{"id":8829,"date":"2025-10-10T09:00:00","date_gmt":"2025-10-10T09:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=8829"},"modified":"2025-10-10T09:00:00","modified_gmt":"2025-10-10T09:00:00","slug":"cops-on-ketamine-largely-unregulated-mental-health-treatment-faces-hurdles","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=8829","title":{"rendered":"Cops on Ketamine? Largely Unregulated Mental Health Treatment Faces Hurdles"},"content":{"rendered":"

<\/em>If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting \u201c988.\u201d<\/em><\/p>\n

ASHEVILLE, N.C. \u2014 A few months ago, Waynesville Police Sgt. Paige Shell was about to give up hope of getting better. The daily drip of violence, death, and misery from almost 20 years in law enforcement had left a mark. Her sleep was poor, depression was a stubborn companion, and thoughts of suicide had taken root.<\/p>\n

Shell, who works in a rural community about 30 miles west of Asheville, tried talk therapy, but it didn\u2019t work. When her counselor suggested ketamine-assisted psychotherapy, she was skeptical.<\/p>\n

\u201cI didn\u2019t know what to expect. I\u2019m a cop. It\u2019s a trust thing,\u201d she said with a thin smile.<\/p>\n

Combining psychotherapy with low-dose ketamine, a hallucinogenic drug long used as an anesthetic, is a relatively new approach to treating severe depression and post-traumatic stress, especially in populations with high trauma rates such as firefighters, police officers, and military members. Yet evidence of the efficacy and safety of ketamine for treatment of mental health conditions is still evolving, and the market remains widely unregulated.<\/p>\n

\u201cFirst responders experience a disproportionately high burden of trauma and are often left without a lot of treatment options,\u201d said Signi Goldman, a psychiatrist and co-owner of Concierge Medicine and Psychiatry<\/a> in Asheville, who began including ketamine in psychotherapy sessions in 2017.<\/p>\n

Law enforcement officers in the U.S., on average, are exposed to 189 traumatic events over their careers, a small study suggests<\/a>, compared with two to three in an average adult\u2019s lifetime. Research shows that rates of depression and burnout<\/a> are significantly higher<\/a> among police officers than in the civilian population. And in recent years, more officers have died by suicide than been killed in the line of duty, according to the first-responder advocacy group First H.E.L.P.<\/a><\/p>\n

Ketamine is a dissociative drug, meaning it causes people to feel detached from their body, physical environment, thoughts, or emotions.<\/p>\n

The Food and Drug Administration approved it as an anesthetic in 1970. It became a popular party drug in the 1990s, and in 1999, ketamine was added to the list of Schedule III nonnarcotic substances under the Controlled Substances Act.<\/p>\n

The death of \u201cFriends\u201d actor Matthew Perry in 2023, which was attributed to ketamine use<\/a>, further tainted the drug\u2019s reputation.<\/p>\n

But starting with a 1990 animal study<\/a> and followed by a landmark human trial<\/a>, research has shown that low doses of ketamine can also rapidly reduce symptoms of depression. In 2019, the FDA approved esketamine \u2014 derived from ketamine and administered as a nasal spray \u2014 for treatment-resistant depression.<\/p>\n

All other forms of ketamine remain FDA-approved only for anesthesia. If used to treat psychiatric disorders, it must be prescribed off-label.<\/p>\n

\u201cThis is a situation where the clinical practice is probably ahead of the evidence to support it,\u201d said John Krystal<\/a>, chair of the Department of Psychiatry at the Yale School of Medicine and a pioneer of ketamine research.<\/p>\n

Krystal has studied the effect<\/a> of ketamine on veterans and active-duty military members \u2014 a population comparable to first responders in their exposure to trauma. While research shows strong evidence of ketamine\u2019s antidepressant effects, he said further studies are needed on its potential role in PTSD treatment.<\/p>\n

The regulatory environment for ketamine also remains a concern, Krystal said. State oversight varies, and federal regulations don\u2019t outline dosing, administration methods, safety protocols, or training for providers.<\/p>\n

In this regulatory patchwork, more than 1,000 ketamine clinics<\/a> have sprung up across the country. At-home ketamine treatments have flooded the market, prompting the FDA to issue a warning<\/a>.<\/p>\n

Side effects of ketamine can range from nausea and blood pressure spikes to suppressed breathing. The drug can also cause adverse psychological effects.<\/p>\n

\u201cBeing on a psychedelic puts people in an extremely vulnerable state,\u201d Goldman said. People can get retraumatized as they relive disturbing memories. That\u2019s why it\u2019s critical that a mental health provider guide a person through a ketamine session, she said.<\/p>\n

With proper precautions \u2014 and when other treatments have failed \u2014 Rick Baker thinks ketamine-assisted psychotherapy is a good fit for first responders. Baker is CEO and founder of Responder Support Services, which provides mental health treatment exclusively to police officers, firefighters, and other first responders in North Carolina, South Carolina, and Tennessee.<\/p>\n

As a population, first responders are more resistant than civilians to traditional therapy, said Baker, who is a licensed clinical mental health counselor. Ketamine provides a potential shortcut into the trauma memory and works \u201clike an accelerant to psychotherapy,\u201d he said. \u201cIt strips away people\u2019s armor.\u201d<\/p>\n

When used for mental health treatment, a dose of ketamine \u2014 typically half a milligram per kilogram of body weight, less than for anesthesia \u2014 creates a mildly altered state of consciousness, Goldman said. It makes people look at their own traumatic memories at a distance \u201cand tolerate them differently,\u201d she said.<\/p>\n

The ketamine sessions in her practice are usually two hours long, and clients are under the drug for about 45 minutes. The drug is administered as an IV drip, an intramuscular injection, under-the-tongue lozenges, or a compounded nasal spray. The drug is short-acting, meaning its dissociative effects largely wear off within about an hour.<\/p>\n

But most insurers won\u2019t pick up the cost of ketamine-assisted psychotherapy, which can be more than $1,000 per session for the IV drip.<\/p>\n

\u201cThat\u2019s certainly prohibitive for first responders,\u201d Goldman said.<\/p>\n

The Department of Veterans Affairs covers some forms of ketamine<\/a> treatment, including ketamine-assisted psychotherapy, for eligible veterans on a case-by-case basis.<\/p>\n

In Shell\u2019s case, a donation made to Responder Support Services covered what her insurance wouldn\u2019t when she decided this spring to try ketamine-assisted psychotherapy with Baker, her counselor.<\/p>\n

Revisiting the most gruesome calls in her nearly two decades as a police officer was not something Shell wanted to do. But Hurricane Helene, which caused catastrophic flooding in western North Carolina last year, pushed the 41-year-old \u201cover the edge,\u201d she said.<\/p>\n

\u201cSome of the sessions were rough,\u201d said Shell, who is also a member of her agency\u2019s SWAT team. \u201cThings came up that I didn\u2019t want to think about, that I\u2019d buried during my entire career.\u201d<\/p>\n

The badly mangled victim in a fatal car crash. A murder-suicide, in which a man cut his pregnant girlfriend\u2019s throat then slit his own.<\/p>\n

Under ketamine, the images came to life as still pictures, she said, like a surreal slideshow replaying some of her darkest memories. \u201cThen I would sit there and cry like a baby.\u201d<\/p>\n

As of early October, Shell had undergone 12 ketamine sessions. They have not provided a sudden miraculous cure, she said. But her sleep has improved, and bad days are now bad moments. She also finds it easier to manage stress. \u201cAnd I smile more than I used to,\u201d she said.<\/p>\n

She was hesitant to share her experience within her department because of the ongoing stigma associated with seeking help in the hard-charging police culture.<\/p>\n

\u201cI just didn\u2019t want my people to think that I couldn\u2019t handle the job,\u201d she said. \u201cI didn\u2019t want them to feel that I\u2019m posing a risk to them.\u201d<\/p>\n

The perception of ketamine plays a role as well, said Sherri Martin, national director of wellness services at the Fraternal Order of Police<\/a>, an organization representing more than 377,000 sworn law enforcement officers. Many cops are used to ketamine as an illegal street drug, she said, or think of it as a counterculture psychedelic.<\/p>\n

\u201cSo, when they are supposed to accept this as a treatment, that\u2019s hard for them to grasp,\u201d she said.<\/p>\n

Few if any police departments provide clear guidance on ketamine-assisted psychotherapy. If it were medically prescribed, it would likely be viewed the same as taking an antidepressant, Martin said.<\/p>\n

Shell ultimately shared her story with colleagues, most of whom were curious and supportive, and she now encourages other officers to speak up about their struggles. She believes seeking mental health treatment \u2014 in her case, ketamine-assisted psychotherapy \u2014 has made her a better and safer police officer.<\/p>\n

\u201cIt\u2019s hard to help other people when you can\u2019t take care of yourself,\u201d she said.<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>","protected":false},"excerpt":{"rendered":"

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting \u201c988.\u201d ASHEVILLE, N.C. \u2014 A few months ago, Waynesville Police Sgt. Paige Shell was about to give up hope of getting better. The daily drip of violence, death, and misery from…<\/p>\n","protected":false},"author":0,"featured_media":8830,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-8829","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8829"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8829"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8829\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/8830"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8829"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8829"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8829"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}