Ketamine: From Party Drug to Prescription Medicine | Hacker News Reader

Ketamine: From Party Drug to Prescription Medicine

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97 pointslaurex101 comments

The suggested price of these treatments is absurd. “And then there is the cost. It is unclear what insurance companies will cover and treatment estimates are in the vicinity of $7,000 per month.”

Its been awhile but Im fairly confident this drug doesnt cost anywhere near that price.

Ketamine is also available for use as an anesthetic. (It used to be used for most heart surgeries.) It's like $10 a shot when used as an anesthetic.

Some insightful background: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...

It’s still used. Moreso in animals, but still in humans, but usually with another sedative.

Also used in palliative care when opiates aren’t working or causing too many side effects.

Right, my comment about "was used" was for heart surgery. The story I heard was that the patients were complaining about the psychedelic effects :D

It was really interesting to watch "Combat Medics", a show about med-evac choppers for the US armed forces in afghanistan. One of the first things they do with bad cases is give them a shot of ketamine. So in addition to calling K disparagingly "cat tranquilizer" and "horse tranquilizer", we should call it "marine tranquilizer".

The big advantage of it is that it works and it doesn’t mess with heart rate or breathing.

Safe to give without having to monitor much, nor carry other items because it has few contraindications.

Someone I used to know was a ketamine user for a while -- when she wasn't busy with cocaine. (The impact was pretty drastic, so I'm guessing she was using rather more than might be recommended...) What I came to say, though, was that I'm quite sure she wasn't paying anything like that much for it.

In my experience a gram of K in the US costs around $100

In the UK it is more like $20-$40

This is a bit like comparing street amphetamine powder with prescription adderall. People are willing to pay for a pure product measured precisely in laboratory, not cut with other dangerous chemicals delivered as a pill.

I’m not an expert but I’ve heard that K is so easy to make and cheap, it’s rarely cut.

From what I remember from the Hamilton's Pharmacopeia episode on Ketamine, this synthesis is actually quite complex and a high-yield synthesis (which is presumably being used currently by manufacturers) is not published in publicly available literature.

However, ketamine is widely used as an anesthetic, so I think the "cheap to make" refers to Ketamine redirected from the pharma market to illicit channels, in which case "making" ketamine is just drying the solution to crystalize the sole ingredient.

Street ketamine is almost always redirected pharmaceuticals. We used to buy cases of bottles unopened back in the 90s

This article says _was_ almost always: https://www.bbc.co.uk/news/resources/idt-bc7d54e7-88f6-4026-...

In the specific case of ketamine, it’s easier and cheaper to acquire, and generally goes through far fewer intermediaries between the pharmacy and the street consumer. So the stuff you find on the street tends to be dramatically more pure than, say, cocaine.

But research, development, and marketing cost.

IIRC most of the money spent on the development of a successful drug comes from the phase 3 clinical trial. R&D does make up a lot of a drug company's budget but that's because you do the R&D for the 10 drugs you start with, not just the 1 that makes it to market.

It should be a joke for a generic drug company to take generic S-Ketamine and put it in another insufflation device and show bio equivalency.

You don’t patent indications.

I don't think it's a joke that they could patent their special version of ketamine, I think it's a joke that despite the fact that we've been using ketatmine for generations and despite the fact that it's anti-depressant qualities are well attested to in the literature this brand of s-ketamine is the only one doctors are allowed to use. And there's research[1] showing that most of racemic ketamine's effect is from the r-ketamine, not the s-ketamine.

[1]https://www.sciencedirect.com/science/article/pii/S009130571...

There’s no way they were the first to synthesize the S énantiomor.

Usually doctors can still prescribe the compounded forms as long as they’re not duplicating something commercially available.

You don’t patent them, but you do get exclusivity with the FDA approval.

FDA won’t approve another drug for 3-7 years.

Ketamine infusions for depression are pretty expensive, but not $7000/mo. They seem to run about $400-600 per treatment.

Given that patients require constant treatment to benefit from ketamine I'm not sure that helps a ton.

I couldn’t imagine it being that expensive to have a home care nurse set up a peripheral line, mix up the bag and run the infusion (or IV push it).

The drug in vials is generic.

No different than IV antibiotics at home.

Not much clinical monitoring required when you’re on a stable dose.

We're comparing this to the 20$ for a months worth of antidepressants though. It's 1000x more convenient (and cheaper) to take a single pill a day vs setting up an IV.

Johnson & Johnson patented and got Esketamine FDA-approved specifically for the treatment of depression, which is literally just the active part of Ketamine, which is otherwise a very cheap generic drug but not approved for the treatment of depression. And with the patent raised prices at least 300x over what Ketamine costs.

And we wonder why drug prices are so high.

Esketamine is just an enantiomer. Both enantiomers are similarly active, and to me it's not 100% clear to me why Esketamine was the enantiomer chosen.

There is no rhyme or reason other than the fact that one or the other could be patented by a private co unlike Ketamine. I assume trying to patent both would've doubled their costs, so why bother, especially if it's highly probable both do the same thing.

Esketamine doesn’t have the same activity as racemic or Arketamine (S- hits some of the dopamine receptors harder and doesn’t bind with the sigma ones iirc). Patients seem to find esketamine more pleasant because of this and it’s eliminated faster than R- so patients can (probably) get back to normal faster.

(Edit: had my right from left mixed up. It’s been a while)

So maybe it makes you a little less groggy but at 300x the price? Don't think anyone can say that justifies the price multiple.

Now r-ket can be developed as a patentable improvement over the state of the art :)

Some studies suggested that the enantiomer they chose was slightly better at driving the effect people thought was causing the anti-depressive effect.

Unfortunately, newer studies suggest that 1) that effect isn't responsible for the anti-depressive effect and 2) the enantiomer they chose doesn't seem to be as good as normal ketamine.

Too soon to say, but early signs suggest this may have all been a fantastically expensive mistake. :(

They started the trials before the NIH study that proved that nmda receptor only played a small role it it's effects and that R-ket and it's metabolite was more important .

They were already too deep it

Take an already active drug, repackage it, patent it, and market it, and nobody knows how much you're charging because thats the insurance companies problem

They ran a bunch of clinical trials on it.

Maybe the gov't should fund trials for the use of generic ketamine to treat depression, and then come to the conclusion that generic ketamine can be used to treat depression (as they've concluded with esketamine) and then any medical profession could prescribe ketamine (in a controlled setting) at 1/300th the price.

The drug was already discovered and in use on humans. Universities everywhere could’ve run clinical trials on it. There’s not much here that’s novel or new, but they get to charge a good used car a month because they ran some trials? Sorry.

No studies on long term use for people with depression . Trials are expensive . esketamine by j&j was done for people that don't have money for clinic which are out of pocket but money enough for insurance

I feel like the street price for a months worth of Ketamine would be way less than $7000...

You could get a couple first class flights and VIP tickets to EDM festivals to go with it :p

Even worse is are the conditions for being prescribed. First you have to have failed 5 previous medications but still be taking one. The dosages are delivered only to your psychiatrist. You have to have it injected there and then you have to wait 2 hours and are not permitted to drive for 24 hours. And that's for the several injections per week...

So not only will the drug be expensive but you're going to be charged a doctors visit every time AND you'll have to figure out how to get off from work for hours each week.

Seems a lot easier to go down to the local high school and buy a bag of K.

My girlfriend did ketamine treatments and her's were once a week for four weeks with a break period in between(don't remember the exact length of the break), where are you seeing the several injections per week number?

Spravato is 2x a week for nasal administration for the first 4 weeks, then weekly or less thereafter. http://www.janssenlabels.com/package-insert/product-monograp... page 2 upper right. Still it's constraining.

Thats not the case for people I know . I know a place that don't need a history of failed AD treatments and each session costs 400$ . After 5 sessions u get a one month supply of oral or intranasal ket for daily use 20mg .

Until I see a detailed cost breakdown, I am going to assume this is just more of the same graft that has infected the rest of the US healthcare system.

I wonder if just giving some people $7,000 a month would help with depression?

Ooh, this would be a really interesting 'placebo' control. Literally hand the patient the cost of providing the treatment as an alternative condition.

I like the active placebo in cash idea.

Funny, a physician friend once commented that the effectiveness of a placebo seems to be directly proportional to its cost :-)

Well, I find this.[0]

> Drug maker Johnson & Johnson has stated that the Average Wholesale Price (AWP) for each treatment of esketamine would range from $590 to $885, depending on dosage and excluding administration and observation costs. This implies a twice-weekly treatment during the first month would cost medical treatment centers offering the drug at least $4,720 to $6,785. Subsequent weekly treatments would cost about half as much.

Purchasers and payers with market power will get discounts and/or rebates, of course. But that's still a damn expensive drug. Also, do note that it's the "cost [to] medical treatment centers". Not what they'd charge patients and third-party payers.

0) https://www.coventrywcs.com/content/dam/pdf_assets/first_scr...

Driving it through FDA trials does though.

We've set up a system where we don't let new drugs hit the market unless someone spends billions on testing. That's...mostly good? I guess? But there's no way ketamine will ever be approved in the US unless someone finds a way to charge $7k a dose for it, because otherwise nobody is going to spend the money for approval.

I mean, nothing is stopping you, RIGHT NOW, from crowdfunding a campaign to get the normal version of ketamine through trials, and once you did, it'd be legal to prescribe the "normal" version, and it'd cost a few dollars a dose. Which would (it seem) be a big net benefit to humanity!

It's just, you know...how would you make that work? The cost structure is not favourable.

Ketamine is practically free to manufacture.

What you're paying for is the FDA approval process for this condition.

Reminds me of the research now starting around MDMA as a cure for tinnitus (ringing in the ears) [1]. Lots of people who use the drug have self reported a reduction in the ringing they hear. It'd be real interesting if this eventually led to it being a prescription medicine too.

[1] http://www.stuff.co.nz/national/9806851/Party-drug-link-to-t...

I cured my stress and tinnitus so loud I could hardly hear and sleep with my own homemade Changa (dmt+hamalas) with one trip. Most amazing drug ever... and I did them all ;)

I’m pretty sure DMT gave me tinnitus, so I guess it affects people in different ways.

Yes I read that happening too temporarily but I was kinda desperate and it got me out of a bad loop and into healthier living and better sleep which took the stress and the tinnitus with it.

Oh man I have mild tinnitus and wish for a cure, but psychedelics are intimidating to me. I feel like if I was 5 years younger I would dive right in but I don't know if I could do it now a days.

I recommend How to Change Your Mind. https://www.amazon.com/Change-Your-Mind-Consciousness-Transc...

The author has a great Joe Rogan interview: https://www.youtube.com/watch?v=tz4CrWE_P0g

As someone who used psychedelics as a teenager and later as an adult cured myself of schizo/bipolar using MDMA and mushrooms, I’d say that being older is nothing to fear.

You are wiser, more mature and the smartest you’ve ever been.

Psychedelics as an adult is so much more enjoyable when done responsibily.

There's more depth to the experience the older we are, especially if it's a first time. I'd argue it's better with age.

I don't know about treating tinnitus, but it's never too late for a magic mushroom trip while camping in the forest.

... and people wonder why users turn to black markets. It costs, what, $40 on the street for a bunch?

I use 10% Ketamine topical cream for nerve pain. It's the business. Irritating it isn't covered by insurance as the research is favorable.

I've got some nerve issues and would be interested in trying this -- how did you get a hold of the cream?

There is very little evidence that these creams work.[1]

Just one example...

CONCLUSIONS: This study suggests that KA cream does not decrease CIPN symptoms in cancer survivors.

[1]https://www.ncbi.nlm.nih.gov/m/pubmed/24531792/

Interesting.

GP seems to say that it worked wonders for them, so I'm still interested in trying it.

Plug: new subreddit for this, https://www.reddit.com/r/spravato. Has an AMA from someone who was part of the trial.

Right now it's hard to find a treatment center participating in the REMS, but spravato.com should have a locator tool up later this month.

I was considering this to aid my depression/bipolar but the prices just don't make it worth it if it only provides up to months of benefit. I could see doing it at around $800-1200 total for the 6 shots, not per shot.

I have a fair amount of familiarity with Ketamine infusion clinics in the Chicago area. Prices seem to be $400-600 per treatment. They like people to go 3-6 times in the first two weeks, and then way less frequently after that.

It has been a godsend for my family.

What places? I am going to a clinic out in NW burbs called Chicago Pain and Wellness. (If I do it that is)

We tried that one and didn't really like it, this one has been excellent: https://www.optketamine.com/

This is supposed to be covered by insurance.

Definitely not.

Spravato will be covered by at least some insurance plans, that was the point of FDA approval. Kaiser is already running ketamine clinics in California.

This is something that I'd try if it wasn't cost prohibited. But no, I'm stuck on benzos forever. At least they are cheap and they work OK I suppose.

As someone who has gone down that road (and managed to get off), I can't emphasize enough how important it is to not take those drugs forever.

It simply isn't possible, at some point your tolerance will become so high you will be forced to find something else. The withdrawals from benzodiazapenes are some of the worst of any drug and will require medical intervention in order to keep your seizure threshold properly regulated.

The Ashton Method has worked miracles for many including myself.

https://www.benzo.org.uk/manual/bzcha02.htm

It is hard to find a doctor who will support you with that treatment, but I went through it and am successfully benzo free now.

Couldn't agree more. The withdrawl severity very much depends on the person and if tapered slowly, it's not bad (it wasn't for me). Cannabis can help there temporarily also. Benzos are awful after awhile due to tolerance and mostly the negative effects persisting.

I don't want to downplay it too much (I've seen my grandmother go through benzodiazapine withdrawal, and it took the best part of a year IIRC), but I would add withdrawal is highly personal. I've quit drugs that I was told (by my consultant) that would be "worse than quitting heroin" and stopped cold turkey, and didn't feel a thing. I also now take regularly take benzodiazapines, and can stop taking them during good periods without any noticeable effects (which has the bonus of limiting my tolerance increase).

"cost prohibitive"

You're correct, typo.

There are doctors around the US that do Ketamine Assisted Psychotherapy for much lower prices. There is a big study about to be published looking at hundreds of successfully treated cases. Keep looking, and good luck.

The J+J spray is a scam, but it does establish the treatments being done off-label with regular ketamine as safe and should give hem some level of additional protection.

A compounding pharmacy can make up capsules. It doesn’t have great bioavailability, but tons of drugs are like that, and resolved with higher doses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120058/

Treatments with regular IV ketamine is not that expensive. Shop around.

Slate Star Codex had a good post about this: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...

Is Ketamine really a party drug? I've no experience but i thought the effect is more like you sit somewhere and won't stand up for a while...

In my scene, it’s the drug of choice. I’ve never really understand why but so it goes

Psy-trance?

Seems to be incredibly popular in UK and just like MDMA they are taking pretty high doses in general so you have teens needing their bladder removed due to abuse.

Yes. It's big in the gay circuit party scene. Along with GHB.

Why is it called a ‘circuit party’?

gay circuit, party scene

What does the ‘circuit’ part mean?

I remember circuittoys.com for cool ‘rave’ toys, but I thought it had to do with electrical circuits.

From what I can tell, more often after the party / show when you're with a few friends on a couch or comfy chairs.

Some people take it and feel like dancing! I met an artist who was in the habit of taking K while painting - it would put him right into the zone for his work. People have really different reactions to drugs.

I did it a fair amount for a few years, it depends how much you take. In small doses it takes the edge off something like mdma and adds a "trippy" element. If you take a higher dose it is a full on introspective trip that can be quite intense and you aint going anywhere. It doesnt last that long per dose, maybe 1/2hours so less of a commitment than say acid, which can be more like 10-12 hours

Oh look, the perennial 'ketamine as a novel treatment for depression' article.

hmm, it'll be interesting to see the prescribing guidelines for this.

Ketamine is not really designed for long term repeated use, mainly because it shrinks your bladder.(https://www.nhs.uk/news/mental-health/experts-call-for-ketam...)

The NHS has been doing basic research since at least 2014: https://www.nhs.uk/news/mental-health/ketamine-tested-as-sev...

If it is approved, it certainly won't be Esketamine thats used.

Esketamine was approved by the FDA two weeks ago, here are the prescribing guidelines: http://www.janssenlabels.com/package-insert/product-monograp...

then there was MXE...

2f-dck is my grail currently for a ket-a-like

AI is on the way to create cheaper alternatives for medication. Recreational or therapeutic use? It'll take the middleman out of the price. it'll be cheap as chewing gum. My guess.

AI doesn't solve the underlying issue that made ketamine depression treatment expensive: intellectual property rights on a particular molecule.

If a company achieved AI that can identify effective alternatives, why wouldn't they just acquire the patents for all of those alternatives and prop up all the prices?

There will be AIs to obscure other AIs work and AIs to clarify the obscured work. The rat race will never end

<God> is on the way to <solve problem>.

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