Your client is doing at-home ketamine. The post I'd start with.
Hello Reader, In a consultation group recently, a newer clinician asked, completely sincerely, whether she was even allowed to talk with her client about the ketamine he was on. She hadn't prescribed it. She wasn't trained in it. It arrived at his door from a telehealth platform. The question stopped the room, because nobody had a confident answer. Here's mine: not only are you allowed, you may be the only clinician positioned to do it. You're the one seeing this person every week. At-home ketamine scaled fast, and almost everything written about its safety was written by the companies selling it. So I went looking for the independent picture, and it isn't reassuring. An analysis of two large patient forums this spring found prescribed doses ranging from 50 mg to 800 mg, a sixteen-fold spread, against the 84 mg ceiling that governs monitored esketamine in clinics. Most platforms watch the first dose by video, then leave patients to dose alone. People are crowdsourcing their own escalation on Reddit, reporting bladder pain and frightening dissociation to each other instead of to anyone with prescribing authority. And the legal floor under all of it, the DEA telemedicine flexibility, is on a temporary extension that expires December 31, 2026. The model your client relies on is provisional, and the people profiting from it haven't told them that. None of this means the treatment is worthless. The medicine has real evidence behind it. The delivery has real holes, and you're positioned to fill several of them: risk awareness, dose-trajectory attention, coordination with the prescriber, and the integration the business model cut. The post lays out the specific questions to work into intake, in plain clinical curiosity rather than alarm. It's the piece I'm proudest of in the rebuilt blog. If you have a client on one of these platforms, I'd start here. Your Client Is Doing At-Home Ketamine. Here's What to Ask. → — Peter |