'I legally signed up for endless ketamine therapy in minutes - the tranquilizer that killed Matthew Perry': Inside America's latest drug craze

'I'm tired, I'm ready to call it a day,' says the psychiatric nurse about to dole out my first ever ketamine prescription.

It's the start of our video consultation that I'm hoping will be a rigorous assessment of my suitability for a new and potentially risky treatment for anxiety and depression.

It doesn't fill me with confidence.

But this is how tens of thousands of Americans are now getting their ketamine fix: a tick-box online questionnaire, a cursory virtual assessment and a mail-order delivery that lands on their doorstep within days.

It is all perfectly legal. But the ease with which customers can now access the sedative, which is sometimes abused as a street drug, has sparked warnings among the medical community that profit-hungry clinics are putting lives at risk.

Matthew Perry's tragic death has shone a light on America's ketamine boom. The Friends actor died from an overdose of the drug. Police have opened an investigation into his death

Evidence suggests that ketamine is on the rise both recreationally and medicinally

The tragic death of Matthew Perry, who overdosed on ketamine, has put the drug's booming popularity in the spotlight.

Evidence suggests it is on the rise both recreationally and medicinally, as more Americans look to alternative forms of therapy.

Celebrity users are partly responsible. Elon Musk has said he has a prescription for ketamine for when his 'brain chemistry goes super negative', while Sharon Osborne underwent three months of ketamine therapy.

Pete Davidson, meanwhile, admitted that he was hooked on the drug, taking it daily for four years before checking into rehab. He subsequently took the drug to treat his depression.

But medical experts have also accused freewheeling online clinics of fueling the craze.

Many, including the online service I have approached, offer mail-order prescriptions such as tablets and nasal sprays at eye-watering prices.

The drugs are shipped to patients, who are then free to take them without medical supervision, contrary to guidance by the Food and Drug Administration (FDA).

This hands off approach allows firms to reduce their own costs and reach tens of thousands of customers. It has attracted millions of dollars from investors.

But some experts say the practice is irresponsible.

Celebrity users such as Elon Musk, who has a ketamine prescription, have fueled its rise

Dr Gerard Sanacora, director of the Yale Depression Research Program who led a team that pioneered ketamine to treat depression, told DailyMail.com that this form of therapy could be 'life saving'.

But he added: 'It also has the potential to be a dangerous treatment for a lot of people if not done carefully, responsibly, and with close monitoring.'

Dr Caleb Alexander, an epidemiologist and professor at John Hopkins Bloomberg School of Public Health, has previously described it as 'a recipe for disaster'.

His last known infusion was a week and a half before his death. The medical examiner noted the ketamine found in his bloodstream could not have been from that session as it typically disappears from the system in a matter of hours

Sharon Osborne said she underwent three months of ketamine therapy

Pete Davidson admitted that he was hooked on the drug, taking it daily for four years before checking into rehab. He subsequently took the drug to treat his depression

The clinic I have signed up to, which DailyMail.com has chosen not to name, is offering me a plan that costs $129 a month and includes a package of ketamine lozenges.

Before booking my virtual consultation, I am asked to fill out a short online survey which essentially amounts to: Are you over 18? Are you sad? And do you have any pre-existing medical conditions?

Any hope that my video call might lead to a more meaningful discussion over whether the drug is right for me quickly evaporates.

The nurse appears disinterested, likely reading from a script, and eager to be through with the whole ordeal.

It appears not to matter that I have never been diagnosed with depression or anxiety, nor have I even been to therapy, nor at any point ever really had my mental health professionally examined.

In reality, I am probably fine. I don't need this.

But why not just sell me some ketamine anyway?

After ticking off a few of these points, the nurse tells me that, as my treatment progresses, I'm 'going to start being like, much more calmer…less stress, less anxiety'.

'You'll be energetic, optimistic about life and who you are, and you're just like, basically, looking forward to each day,' she adds.

Sign me up.

But what I am not told about is an FDA warning issued in October, in which the agency voiced concerns over the increased use of ketamine therapy.

It warned that the drug, which is approved as an anesthetic, is not approved for the treatment of psychiatric disorders.

'FDA is aware that compounded ketamine products have been marketed for a wide variety of psychiatric stress disorders (e.g. depression, anxiety, post-traumatic stress disorder ... and obsessive-compulsive disorder); however, FDA has not determined that ketamine is safe and effective for such uses,' the statement read.

Use of ketamine for those treatments without monitoring 'may put patients at risk for serious adverse events,' the agency added.

The one-sided narrative peddled by online clinics is rife.

Ketamine firm Joyous, for example, includes a quote, attributed to Yale research, that states: 'The rapid therapeutic response of ketamine in treatment-resistant patients is the biggest breakthrough in depression research in a half century.'

While Yale and Dr Sanacora do advocate the potential benefits of ketamine administered under medical supervision, they categorically do not support at-home ketamine treatment offered by firms such as Joyous.

Joyous said its website did not claim that the university endorses mail-order ketamine. 

Another online clinic, Mindbloom, which offers mail-order ketamine therapy for up to $359 a month, claims that 89 percent of its clients report improvement for anxiety and depression.

But the figure comes from a study where more than half of participants didn't report any follow-up data.

The research, titled 'At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression', has been met with public criticism by Dr Sanacora.

In a written response, the professor and his Yale colleague Dr Samuel Wilkinson said they objected to the title of the paper 'for several reasons', adding that 'the authors' conclusions go well beyond the data'.

They continued: 'Potential worrisome scenarios with at-home ketamine administration include drug diversion, abuse, and dysphoric reactions which could leave patients in a fearful and paranoid state without appropriate monitoring that could lead to harm of self or others.'

Dr Sanacora's letter was sent in August 2022, but Mindbloom still proudly trumpets the paper as 'the largest ketamine therapy study to date' on its website.

The Yale professor told DailyMail.com that he regularly has to comb through marketing material of ketamine clinics and ask them to remove out-of-context quotes and his photograph.

Mindbloom's Chief Strategy Officer, Mike Petegorsky, said in response that online clinics make ketamine therapy 'accessible and affordable for people in need'.

'I've seen the concerns about at-home ketamine therapy, but I haven't seen data to support them,' he added.

Mail-order ketamine clinic Joyous includes a quote from Yale research stating that the treatment is 'the biggest breakthrough in depression research in a half century'

These mail-order clinics, including Mindbloom, which offers at-home ketamine therapy for up to $359 a month, have been accused of putting patient safety at risk by medical experts

Back to my consultation, and I am being told that after I start my treatment, my point of contact for up to four weeks will be via text.

I will send feedback to an AI tool, which collates data to be analyzed by a doctor.

They can then increase my dosage before I have a full follow up consultation on my progress.

This rings alarm bells for Dr Sanacora. 'If you start a regular antidepressant and don't have a follow up with a licensed professional in a relatively short amount of time, that could be considered negligence,' he said.

'This is really pushing it to the limits. Not having some follow up is definitely concerning.'

Before I am sent the ketamine, there is at least some due diligence.

I am asked to provide blood test results so they can check my liver is healthy - as this is the organ that processes ketamine.

But once that is cleared, the drugs are mine.

The degree of pre-treatment scrutiny varies across the board. Innerwell, which offers an eight-week at-home ketamine course for upwards of $900, requires an hour-long medical consultation before the patient is signed off.

Dr Sanacora, however, is skeptical as to whether any degree of screening can make unsupervised ketamine treatment safe.

'You can minimize the risk, but you can never eradicate it,' he said.

The clinic used by DailyMail.com said that all medical staff are licensed nurse practitioners who are put through a 'rigorous onboarding process'.

The firm added that if its team detected any issues with the medication from a patient's texts, they are required to meet with a practitioner 'as soon as possible'.

It also said its lozenges used microdoses, which prevent 'overwhelming or intense experiences' and ensures patients 'are coherent and fully oriented when taking the medication'.