Medical practitioners are raising concerns over start-ups prescribing generic ketamine online.

“It just boggles my brain,” Leslie Hill, wife of Dr. Jerron C. Hill and front desk manager of Ketamine Health and Wellness Center in Plano, Texas, told The Dallas Express.

Ketamine was first synthesized in 1962 and has been used medically as an anesthetic since the 1970s. More recently, psychiatrists have been using the drug off-label to re-establish neural pathways in order to treat PTSD, anxiety, depression, and chronic pain.

Online healthcare flourished in every arena during the pandemic, including ketamine usage. Intravenous ketamine can only be administered by a medical professional. However, lozenges and tablets with ketamine can be used with little medical oversight. About a dozen startups, such as Mindbloom Inc. have taken advantage of the lax restrictions.

“In order to really reboot the neurotransmitters or receptors in the brain…[tablets] can’t do what intravenous can do. There’s no real comparison,” said Leslie.

Dr. Hill, an anesthesiologist, has been administering ketamine for over 30 years. Each one of his patients is closely monitored and given a specific dosage. Dr. Hill believes that ketamine should be used as part of a holistic treatment combined with proper diet and exercise.

By contrast, Mindbloom Inc. was founded in 2019 as the first psychedelic telehealth clinic by CEO Dylan Beynon. In a Forbes interview, Beynon discussed the benefits of online telehealth and treating depression via ketamine.

“Mental health treatments are notoriously expensive. People wait weeks or months for appointments and traveling to offices or clinics can be inconvenient or impossible,” Beynon said. “Mindbloom is improving outcomes and increasing access.”

Mindbloom’s website offers potential patients a short quiz that asks basic questions such as medical history and symptoms in order to determine whether a patient is eligible for ketamine treatment. In total, the quiz takes about 10 minutes to take. After the quiz, the patient can book a video consult with a practitioner and make the first of three $386 payments for six treatments of ketamine–totaling $1,158, a fraction of in-person intravenous treatment, which can cost anywhere between $1,400 and $12,000, depending on the clinic and the number of rounds.

Since ketamine is used off-label to treat anxiety and depression, it is typically not covered by insurance.

The first two times a Mindbloom patient uses ketamine are with virtual assistance of a clinician. For the final four treatments, Mindbloom is taken by following strict instructions.

With increased access, however, comes increased risk. Medical director of the ketamine and esketamine program at Brigham and Women’s Faulkner Hospital in Boston, Dr. Benjamin Yudkoff argues that clinics offering “virtual ketamine are negotiating a compromise between accessibility and safety.”

Mindbloom explains in its Terms of Service that it is “not a medical practice” and not liable for adverse effects because it is just a platform to connect patients with clinics.

Leslie describes two patients who came to their clinic, each of whom had a bad trip during a virtual prescription program.

“They were at home, hallucinating, totally out of sorts, scared to death because [the clinicians] didn’t get the dose correct,” Leslie said.

Mindbloom writes in its section, “Is there a risk I’ll have a bad trip?” that “the likelihood of having a negative experience has been shown to be very low when two conditions are met: a positive mindset going into the experience and a comfortable physical setting.”

Leslie worries that online prescription models can lead to abuse.

As a psychedelic and control III substance with dissociative, hallucinogenic effects, ketamine has been used recreationally. It has been referred to as KitKat, Special K, and Vitamin K on the street.

“We had an opioid crisis, and if we have more clinics just prescribing ketamine…we will again have another epidemic,” added Leslie.