Is Ketamine Addictive Like Opioids?

Ketamine therapy has exploded in popularity, with celebrities sharing their healing experiences. But Matthew Perry's tragic death raised an important question: is ketamine addictive like opioids?

With industry insiders raising concerns about patient safety, especially from online ketamine companies, many patients are rightfully skeptical after what happened with the opioid epidemic.

Ketamine vs Opioids: The Politics of Medicine

Ketamine is a 60-year-old anesthesia drug that happens to work incredibly well for depression, anxiety, PTSD, and chronic pain. Studies show 70% response rates for treatment-resistant depression, better than traditional antidepressants. Furthermore, ketamine therapy tends to have fewer side effects and far less frequent dosing, especially in IV form.

But here's the catch: the FDA only approved it for anesthesia. Everything else is "off-label," which means insurance won't cover it. Since ketamine is old and off-patent, there's no money in getting FDA approval for mental health uses. So patients pay cash, and companies make money.

This problem is because medicines need to be rigorously studied and approved by the FDA for each specific indication.

Opioids have been FDA approved for various pain syndromes. Ketamine has a different set of FDA approvals, and its main approved use is for anesthesia, not mental health. This makes ketamine different than opioids from a regulatory perspective, even though both can relieve pain: both physical and emotional.

During COVID, the DEA allowed doctors to prescribe controlled substances through telemedicine without ever meeting patients in person. Suddenly, ketamine lozenges could be mailed to people's homes.

Here's where it gets concerning: there are zero regulations on monitoring patients taking ketamine at home. It's a complete regulatory blind spot.

The problem with at-home ketamine? There's no one making sure you're not using too much or too often. That's when risks increase.

So Is Ketamine Addictive, like Opioids?

The short answer: it's complicated, but very different from opioids.

Ketamine overdose deaths are very rare—well under 1%. When doctors supervise ketamine therapy in clinical settings, addiction risk appears very low. There's many reasons for this, largely because medical doses are much lower when directly supervised by doctors.

But recreational users taking 90+ times the medical dose? That's where addiction risk shoots up. Similar to opioids, when use is not supervised by doctors, the addiction risk rises.

What makes ketamine different from opioids is how it works in the brain. It doesn't create the same addictive brain changes as cocaine or opioids. There's no physical withdrawal—no vomiting, tremors, or diarrhea. Withdrawal is mostly psychological.

The Real Risks of Ketamine: Addiction and Cystitis

The biggest long-term concerns are addiction and bladder damage. The first bladder injury case was in someone using ketamine lozenges for a year. Most cases reverse if you stop, but some are permanent.

The problem with at-home ketamine? There's no one making sure you're not using too much or too often. That's when risks increase.

How to Stay Safe

If you're considering ketamine therapy, here's what matters:

• ‍Get supervised treatment. Medical experts strongly recommend against taking ketamine at home without direct oversight. IV ketamine in a clinic is the safest option.
• ‍Talk about your addiction history. While ketamine can actually help people with substance use issues, you need close monitoring so you don't swap one problem for another.
• ‍Less can be more. Find a doctor focused on getting you the most benefit from the fewest sessions, not one pushing you to come back constantly.
• ‍Ask about Spravato. If you have treatment-resistant depression, esketamine (Spravato) is FDA-approved and covered by most insurance. It may have even lower addiction risk than regular ketamine.

Is Ketamine Therapy Safe? The Bottom Line

Ketamine is not considered as addictive or dangerous as opioids, but it's not risk-free either. When used responsibly with proper medical supervision, it can be very safe and even life-changing. But when companies prioritize profits over safety, and patients use it without oversight, serious problems can happen.

Don't let convenience or clever marketing override basic safety. Find a doctor who actually sees you, discusses risks honestly, and isn't just trying to sell you more sessions.

Watch Dr. Kaveh's video above for more details on ketamine therapy safety.

Speak with a doctor at Clarus Health today to learn if IV ketamine therapy may help your depression, anxiety, PTSD, or chronic pain.‍