The ‘Wild West’ Of Ketamine

BY SHALINI RAMACHANDRAN AND BETSY MCKAY

Tricia Anne Dewey struggled for many years with domestic violence and a subsequent painkiller addiction.

As she emerged from that harrowing period by age 41, the Pound Ridge, N.Y., paralegal thought she’d found a way to repair some of the damage—a drug that internet ads and marketing on social media said would rewire her brain.

The drug was ketamine, a psychedelic-like anesthetic at the center of a booming, largely unregulated industry that promises to offer relief from conditions including depression, anxiety and insomnia. Dewey turned to Better U, one of several telehealth companies and online clinics that have emerged in recent years that offer ketamine to customers based on a remote consultation with a clinician.

“Reclaim your happiness with online ketamine ther-

apy,” the Better U website promises.

Dewey told Better U she was already on Xanax, according to her Better U health record. The Food and Drug Administration warns that combining that with ketamine can lead to respiratory issues and even death. A clinician using the company’s platform prescribed ketamine anyway— in small Starburst-like squares that dissolve in the mouth.

One evening last July, after Tricia took a dose, her mother found her face down on her bedroom floor, unresponsive. She was pronounced dead at the hospital.

“She trusted Better U and she really wanted to have a better life,” said her mother, Carleanne Fierro, who along with Tricia’s father filed a lawsuit against Better U in February.

The Westchester County medical examiner deemed Dewey’s death an accidental intoxication due to the combination of ketamine and Xanax.

“When someone is harmed or dies while seeking help for their mental health, it is a tragedy, and my heart goes out to Ms. Dewey’s family and loved ones,” said Derek Du Chesne, chief executive of Better U, in an emailed response. He said he can’t comment on specifics of her case due to patient- privacy obligations and on the advice of his counsel.

But he defended Better U’s model, saying that it’s designed around careful screening, conservative dosing, required preparation appointments and safety protocols like blood-pressure monitoring. He said Better U is a technology platform that provides access to independent clinicians not employed by the company who make medical decisions based on their professional judgment.

“Ketamine‑assisted treatment is an evolving area that carries both potential benefits and meaningful risks,” Du Chesne said.

Dual existence

Just a few years ago, ketamine had mostly a dual existence: as an anesthetic to sedate patients in operating rooms and as a street drug known as “K” that can deliver out-of-body experiences.

That changed after 2019, when the FDA approved a drug for treatment-resistant depression that shares some chemical similarities with ketamine. The drug, marketed under the brand name Spravato, must be administered in a specially certified doctor’s office or clinic. Patients are then placed under observation for at least two hours.

Those hurdles drove more people to seek out ketamine itself, which can be prescribed for any use a doctor deems medically appropriate. It is FDA-approved only as an anesthetic, and its use for psychiatric conditions is “off-label,” meaning its safety and efficacy hasn’t been vetted by the FDA for that purpose.

A pandemic-era federal rule change in 2020 loosened oversight further, allowing doctors to prescribe controlled substances, including ketamine, after a remote consultation, without first meeting a patient in person.

Operating under scant regulation and disparate safety standards, more than 500 businesses offer the powerful mind-altering drug nationwide, according to a 2024 report released by the Drug Enforcement Administration, often for patients to take at home without medical supervision.

“It’s the Wild West,” said Bill Bodner, a former DEA agent, who grew alarmed when he saw ketamine clinics sprouting up all over Los Angeles four or five years ago advertising off-label uses such as addiction recovery.

More than a million Americans used ketamine in 2024, legally or not, twice as many as in 2021, according to federal data. Prescriptions dispensed by pharmacies, including for at-home use, rose more than eightfold in the first nine months of 2025 compared with all of 2024, according to the Iqvia Institute for Human Data Science.

Evidence is mounting of ketamine’s potential dangers. In 2023, “Friends” star Matthew Perry drowned in a hot tub after using the drug. Several people, including two doctors and a drug dealer known as the “ketamine queen” were charged in connection with his death. Perry initially took ketamine infusions for pain and depression, but later developed a debilitating ketamine addiction.

In 2024, ketamine was detected in at least 395 overdose deaths in 38 states, according to incomplete federal data.

“This is a dangerous, addictive drug that is being given with minimal oversight and causing a lot of harm,” said Dr. Christopher Blazes, director of the addiction psychiatry fellowship at Oregon Health & Science University, who has seen multiple patients with a ketamine addiction. “Many of these people will never see a physician.”

The drug’s availability in easy-to-use oral forms such as lozenges has broadened its popularity. Some online clinicians suggest taking them one to three times a week at doses that can leave a patient impaired the rest of the day. Telehealth patients say they easily get refills through online message exchanges or by filling out a survey.

In 2023, the FDA warned about at-home use of oral ketamine for psychiatric disorders, noting risks of abuse, bladder problems, slowed breathing and psychiatric reactions. The warning singled out ketamine made by socalled compounding pharma-cies, which custom-mix these oral forms of the drug. Some work with telehealth companies to serve their customers.

Telehealth executives and some patients say that ketamine lozenges can be lifechanging for people who have struggled to find treatment for their depression. They point to some published studies showing an association between ketamine therapy at home and reduced depressive symptoms.

Psychiatrists say that for ketamine to be safe and effective against depression, it should be given in low, intermittent doses under medical supervision. With adequate recovery time between sessions, it can stimulate the brain to form healthy new neural connections and allow for cognitive and behavioral changes, said Dr. Gerard Sanacora, professor of psychiatry at the Yale University School of Medicine and director of the Yale Depression Research Program.

Impaired cognition

But more frequent doses can impair learning and memory, Sanacora said. Large amounts of ketamine over a long period can cause damage to the brain, impairing cognition and leading to poor decision- making, he said.

Joseph Palamar, a professor at NYU Langone Health who studies drug use epidemiology, said his team examined the websites of more than 200 ketamine providers in New York, New Jersey and Connecticut. They advertise treatment for Parkinson’s disease, post-stroke rehabilitation and many other conditions in addition to depression, Palamar said, adding that less than half mention risks associated with ketamine use.

Jeffrey Gold, a psychiatric pharmacist in Colorado, said he sees patients who have gotten ketamine lozenges from other providers and take them when they feel they need it, rather than on a set schedule. “It feels like they’re becoming their own doctor,” he said.

When 32-year-old Tranyelle Harshman sought help in late 2024 for postpartum depression from Sage Psychiatry Services in Wyoming, a nurse practitioner named Krista Blough met her in person and prescribed ketamine lozenges for Harshman to take at home.

Harshman suffered heart palpitations, had difficulty focusing, and felt disconnected from reality for days after taking the drug.

Harshman was scared, but Blough told her that such side effects were common at first and increased her dose, according to Harshman’s mother, Rhonda Coplen. “She was given the understanding that oftentimes it gets worse before it gets better,” Coplen recalled.

On Feb. 10 of last year, Harshman scheduled playdates for her four girls, ages 2 to 8, and put them down for a nap. Then she took her increased dose of ketamine.

Soon afterward, in an eerily emotionless voice, Harshman called 911 and told the emergency responder that she had shot and killed her four daughters and was about to kill herself too, according to a 911 recording reviewed by the Journal. She told the operator that someone had been trying to take her girls.

All five died. Harshman had no history of violence or suicidal thoughts, Coplen said.

Toxicology report

Harshman’s toxicology report, which was reviewed by the Journal, shows that the level of ketamine in her blood was more than four times the threshold reported in studies for mind-altering effects and physical impairment. Some medical reports suggest that patients could be prone to violent behavior under the drug’s influence or coming off it, since they are dissociated from reality.

“She was a good mom and loved her girls,” said Coplen, who filed a lawsuit against Sage Psychiatry and Blough alleging wrongful death. She said she believes ketamine has a purpose, but “it is reckless to allow it to be in a setting where you don’t have clinical supervision.

In a legal filing in November, lawyers for Sage Psychiatry and Blough said that they didn’t cause the tragedy, adding that the “injuries and damages” may have been caused by third parties or from pre-existing conditions, and that Harshman was “adequately informed of the risks, benefits and alternatives of the treatment and gave their consent based on that information.” It added that the providers’ actions and the treatments given were common and not a deviation from any applicable standard of care.

All Points North, a behavioral health company that offers treatment for addiction, trauma and mental health said it has had as much as a threefold increase in the number of patients addicted to ketamine over the past two years, according to CEO Noah Nordheimer.

“Any adult with a computer and credit card can have ketamine delivered to their door, and that’s a problem,” said Nordheimer. A patient can get up to eight weeks’ worth of ketamine delivered and take it within a few days, then get more from another source, he said. His company offers ketamine sessions in person.