People keep talking about ketamine. The drug has become a favorite of celebrities, billionaires, and ordinary patients, many of whom view it as a potential miracle drug for depression and other mental health conditions.
Whether on Facebook or Instagram, patients and clinics alike are giddy about the possibilities. But it is a drug that and can be deadly. Thus, ketamine is the latest challenge for Meta, the social media platforms鈥 parent company, which for years has struggled to moderate posts and ads touting health-related products like weight loss supplements and dodgy covid-19 cures.
Still, about the drug鈥檚 dangers, Meta allows ads and posts about ketamine. Sometimes that chatter comes from sources that don鈥檛 meet the conglomerate鈥檚 voluminous standards, which, in theory, ensure posts are based on credible information.
Other internet ad networks are also trying to strike balances. Google says that because ketamine is a prescription drug, it can be advertised only if a provider is offering a prescription and is certified with a third-party oversight group; advertisers can鈥檛 promote 鈥渉ighs.鈥 TikTok, which didn鈥檛 reply to a request for comment, advertising from unauthorized pharmacies or dispensaries, or advertising that features prescription drug abuse.
Meta鈥檚 rules have created a conundrum for the company. Posts about ketamine, both a party drug and a possible mental health therapeutic, are governed by very different rules depending on the context, according to an investigation and report by the company鈥檚 outside Oversight Board, an organization dubbed Facebook鈥檚 鈥淪upreme Court鈥 for its role in refereeing the platform鈥檚 speech regulations. That balancing act was on public display after a post about the substance was inspected repeatedly by the company鈥檚 content review bureaucracy. When asked to comment for this article, Meta simply referred KFF 国产精品视频 News to and the company鈥檚 reply to the report.
This back-and-forth dates to December 2022, when a paid influencer posted on Instagram how the drug eased the influencer鈥檚 鈥渢reatment-resistant depression and anxiety.鈥 The a 鈥渕agical entry into another dimension.鈥
After reviewing the paid post and Meta鈥檚 rules on drug promotion, the Oversight Board found that the post inappropriately hyped the high of the drug, while not placing it in a medical context 鈥 a problem, given the tension in the company鈥檚 rules allowing discussion of pharmaceutical products and disallowing references to illicit drug use.
, which is available in both liquid and powder form, emerged first as an anesthetic and became popular as a party drug because of its dissociative and hallucinogenic effects. It鈥檚 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 , especially for people with a history of addiction to other substances. But researchers are intrigued by another aspect of ketamine: its mind-altering properties, which have potential therapeutic benefits.
These possibilities, aided by a boom in ketamine-focused medical startups and spas promoting the prescription drug as part of 鈥渉olistic healing鈥 or other wellness purposes, are fueling consumer interest, news coverage, and social media attention.
But there are indications of a dark side. According to an from Los Angeles County鈥檚 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, .
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 鈥渒etamine,鈥 you learn the term 鈥渕ay be associated with the sale of drugs鈥 and are offered a button to 鈥済et help鈥 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 since 2019. Membership includes former heads of state, prominent journalists, and human rights advocates.
For the 鈥渕agical entry鈥 post, according to a Meta missive cited in the board鈥檚 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鈥檚 policies, the post inappropriately made ketamine seem like a 鈥渉igh,鈥 rather than a medical experience.
鈥淭his case indicates that Meta鈥檚 strong restrictions on branded content promoting drugs and attempts to buy, sell, or trade drugs may be inconsistently enforced,鈥 the board concluded in its report.
Indeed, in a , the National Association of Boards of Pharmacy suggested it鈥檚 easy to find sellers offering the drug for recreational use, citing two clear examples found 鈥渨ith only a cursory search.鈥
The company鈥檚 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, , to the company brushing off some of the board鈥檚 suggestions, which could directly impact ketamine clinics鈥 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 of ketamine clinics鈥 advertising online, which was published in JAMA Network Open, found prices ranging from $360 to $2,500 per infusion.
When a particularly influential influencer posts about his clinic, there鈥檚 鈥渁 sharp uptick鈥 in interest 鈥渆very single time,鈥 Jacob Silverstone, the medical director of a ketamine infusion clinic outside Miami, told KFF 国产精品视频 News. That interest often drives patients to his clinic, he said.
Still, despite the social media buzz, evidence for ketamine as a mental health treatment is unsettled.
鈥淒ata from clinics strongly suggest that there’s a benefit鈥 from the drug, said Boris Heifets, a Stanford University School of Medicine professor of anesthesiology studying ketamine and other psychiatric therapies like MDMA. Ketamine, some of these studies indicate, can work for depression 鈥 even for patients who don鈥檛 respond to conventional treatments like SSRIs, or selective serotonin reuptake inhibitors.
But, Heifets said, pop culture oversells the potential. On social media, some clinics promote practices without scientific backing, he said. 鈥淚t’s not clear that they have any mental health expertise,鈥 he said.
Some clinic ads he has seen, Heifets said, dwell on the idea that the drugs act quickly and comprehensively 鈥 avoiding the lack of good data about long-term therapeutic use.
The review of ketamine clinics鈥 claims in ads on Google found the businesses rarely disclosed potential side effects, while aggressively marketing its benefits. Some ads falsely claimed the drug is nonaddictive, the review said.
Facebook and Instagram advertising can be similarly bullish about ketamine鈥檚 potential. A fall 2023 search of Meta鈥檚 ad library shows an armada of ketamine clinics with sunny claims, some promising 鈥渞apid relief鈥 or telling viewers they can 鈥渟ay goodbye to a once-daily SSRI鈥 or that 鈥淚V ketamine can be your light in the darkness.鈥
These types of claims, while downplaying risks like substance use disorders, create outsize expectations in patients, Heifets said. 鈥淵ou can create expectations for some of these kind of big interventions that if they’re not met 鈥 that can actually be disastrous for patients.鈥
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 国产精品视频 News suggests.
Meta鈥檚 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鈥檙e 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鈥 operations, like their clinical leadership and partnerships with pharmacies.
But in practice, ketamine advertisers often don鈥檛 go through this process even if they fall into a category that should. KFF 国产精品视频 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 online ads promote services, generally via telehealth, that prescribe ketamine 鈥 often in a lozenge prepared by a compounding pharmacy. There鈥檚 much less evidence 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鈥檚 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 the telehealth practice of at least one physician who prescribed ketamine nationwide. In October 2023, the FDA issued a warning about compounded ketamine 鈥 which these telehealth startups tend to rely on, Silverstone said.
