Darius Tahir | (TNS) KFF Health News
People continue to talk about ketamine. Celebrities, billionaires, and regular patients alike have taken a liking to it, seeing it as a potential wonder drug for depression and other mental health issues.
Whether on Facebook or Instagram, both patients and clinics are excited about the potential. But it is a drug that can be misused and can be fatal. Therefore, ketamine presents a new challenge for Meta, the parent company of social media platforms, which has struggled for years to regulate posts and advertisements promoting health products such as weight loss supplements and questionable covid-19 remedies.
Still, despite warnings despite warnings about the drug’s risks, Meta permits advertisements and posts about ketamine. Sometimes this content comes from sources that do not meet the conglomerate’s extensive standards, which are intended to ensure that posts are based on reliable information.
Other internet advertising networks are also working to find a balance. Google states that because ketamine is a prescription drug, it can only be advertised by providers who offer a prescription and are certified by a third-party oversight group; advertisers cannot promote “highs.” TikTok, which did not respond to a request for comment, generally prohibits advertising from unauthorized pharmacies or dispensaries, or advertising that promotes prescription drug misuse.
Meta’s regulations have created a dilemma for the company. Posts about ketamine, a drug used for both recreational purposes and as a potential mental health treatment, are subject to very different regulations depending on the context, as revealed in an investigation and report by the company’s external Oversight Board, an organization known as Facebook’s “Supreme Court” for its role in overseeing the platform’s speech rules. This balancing act was publicly demonstrated following a post about the substance that was repeatedly examined by the company’s content review process. When asked to comment for this article, Meta simply referred KFF Health News to the board’s report and the company’s response to the report.
This situation dates back to December 2022, when a paid influencer posted on Instagram about how the drug helped with the influencer’s “treatment-resistant depression and anxiety.” The post detailed a “magical entry into another dimension.”
After reviewing the paid post and Meta’s rules on drug promotion, the Oversight Board concluded that the post improperly exaggerated the recreational effects of the drug, without putting it in a medical context — a problem, considering the tension in the company’s rules allowing discussion of pharmaceutical products and disallowing references to illicit drug use.
Ketamine, which comes in both liquid and powder forms, was initially developed as an anesthetic and gained popularity as a recreational drug due to its dissociative and hallucinogenic effects. It is FDA-approved as an anesthetic and, in certain formulations, as a prescription antidepressant, to be administered in medically supervised settings. Classified as a Schedule 3, nonnarcotic substance under the Controlled Substances Act, the drug has been proven to create addiction, particularly for individuals with a background of dependency on other substances. However, scientists are fascinated by another aspect of ketamine: its ability to alter the mind, which could have positive effects for therapy.
These opportunities, supported by a surge in medical startups and wellness centers promoting ketamine as part of holistic healing or other health-related purposes, are driving interest from consumers, media, and social platforms.
But there are signs of a negative aspect. According to an autopsy report from Los Angeles County’s medical examiner department, actor Matthew Perry had ketamine in his system while reportedly undergoing infusion therapy for depression and anxiety. Reports from poison centers about exposure to ketamine increased by just over 80% from 2019 to 2021, a study revealed.
This struggle is causing conflicts between social media companies and advertisers. While Meta and similar companies sometimes permit posts about the drug, they also provide warnings. For instance, when searching for “ketamine” on Instagram, users are informed that the term “may be associated with the sale of drugs” and are given the option to “get help” for substance abuse treatment. (Users can still choose to view the results.)
In 2023, in an attempt to address the situation, Meta referred the controversy regarding the post to its Oversight Board. The group has received $280 million in irrevocable funding since 2019. Membership includes former heads of state, prominent journalists, and human rights advocates.
Regarding the “magical entry” post, as stated in a Meta message referenced in the board’s report, the company expected the board to approve and allow more posts about mind-altering drugs with therapeutic potential. However, the board instead provided sharp criticisms and questions, which could threaten the status of other ketamine posts. The board argued that, according to the company’s policies, the post improperly portrayed ketamine as a “high” rather than a medical experience.
“This case indicates that Meta’s strong restrictions on branded content promoting drugs and attempts to buy, sell, or trade drugs may be inconsistently enforced,” the board concluded in its report.
Indeed, in a comment to the board, the National Association of Boards of Pharmacy suggested it’s easy to find sellers offering the drug for recreational use, citing two clear examples found “with only a cursory search.”
The company’s executives disagreed. When presenting the controversy to the board, they said they expected medical use of ketamine to increase, so it should allow the post. That led, in its response, to the company brushing off some of the board’s suggestions, which could directly impact ketamine clinics’ profits. After all, Facebook and Instagram audiences overlap with their clientele, and these ads are one of the main ways they promote their brands. Consider the money at stake. One recent academic review of ketamine clinics’ advertising online, which was published in JAMA Network Open, found prices ranging from $360 to $2,500 per infusion.
According to Jacob Silverstone, the medical director of a ketamine infusion clinic near Miami, when a very influential influencer posts about his clinic, there is always a noticeable increase in interest. This increased interest often leads to more patients coming to his clinic.
Even though there is a lot of talk about ketamine on social media, the evidence supporting its use as a mental health treatment is not completely established.
Boris Heifets, a professor at Stanford University School of Medicine who is researching ketamine and other psychiatric therapies, stated that data from clinics strongly suggests that the drug has a positive effect. Some studies even indicate that ketamine can help with depression, especially for patients who do not respond to traditional treatments like SSRIs.
Heifets also mentioned that popular culture exaggerates the potential benefits of ketamine. Some clinics promote practices on social media without scientific support, and he doubts their expertise in mental health.
Heifets observed that some clinic advertisements emphasize the idea that the drugs work quickly and comprehensively, without having good long-term therapeutic use data.
A review of ketamine clinics' claims on Google revealed that these businesses seldom disclose potential side effects while aggressively promoting its benefits. Some ads even falsely claim that the drug is nonaddictive.
Ads on Facebook and Instagram also overstate the potential of ketamine. In fall 2023, a search of Meta's ad library showed numerous ketamine clinics making sunny claims, some promising rapid relief or suggesting that ketamine can replace daily SSRIs.
These kinds of claims, which downplay risks like substance use disorders, can create unrealistic expectations in patients, according to Heifets. If these high expectations are not met, it can be disastrous for patients.
The ads that make these claims and minimize or ignore the risks seem to be slipping through a system with inconsistent regulations, according to a review by KFF Health News.
Although Meta's policies require many advertisers offering prescription drugs, and all advertisers offering drug and addiction treatment services, to undergo additional vetting by a group called LegitScript before they can advertise on Facebook and Instagram, in practice, many ketamine advertisers do not go through this process even if they should.
In October and November 2023, KFF Health News examined 27 advertisers on Meta and found that 10 advertisers, who were offering ketamine for drug addiction or ketamine via telehealth, were not registered with LegitScript, despite the requirement for certification.
The internet advertisements promote services, usually through telehealth, that prescribe ketamine—often in a lozenge made by a compounding pharmacy. Heifets mentioned that there is much less evidence for the safety and effectiveness of oral ketamine compared to intravenously administered ketamine, which has been studied more frequently.
Enforcement is a priority for Meta. In its response to the Oversight Board regarding the ketamine case, Meta stated that it has enhanced its automated review tools for certain advertisements promoting drugs, and committed to considering auditing its policies in the first half of this year.
Federal regulators are expressing concern about ketamine, especially when acquired online. Last year, the Drug Enforcement Administration shut down the telehealth practice of at least one physician who prescribed ketamine nationwide. In October 2023, the FDA issued a warning about compounded ketamine—which these telehealth startups tend to rely on, Silverstone noted.
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(KFF Health News, previously known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling, and journalism.)
©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
