Ketamine was never supposed to become wellness culture’s answer to despair.
Developed in 1962 as a dissociative anesthetic and approved by the FDA in 1970, it earned a legitimate and important place in hospitals, battlefield medicine, and procedural anesthesia, valued precisely because it preserved breathing and cardiovascular stability better than many alternatives. Decades later, researchers began exploring something more controversial: could ketamine rapidly interrupt severe, treatment-resistant depression and suicidal thinking in patients for whom every other treatment had failed?
In tightly controlled academic settings, such as Yale, Johns Hopkins, and Mass General, the answer appeared to be yes, at least for some patients. Esketamine, a derivative marketed as Spravato, ultimately received FDA approval in 2019 for treatment-resistant depression, but under strict monitoring requirements. Patients were required to remain under supervision after administration because of known risks involving dissociation, blood pressure changes, sedation, and impaired judgment.
That distinction matters greatly, because the original clinical vision for ketamine was never casual or consumer-driven. It was intended for severely ill patients, under careful medical observation, with rigorous screening and follow-up and as a last-line intervention for people living in devastating psychiatric states. It was not designed to become an unregulated marketplace of infusion lounges, online prescribers, and profit-driven experimentation.
From Clinical Treatment to Commercial Marketplace
Yet, that is exactly what America has allowed it to become, and we should act now before the consequences grow worse. Today, ketamine clinics operate across the country with wildly inconsistent standards. Some are medically responsible, but many are not. Physicians with minimal psychiatric training can open clinics offering repeated infusions with little oversight, limited psychological evaluation, poor screening for addiction vulnerability, and almost no long-term outcome monitoring. Telehealth companies have mailed ketamine to patients’ homes with inadequate safeguards. The FDA itself has issued warnings about compounded ketamine products used for psychiatric disorders outside of approved settings, specifically noting the dangers of unsupervised home use.
The problem is not ketamine itself. It is what happens when medicine outpaces ethics, regulation, and humility, and America has seen this story before.
We watched aggressive opioid prescribing become normalized under the language of compassionate pain care. We watched benzodiazepines marketed as safe answers for anxiety before dependence and withdrawal devastated millions. We watched the wellness industry blur the line between medicine and lifestyle enhancement until vulnerable people became consumers first and patients second. Ketamine is entering that same dangerous territory.
The Matthew Perry Case and a Larger Warning
The death of actor Matthew Perry should have been a clarifying moment. According to the Los Angeles County Medical Examiner, Perry died from the acute effects of ketamine, with drowning as a contributing factor. Court filings later alleged that he continued receiving ketamine even after adverse reactions, and prosecutors charged multiple individuals connected to the supply chain that had provided it — physicians, intermediaries, and dealers. Whatever the ultimate legal findings, the picture that emerged was not simply of one man’s relapse. It was a portrait of a system willing to monetize desperation while calling it treatment.
The Risks Being Minimized
This pattern recurs with troubling regularity wherever wealth, addiction vulnerability, and permissive medical oversight intersect. The modern ketamine industry too often ignores a fundamental truth: dissociation can feel like relief. For traumatized, depressed, or addicted individuals, ketamine’s effects may initially feel transcendent. Internal pain quiets. Shame softens and fear disappears, but dissociation is not the same thing as healing, and when a drug that creates psychological escape is repeatedly administered without comprehensive psychiatric care, trauma treatment, or accountability structures, medicine quietly becomes sanctioned avoidance.
This is especially dangerous for people with addiction histories, personality disorders, untreated trauma, bipolar spectrum conditions, or psychosis vulnerability. Yet, many clinics market ketamine with language that borders on salvation by promising “ego dissolution,” “consciousness expansion,” or rapid emotional breakthroughs without adequately discussing dependency risk, cognitive effects, bladder toxicity from chronic exposure, or the psychological destabilization that can occur in vulnerable individuals.
The regulatory gap here is stark. Esketamine, the FDA-approved version, is governed by a Risk Evaluation and Mitigation Strategy requiring observation after dosing. Yet, outside those guardrails, compounded ketamine is increasingly offered in loosely supervised environments with far fewer protections. And the science itself remains incomplete, while evidence suggests ketamine can produce rapid antidepressant effects for some patients, researchers continue to caution that long-term efficacy, optimal protocols, relapse prevention, and safety standards remain insufficiently understood. Medicine should proceed with caution when evidence is still evolving. Instead, parts of the ketamine industry have proceeded with marketing.
What Needs to Change
What’s needed is straightforward, even if the politics are not. Congress and the FDA should establish national standards for ketamine clinics, mandate comprehensive psychiatric screening and addiction assessments before treatment, require uniform monitoring protocols, and create genuine transparency requirements around long-term outcomes. State medical boards must be empowered and motivated to act against practitioners who treat vulnerable patients as revenue sources.
A Cultural Problem Beyond Ketamine
There is also a deeper cultural question beneath all of this. America increasingly seeks relief without relationship, symptom reduction without systems change. Ketamine cannot repair isolation. It cannot replace human attachment or resolve family trauma. It cannot teach emotional regulation or rebuild meaning and community. For some carefully selected patients under excellent psychiatric supervision, it may absolutely have a role — it may save lives, interrupting suicidal despair long enough for deeper treatment to begin. That possibility is real and should not be dismissed.
But what is being built now is something else entirely: a powerful dissociative drug with abuse potential, commercialized faster than our ethical safeguards can keep pace, normalized through the language of wellness and breakthrough while the seriousness of the medicine itself is minimized. That is not innovation. It is deregulation dressed as progress.
The lesson from Matthew Perry’s death is not simply that addiction kills, because we already know that. The lesson is that vulnerable people too often encounter systems willing to profit from their suffering while calling it care. We have learned this lesson before, at enormous cost. The question is whether we are willing to act on it before we learn it again.
