific needs — taking your medical history into account.

The goal is to create an evidence-based ketamine treatment program that works for you, and that process involves doses far below the level where dependence and addiction become a concern.

KAT as A Treatment for Substance Use Disorders

Ketamine has been used to treat a wide variety of mental health and chronic pain conditions, with a lot of promise. Even as the list of conditions ketamine has a track record of treating expands, some people may be surprised to hear that ketamine has joined the list of treatment options for people suffering from substance use disorders.

How could a medication that people sometimes happen to abuse as a street drug also help with recovery? It's a fair question to ask, and the answer lies in the way ketamine acts on the brain. While this remains an ongoing area of research, there's a lot we do know so far.

Ketamine acts on the NMDA receptors in the brain, which play an important role in the development of addictions. At therapeutic doses, ketamine blocks the excitatory brain activity involved in causing cravings and substance-seeking behaviors.

At the same time, at home ketamine treatment stimulates new brain connections — creating a neuroplastic window that leaves the mind open to growth and change. In plain language, a ketamine therapy plan can help a brain rewired by the pattern of addiction heal itself and (alongside other forms of treatment, like psychotherapy) reorganize its reward system.

It doesn't stop there, though. Ketamine therapy also slows the brain's so-called default mode network, which is responsible for much of the negative thinking patterns people get stuck in (including during recovery). It can stimulate the production of the neurotransmitters glutamate and GABA, which are both associated with stress and substance cravings alike.

Recreational use, on the other hand, involves much higher doses much more often. Although a similar mechanism of action is at work in that case, the intensity is turned up so much that the brain is flooded with too much activity. Rather than having a calming, soothing, and therapeutic effect, ketamine can then cause dissociative experiences and memory problems.

The medication may be the same, in other words, but how it's used differs so greatly that it has a radically different (and even directly opposing) effect. This is not dissimilar to the way fentanyl can be an effective medication in palliative care settings, but a deadly drug on the streets.

Have Questions?

Having witnessed and guided the life-changing positive changes a ketamine therapy protocol can bring first hand, the Mind Clinic team is passionate about its immense promise. We wholeheartedly believe that everyone who is a good candidate for ketamine treatment should have the opportunity to heal with its help.

Combating stubborn misconceptions about at home ketamine therapy is just as important to us. If you are exploring whether at home ketamine therapy may be the next step you're looking for in your treatment, we are always available to answer your questions.

Schedule a free assessment or email us if you have concerns about the addictive potential of ketamine treatment or would like a more in-depth explanation of the mechanism of action at work. We would be happy to answer any questions you may have about dosing with a focus on maximizing efficacy and minimizing potential side effects, too.

Ketamine has been a life-changing medication for many, bringing hope where all other treatment options failed. While it is true that some people abuse ketamine as a street drug, misconceptions about its potential as a therapeutic option are just as dangerous. We're proud to be at the forefront of changing that — and helping those whose lives can be positively touched by a medication with a long and tested track record of safety.