The benefits of clinically-administered ketamine for certain mental health issues have become increasingly prominent over the past decade, with neuroscientists and psychiatrists championing the drug as a promising anti-depressant – yet medical access to the drug remains limited in the UK.
Studies suggest that ketamine can be used to treat, or even prevent, depression and post-traumatic stress disorder (PTSD). Dr Rupert McShane, who led a recent UK study into the use of ketamine to treat severe, treatment-resistant depression, says that he found the drug to work on patients “where nothing has helped before”. Among the 101 trialled patients that the study focused on, 42 claimed to have experienced positive results from the drug. One patient said that the first ketamine dose “literally saved my life", while another stated that “ketamine treatment has enabled me to return to my job full-time”.
The study concluded that ketamine offered considerable potential in mental health treatment, although it must be treated with caution. “Based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles,” researchers said, “however, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, [including] that all experimental and trial data are made available through national registries.”
Depression is the leading cause of disability globally, according to the World Health Organization (WHO), while suicide is the biggest killer of young, British men. Increasing medical access to ketamine treatment for British people suffering from depression and anxiety could thus have the potential to save lives.
In another staggering recent development, researchers found that ketamine may be able to prevent the onset of certain mental health conditions. In 2016, a Colombia University study on mice found that ketamine could act as a “prophylactic against stress-induced depressive-like behaviour.” Neuroscientist Rebecca Brachman, one of the study’s authors, later said in a TED talk that “this could be the beginning of the end of the mental health epidemic”.
Despite the potential shown in such research, access to ketamine treatment in the UK is highly limited. What is holding it back?
Rebecca Brachman has remarked that increasing medical access to ketamine is a challenging issue around the world because of the lack of financial gain available to pharmaceutical companies. “There are no incentives in place once a drug is generic and off patent and no longer exclusive to encourage pharma companies to develop them, because they don't make money,” she said.
In the UK more specifically, prohibitionist drug legislation is an obstacle. Professor David Nutt, professor of neuropsychopharmacology at Imperial College London and former chair of the government's Advisory Council on the Misuse of Drugs, says that the prohibition of ketamine – its designation as an illegal drug – is hindering medical access. Nutt told TalkingDrugs that stigma plays a role, alongside “fear that as a controlled drug it is dangerous to use”.
Professor David Nutt told TalkingDrugs that he hopes ketamine could be used for patients who suffer from treatment-resistant depression. (Image source: Wikimedia)
Indeed, ketamine is a Class B drug in the UK – having been reclassified from Class C in 2014. At the time of its reclassification, crime prevention minister Norman Baker said the legislative change would “send a message that the drug is harmful”. Of course, the drug is not without potential physical harms; the British Medical Association warns that “frequent and heavy ketamine misuse can cause significant toxicity to the bladder, urinary tract and kidneys” and can cause nausea or a feeling of dissociation. This reclassification increased the potential prison sentence for possession from two to five years, while supplying the drug can now garner a prison sentence of up to 14 years in prison.
Following this reclassification, the government also rescheduled ketamine; moving the drug from Schedule 4 to Schedule 2, the same category as heroin. In UK legislation, all controlled drugs are listed in Schedules 1 to 5 of the Misuse of Drugs Regulations 2001, with schedules numbered in decreasing order of severity of control. The scheduling system determines in what circumstances it is lawful to possess, supply, produce, export, or import controlled drugs. Within its new stricter schedule, ketamine continues to be allowed for medical use, but faces further restrictions on how and when it can be prescribed – including a requirement for health professionals to provide extensive justification when choosing to prescribe it.
On top of stigma and increasingly strict regulations, the medical use of ketamine is being hindered by a lack of state funding for mental health research. As Professor Allan Young of the Royal College of Psychiatrists describes in a recent Guardian article, “Mental health is under the cosh and it’s one of the worst parts of the NHS for funding. We hear a lot about A&E cuts but a lot of people presenting at A&E do so for mood crisis or suicidality. Ketamine is a way of treating that, but there is little money to set up clinics.”
Professor David Nutt told TalkingDrugs that he hopes ketamine will soon “have a role for emergency room treatment of active suicidality and [treatment-]resistant depression” in the UK, but stigma, strict drug laws, and a lack of funding continue to be obstacles to this. Regardless, research into the drug’s medical benefits continues, as do hopes for its wider availability for patients in need. It remains unclear if and when these hurdles will be overcome, and when an evidence-based approach can enable more widespread use of medical ketamine in the UK.
