The American Society of Anesthesiologists is calling on policymakers to address the fast-growing problem of home delivery of ketamine and the lack of physician oversight in ketamine clinics. In guidance updated this month, ASA emphasizes that ketamine used for non-anesthetic purposes should meet the same safety standards as other anesthetic drugs, including appropriate patient selection, monitoring and physician oversight.
As the U.S. ketamine market surpasses $5 billion, the rapid boom in clinics and at-home telehealth prescribing is alarming anesthesiologists, who warn that access to the powerful anesthetic is expanding faster than patient safety standards. The market is projected to nearly triple in the next decade, prompting calls for stronger safeguards and broader regulatory action.
Used in hospitals for anesthesia and sedation, ketamine is increasingly prescribed off-label for mental health conditions. Existing literature suggests that the drug can benefit patients, including veterans, with conditions such as depression and post-traumatic stress disorder. However, in some cases, ketamine is prescribed remotely and delivered to patients’ homes—without an in-person evaluation or direct medical supervision.
The risks are not theoretical. Last year, a 41-year-old New York woman seeking relief from depression died after being prescribed at-home ketamine through a telehealth company, even though she had reported taking Xanax, a combination the FDA warns can lead to fatal breathing problems.
ASA is urging policymakers and medical experts to scrutinize this trend and work to advance proposals to strengthen patient protections.
The Texas Medical Board recently proposed rules to regulate the administration of ketamine in medical facilities and clinics and require greater oversight during treatment. ASA submitted a comment letter emphasizing that ketamine administration should occur under the direct supervision of a qualified physician who is immediately available for in-person evaluation and intervention.
Rather than endorsing Texas’s proposed rules, ASA urged stronger safeguards. Bills to strengthen patient protections have been introduced in Georgia, Missouri and Utah.
“We have grave concerns about the home delivery and use of ketamine,” said ASA President Patrick Giam, M.D., FASA. “You can move very quickly from feeling relaxed to becoming deeply sedated, and without proper monitoring and supervision, this can become dangerous. I’m concerned that without stronger regulation, we risk repeating another opioid-like public health crisis, particularly because many people underestimate the potential dangers of ketamine.”
Anesthesiologists note three key safety concerns that require close medical supervision:
- Breathing complications: Ketamine can slow or stop breathing, especially at higher doses or when combined with other medications.
- Heart and blood pressure instability: The drug can cause sudden and dangerous increases in blood pressure and heart rate.
- Risk of misuse and diversion: Without proper safeguards, ketamine may be misused, shared, illegally resold or combined with other substances, increasing the risk of harm.
In hospitals and accredited medical facilities, ketamine is administered with continuous monitoring and immediate access to emergency care. These safeguards—including trained personnel to manage airway or cardiovascular emergencies—may not be available in all outpatient settings and are typically not available at home.
“You can go from a short online screening to receiving a powerful anesthetic at home,” said Giam. “If something goes wrong, there may be no one there trained to respond. In the hospital, we have strict protocols to account for every milligram of ketamine administered, yet ketamine used at home is subject to far less scrutiny.”
Patients considering ketamine therapy for mental health conditions should talk with their physician and ask how the drug will be administered, who will monitor them and what safety protocols are in place in case of an emergency.
More information
Guidance on the Safe Use of Ketamine Outside of Acute Pain Management and Procedural Sedation (2026)
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