Ketamine breaks into B.C.'s public health sector as 'powerful intervention' for severe depression

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At parties, it’s known as Special K, an illegal, hallucinogenic drug that offers an out-of-body experience for those who use it.

But to psychiatrists in B.C., ketamine is regarded as a “powerful intervention” for patients who have exhausted standard treatment options for their depression.

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The drug’s use is now expanding across North America, from an anesthetic used in the sedation of patients before medical procedures to a fast-acting antidepressant that is being offered in more and more hospitals and private clinics in B.C.

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Dr. Joseph Tham said he has seen the complete turnaround of patients at Vancouver Coastal Health’s ketamine intervention program, which is expanding this month to treat more patients free of charge at UBC Hospital.

“We have been sent suicidal patients who have been in hospital for months, but with treatment, they were able to be discharged relatively quickly,” said Tham, a psychiatrist and professor at the university.

“For some, ketamine proves to be a powerful intervention that allows the mind to re-network itself from being stuck in a negative and cognitively impaired state to a more forward-looking one,” by promoting a surge of new connections between nerve cells in areas of the brain involved in emotions and mood.

Injected intramuscularly two times a week over a three-week span, the fast-acting analgesic — which first made waves in North American psychiatric trials in the 1990s for its surprising antidepressant effect — has been lifting the moods of hospital patients for weeks after treatment. Doses given are around a quarter of what is typically used for procedural sedation.

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“The goal is to not keep knocking our heads over the same antidepressant combination that hasn’t been working, but to give patients a short-term intervention while they get connected to long-term psychiatric care in their community,” Tham said.

While ketamine has been prescribed as an anesthetic since the 1970s, Health Canada approved its use for treatment-resistant depression in patients who have not responded to other antidepressants or where urgent care is required in May 2020, in the form of a nasal spray.

Since the program’s 2021 inception, 30 patients have been treated at UBC Hospital, the only one in the city where the medication is covered under public health insurance. Close to 70 per cent reported a positive impact from the intervention, with nearly half having “gotten a lot better” or “more free of their depression,” Tham said.

Vancouver Coastal Health is planning to expand the pilot to Squamish Hospital — to not only patients who are hospitalized but also to those who have referrals from a primary physician.

“If it works well, we can save both the medical system and patients from having to come to the hospital and reduce the overall risk of suicide,” said Tham. Federal data puts suicide as one of the leading causes of death for Canadians aged 15 to 44.

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ER physician Dr. Quyn Doan is in the midst of assessing whether ketamine will be just as effective for youth who have been admitted to B.C. Children’s Hospital with suicidal thoughts and self-harming behaviours.

In a first-of-its-kind Canadian trial, adolescents between ages of 10 and 16 are being given either a low-dose IV infusion of ketamine, another sedative, or a placebo saline solution and monitored for weeks afterward to see how their depression responds. Close to 30 patients have been treated so far as part of the study, which aims to evaluate 96 youths.

“While data for B.C. adults has been encouraging, we know that some medications don’t work as well in children. So, we’re hoping to test out ketamine,” Doan said. “If it works, it could be like a reset button to buy youth some time until therapy and standard antidepressant medications start to kick in.”

Outside of the publicly funded realm, ketamine-assisted therapy costs a minimum of $400 per session at an array of private Canadian clinics such as Vancouver’s Numinus Wellness.

CEO Payton Nyquvest said since starting to offer the medication in a nasal spray, lozenge and injection form at its Commercial Drive clinic a few years ago, interest in the treatment has skyrocketed.

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“The average session is about two hours and done either with a therapist in the room who can help the client unpack their experience or with someone getting support and preparation from one,” said Nyquvest. “While psychedelic drugs are powerful tools, we believe they need to be used with trained professionals who understand both the benefits and risks.”

There are some side effects associated with the prescribed use of ketamine, according to B.C.’s College of Physicians and Surgeons, which cautions doctors against prescribing the drug for use in non-medical or surgical settings or in the form of oral, sublingual and transdermal varieties.

“It is an expectation of the college that registrants not only observe and monitor the patient but have the necessary equipment and competence to manage any adverse reactions,” reads its interim guidance, last updated in August.

Health Canada says potential short-term side effects include high blood pressure, dizziness, headache, blurred vision, anxiety, nausea and vomiting with longer-term concerns related to urinary and bladder problems as well as liver inflammation.

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The public health agency told Postmedia that before approving a pharmaceutical drug for a certain usage, it “reviews the evidence to determine whether the risks associated with the product are acceptable in light of its potential benefits. If they are, and if the product has been proven to be effective under specified conditions, it is authorized for sale.”

Ketamine, in powder form, continues to be an illegal substance seized during B.C. police raids. Illicit dealers are known to target youth, who buy the drug in combination with ecstasy for recreational use at parties and raves.

Given its odourless and tasteless quality when mixed in liquid, the sedative has also been used as a date rape drug.

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