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 July 1, 2026 DOI: 10.1176/appi.ps.20260203 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Ketamine Esketamine |
| Keywords | Affective disorders Ethics Off-label prescribing Psychedelic Telehealth |
| Key points | 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.
Comparable studies
Other theoretical and historical papers on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| From PCP to MXE: a comprehensive review of the non-medical use of dissociative drugs. | 2014 | Historical analysis | |
| A Dendrite-Focused Framework for Understanding the Actions of Ketamine and Psychedelics | 2020 | Theoretical or philosophical paper | |
| Neuroscience and the Near-Death Experience: Roles for the NMSA-PCP receptor, the sigma receptor and the endopsychosins | 1990 | Theoretical or philosophical paper | |
| A unified model of ketamine's dissociative and psychedelic properties. | 2022 | Theoretical or philosophical paper | |
| An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression. | 2021 | Theoretical or philosophical paper |