Self-medication can be problematic because it's non-objective, but it can easily lead to (psychological) addiction. The brain optimizes/skips a step - not-being-depressed looks a lot like actually being happy when compared to being depressed, so then there emerges this belief that the user needs to be high on ketamine constantly, which is when it becomes a problem.
GP post isn't arguing that no one should use ketamine, or any other medication that works. They are giving first-hand perspective that ketamine addiction is real, and having heard stories myself, I'm inclined to believe GP. It would be great if ketamine had to be prescribed by a doctor to avoid addiction, and that such a requirement didn't end up excluding those outside of mainstream society (often because of mental problems like, say, depression).
FDA approval of ketamine for depression will go a long way to improving the situation but for now one choice is to pay some $1500/session (not covered by insurance), to a clinic run by medical professionals risking their license. (Each session uses less than $20 of ketamine, so it's quite the markup!)
The other option is to buy street ketamine, which is a move of desperation, but looks a lot better than committing suicide.
I don't understand the objection int the article about the possible necessity of "booster" treatments though.
Most GPs won't write you a scrip for ADHD medication on a whim, either, but I wouldn't describe Vyvanse as "illicit." They just "know what they don't know" and so don't trust their own evaluation of you and think you should get a professional evaluation by a specialist (i.e. a psychiatrist, in this case.)
They're usually perfectly willing to continue prescribing after you've gotten a previous scrip from a psychiatrist, though. I suspect ketamine would be much the same, except that you'd need to get your scrip filled at the pharmacy of an inpatient hospital (since that's where they'd have it in stock), rather than the corner store.
It's the same story as, say, methamphetamine. Scheduled drug—but that doesn't mean you can't just get a prescription and get it filled. It's a lot of work to get that prescription (since methamphetamine is also a last-line treatment), but once you have it, any hospital pharmacy should have some in stock.
Depression is an insidious disease, and being able to fill it at the corner store, rather than having to go all the way to hospital (which can be a scary and frustrating experience) might make the difference between having the medication, and not.
So in turn, I put forward that we should hope a discovery of the mechanism of action and a way to put it to use without ketamine. Ketamine's action itself is assumed to _not_ the primary mechanism of action but rather a metabolite is (the experience has a part of it I'm sure - it's pretty fairly a psychedelic but the yin to LSD's yang) and scientists are working to find a drug that will have the same effect without the psychedelic dissociative qualities of ketamine (and it's monstrous allure which some people notice and fall for - but many don't)
Seems to me that only certain personalities thirst for ketamine after experiencing it. But that will all come to view in time because the black market is ready to supply to an increase in demand and it will happen that way once people start diverting ketamine. The black market will compete in that market. It will offer a product of similar quality (most clandestine on the street is close to 100% purity) but will find its competitive advantage is price and availability.
Are you sure? That is a lot of ketamine
Dosing regimens for ketamine to treat depression are still being worked out, especially because that still considered an "off-label" use by the FDA. Using the upper bound of 0.75 mg/kg [0] and a person weighing (again, upper bound) 300 lb, I calculate 100 mg dose/session, which is roughly $3 of ketamine (when procured by a doctor).
I'm not sure what you mean by "social cost".
You generally can not physically get addicted to nmda antagonists like ketamine. In fact nmda antagonists and modulators are being studied because "research suggests that N-methyl-D-aspartate (NMDA) receptor neurotransmission contributes to mediating the behavioural effects of alcohol and other drugs of abuse" https://www.ncbi.nlm.nih.gov/m/pubmed/11060803/
I want to make clear that I mean physical in the biological sense. It is still possible to form an addiction to these drugs. I only mean to say that it's rare to have dangerous withdrawal effects, unlike with alcohol.
I know the IV user in this film (they call him Chris on camera). This user is atypical but there are many people with extensive bladder damage and negative social effects. You'll have to take my word for it. I'm sure there is more research from china especially as it's very common drug used there. Police note (anecdotally) the typical user in north america has changed to middle aged and affluent as the price of street ketamine has gone up from maybe $25/g to +$90 https://www.snagfilms.com/films/title/drugs_inc_ketamine
I believe in its power as an antidepressant. I'm just concerned about the effects a bit. It will fuel research - it seems it's not ketamine but metabolites and effects on ganglial growth that spur the sudden changes to a depressed mind. And a new objective view on life and reality.
That's not pharma grade ketamine. We have no idea what these drug users are taking.