The Texas Medical Board is proposing tighter regulations around ketamine, a popular fast-acting sedative used to treat mental illness, including more physician oversight during administration of the drug and banning in-home use of it.
The revised rules are expected to publish May 8, and the Texas Medical Board is scheduled to vote on the changes in June.
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Supporters of ketamine regulations in Texas say the drug, which can cause comas and even death, has grown in popularity because it is easy to access. One of the most common ways people access ketamine is through telehealth prescriptions, which allows them to take it at home while a medical professional monitors them online.
Medical spas, which often do not have the stringent regulations of a medical clinic, also administer the highly addictive sedative, and night clubs promote it as a social drug instead of a potentially dangerous medication.
“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,” said Rep. Tom Oliverson, R-Cypress, an anesthesiologist and a former medical board member who helped pass rules on administering sedatives for things like cosmetic surgery and dental work. “So then the question is, who should be allowed to administer those things so that it’s done safely?”
Ketamine’s role in the death of actor Matthew Perry has increased the drug’s visibility, including its dangers. The most recent medical report examining data from poison centers across the country found that ketamine poisonings are at their highest point in recent history, more than doubling since 2019 to 414 in 2023.
Data provided by the Texas Poison Center Network confirms a steady increase in ketamine-related calls beginning in 2020, during the COVID-19 pandemic, from 15 to 40 calls in 2024.
Of the 167 cumulative ketamine-related calls to poison centers from 2020 to 2025, two resulted in death, and 75 reported moderate effects.
Although ketamine clinics in Texas usually have a physician on staff to respond to bad reactions to the treatment, a physician is rarely on site. Advanced-practice registered nurses and certified registered nurse anesthetists primarily administer and oversee several ketamine treatments at a time in clinics.
The proposed rules, first released in January, include a requirement that if a physician is not on site, medical staff can’t administer ketamine to more than two patients at a time. It also prohibits ketamine treatments outside of a registered clinic, including in-home use. The rules also require health providers to complete training on mental health treatment before being allowed to administer ketamine.
“Due to its potency, proper administration methods are essential. Ketamine, unlike opioids, cannot be counteracted by other medications like Narcan,” said Spencer Miller-Payne, spokesperson for TMB. “Therefore, it can be dangerous if a patient accidentally moves into moderate or deep sedation from ketamine.”
Miller-Payne said the board doesn’t want to reduce access to care, but it also recognizes that the environment in which these ketamine treatments are being offered plays an important role in ensuring patient safety.
Industry leaders criticized the proposal, saying that forcing them to choose between hiring an on-site physician or seeing fewer patients will severely limit the number of people they can serve and will raise the price of treatment by $300 to $500.
APRNs and other non-physician medical providers say requiring a physician to oversee them is confusing, unnecessary and insulting because they know the same life-saving measures that medical doctors do. They say the current proposal is a power grab by physicians under the guise of patient safety and will force clinics to shutter.
“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?” said Alli Waddell, CEO and co-founder of Illumma, an Austin ketamine clinic. “They keep telling us it’s about patient safety, and it’s not.”
When used in a clinical setting, ketamine is considered one of the safest drugs to use. In low doses, ketamine creates an altered state of consciousness and, paired with counseling, can lead to rapid relief of severe mental illness for a period of time.
Mental health providers say a lot of ketamine clients are low-income and highly suicidal and can’t afford the cost — financially or mentally — of these new rules.
The regulatory framework that Texas creates is likely to become the model for other states, ketamine industry leaders say.
“This is going to radiate throughout the entire nation, and there’s literally only a handful of people fighting for it,” said Will Ratliff, a nurse and paramedic, and the director of operations at Transcend Health Solutions, an Austin ketamine clinic. “Physicians are actively shutting down the practice of something that saves a lot of lives just because of ignorance.”
What is ketamine therapy?
Five years ago, Bradley Armendariz was studying to become a licensed provider when he decided to take a break for the day and try ketamine while listening to some contemplation audio tapes. He said what happened next was life-changing. The ketamine enhanced the words from the audio tapes and guided Armendariz through his self-doubts. By the end, he said he felt invigorated and determined about his next steps.
“It changed not only how I experienced ketamine, but also how I thought to help my clients,” said Armendariz, a licensed professional counselor in Big Sandy in East Texas who now provides ketamine treatments.
Ketamine is a synthetic compound that helps repair brain connections often damaged by mental illness. Mental health providers use ketamine to guide clients through deep-seated trauma without damaging their mental state, which can happen with talk therapy. Low-dose ketamine intravenous infusions, nasal sprays and oral medications are often used for treatment-resistant mental illnesses, such as depression, PTSD and suicidal ideation.
“Ketamine has some chemical effects that allow the brain to be more malleable for change, like when we were young children and could learn a new language or new instrument, without feeling down,” Ratliff said.
Ketamine has a high potential for dependency, which can lead to clients requesting higher doses to achieve the desired effect. The psychoactive drug can cause cardiovascular strain, respiratory depression and organ damage from long-term use.
Mental health providers say ketamine must be paired with ongoing mental health work.
“You can’t just take ketamine and fix your life. You will feel temporarily good and then go back down,” Armendariz said. “It still requires work and action on the client’s and the mental health providers’ part, too.”
‘Gut the industry’
Waddell said many ketamine industry leaders are grateful to see the state propose tighter restrictions.
“The industry is not against regulation. It just wants mindful regulation so that we can maintain access for people who are really struggling and use this tool to save their life,” Waddell said. “But these regulations will completely gut the industry because it will get rid of the model that makes this treatment possible.”
The main concern for many ketamine clinics is that they won’t be able to afford to pay for a physician to be on-site. Most clients are in severe mental distress and are either jobless or low-income, so they can’t pay high prices for treatment. Also, insurance doesn’t cover ketamine therapy treatments. Ketamine clinics said to make the drug affordable, they already have to break even on their profits.
Allowing two patients to undergo treatment at a time also will hurt their revenue, so these new regulations will force many clinics to close, ketamine advocates say. If at-home use is banned, rural users will be affected the most because the statewide physician shortage is worse in rural communities and many patients rely on in-home use.
“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,” said Leonardo Vando, the medical director of Mindbloom, one of the country’s largest telehealth programs.
Regulations can legitimize ketamine
Flavored ketamine nasal sprays advertised at parties and ketamine administered during massage therapy have given the drug a bad reputation, proponents of regulations say.
“It needs to be legitimized for insurance to get on board, but we can’t do that when you have a lot of bad actors out there running around giving it a bad name,” said Mary Moore, owner and clinical director of Lake Austin Psychotherapy, which provides ketamine treatments.
Oliverson said that under the current system, too many underqualified medical providers can administer a dangerous anesthetic, such as ketamine. He said paramedics and emergency medical technicians masquerading as nurses are administering the treatment.
“A lot of time, there wasn’t even a physician involved except on paper,” he said. “We have physicians who are only there via call or Zoom? I think that is a total joke. There’s no meaningful supervision actually going on there, and if something goes wrong, you are calling 911 because they can’t respond in time.”
Moore said she wants to see the state’s medical board require an on-site physician for every ketamine treatment because that is the safest way to conduct treatment.
“Is that more expensive? Yes. Does that hit their profit model? Yes. And I think that is part of the pushback,” she said. “The psychotherapy portion is really getting ignored in a lot of these clinics. It’s a conveyor belt model.”
Truman Milling Jr., medical director of Lake Austin Psychotherapy, suggested that the state medical board focus on the skills of the person administering the treatment rather than on whether they are a medical doctor. He said, for example, an APRN with ICU experience can meet the requirements of a physician, but not all medical providers have the same skill set.
“I think the demand [for ketamine] will go down somewhat, but if it’s done more appropriately, I think that’s the price you have to pay,” Milling said.