Darius Tahir | (TNS) KFF Health News
People continue to discuss ketamine. Celebrities, billionaires, and regular patients are all fans of it, as they see 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 benefits. However, it is a drug that can be misused and can be fatal. Therefore, ketamine poses a new challenge for Meta, the parent company of social media platforms, which has long had difficulties in controlling posts and advertisements promoting health-related products such as weight loss supplements and questionable covid-19 treatments.
Still, despite warnings about the dangers of the drug, Meta permits advertisements and posts about ketamine. Sometimes this discussion comes from sources that do not meet the conglomerate’s extensive standards, which are meant to ensure that posts are based on credible information.
Other internet advertising networks are also trying to find a balance. Google states that because ketamine is a prescription drug, it can only be advertised if a provider is offering a prescription and is certified by a third-party oversight group; advertisers cannot promote getting “highs.” TikTok, which did not respond to a request for comment, generally prohibits advertising from unauthorized pharmacies or dispensaries, as well as advertising that promotes prescription drug abuse.
Meta’s regulations have presented a dilemma for the company. Posts about ketamine, which can be both a recreational drug and 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” due to its role in overseeing the platform’s speech regulations. This balancing act became public after a post about the substance underwent multiple reviews by the company’s content review process. When approached for comment on this article, Meta simply referred KFF Health News to the board’s report and the company’s response to the report.
This back-and-forth 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 examining the paid post and Meta’s rules on drug promotion, the Oversight Board concluded that the post inappropriately exaggerated the pleasurable effects of the drug without placing it in a medical context — a problem considering the tension in the company’s regulations, which allow discussion of pharmaceutical products while disallowing references to illicit drug use.
Ketamine, which is available in both liquid and powder form, was initially used 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 some formulations, as a prescription antidepressant, to be administered in medically supervised settings. Regulated as a Schedule 3, nonnarcotic substance under the Controlled Substances Act, the drug has been known to lead to addiction, especially for individuals with a history of being addicted to other substances. However, scientists are interested in another aspect of ketamine: its ability to alter the mind, which could have therapeutic advantages.
These possibilities, supported by a surge in ketamine-focused medical startups and spas promoting the prescription drug as part of “holistic healing” or other wellness purposes, are driving consumer interest, media coverage, and attention on social media.
However, there are signs of a negative side. According to a report from Los Angeles County’s medical examiner department, actor Matthew Perry had ketamine in his system when he was undergoing infusion therapy for treating depression and anxiety. Reports from poison centers about exposures to ketamine increased by just over 80% from 2019 through 2021, according to a study. autopsy report from Los Angeles County’s medical examiner department, actor Matthew Perry died with ketamine in his system as he reportedly was undergoing infusion therapy meant to treat depression and anxiety. Poison center reports of exposures involving ketamine surged just over 80% from 2019 through 2021, a study showed.
The tug of war is leading to conflicts between social media giants and advertisers. While Meta and its peers sometimes allow posts on the drug, they also include warnings. For example, if you search Instagram for “ketamine,” you learn the term “may be associated with the sale of drugs” and are offered a button to “get help” for substance abuse treatment. (You can also opt to get the results anyway.)
In 2023, hoping to resolve the situation, Meta referred the controversy concerning 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.
For the “magical entry” post, according to a Meta missive cited in the board’s report, the company expected the board would agree and open its platforms to more posting about mind-altering drugs with therapeutic potential. But the board instead offered pointed critiques and questions, threatening the status of other ketamine posts. The board argued that, based on the company’s policies, the post inappropriately made ketamine seem like 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.
When a very influential person who promotes products talks about his health center, there’s a significant increase in interest every time, according to Jacob Silverstone, the medical director of a ketamine infusion center near Miami, told KFF Health News. That interest often leads patients to his center, he said.
However, despite the excitement on social media, there is no clear evidence supporting the use of ketamine as a treatment for mental health.
Boris Heifets, a professor of anesthesiology at Stanford University School of Medicine who studies ketamine and other psychiatric therapies like MDMA, said that data from clinics strongly indicates that the drug is beneficial. Some studies suggest that ketamine can help with depression — even for patients who do not respond to traditional treatments like SSRIs, or selective serotonin reuptake inhibitors.
However, Heifets warned that popular culture exaggerates the potential benefits. Some clinics on social media promote practices without scientific support. “It’s not clear that they have any mental health expertise,” he said.
Heifets noted that some clinic advertisements focus on the idea that the drugs work quickly and comprehensively, but they don't address the lack of solid data about long-term therapeutic use.
A review of ketamine clinic claims in ads on Google revealed that the businesses rarely mention potential side effects, while aggressively promoting the benefits. Some ads falsely claimed that the drug is not addictive, the review stated.
Advertising on Facebook and Instagram can also be very optimistic about ketamine’s potential. A search of Meta’s ad library in fall 2023 revealed a large number of ketamine clinics making positive claims, with some promising “rapid relief” or telling viewers they can “say goodbye to a once-daily SSRI” or that “IV ketamine can be your light in the darkness.”
These types of claims, while downplaying risks like substance use disorders, create exaggerated expectations in patients, Heifets said. “You can create expectations for some of these kind of big interventions that if they’re not met — that can actually be disastrous for patients.”
The ads making such claims and minimizing or not mentioning the risks often appear to be slipping through a system with inconsistent regulations, and puzzling gaps, a review by KFF Health News suggests.
Meta’s policies require many advertisers who offer prescription drugs, and all advertisers offering drug and addiction treatment services, to undergo additional vetting by a group called LegitScript before they’re allowed to hawk their wares or services on Facebook and Instagram. (Google similarly requires certification from an outside body like LegitScript for online pharmacies, telemedicine, and addiction services.) LegitScript reviews the advertisers’ operations, like their clinical leadership and partnerships with pharmacies.
But in practice, ketamine advertisers often don’t go through this process even if they fall into a category that should. KFF Health News reviewed 27 advertisers on Meta in October and November 2023. Of those, 10 advertisers, spread over both months, either offered ketamine for drug addiction or ketamine via telehealth, and were not registered with LegitScript.
The internet advertisements promote services, usually through telehealth, that prescribe ketamine — often in a lozenge made by a compounding pharmacy. There’s much less proof for the safety and effectiveness of oral ketamine, Heifets said, compared with that of intravenously administered ketamine, which is more often studied.
Enforcement is on Meta’s agenda. In its response to the Oversight Board on the ketamine case, Meta said it has improved its automated review tools for some advertisements promoting drugs, and pledged to consider auditing its policies in the first half of this year.
Federal regulators are showing signs of concern about ketamine, particularly when obtained 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 said.
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(KFF Health News, formerly 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.
