Ketamine clinics are popping up everywhere and can provide another option for patients when traditional therapies have failed, but they are still struggling with depression or pain. Did you know about this newer treatment modality for depression or pain? How does it work? How do you find a reputable clinic?
This week we will focus on a growing and still largely undiscovered trend in healthcare. I will go over the basics of ketamine treatment, how patients can do their due diligence to find a good provider, and how clinics can set themselves apart from their competition by working with a qualified consultant pharmacist.
What is ketamine treatment?
Ketamine was developed in the 1960s and approved by the U.S. Food & Drug Administration (FDA) in 1970 as an anesthetic. In more recent years, ketamine was shown to successfully treat various conditions, including depression that has not responded to other therapies and pain management. It is important to note that currently ketamine is only FDA approved as an anesthetic, even though it is often used “off-label” to treat other conditions. A nasal spray (Spravato) containing esketamine (a variation of ketamine) is FDA approved and available to treat depression.
For patients who haven’t responded to traditional antidepressant therapies, there are two main types of ketamine therapy: 1) administered intravenously (IV) and 2) delivered via a nasal spray. Ketamine IV infusion is the most common and most effective type of ketamine therapy. Additionally, most of the research conducted has been on ketamine IV therapy.
Does ketamine treatment work?
Ketamine, like many other drug therapies doesn’t work for everyone. The patients who respond to IV ketamine will most likely respond to it within six infusions. Patients who experience some relief from depression within one to three ketamine treatments are most likely to benefit from a continuation of the therapy. If a person experiences no response at all after the first six weeks, then they are unlikely to respond to further infusions.
Who can provide ketamine treatment?
The licensing of clinics will vary from state to state, so it’s important to check with the licensing boards in your jurisdiction. Some clinics are run by psychiatrists and others by anesthesiologists. That doesn’t make one clinic better than the other. One of the most important pieces of the puzzle is collaboration. Regardless of who owns or runs the clinic, they need to be coordinating care with other providers. An anesthesiologist should be expert in the administration of the medication, but they need to rely on a psychiatrist to manage the mental health aspect of care. The mental health provider can either be part of the clinic or an independent provider. A good clinic will both assess a patient to see if they’re qualified to receive ketamine treatment, as well as follow a patient and manage their ongoing mental health and other medication needs.
How do you find the best ketamine clinic?
As is the case in any industry, there are good providers and providers that are not so good. It’s no different with ketamine clinics; some are exceeding all medical and regulatory standards and others aren’t even close. Doing a little bit of work ahead of time will help you make a decision that increases your odds of successful treatment and minimizes your risk of being harmed.
Finding a great clinic is critical to both patient safety and successful outcomes. How can you tell the good from the bad? Since the OctariusRx team is relentlessly focused on safe medication management and patient safety, evaluating, and working with ketamine clinics to enhance patient safety comes naturally to us, so let us give you some tips.
Some items you may want to compare are: how they screen their patients; how they coordinate care with your mental health provider; do they follow the guidelines of the American Psychiatric Association; and are they following best practices for recommended dosing and frequency of infusions. Finally, cost will be a consideration, but do not use this as the measuring stick by which you choose a provider.
How can you tell if your ketamine clinic is a good one?
- Do they provide coordination of care?
As mentioned above, treating depression with ketamine, as well as other mental health conditions requires a team approach. As a patient, you may be working with a psychiatrist who can assess, refer, and provide follow up care. If not, it’s essential that the clinic be able to provide this service. The best clinics will be happy to work with your current provider or they will have one of their own. Ultimately, you should get a complete assessment from both a mental health provider as well as an anesthesia provider. It doesn’t stop there. Who will provide your follow-up care? It’s good to find out ahead of time who is involved and how the coordination of care will take place. The best clinics will ensure you have continuity of care and not just provide you with a place to receive medications.
- Do they have an authoritative website?
That’s just the beginning. Having a beautiful website does not make you an expert. I wrote about having an authoritative website in a recent post titled “Who is the Best Consultant Pharmacist?”. This is the first step in helping you determine if the person or company you’re looking at is best in class, or a fly by night operation. Was their website just an extension of their business card or did it offer substantive information? Did they provide expertise, or tools right on the website? Do they answer the most commonly asked questions you may have? The website needs to communicate transparency. Are you able to tell who the team of providers is? What are their backgrounds? Do they have a blog where they post of relevant topics? Do they seem expert at what they do? Spend a little time on their website and you should be able to learn a lot about the clinic and how they operate.
- Does the clinic work with a consultant pharmacist?
Regulations vary from state to state, but generally, clinics are not required to work with a consultant pharmacist. Therefore, if the clinic you are researching has hired a consultant pharmacist, it’s a telltale sign they are being proactive and have a culture of patient safety. Pharmacy consultants who specialize in this area will have expertise in safe medication management, regulatory compliance, clinical compliance, safe injection practices and achieving positive patient outcomes. When selecting a provider, do you want someone who meets the minimum standards, or a clinic who is on the leading edge?
If you are a ketamine clinic or provider, how can a pharmacy consultant help you?
Let’s start with the most obvious; ketamine is still a DEA Schedule III controlled substance, even if it’s being used off-label to treat psychiatric or pain related conditions. Clinics are required to follow state and federal laws around controlled substance registration, storage, inventory management, security, record keeping, and prescription protocols. Do you know how to properly store, document administration, and dispose of ketamine? A pharmacy consultant can ensure the facility has a comprehensive management system in place to show a proper documentation trail for ordering, receipt, administration, and disposition of controlled substances. A ketamine clinic, or provider would benefit not only from proper documentation, but also receive guidance on regulatory changes, such as the recent trend away from paper and toward electronic processes. What about disposal? Can you place empty vials in regular trash containers? Can you flush remaining amounts down the sink or toilet? An expert pharmacist can ensure compliance in all these areas. Failing to comply can have ramifications at both the state and federal level.
What about safe injections practices? Are you following all Centers for Disease Control and Prevention (CDC), Association for Professional in Infection Control and Epidemiology (APIC) and USP797 guidelines? There are many areas of potential patient harm when it comes to injectable therapies. How does your clinic draw up medications? How are syringes labeled? Are you using multi-dose vials? How are those handled to ensure patient safety? Safe injection practices require a lot of ongoing effort and vigilance to maintain best practices and avoid patient harm.
How do you handle look-alike-sound-alike (confused drug names) and high alert medications? Without a proper system in place these medications can be a major cause of errors that can lead to serious patient harm. How are you minimizing the risk?
Preparing for and handling emergency situations is a must for all clinics. Do you have protocols in place to handle emergency situations? How about the proper medications and equipment? Do you know what items should be in your code cart? Who is reviewing these items to ensure ongoing compliance? We have a comprehensive and systematic approach to making sure all these items are addressed and up to date. If you are missing any of these items or are unsure, let us perform a complete assessment and provide you with a fully compliant system. Once compliant, we will periodically monitor and provide ongoing updates.
As a consultant pharmacist, I work with my facilities to ensure they are exceeding requirements, making changes when necessary to improve processes, and implementing best practices. Clinics have options when it comes to working with a pharmacy consultant. Just as it’s important for a patient to select a clinic carefully after due diligence, it’s also important for clinics to choose wisely when picking a consultant pharmacist. Remember that anyone can call themselves a consultant, but few are specialized or expert. To learn more about selecting the right pharmacist, read my post titled: “Are you working with a highly qualified consultant pharmacist?” If you have questions or would like to learn more about how we can help, don’t hesitate to reach out.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.
