Welcome to Public Health On Call, a podcast from the Johns Hopkins Bloomberg School of Public Health,

where we bring evidence, experience, and perspective to make sense of today's leading health challenges.

If you have questions or ideas for us, please send an email to public health question at jhhhu.edu.

That's public health question at jhhu.edu for future podcast episodes.

This is Lindsay Smith Rogers.

Chetamine is an anesthetic used in clinical settings, but more and more, it's being prescribed

off-label as a treatment for chronic pain and mental health issues. Dr. Caleb Alexander

returns to the podcast to talk about what we know about the safety and effectiveness of ketamine's

off-label use and how it's being marketed. Let's listen. Caleb Alexander, welcome back to Public Health On Call.

So usually when we have you on, we're talking about opioids.

But today we're going to talk about another controlled substance, ketamine.

And I think ketamine landed on a lot of people's radars recently when it was revealed that the actor, Matthew Perry, died from acute effects of ketamine. And we don't know the specific circumstances there, but it is being talked about a lot now that it's being used for mental health treatment. So you've done some research in this area. Tell us a little bit about what is ketamine?

Yeah, well, thanks for having me and for spending a little bit of time on this.

Ketamine is an NMDA antagonist, so it blocks a particular neurotransmitter in the brain.

And interestingly, there's a fairly rich history of the development of

these types of products. In fact, the first was PCP, which everybody knows is an illicit drug,

but not one that's certainly not prescribed or dispensed in modern healthcare systems.

And while it was developed as an anesthetic in the 1950s, its potency

and its dissociative properties, in other words, causing people to feel like they were outside

of themselves, essentially led to its abandonment. And ketamine was a follow-up to PCP, was sort of a

cousin of PCP, and was developed in the 1960s,

and used as a battlefield anesthetic in the Vietnam War, and also used clinically in health care settings.

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