Ketamine will be available under Medicare and the Pharmaceutical Benefits Scheme (PBS) for treatment-resistant depression. It will be administered as a nasal spray under the brand name Spravato.
It will be available for people who have already tried at least two other antidepressant medications without experiencing improvements.
Under the PBS, Spravato will cost just $30 per dose. The price is lower again for concession card holders.
The recommended dose is twice per week during the first month of treatment. Dosing gradually tapers off to weekly or fortnightly.
The announcement came as a surprise to those familiar with ketamine’s popularity as a party drug. The drug is considered fun and uplifting but also strongly dissociative at high doses.
As its manufacturer says, Spravato’s “side effects” include sleepiness, dizziness, spinning sensation and dissociation “from yourself, your thoughts, feelings, space and time (dissociation)”. For these reasons, while the medication is a simple nasal spray, users will be expected to attend a medical centre to take it under supervision.
Yet some advocates see this as an overly cautious approach. On their view, the dissociation is the therapeutic aspect of the drug.
The Multidisciplinary Association for Psychedelic Studies (MAPS) is the major advocate for psychoactive therapies in the US. MAPS favours the use of strong psychoactives and with psychotherapists in attendance.
They describe the Spravato dose as a low dose, conducive to “emotional and somatic relaxation…foster[ing] communication and emotional openness.” At around double that dose, the user enters “a deeply internal space” for 20-30 minutes. “Traditionally referred to as the ‘k-hole,’ we prefer the term Transformational Space,” MAPS says on its website.
“Ketamine is, at its core, a meditative medicine,” according to MAPS. “It facilitates access to otherwise unreachable states of consciousness. With care, intention, and support, it can become a tool for profound healing and self-discovery.”
This is a different idea of medicine to what most of us are used to. The approach enabled MAPS to produce unprecedented results in its Phase 2 studies on using MDMA to alleviate PTSD. But their programs have also attracted unscrupulous facilitators with delusions of grandeur, leading one analyst to call MAPS “a therapy cult.”
How to facilitate these “transformational” states of healing on a mass scale and without abuses is a problem yet to be solved. With Spravato, Australian regulators seem to be favouring a pharmaceutical approach over a “transformational” approach. It’s clearly lower-risk, but will it also be low-reward?
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