To provide affordable Ketamine therapy for the treatment of depression, PTSD, anxiety and addictions to both alcohol and opiates, recognizing that in the past ten years ketamine has been uniquely suppressed by our pharmaceutical and psychiatric societies for distinctly non-medical reasons.
If these ideas can be instituted everyone in America will have much greater access to this critical drug.
And, they will be able to afford it.
Money on many different levels has been a source of great dysfunction in delivering ketamine to the 70 to 80 million people that are in need of it. Crystalline-pure capitalism produces such things routinely in worlds where self-serving enrichment rules exclusively over the sensitivity, empathy, and sense of giving that medical healing demands. Sure, make a reasonable profit, but no citizen should be allowed to thrive at the medical expense of another human being, let alone a fellow member of one's own society.
Modern medicine has gone very wrong in its addressing of the 50-80 million Americans suffering from depression, anxiety, or PTSD; these medically sick people are being steered away from the only medicine recognized to effectively treat these horrible and growing diseases. What is truly ugly about this misdirection is that it is being instituted by the very people who assert themselves to be helpers of the people they are hurting; an ultimate deception is to substitute disease for healing. Big Pharma does not have your interests at heart when it tells you to take Prozac, or any others of the medicines categorized as SSRIs; these medicines, despite earning billions yearly for the industry, are statistically worthless for the illnesses they say they are treating. For most, only their side effects remain as evidence of their having been ingested; though SSRIs may alter your brain state for a semblance of normalcy, your fundamental illness of stress will statistically remain unchanged.
We mention this dysfunction only because it's necessary for an understanding of the math of ketamine medical money. What we are alluding to here is the fact that the money spent on the depression-anxiety-PTSD complex of diseases is huge, but only a fraction of it goes to effectively treat depression, anxiety, or PTSD.
To make that statement, we can call upon any number of studies and medical conversations that all agree that there is no statistical evidence of benefit in the treatment of depression, anxiety, or PTSD with SSRIs beyond that of sugar pills. This is not a controversial fact.
The first level of controversy of ketamine is that it is the only medicine that works for these three diseases, and Big Pharma can't make any money on ketamine; its patent expired decades ago. But, if they can keep ketamine from the public, they can keep selling their medically worthless, billions-a-year drugs while they keep you whimpering in a dark corner, paying them for that darkest of privileges.
The second level of controversy with ketamine is in its current pricing in many varieties of private practice. General anesthetic, psychedelic, short-acting: as discussed in the ketamine consent form elsewhere on this site, ketamine is a strange drug that has very particular requirements to be addressed before it can be defined as safe. But once those rough spots have been addressed, ketamine is truly a wonder drug that changes the lives of people for the better as have few other drugs in the history of humankind.
Big Pharma does not want to admit this. But when I make the assertion that in the past few years I have seen cures from ketamine that no other human being without ketamine has witnessed since the stories of Jesus, I am simply being scientifically accurate. Anyone with a syringe of ketamine could do the same thing and see the “born again” responses that are so frequent with this wonder drug.
Which leads to the question that defines the second level of controversy; how much is that syringe of ketamine worth?
Let's start with the cost of ketamine. Rounded off for easy math, ketamine costs a little over a penny a milligram, which means less than a dollar a dose for most people, five dollars for a series of six treatments.
So, what is the source of those different prices of ketamine? I have seen prices up to $1200 per infusion. And at a pain clinic, I developed an approach to ketamine that allowed an insurance collection of $2000 a dose and over $10,000 for a ketamine series of six, and I would guess that the patients thought it worth every penny. When depression, anxiety, or depression are effectively treated, isn't it always worth it? Only in a Jack Benny joke would anyone pause to think it over, and most of you are of insufficient maturity to have even heard a Jack Benny joke.
But should a single dose of ketamine cost $1200? The answer to that will depend upon who you ask and the medical situation at hand. Treating depression with ketamine is an off-label usage that poses unique challenges to any physician utilizing the medicine. Those charges imply a certain amount of added risk that is in most cases valid.
But I also hold that if the risk of ketamine can be accurately defined, they can also be contained; ketamine, though sharing the same pharmacologic category, does not pose the singular danger of Michael Jackson's propofol. In fact, safety with ketamine is very much the opposite situation if handled correctly.
Consider that around 40-80 million Americans suffer major debilitation from these three illnesses. If you have the money, you get the cure; only a few sorry folks would deviate from that course. But how many Americans could afford a $7200 bill every three months? Even half that, which is closer to the average price in office practices, is too much.
Especially if you're depressed.
I would estimate that without insurance, the current working prices of ketamine are beyond the practical reach of 90% of the population. Individual practitioners are currently trying to keep the price up both for the reasons mentioned above as well as for the simple practicality of making more money which is, of course, the American way.
This inaccessibility comes as a consequence of price in the face of no insurance coverage. For every dollar of price increase for ketamine, there are Americans who must continue to suffer the worst disease known to Humankind.
Consider these price consequences:
At $1,200/dose, the price of ketamine is $24,000/year.
At $166/dose, the price is $4,000/year.
At $80/dose, the price is $2,000/year.
I would suggest that at $1,200/dose, less than 1% of the 50 million sufferers can afford the drug. Drop the price to $166/dose and I would coarsely estimate that 25 million people could afford the drug, and at $80/dose, another 15 million get treated.
Do some math here and we see that the drop in price from $1,200 to $166/dose translates to 1,250 sufferers not treated for every dollar increase in price. And going from $166 to $83/dose is an even greater bonus with every dollar less in price resulting in another 7,500 sufferers treated.
In our current world of ketamine, dropping the price hugely increases the treatment of one of our greatest health problems. Dropping the price of ketamine can very logically be considered a national security priority. Put 50 million Americans back into functionality and we as a nation are going to a different place than we are now headed.
The price of ketamine, I assert, should be determined in much the same fashion as small pox or polio where their infectious natures make every effective individual treatment a tool protecting the larger society. Just as the small pox virus spreads through contact, a depressed personality reaches out in every contact and effects the social, professional, and medical worlds around them. A quarter of America is waiting for this drug.
So, Henry Ford showed us the way to get there. We industrialize this simple task. We figure out how to set this up as an assembly line, which this treatment lends itself to, owing to the felicitous combination of ketamine's general safety and its simplicity of administration.
There are two major concerns unique to ketamine: physical instability, or the fall risk, and hypertension. Allergies are very rare, and the occasional nausea and anxiety accompanying administration of the drug are inconveniences easily dealt with and seldom problems precluding the drug.
This means that driving and mobility restrictions, combined with patient monitoring during treatments, covers the vast majority of adverse situations possible with the administration of ketamine. Though only rarely needed, and probably not a need related to ketamine when it is, an AED should always be present.
When the above considerations are turned into an equation that will define the cost per treatment in a concern that depends on a positive bottom line, I get optimistic. My first intuitive jump at pricing gave me a $100/dose figure, and I hope to one day get to that efficiency.
Close to that is our starting figure of: $1000 for the first series of six treatments. These will be intramuscular; IVs will cost $75 apiece.
IV versus IM is another point of confusion and illusion not well understood in the ketamine world. I will talk much on this in person, but let me assert that there is no medical evidence of superiority of IV versus IM dosing, and that that IV certainly has an air of being more professional and appropriate, doesn't it? But is it? Ketamine’s usual IV administration is a product of its usage in an operating room where an IV is always present; if an IV is already present then, of course, it will be given IV. But in treating depression, an IV is NOT normally present and in that situation it is not necessarily indicated.
And, in general, IV has relatively more risk; no error embolus with IM dosing and the minimal infection rate is even less. As an ER doc I also recognize that an IV can cost venous access eventually; veins get wasted.
In short, the only way that the bottom economic half of that 80 million people is going to get ketamine is to make ketamine affordable.
At $1.00/dose, I assert that it's already affordable; all that we in medicine must do to make that statement valid is to say that it is so.
And do we broach the idea of a ketamine-coop? If ketamine remains a product uniquely able to treat depression, anxiety, and PTSD – which appears to be the situation for at least the next five years – it should be possible to streamline its administration safely and get the price down even farther.
Time and technology will tell.