When Off-Label Ketamine Meets Direct-to-Consumer Telehealth: Liability Risks and Ethical Responsibilities.
Joshua Mitchell, Benjamin Bregman, Renuka Surujnarain, Dominic Sisti, Amy L. Mcguire
Psychiatric services (Washington, D.C.) July 1, 2026 DOI: 10.1176/appi.ps.20260203 (opens in new tab) via PubMed
Summary
AI-generated from the abstractTelehealth platforms expanded access to mental health care during the COVID-19 pandemic, including online prescribing of ketamine for off-label psychiatric use. A wrongful death lawsuit against a telehealth ketamine provider illustrates how combining off-label prescribing with on-demand delivery can weaken clinical safeguards. With limited oversight of many telehealth platforms and the drugs they prescribe, responsibility for patient safety falls heavily on clinicians. To sustain responsible care, structures must support robust clinical relationships, monitoring, and accountability.
Study at a glance
| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Ketamine |
| Keywords | Affective disorders Ethics Off-label prescribing Psychedelic |
| Key finding | Argues that combining off-label prescribing with on-demand telehealth strains clinical safeguards and that responsibility for patient safety rests heavily on clinicians due to limited oversight of telehealth platforms. |
Abstract
Aided by COVID-19-era regulatory flexibilities, direct-to-consumer telemedicine has expanded access to mental health care. Ketamine prescribed off-label for psychiatric conditions is increasingly marketed online and delivered at home through telehealth platforms. Taking a wrongful death lawsuit against a telehealth ketamine provider as a point of departure, the authors examine how combining off-label prescribing with on-demand delivery can strain clinical safeguards. Given the limited oversight of many telehealth platforms and the drugs they prescribe, responsibility and liability for patient safety rest heavily on clinicians. When off-label prescribing is combined with on-demand telehealth, the structures that sustain responsible care require support, including the capacity to sustain robust clinical relationships, monitoring, and accountability.