Smith, a longtime physician, was the subject of a Washington Post story in 2022. He obtained licenses to practice medicine in almost every U.S. state, capitalizing on pandemic-era telehealth flexibilities that enabled him to prescribe ketamine nationally. Smith tapped into a deep well of need from patients looking for an alternative to antidepressants, emerging as an evangelist for prescribing ketamine to treat anxiety and depression even though the drug hasn’t been approved by the Food and Drug Administration for that purpose. Several of his patients have credited ketamine with saving their lives.
Smith’s work and that of other at-home ketamine providers have been controversial among academics and psychiatrists who’ve questioned the wisdom of dispensing ketamine — a tightly regulated drug with a history of recreational abuse — to patients outside the direct supervision of a health-care professional.
Smith didn’t respond to messages seeking comment Wednesday. The Drug Enforcement Administration also didn’t immediately provide comment in response to a request.
Dylan Savage, a 28-year-old industrial-equipment executive in New York, said he had a follow-up appointment with Smith’s office Tuesday morning where he renewed his prescription for ketamine tablets. But barely an hour after Smith sent his notice to patients, the pharmacy said it would refund Savage rather than fill the prescription.
He spent most of the night searching Reddit for other ketamine providers, he said, and is worried that Smith shutting down will put suicidal patients at risk. “DEA is going to have blood on their hands for pulling out the rug so abruptly,” he said.
Word of Smith’s closure came the same day the DEA extended the ability to prescribe controlled substances by telehealth for six months, as it works to craft a new regulation on prescribing such drugs virtually. The ability to prescribe these medications without seeing patients in person was introduced during the pandemic, and transformed the way many patients receive drugs, from Adderall to opioid-addiction drug buprenorphine.
Ketamine in recent years has emerged as a promising treatment for people with severe depression, and a derivative of the compound has been approved by the FDA to treat depression under strict guidelines. Many patients, however, have their first experience through an off-label use of the drug, such as clinics that administer generic ketamine by infusion through an IV. Smith and a growing number of start-ups have brought ketamine into patient homes by prescribing it in the form of lozenges that dissolve under the tongue and can be obtained from compounding pharmacies.
Smith previously told The Post he has treated some 3,000 patients with ketamine, that more than half benefited, and only two wanted to abuse the drug. In interviews, Smith was candid about the limitations of his virtual practice and how seriously he took the risk of misusing the drug.
“I can have my medical license taken away. I can be fined, can do jail time for continuing to treat people” who are abusing ketamine, he previously said. Still, he described his practice as a calling to help people in need. “I’m like a medic running around on the battlefield taking care of wounded people, and ketamine helps the people I’m taking care of,” he said.
Now patients such as Julie Minor-Hackworth are struggling to find a way to continue ketamine therapy.
“I was starting to experience positive, happy, joyful feelings, and now that’s just been taken away,” said Minor-Hackworth, 51, of Kentucky. She said ketamine was “profoundly better” than antidepressants, describing the effect as “immediate and obvious.”
Adam Pruett, a psychiatrist in Vermont who is one of few ketamine providers with Smith’s national reach, said he had heard from “well over 100” of Smith’s patients since Tuesday afternoon and was trying to address the demand. “It’s exceeded my capacity to respond to,” he added.
Many patients gravitated to Smith for his business model, where they generally would pay $250 a month for a consultation and supply of ketamine, plus whatever the compounding pharmacy charged for the lozenges. That is far more affordable, patients say, than IV infusions that can run several hundred dollars per treatment, as well as packages that include coaching and therapy offered by at-home ketamine companies.
“That’s not what I need,” said another Smith patient, a researcher in Maryland who spoke on the condition of anonymity because he worried the stigma associated with ketamine could complicate his ability to get a security clearance. “I need a routine of every three days,” the dose he would take under Smith’s supervision.
“Everyone else seems like a money grab. Dr. Smith never once struck me as a money grab,” said Savage, the executive in New York. He is hopeful that he can find a general practitioner to prescribe ketamine, pointing out that it is classified by the DEA as less prone to abuse than Adderall.
“This is a medication that any doctor with a DEA license could prescribe,” he said. “They don’t because most of the medical community is ignorant and fearful of it.”
