Texas is moving to tighten how ketamine can be administered for mental health treatment, a push that supporters say is needed for safety as clinics expand telehealth and at-home options, and that opponents say could make treatment too expensive or unavailable.
The proposal, first released in January by the Texas Medical Board, would require more physician oversight during ketamine administration and would prohibit ketamine treatments outside a registered clinic, including in-home use, the report said. The board is expected to publish the revised rules on May 8, and it is scheduled to vote on the changes in June.
Spencer Miller-Payne, a Texas Medical Board spokesperson, said the board is not trying to reduce access to care but argued that the environments where ketamine treatments are offered affect patient safety. Miller-Payne said ketamine’s potency matters because, unlike opioids, it cannot be counteracted with Narcan; he also warned that it can become dangerous if a patient accidentally moves into moderate or deep sedation from ketamine.
Regulators and other backers pointed to a rise in ketamine-related poison center calls nationwide as part of the broader context for tighter controls in Texas. The report cited a recent medical report analyzing data from poison centers that found ketamine poisonings at their highest level in recent history, more than doubling since 2019 to 414 in 2023. It also cited data from the Texas Poison Center Network showing ketamine-related calls increasing from 15 in 2020 during the COVID-19 pandemic to 40 in 2024.
Ketamine’s increased visibility in the public debate has also been tied to the death of actor Matthew Perry, the report said. In Texas, clinics often have a physician on staff for bad reactions, but the physician is “rarely on site,” according to the report, with advanced-practice registered nurses and certified registered nurse anesthetists administering and overseeing multiple ketamine treatments at a time.
Under the proposed rules, if a physician is not on site, medical staff would not be allowed to administer ketamine to more than two patients at a time, the report said. The proposal also would require health providers to complete training in mental health treatment before they are allowed to administer ketamine.
Critics in the ketamine industry said the proposed staffing and access limits would create a financial squeeze for clinics. Industry leaders said forcing providers to choose between hiring an on-site physician or seeing fewer patients would severely limit how many people they can treat and would raise the price of treatment by $300 to $500, according to the report.
Some non-physician providers also said the proposal is confusing or insulting because they view themselves as capable of delivering the same safety measures as medical doctors. Alli Waddell, CEO and co-founder of Illumma, an Austin ketamine clinic, said in the report: “People think ketamine is a wellness treatment when it’s not. Everyone wants a miracle cure. But the reality is this is a dangerous anesthetic,” and she argued that the effort is not about patient safety. In a separate quote included in the report, Waddell said: “It doesn’t make sense. Nurse practitioners are running the entire intensive care units with 25 patients who are very sick, and they are comfortable with them doing that, but they can’t be in a space with a very safe drug?”
Supporters of the tighter restrictions pointed to what they described as gaps in supervision when ketamine is delivered through models that rely on remote oversight. Rep. Tom Oliverson, R-Cypress, who is an anesthesiologist and a former medical board member, said the question is “who should be allowed to administer those things so that it’s done safely?” and argued that some underqualified providers can administer the anesthetic without meaningful supervision. Oliverson said, “A lot of time, there wasn’t even a physician involved except on paper,” and he added that emergency responders would be needed if something goes wrong because the physician could not respond in time.
Mental health providers also told the report that many ketamine clients are low-income and highly suicidal and may not be able to afford increased costs or navigate rules that could reduce access. Will Ratliff, a nurse and paramedic and director of operations at Transcend Health Solutions, said the proposed Texas framework could spread to other states and argued that physicians are shutting down a practice he said saves lives.
The report also described how patients and providers see ketamine treatment: Bradley Armendariz, a licensed professional counselor in Big Sandy in East Texas, said ketamine changed how he experienced the drug and how he thought about helping clients. Armendariz told the report: “It changed not only how I experienced ketamine, but also how I thought to help my clients.” Mental health providers said ketamine can lead to rapid relief of severe mental illness for a period of time when used in clinical settings, often paired with counseling, but they also said it must be paired with ongoing mental health work.
Clinics said the proposed ban on in-home use and limits on concurrent treatments could hit rural patients hardest, particularly where local options are limited. The report quoted Leonardo Vando, the medical director of Mindbloom, one of the country’s largest telehealth programs, saying: “We have a lot of our patients from Texas. Most of them choose at-home. Not because they are choosing between us and in-person, but because we are their only option within a span of two hours.”