The rapid expansion of ketamine therapy for depression has outpaced standardization, creating a need for structured guidelines. Now, leading clinicians and researchers, including Osmind’s own Alison McInnes, M.D., M.S., (VP of Scientific Affairs), and Carlene MacMillan, M.D. (VP of Clinical Innovation), are bringing evidence-based standards of care to bring order and consistency to ketamine treatments.

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The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3), the largest society and think tank for ketamine practitioners, has launched of its Pledge Program, meant to provide practitioners with basic guidelines and standards for the administration of ketamine to treat mental health disorders and pain conditions.

The pledge program establishes clear protocols for patient screening, treatment administration, safety monitoring, and clinical documentation - essential elements for any practice offering ketamine therapy.

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The ASKP3 Basics of Ketamine Administration are as follows:

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1) Treatment Context

ASKP3 serves as a forum to discuss the use of therapeutic Ketamine for Non-Anesthetic Indications (KNAI). KNAI is fundamentally different than the traditional use of ketamine as an anesthetic.

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2) Administration Routes & Safety

ASKP3 does not endorse any particular route of delivery, however it is important that the combination of delivery and dose do not cross over from KNAI to a level of sedation inappropriate to the provider and clinical setting.
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• Multiple delivery routes accepted (IV, IM, IN, PO)
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• Dosing must maintain non-anesthetic levels
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• Setting must be appropriate to delivery method

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3) Patient Selection & Screening

Screening and selection of patients for ketamine treatment should be informed by direct research supporting a given use or the rational application of ketamine's mechanism of action towards addressing accepted medical pathophysiology.

Patients should be screened for and have been found to have a condition that is appropriate for ketamine treatment.

Evidence-based indications for ketamine include:

• Unipolar Major Depression
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• Bipolar Depression
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• PTSD
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• OCD
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• Anxiety
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• Eating Disorders
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• Suicidal Ideation
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• Fibromyalgia
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• CRPS
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• Other chronic pain conditions
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4) Medical Documentation and Screening

Screening and selection of patients for ketamine treatment should be informed by direct research supporting a given use or the rational application of ketamine's mechanism of action towards addressing accepted medical pathophysiology. A full history and physical including psychiatric disorders and substance abuse disorders should be completed in the patient's chart. The patient's medications and allergies should also be documented to reduce reasonable risk of medication interaction and side effects.

The following should be screened for and documented:

• Complete psychiatric history
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• Substance abuse disorder screening
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• Medication list and allergies
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• Documentation of potential interactions

5) Informed Consent

Obtain appropriate consent for ketamine treatment documenting risks, benefits and the off-label nature of ketamine for these disorders.

Given the off-label nature of ketamine use for these disorders, appropriate consent should be obtained:

• Clear communication of risks and benefits
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• Explicit acknowledgment of off-label use
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• Documentation of consent process

6) Protocol Transparency

Always make your basic protocol and details of treatment available to the patient upon request.

• Treatment protocols must be available to patients
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• No "secret formulations" or "proprietary blends"
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• Commitment to evidence-based medicine

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7) Monitoring & Safety

Document vital signs and any monitoring that may occur during administration, as well as appropriate indicators of patient status upon discharge from the clinic.
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Related Reading: Vitals Monitoring without Distraction
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The patient's vital signs should be monitored during administration and return to pre-administration values before discharge from the clinic. An appropriately licensed and qualified medical provider should be present during the administration as well.

In summary:

• Vital sign documentation during administration
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• Qualified medical provider present
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• Return to baseline before discharge
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8) Post-Treatment Safety

Advise patients receiving ketamine that they shall not drive themselves home from their appointment or operate heavy machinery, including automobiles, for 12-hours after infusion.
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Patients receiving ketamine therapeutically should not be allowed to drive themselves home from their appointment, or for 12 hours after their infusion.

In summary:

• No driving for 12 hours post-treatment
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• No operation of heavy machinery
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• Safe transportation arrangements required
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9) Medical Supervision

ASKP does not currently support the use of medically unsupervised parenterally administered ketamine unless warranted by extreme circumstances.
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They do not support the use of medically unsupervised parenterally administered ketamine except in circumstances where benefits clearly outweigh the risks (e.g., severe hospice pain).
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Pledge recipients further agree to uphold best practices in the administration of ketamine as outlined in the ASKP3 Standards. Pledge applicants must complete and submit the Pledge Agreement, annually. There is no cost for ASKP3 members to take the ASKP3 Pledge.
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Pledge recipients earn the Annual ASKP3 Pledge Program digital badge and receive a Pledge Certificate (available as a free download).

In summary:

• Supervised administration required
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• Exceptions only for extreme circumstances (e.g., severe hospice pain)
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• ASKP3 members can earn a digital badge and receive a pledge certificate

Why Standards Matter Now

For clinicians, these guidelines arrive at a critical juncture. Ketamine therapy has moved beyond academic centers into community practices. We need clear protocols to:

• Ensure patient safety
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• Build insurance company confidence
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• Maintain treatment quality
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• Support practice credibility
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• Advance field-wide acceptance
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Building on Real-World Evidence

These standards reflect years of clinical experience and research. With real-world evidence showing ketamine's potential - including data from thousands of patients demonstrating significant reductions in difficult to treat depression - standardization represents the next step in expanding access to care.

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Looking Forward

For clinicians currently offering or considering ketamine therapy, these standards provide a roadmap for implementing safe, effective treatment protocols while participating in the field's evolution.
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ASKP3 members can earn a digital badge and certificate by taking the pledge, demonstrating their commitment to these evidence-based standards at no cost. Annual renewal ensures ongoing dedication to best practices.
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Learn more about ASKP3’s standards of care here.