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Three psychiatrists argue that inconsistent safeguards for off-label ketamine prescribing leave patient risks unevenly assessed, particularly for people with a history of addiction. Their October 11 opinion cites the ongoing investigation into Presley Gerber’s death but says his official cause of death is pending.
Three psychiatrists writing in MedPage Today on October 11 called for clearer safety standards for ketamine prescribing, pointing to reports that model Presley Gerber had received prescriptions for months despite a history of addiction. Gerber, 27, died on September 20; authorities are investigating a suspected overdose, but his official cause of death has not been determined.
The opinion’s authors, Tucker Avra, Renée Sorrentino and Fernando Espi Forcen, say ketamine has legitimate uses but that safeguards for off-label prescribing vary. They argue that assessment of a patient’s substance-use history, monitoring during treatment and informed consent can depend on the provider, without a single consistently enforced standard across clinics and telehealth services.
Ketamine is prescribed off-label for conditions including depression, post-traumatic stress disorder and obsessive-compulsive disorder. The authors contrast this with esketamine (Spravato), a specific form approved by the U.S. Food and Drug Administration in 2019 for treatment-resistant depression. Esketamine is dispensed through a federal Risk Evaluation and Mitigation Strategy; the authors say off-label ketamine does not have a comparable mandatory safety program.
The psychiatrists describe potential risks associated with at-home treatment without adequate supervision, insufficient monitoring of injections or infusions, online prescribing without in-person evaluation and inadequate consent. They also say some patients may need careful risk-benefit assessment, including people with a history of substance-use disorder. These are concerns raised by the authors, not findings about the care Gerber received.
Safety Rules Across Ketamine Care
The debate affects patients weighing ketamine treatment as well as clinicians and providers responsible for prescribing and monitoring it. The authors argue that inconsistent safeguards can mean a patient’s risks are handled differently depending on where and from whom they seek care. Clearer standards could define assessment, monitoring and documentation without treating ketamine’s potential benefits as proof that every treatment setting is safe.
The report also highlights a difficult balance: ketamine can be a useful treatment, while repeated or poorly monitored use may carry risks that are not fully understood. The authors say clinicians should make and document an individual risk-benefit decision, and withhold treatment when risks cannot be managed. Their argument is for standards that protect patients while recognizing legitimate medical use.
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Ketamine’s Different Oversight Paths
Ketamine was approved in the United States in 1970 as an anesthetic. Its use for psychiatric conditions has since expanded, including off-label prescribing. FDA approval of esketamine in 2019 brought a defined safety program for that product and indication, but it did not establish an equivalent federal program for all ketamine treatment.
The authors point to the Massachusetts General Hospital Ketamine Clinic for Depression as an example of supervised in-person care. They report that it has delivered more than 11,000 infusions and quadrupled its treatment volume since opening in 2018. They say research and their experience suggest ketamine use disorder is uncommon in such controlled settings, while cautioning that the shift toward longer-term use raises questions about effects that remain largely unknown.
The opinion also cites an increase of more than eightfold over the past decade in the number of people in the United Kingdom starting treatment for ketamine addiction. It gives no underlying counts in the supplied report, so the figure describes a reported trend rather than the total number affected. The authors cite lawsuits involving telehealth ketamine treatment and calls from the American Society of Anesthesiologists for greater oversight, including of at-home delivery.
“prescribing ketamine to a patient with a known addiction history requires risk-benefit decision-making that is both discussed and documented in the medical record.”
— The opinion’s authors
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Gerber Investigation and Care Details
Gerber’s official cause of death remains pending, and the report says his death is being investigated as a suspected overdose. The opinion says his friends reported that a doctor prescribed ketamine for months despite knowing about his addiction struggles. The supplied material does not establish the details of the prescriptions, the physician’s response, or whether ketamine caused or contributed to Gerber’s death.
The authors compare the case with Matthew Perry’s death, but the circumstances differ. Perry’s autopsy identified acute ketamine effects as a contributing factor, while the lethal dose came from another source; a doctor who had prescribed ketamine to him later pleaded guilty to distributing it without a legitimate medical purpose. The Gerber investigation has not reached a comparable conclusion. The longer-term effects of chronic ketamine use, and the extent of addiction risk across treatment settings, also remain uncertain.
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Cause of Death and Standards Review
The next factual milestone in Gerber’s case is the release of an official cause of death or further information from investigators. Until then, claims about his prescribing and the role of ketamine should remain attributed and should not be presented as settled findings.
The psychiatrists’ opinion calls for an evidence-based standard covering patient screening, informed consent, monitoring and documentation. The supplied report does not announce a new rule or give a timetable for regulatory action. Whether professional bodies, regulators or lawmakers adopt stronger requirements—and how any rules would apply to off-label prescribing, clinics and telehealth—remains open.
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Key Questions
What did the psychiatrists recommend?
They called for a clear, evidence-based standard of care that accounts for ketamine’s potential benefits while protecting patients. They emphasize assessment, monitoring, informed consent and documentation of risk-benefit decisions.
Has Gerber’s cause of death been confirmed?
No. The report says his death is being investigated as a suspected overdose, but his official cause of death is pending. The available material does not establish that ketamine caused his death.
How does ketamine differ from esketamine in oversight?
Esketamine (Spravato), approved for treatment-resistant depression, is distributed under a federal Risk Evaluation and Mitigation Strategy. The authors say off-label ketamine prescribing has no comparable mandatory safety program.
Does the report say ketamine is ineffective or unsafe for everyone?
No. The authors describe ketamine as a legitimate and effective treatment for some conditions. Their concern is that safety practices vary and that risks, including a history of substance-use disorder, may not be assessed consistently.
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