Global Courant 2023-05-14 17:00:00
A shortage of a powerful drug used in surgery is affecting some Canadians who have been approved to use it for mental health treatment.
The strong sedative ketamine, sold on the black market under other names such as Special-K, is a fast-acting pain reliever and anesthetic. It is also used in some specialty clinics across Canada to help people with major depression.
But lately, the drug has been scarce in the country.
Paul Verity, vice president of regulatory affairs at Juno Pharmaceuticals, told CTVNews.ca in an interview that there are “numerous reasons” behind this shortfall.
“In recent years there has been a shortage of ingredients, a shortage of different materials that are needed to make different products, not just ketamine,” Verity said. “And as a result, there is a shortage of products in general.”
Products usually end up in the largest markets where they can be used the most, says Verity. This also means product availability can be determined by price, something Canada has resisted, adding “pressure” for cheaper drugs, he said.
“All those things work together, and in some cases (a deficiency) is how it turns out,” Verity said.
While hospitals can replace ketamine with other painkillers such as morphine, specialty depression clinics cannot, which could pose a problem for those using ketamine for mental health.
WHAT IS KETAMINE USED FOR
In Canada, ketamine is mainly used in veterinary surgeries, but it is also used to a “lesser degree” in human medicine, can be found on the website of the Center for Addiction and Mental Health.
It is also sold illegally under names such as blind, kitkat, vitamin K, special K and feline sedatives, and is sometimes used as a date-rape drug. Health Canada warns that possession and sale are illegal unless authorized for medical, scientific or industrial purposes.
People who take ketamine describe vivid dreams and the feeling of having “dissociation” from their bodies.
In medical settings, ketamine is usually given with a sedative to offset the drug’s effects, but a handful of clinics across Canada are seeking the effects of ketamine to reduce the symptoms of major depression.
“For people who try ketamine, and it works, it can be like a light switch that goes on and off,” Justin Davies, CEO and founder of the Toronto Ketamine Clinic, told CTVNews.ca in an interview.
If the ketamine shortage continues, clinics like Davies’s will not be able to treat patients.
In 2021, the UK’s University of Exeter, in collaboration with the University of British Columbia, reviewed more than 33 reviews, 29 randomized trials, and 21 observational studies on the use of ketamine in depression.
It found that the drug can quickly treat major depression symptoms within one to four hours of a single treatment with effects lasting up to two weeks.
“We treat people in our clinic for so-called treatment-resistant mood disorders — especially depression,” Davies said. “Broadly defined as people who have tried several — at least two — antidepressants that have failed.”
According to Davies, about 30 percent of people taking antidepressants don’t get the ideal result.
People can’t easily be prescribed ketamine for depression, Davies said. Before considering treatment, a “comprehensive” psychiatric evaluation should be done.
Once a person is prescribed ketamine, they will be on treatment under the supervision of an anesthesiologist and psychiatrist, and closely monitored for the six weeks of injections.
“Normally, if you’re going to respond… you do it within those six sessions,” Davies said. “A psychiatrist follows you, monitors your dose from drip to drip, talks to you about how you’re doing during that treatment, and makes adjustments as needed. The hope is that by the end of six you’ll be back to feel yourself a little bit and get a sense of the relief it feels to not be depressed.”
‘IT IS NOT A MEDICINE’
For the clinic, ketamine is “very important” because it provides fast-acting relief for patients who are resistant to antidepressants, Davies said.
Although the use of ketamine to treat depression is still being studied, some scientists believe the drug triggers a process called synaptogenesiswhich likely influences mood through patterns and cognition, reads a Harvard University health article.
Short-term effects of the drug include feeling “outside your body,” says Davies, with a disconnection between the body and brain. This usually lasts as long as the infusion is taking place.
If someone uses ketamine in a non-medical sense, the long-term effects can be flashbacks, social withdrawal, and memory loss. It is a narcotic and can be highly addictive if left unchecked, the CAMH website says.
“It’s not considered a cure for depression,” Davies said. “It gives people the opportunity to help get back to a point where they felt they were stronger and more resilient and able to handle life’s challenges.”
When the patient finishes the sessions, Davies says, they often return every few months for a “booster infusion” until they can reintegrate into daily life without ketamine.
KETAMINE BOOSTER INFUSION
Davies is one of the people who periodically uses ketamine to treat his depression.
“I would say twice a year, maybe three times a year, I’ll go for a booster infusion and this is when I feel my symptoms return,” he said.
In 2015, Davies said he was a treatment-resistant individual struggling to live with his debilitating depression.
“When you’re really desperate and in a serious depression, you become resourceful,” he said.
After seeing clinics across the United States and experiencing the effects of ketamine, Davies began bringing the drug to Canada, battling what he called “regulatory hurdles” throughout the process.
“This is like a tool in the toolkit that is really needed,” he said. “And we really needed it here, so that was kind of the impetus for bringing the Toronto Ketamine Clinic to the city.”
It appears that the federal government has taken steps to address the shortage of the drug.
Juno Pharmaceuticals was approved by Health Canada on April 27 to import 25,000 vials of 50 milligram doses of ketamine from the UK. It is the only company approved.
Both Ketamine at strengths of 10 and 50 milligrams has a deficiency statusshow the Drug Shortages Canada website.
