Ketamine is a dissociative anesthetic classified by the United States Drug Enforcement Agency as a Schedule III controlled substance. Despite being an older drug, ketamine is often misunderstood and misused, and its regulatory status for specific uses can be unclear to prescribers and their patients. Currently, ketamine hydrochloride is a form of ketamine approved by the FDA as an injected general anesthetic and esketamine is a form approved by the FDA for use in conjunction with another antidepressant. Ketamine prescriptions, however, are regularly issued by veterinary or medical clinicians, often in for-profit clinics or telehealth settings, to treat a range of conditions (eg, pain, post-traumatic stress, treatment-resistant depression, anxiety).
Ketamine has also been used controversially and inappropriately, yet legally, in some emergency medical service practices. Even when legally prescribed and professionally dispensed, ketamine off-label uses poses risk, especially when compounded, and regulatory opacity around both ketamine and pharmaceutical compounding in general seems to nourish a lucrative, growing “gray market” economy, even for legal prescriptions. Ketamine is also illegally acquired and sold by street vendors for recreational or nefarious use, particularly to facilitate rape or sexual assault. This theme issue considers the roles of clinicians—especially mental health clinicians and pharmacists—and pharmaceutical industrial stakes in expanding and regulating ketamine use and in ketamine entrepreneurship in both legal and illegal marketplaces.
We seek interprofessional, cross-disciplinary, wide-ranging manuscripts on these and other interesting and important content about ketamine.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 July 2025.
The AMA Journal of Ethics® invites original, English-language contributions for peer review consideration on the upcoming themes.