Canada is experiencing a ketamine shortage. What this means for clinics treating depression

A shortage of a powerful drug used in surgeries is impacting some Canadians who've been approved to use it for mental health treatment.

The strong sedative ketamine, sold on the black market under other names like Special-K, is a fast-acting painkiller and anesthetic. It's also being used in some specialized clinics across Canada aiding those with severe depression.

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But recently, the drug has been in short supply in the country.

Paul Varady, vice-president of regulatory affairs at Juno Pharmaceuticals, told CTVNews.ca in an interview that "numerous reasons" are behind this shortage.

"Over the last few years, there's been a shortage of ingredients, a shortage of different materials needed to manufacture different products, not just ketamine," Varady said. "And as a result, there's been a shortage of products available in general."

Products typically end up in the largest markets where they can be used the most, Varady says. This also means the availability of products can be driven by price, something Canada has pushed back against, adding "pressure" for lower-cost medications, he said.

"All of those things act together, and in some instances (a shortage) is how it turns out," Varady said.

While hospitals can substitute ketamine for other painkillers like morphine, specialized depression clinics cannot, which could create a problem for those accessing ketamine for mental health.

WHAT KETAMINE IS USED FOR

In Canada, ketamine is primarily used in veterinary surgeries, but it is used, to a "lesser extent," in human medicine as well, the Centre for Addiction and Mental Health's website reads.

It is also sold illegally under names including blind, kit kat, vitamin K, special K and cat tranquilizers, and is sometimes used as a date rape drug. Health Canada warns its possession and sale is illegal unless authorized for medical, scientific or industrial purposes.

People who take ketamine describe having vivid dreams and feeling "dissociation" from their bodies.

In medical settings, ketamine is typically given with a sedative to offset the impacts of the drug, but in a handful of clinics across Canada, the effects of ketamine are sought after to reduce symptoms of severe depression.

"For people that try ketamine, and it works, it can be like a light switch going on and off," Justin Davies, CEO and founder of the Toronto Ketamine Clinic, told CTVNews.ca in an interview.

If the shortage of ketamine continues, clinics like Davies' can not treat patients.

In 2021, the U.K.'s University of Exeter, in collaboration with the University of British Columbia, looked over 33 reviews, 29 randomized trials and 21 observational studies on the usage of ketamine for depression.

It found the drug can treat major depression symptoms quickly in one to four hours after a single treatment with effects lasting up to two weeks.

"We treat people at our clinic for what's called treatment-resistant mood disorders — particularly depression," Davies said. "Broadly defined as people who have tried multiple – at least two – antidepressant medications that have failed."

According to Davies, about 30 per cent of people who take antidepressants are not getting the ideal outcome.

People cannot be prescribed ketamine for depression easily, Davies said. A "comprehensive" psychiatric examination must take place before the treatment is considered.

Once a person is prescribed ketamine, they will be in treatment overseen by an anesthesiologist and psychiatrist, and monitored closely throughout the six weeks of injections.

"Typically, if you're going to respond…. you're going to do it within that six sessions," Davies said. "A psychiatrist is following you, monitoring your dose from infusion to infusion, speaking with you about how you're doing throughout that treatment, and making adjustments as needed. The hope is that by the end of the six, you've come back to a sense of yourself a little bit and get a sense of the relief that it feels like to not be depressed."

'IT IS NOT A CURE'

For the clinic, ketamine is "very important" because it allows fast-acting relief to antidepressant-resistant patients, Davies said.

Although the use of ketamine to treat depression is still being studied, some scientists believe the drug kickstarts a process called synaptogenesis, which likely affects mood through patterns and cognition, a Harvard University health article reads.

Short-term effects of the drug include feeling "outside of your body," Davies says, with a disconnect between the body and the brain. This typically will last as long as the infusion is happening.

If a person is using ketamine in a non-medical sense, the long-term effects can include flashbacks, social withdrawal and memory loss. It is a narcotic and can be highly addictive if not controlled, the CAMH website says.

"It is not considered a cure for depression," Davies said. "It's giving people the ability to help get back to a point where they felt like they were stronger, more resilient, able to deal with life's challenges."

As the patient finishes the sessions, Davies says, they often come back every few months for a "booster infusion" until they can reintegrate back into daily life without ketamine.

KETAMINE BOOSTER INFUSIONS

Davies is one of the people using ketamine periodically to treat his depression.

"I would say twice a year, maybe three times a year, I will use for a booster infusion and this is if I feel my symptoms are returning," he said.

In 2015, Davies said he was a treatment-resistant person struggling to live with his debilitating depression.

"When you're really desperate, and in a significant depression, you do become resourceful," he said.

After seeing clinics in the United States and experiencing the effects of ketamine, Davies set out to bring the drug to Canada, battling what he called "regulatory hurdles" throughout the process.

"This is like a tool in the toolkit that is really needed," he said. "And we really needed it here, so that was kind of the impetus around bringing the Toronto Ketamine Clinic to the city."

It appears the federal government has taken steps to address the shortage of the drug.

Juno Pharmaceuticals was approved by Health Canada on April 27 to import 25,000 vials of 50-miligram doses of ketamine from the U.K. It is the only company that has been approved.

Both the 10- and 50-milligram strength of ketamine are in a shortage status, the Drug Shortages Canada website shows.