Shirola: The U.S. government must ensure open access to ketamine infusions

Wesley Shirola, Columnist

This is the third column in “Failed Policy,” a series examining the history of drugs and drug policy in the United States since its founding.

Ketamine, which is a drug most commonly used to induce and maintain anesthesia, was developed in the late 1950s and approved for use in humans in the U.S. in 1970, largely as an anesthetic for battlefield use in the Vietnam War. People began using it recreationally as well, first on the West Coast and, eventually, across the world. Subanesthetic doses, those lower than used medicinally, produce a state characterized by a sense of detachment from one’s body and the external world. As a result, the drug quickly became popular, especially on the dance and music scene in the mid-1980s. It is still used recreationally across the world.

Though no longer administered as frequently, ketamine still has several medical uses. Today, doctors use it as an anesthetic for minor operations in both hospitals and war zones, as well as for postoperative pain management, where it may be used in low doses to reduce morphine use and limit post-op nausea and vomiting. The World Health Organization includes ketamine on its List of Essential Medicines. Possibly as a result of its widespread medicinal use, it remains relatively cheap. Its street price per dose ranges from $20 to $25 on average.

Over the past few years, several studies finally concluded what researchers had suspected for years: Ketamine is effective in treating severe cases of depression, especially those including suicidal ideations. Dr. Kevin Kane, an anesthesiologist at a ketamine clinic in Milwaukee, told CNN that this might be “the biggest breakthrough in mental health in the last 50 years.” He goes on to estimate that ketamine is effective for 70 percent of patients with otherwise treatment-resistant depression.

Depression is a global health issue. Fortunately, ketamine can help combat this epidemic. As such, it is imperative that the U.S. government and governments across the globe impose price caps on the drug in order to ensure that all of those who need it can receive the treatment that may, in fact, save their lives.

At ketamine clinics, doctors administer the drug intravenously, and relief can occur within hours, including the cessation of suicidal ideation. Thus, ketamine-infusion treatment has the possibility to be a life-saving treatment for millions of people every year.

Indeed, earlier this year, the New York Times reported that more than 40 percent of college students in the United States said they felt so depressed that their ability to function was significantly impaired. An estimated 16.2 million adults, or 6.7 percent of the U.S. adult population, suffer from at least one major depressive episode in any given year. Globally, the WHO reported in 2017 that approximately 300 million people suffer from depression.

But the U.S. is already failing in this endeavor. Ketamine has been an extremely cheap drug for much of its existence due to its wide use and the fact that it isn’t covered by a patent. Nonetheless, Janssen, a pharmaceutical company, announced in March 2019 that it had patented the left part of the molecule, esketamine, which was not covered under the original patent, and that its newly FDA-approved nasal spray depression treatment, called Spravato, would be priced at $590 for a 56 mg dose and $885 for an 84 mg dose. For the first month of the treatment, patients receive treatment twice a week with either size dose, leading to a wholesale cost ranging from $4,720 to $6,785. Patients may also need subsequent maintenance doses either weekly or biweekly, adding an additional cost of $2,360 to $3,540 per month.

This, of course, is not necessarily the price that patients will pay. Out-of-pocket costs will depend on a patient’s health insurance plan. But it’s unclear which insurance companies will cover the treatment, nor is it clear how much of the cost they will actually cover. Health insurance companies have fallen short when it comes to mental health care compared to other forms of illness. If the past holds any evidence of the future, ketamine treatments will not be entirely covered by insurance.

As promising as this new treatment may sound, it reveals a sickening reality of the U.S. healthcare system: profits over patients. As students, academics and (for a lot of us) patients, we must pressure the U.S. government to step in and control ketamine prices now before they balloon completely out of control as has so often happened with life-saving drugs and treatments in the past.

Wesley Shirola is a Weinberg junior. He can be contacted at [email protected]. If you would like to respond publicly to this column, send a Letter to the Editor to [email protected]. The views expressed in this piece do not necessarily reflect the views of all staff members of The Daily Northwestern.

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