Healing Hypocrisy: A Closer Look at Mail-Order Ketamine Therapy

Candified ketamine, inflated promises, downplaying serious risks, & a ride on the coattails of authentic psychedelic medicine. Welcome to the hyper-capitalistic world of online ketamine therapy.

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Sep 15, 2023

Ketamine has been around since the 1960s. It was developed as an alternative to the anesthetic PCP (phencyclidine), the surgeon's go-to for nearly ten years.

PCP was cast aside because of some rare but significant side effects — every now and then, a patient would wake up from surgery in a state of psychotic delirium. Most cases cleared up within about 12 hours or so, but not without leaving patients traumatized.

Ketamine, another arylcyclohexylamine closely related to PCP, replaced its contemporary in 1962 and established itself as the gold standard for anesthesiology within three short years.

Ketamine is fast-acting, highly efficient at inhibiting consciousness, and, best of all, it doesn't cause people to go temporarily insane after surgery. Ketamine also doesn't slow breathing the way opiates do, and even very high doses rarely result in overdose.

Ketamine broke out of the operating room sometime in the late 1960s — first winding up on the street as a recreational drug and then finding its way back into the clinic — this time for a completely different purpose.

Perhaps one of the most influential researchers to bring ketamine into the mental health field was the Mexican psychologist Salvador Roquet. Throughout the ‘60s and ‘70s, Roquet conducted experiments using ketamine (and other psychoactive substances), combined with Jungian-inspired psychotherapy.

Many of these ketamine experiments are considered both pioneering and controversial.

Roquet’s work proved foundational in the development of ketamine as a tool for reconsolidating repressed traumatic experiences to treat depression, anxiety, and PTSD. This is the basis of ketamine-assisted therapy in use today.

Today, ketamine clinics are ubiquitous. There are between 600 and 1,000 ketamine clinics currently registered in the United States, and similar markets are opening up in places like Canada, Australia, the United Kingdom, and the European Union.

More recently, there’s been a surge in “wellness companies” offering online ketamine therapy.

These companies ironically owe their existence to the DEA, which created a temporary exception to the Ryan Haight Act in 2021. This act imposed mandatory in-person appointments with a doctor before they could prescribe any medications. Waiving certain provisions of this act was done to ensure medications remained available to citizens during the chaos imposed on the medical system during the pandemic.

Now, doctors can meet their patients online to prescribe medicines.

Companies like MindBloom, Nue Life, Better U, and dozens more are capitalizing on this new telemedicine wave. Users sign up, pay a few hundred to a few thousand dollars and speak with a doctor for 5 or 10 minutes to receive a prescription for ketamine.

Ketamine is then shipped directly to the patient's home, along with a fancy box containing things like an eye mask, an integration journal, and a blood pressure monitor.

But there are several aspects in the way these companies conduct themselves that have many professionals in the psychedelic space up in arms — and for good reason.

Before we get too much further, let me be clear about a few things:

Ketamine has a profound capacity to heal — but only when placed in the right hands.

Studies have uncovered phenomenal results in the treatment of major depressive disorder, post-traumatic stress disorder, suicidal tendencies, and chronic pain.

Salvador Roquet (and his contemporaries) used ketamine to reconsolidate the traumatic memories and emotions that underpin these mental health conditions. This differs significantly from the “silver bullet” approach being peddled by modern online ketamine vendors.

Roquet and others like him employed a masterful combination of psychotherapy and altered states of consciousness to achieve the spectacular results ketamine is famous for today.

You can read all about these miraculous results in the book The Ketamine Papers: Science, Therapy, and Transformation.

In contrast, online ketamine companies act more like pharmacies — placing all the emphasis on the ketamine itself. Most offer the bare minimum in terms of psychotherapy.

For example, the MindBloom package advertises "guided ketamine sessions" as a core part of their offering. However, a quick look at the company's job postings demonstrates that what you're actually getting is a glorified ketamine trip sitter earning minimum wage to guide your experience. These are not trained therapists.

Another company, Nue Life, advertises just two 15-minute sessions with a therapist for every 6 doses of ketamine. Unsurprisingly, the quality of this company's therapy aspect is constantly being called into question, even by past employees of the company.

The fact that all of this is going unchecked is quite astonishing since ketamine has only ever been approved by the FDA for use as anesthesia. The only exception is Johnson & Johnson’s Spravato — an over-priced ketamine nasal spray approved for treatment-resistant depression.

Off-label use of ketamine is not only tolerated but is fueling a booming industry estimated to be worth over $3 Billion USD.

The lucrative nature of this space has attracted a ton of entrepreneurs and venture capitalists with no background in mental health who’ve found an opportunity to make rapid profits in the burgeoning psychedelic wellness space through ketamine.

What could possibly go wrong?

In the words of Dylan Beynon, founder of MindBloom, the company is in the process of ”massively scaling out our platform to bring ketamine to every single person in the US who needs them for every single indication that psychedelics could help people for.”

This statement demonstrates a shocking ignorance of the medicines these companies are peddling.

Instead of following through on the altruistic motivations these companies advertise — what we’re stuck with are profit-driven tech companies selling ketamine-infused candy at an outrageous markup.

Even more concerning — none of the companies we’ve investigated so far are honest about the risks of the products they’re selling.

Ketamine: The “Silver Bullet”

Jules Evans

from Ecstatic Integration did a great job of highlighting the absurd marketing methods employed by ketamine companies today.

Billboards and social media ads promising “instant happiness” are commonplace in this industry. There are even marketing firms like Ketamine Media that exist for the sole purpose of convincing the world they need ketamine to feel happy.

If ketamine truly offers "rapid, long-term relief" and "addresses the root cause of the issue, unlike conventional antidepressants like SSRIs," why are so many of these companies selling their programs as subscription services?

Even the ones that don't rely on subscriptions offer aggressively discounted refill programs to ensure people keep coming back for more.

Dissociative drugs, like ketamine, are powerful mind-altering substances. The states of consciousness they produce aren't something to be taken lightly.

When administered skillfully, ketamine has a powerful capacity to heal. But if used recklessly, it can lead to further mental turmoil, depression, and psychological distress.

Ketamine can be used as a form of spiritual bypassing, drug-based escapism, and can even cause physical harm (namely, ketamine cystitis).

The issue isn't ketamine itself; it's the way these companies are aggressively marketing the use of ketamine for the wrong reasons and parasitizing off a genuine psychedelic renaissance.

The way these medicines are being administered en masse misses a key component that makes them work. Without the crucial psychotherapy aspect, the antidepressant effects of ketamine fade within just a few days.

A combination of effective hype marketing, fancy onboarding platforms, and low-effort integration programs ensure patients need to keep taking ketamine to maintain the initial antidepressant effects.

It even gets worse when you start looking at the shady tactics a few of these companies are using to avoid acknowledging the risks of ketamine.

Is Ketamine As Safe As Its Made Out to Be?

Ketamine itself has an impressive safety profile — especially in lozenge form. This is (partly) why online ketamine programs rely solely on this milder form of ketamine.

Even in high doses, ketamine doesn’t interfere with breathing or heart rate the way other anesthetic drugs do. It also has a short duration of effect, which makes it much more difficult to result in fatal overdose (though still possible with extreme doses or adverse reactions).

There are two major safety implications associated with ongoing ketamine use that none of these wellness companies are being honest or open about.

Ketamine Can Become Habit-Forming

Ketamine is, in fact, addictive.

The way it’s being distributed in packets of 6–30 doses at a time and marketed as “totally safe” is misleading, at best.

Ketamine becomes addictive over time — especially if people are conditioned into a habit of taking ketamine to “zen-out” (escape) whenever they’re feeling anxious or depressed.

The problem arises from the fact that so many of these companies are building their model around long-term customers.

This runs completely antithetical to the original argument that psychedelic therapy (including ketamine) offers a rapid but long-term fix for depression, PTSD, and anxiety. The finger is pointed at conventional SSRI therapy as the bad guy — yet these companies set up treatment protocols that ensure customers need similar ongoing treatment to maintain efficacy.

A comparative ranking of 20 substances with the potential for misuse, led by psychedelic researcher David Nutt and his team, ranked ketamine as sixth overall, based on a massive review of the available literature. The physical harm rating and dependency risk for ketamine were on par with drugs like benzodiazepines and amphetamines. Only heroin, cocaine, barbiturates, street methadone, and alcohol carried a higher risk for abuse than ketamine.

This comes despite the fact that ketamine shows fewer signs of physical dependence than most other drugs.

The issue with ketamine is primarily psychological dependence. People believe they need the drug to feel happy. They rely on it as a means of escape from the physical and emotional pain they experience on a daily basis.

Ketamine offers a “quick fix” for these feelings — but the more often you take it, the less able you are to deal with these emotions on your own.

Ketamine Can Cause Bladder Damage

Ketamine is also well-known to cause serious kidney and bladder disease — especially when used repeatedly for weeks or months. This condition is known as ketamine cystitis and is something inherent to most arylcyclohexylamines. It’s a well-known issue at this point, yet it’s something none of the major online ketamine providers are being honest about.

I searched over a dozen ketamine vendor websites for the keywords “bladder,” “bladder disease,” “LUTS,” and “cystitis” — only two companies offered any warning about this.

The first was MindBloom — which only includes this warning on a hidden safety page. The front-facing safety page, which is linked from everywhere else on the site, has no mention of bladder disease whatsoever — neither do any of the company’s blog posts.

Nue Life is the other one. It suggests in its FAQ that bladder disease is very rare with long-term ketamine users. However, this isn’t supported by the research. This study suggests the incidence of lower urinary tract symptoms (LUTS) is around 30%. An even larger Hong Kong study reported LUTS at significantly higher rates among ketamine users — closer to 46%.

The main culprits of this issue are a group of metabolites, including norketamine, dehydronorketamine, hydroxyketamine, and hydroxynorketamine that form as ketamine is broken down. These metabolites are toxic to the kidney and bladder epithelial cells.

So, Where Do We Go From Here?

Online ketamine therapy can certainly be safe, and it can be effective.

Legal ketamine companies provide much better assurance that the medication itself isn’t contaminated — which is already a significant improvement from street-level ketamine.

The problem comes from the way these companies downplay the risks of ketamine and the subtle and often misleading methods they’re using to market this powerful psychoactive drug.

The other issue is the hypocrisy in the way these companies advertise “rapid, long-term relief” — yet take aggressive methods to retain customers as long as possible.

For ketamine to be effective, it needs to be administered alongside high-quality, personalized therapy — something most of these companies are overpromising and under-delivering on.

Taking a single dose of ketamine offers a dramatic easing of depression symptoms — the effects of which only last a few days. Without proper therapy, these effects simply wear off, so the customer needs to come back for another dose of ketamine — and another one after that.

If you want to truly benefit from online ketamine therapy, our advice is to aim to limit yourself to the initial 6 doses, and to find an external therapist to help you properly prepare (starting at least 1 month or more before the first session). We also recommend you continue to see them for (at least) 3 months afterward (the longer, the better).

Ketamine clinics offering intravenous ketamine, plus a qualified psychotherapist, is an even better (albeit more expensive) option.

Don’t fall for gimmicks like “integration playlists,” apps, fancy care boxes, or “daily microdoses of ketamine.”

Look for companies that aren’t trying to convince you that ketamine is going to magically make you a better person — it’s not.

Ketamine is a tool to help identify unconscious influences that are secretly directing your life — but it’s the therapy and integration of these insights that offer true “long-term benefits” these companies are preaching.

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