New Ketamine Guidelines in Saskatchewan Limit Access to Treatment

VANCOUVER, British Columbia - Oct. 26, 2022 - PRLog -- -
The Ketamine Assisted Therapy Association of Canada (KATA) highlights that recently announced changes to guidelines in Saskatchewan are having significant impacts on patient access to this potentially life-saving medicine for people struggling with mental health conditions.

The College of Physicians and Surgeons of Saskatchewan published new guidelines for ketamine administration on October 1, 2022 that include changes that have delayed access for some patients already accessing ketamine-assisted therapy (KAT).  Saskatoon's New Earth Therapy is one facility that has reported having had to cancel treatments based on the new restrictions.

While reiterating that intravenous ketamine must continue to be delivered in a non-hospital accredited facility or in a hospital, the new Guidelines state that other routes of ketamine may only be given in outpatient or community settings only if the facility applies for an "exemption" and if all of the requirements of the bylaws are met, which include additional cost-prohibitive monitoring requirements (see detailed outline of changes below).

These guidelines came as a surprise to physicians who have been safely doing ketamine-assisted therapy in the province for years.

"The fact that all dissociative, non-intravenous ketamine treatments must be administered by a physician trained in anaesthesia and sedation is significant.  This will add a considerable cost to patients for an already expensive treatment." - Dr. Monika Hooper MD, Clinical Assistant Professor of Psychiatry, University of Saskatchewan.

Analysis of the new Saskatchewan Guidance Documents:

Guideline	Impact
The new Guidance document states that practitioners in community-based settings (without a physician trained in sedation) must only administer ketamine in sub-dissociative/sub-anesthetic doses	KAT at a sub-dissociative dose is probably no more effective than psychotherapy alone. Clinically it is demonstrated that KAT with a dissociative dose of ketamine is what makes KAT effective. Treatments in Saskatchewan have already been restricted due to this new Guideline.
The Guidance document recommends that ketamine administration and monitoring should be limited to physicians who: are trained in the use of ketamine for sedation and anesthesia (anesthesiologists, ED physicians, critical care, GP anesthesia, pain fellowships, etc)	This will significantly impact the availability and increase the cost of KAT. Instead, the intent of this requirement could be easily met by having a qualified medical professional on-site who is trained to respond to cardiovascular and airway emergencies.
can perform the appropriate monitoring, and possess the appropriate training, skills, and currency in the use of this medication and in the appropriate emergency response to any adverse events.	This removes the ability of psychiatrists to primarily administer and monitor patients receiving ketamine for mental health conditions via non-intravenous routes (intramuscular, subcutaneous, oral, sublingual and transdermal). A physician trained in the use of ketamine for sedation and anesthesia must administer and monitor the patient. This, again, has restricted access treatment to existing patients in the province.

Ketamine, when used off-label for mental health conditions, including depression, anxiety and others, can produce rapid-acting benefits and show a high rate of effectiveness compared to other available treatments. When given at doses below those used for anesthesia or sedation, ketamine is a safe medication that does not require extensive monitoring.  KATA has written "Outpatient Use of Ketamine for Mental Health Conditions - Practice Standards Recommendations". These recommendations outline: patient care and monitoring, staffing and session requirements, emergency equipment and procedures, emergency management, and physician competencies and training. KATA's recommendations for patient monitoring are consistent with the College of Physicians and Surgeons of BC, Interim Guidance and the College of Physicians of Alberta Ketamine and Esketamine Clinical Toolkit, which state that physicians may prescribe ketamine if they have the competence to manage any adverse reactions.

KATA Canada is encouraging regulators to engage in a consultation process that includes more experts in their respective fields. KATA is also encouraging patient groups and other stakeholders affected negatively by these regulations to share their feedback.

About KATA Canada:

The Ketamine Assisted Therapy Association of Canada (KATA) is an interdisciplinary, not-for-profit organization established in 2019 that supports practitioners and physicians to provide ketamine assisted therapy, and is informed by evidence-based safety and ethics standards that respect patient values. KATA advances ketamine clinical practice, protects the public interest through conducting research, as well as publishes clinical resources, practitioner education and policy recommendations.