In 2019, the FDA released S-Ketamine with more REMS regulation than any psychiatric drug of past.

But they left its racemic cousin ketamine practically laying on the table,

and online startups are delivering the drug with unregulated speed.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsome, a psychiatric MP and a dedicated reader of every issue.

Joyous Mind Bloom, new life, Wonderbed.

These are the hyperbolic names of a new kind of mental health clinic that has cropped up during COVID. At-home ketamine therapy. In early 2020, the DEA issued a waiver that relaxed restrictions

in the Ryan Hyite Act, allowing clinicians

to prescribe controlled substances by telemedicine without ever meeting the patient in person.

For patients on concerta, Ambien and Suboxin, it allowed treatment to continue as usual,

but it also opened up new markets and new modes of treatment. That emergency

waiver is coming to an end in May 2023, but we'll be dealing with the after effects for a while.

Last month, we covered one of those after effects, the Adderall shortage. Telehealth companies

crept up during a lockdown, offering easy access to stimulant medications.

Prescriptions rose, but production didn't change.

Stimulant quantities are regulated at the factory level, and when a labor shortage hit the main supplier of generic adderol, the system collapsed, creating a domino effect of shortages throughout the stimulant category.

Today, we're going to cover another side effect of the loosened regulation,

at-home ketamine. But first, a preview of the CME quiz for this episode.

What limits the efficacy of oral ketamine?

A, it has a slow speed of onset.

B, it has low bioavailability.

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