What You Need to Know About Ketamine Safety, with Ronald L. Harter, M.D.

Ronald L. Harter, M.D., FASA

Credit: The Ohio State University Wexner Medical Center

Ketamine has gained significant attention as a potential breakthrough treatment for post-traumatic stress disorder (PTSD) and treatment-resistant depression. However, as its use expands beyond anesthetic and surgical settings, concerns about safety, regulation, and appropriate medical oversight have emerged.

In an interview with The Educated Patient, Ronald L. Harter, M.D., FASA, past president of the American Society of Anesthesiologists (ASA) and professor of anesthesiology in the Department of Anesthesiology at The Ohio State University Wexner Medical Center, discusses the ASA’s stance on ketamine, key safety considerations for patients and what to look for in reputable providers.

What inspired the ASA to release guidance on the safe use of ketamine outside of anesthesia?

Ronald L. Harter, M.D., FASA: Our focus at the ASA is on ensuring its safe use. Ketamine has long been used as a potent anesthetic and sedative. Recently, it’s gained attention for psychiatric and chronic pain treatments. We issued a statement emphasizing the importance of proper medical supervision due to concerns about unsafe use.

The tragic passing of Matthew Perry highlighted the risks associated with unsupervised ketamine use. Additionally, reports emerged of people obtaining ketamine via mail order in certain states, raising serious safety concerns. Some media claims suggest ketamine is impossible to overdose on, which is simply not true. As anesthesiologists, we administer high doses in controlled settings with continuous monitoring — demonstrating how powerful this drug is.

We also recall cases from Colorado where emergency responders were authorized to use high doses of ketamine on agitated patients, leading to severe [side] effects, including fatalities. Given ketamine’s increasing use in various medical fields, we want to ensure both patients and health care providers recognize that it is a potent drug requiring careful administration and oversight.

What are the biggest safety concerns for patients seeking ketamine treatment?

RH: Like any strong anesthetic, ketamine can suppress breathing at high doses. It also causes sedation, which can lead to falls, respiratory distress or even cardiac arrest in extreme cases. Another concern is that ketamine’s effects can be amplified when combined with alcohol or other sedatives, increasing the risk of dangerous side effects.

With ketamine clinics increasing nationwide, how can patients identify reputable providers who follow safety guidelines?

RH: That’s a great question. Patients should ask about the qualifications of the personnel monitoring them. Ideally, a trained medical professional should be dedicated solely to patient monitoring, without other responsibilities. This is especially important for intravenous or intramuscular administration, which rapidly delivers the drug into the bloodstream. Even in licensed facilities, if a provider is juggling multiple patients or other tasks, that should raise concerns.

Do you think ketamine will ever receive U.S. Food and Drug Administration (FDA) approval for psychiatric use?

RH: It’s difficult to predict. The FDA typically does not approve new indications for drugs that are already widely available unless new, large-scale studies are conducted. While ketamine is already used off-label for psychiatric conditions, full FDA approval would require rigorous clinical trials, which may or may not happen. Many drugs are used off-label with published research guiding their use rather than official FDA sanctioning.

Is there anything else you’d like our audience to know?

RH: Our goal at ASA is not to discourage the use of ketamine for psychiatric or pain management purposes but rather to ensure it is administered safely. This is a powerful drug, not suitable for home use, and patients should be properly monitored whenever they receive it.

This transcript was edited for clarity.