Hi Folks,
I did bring up Ketamine at the Las Vegas conference. Would have liked a more substantive discussion however, but there were time issues!
As some of you know, I do prescribe it on occasion. It is certainly no worse that using opioids and likely better! Yes one must be careful, like with many many things. It will always be a challenge to get it from someone who has NEVER prescribed it before. The US is lucky that it is only a schedule 3 agent, while in Canada it is schedule 1, non starter!
As with other medications, take enough and you are 'out of your tree' (like with Benadryl, alcohol etc) but I generally trust patients to be cautious and give them the benefit of the doubt. I have found that the compounding pharmacies have been helpful and do not look upon me as a dope peddler! Remember the compounding pharmacies are our friend.
It has yet to be determined what long term treatment concerns there would be with ketamine. I suspect it is best used with breaks so the body can loose the tolerance to it.
Desperate situations deserve brave choices and that is how I ended up writing some patients for this. Have to admit as yet no disasters and nobody hated it. All some degree of positive. As yet we still do not know the ideal role it should play.
FYI Very soon, the academic journal HEADACHE will publish a 5,500 word review of mine that covers cannabinoids (not useful here) and hallucinogens for headache. I do mention ketamine positively so that would be something to show a skeptical physician (yes psilocybin mushrooms are covered in a positive way as well).
Cheers,
BostonHeadacheDoc