A commercial medical clinic set up to profit from the sale of an unapproved prescription depression treatment has been offering take-home packages of up to 10 doses of ketamine and teaching patients how to inject the drug.
An ABC investigation can reveal Aura Medical has been offering the DIY option for months at its Sydney and Melbourne clinics so patients can self-administer the highly restricted drug without medical supervision.
It is just one of a number of serious concerns raised by former staff and patients who allege “client liaison officers” and managers are pressuring patients to sign up to the treatment, which costs up to $1,200 for a four-week course of eight injections.
Ketamine is an approved anaesthetic, a party drug and a schedule 8 controlled substance in Australia and can only be prescribed by a doctor.
Despite several clinical depression trials showing a dramatic short-term improvement in mood, ketamine is not approved for the treatment of depression by the Therapeutic Goods Administration (TGA) and the long-term safety of regular use has not been established.
The ABC has obtained receipts, photographs, one of the take-home syringe packages and other evidence from patients and whistleblowers who say they are alarmed by practices at the clinics.
The ABC spoke to one former staff member who alleged about 25 patients a week were being given pink zip-up packs of ketamine syringes to take home from the Melbourne Aura Medical clinic.
The former employee, who does not want to be named for fear of retribution, said at first patients had two consultations before being offered the drug.
“Then they started prescribing and dispensing on the same day when the managers pushed for more patients to be seen,” the former employee said.
“The doctors were under a lot of pressure.”
The staff member said they decided to quit after seeing high school students attending the clinic for treatment.
“I felt like they were taking advantage of depressed people coming in, the whole time I was there I only saw one person (seeking ketamine) turned away,” the former employee said.
“A lot of patients are hooked on it, and don’t want to say anything bad about the company.”
Patients call for greater regulation for ketamine clinics
Aura Medical patients have told the ABC they were never told ketamine was not approved by the TGA for the treatment of depression and were not offered any other treatment options or psychiatric support after taking the drug home.
Jennette Jenkin was told the company was running a “medical trial” when she visited Aura Medical’s Sydney Clinic for depression treatment this year.
“When they told me how much the injections were — they would have cost me $300 a week — which I could not afford,” she said.
“So they said we will give you a discount, (they said) make it $260.”
Ms Jenkin, who has been suffering from depression for more than 18 years, said she was desperate for help so she agreed to a course of eight injections.
“Both my daughters have had depression, one of them is still medicated, my eldest son, I believe, suffered from depression but he took his own life,” she said.
After finishing the prescribed course, she alleged the doctor told her she would need more ketamine and it could be dangerous to stop taking the drug suddenly.
“They said things had changed, that I would need another six injections, and I just couldn’t see myself affording more,” Ms Jenkin said.
“I started to question things, even the first time I saw them and how short my appointment was, they didn’t require anything from me … no confirmation from my GP.”
She was also given the ketamine in vials to take home and taught how to draw the liquid into syringes.
“I was not going to inject myself with the five injections at once, but who knows what anyone else would do,” Ms Jenkin said.
“During the time I had taken those injections home, they didn’t call me [or] contact me to find out how I was going, nothing.”
Ms Jenkin said she also felt pressured by a manager at Aura Medical’s Sydney Clinic to commit to the treatment.
“(She) seemed to be pushing it, even my husband felt the same way, I guess because she mentioned the Black Dog Institute were doing trials as well, and that made me think it should be legit,” she said.
Psychiatrists concerned controversy could compromise treatment
The Black Dog Institute has become so concerned about the situation it has issued a position statement warning patients not to attend commercial ketamine clinics.
The institute is conducting an approved clinical ketamine trial in conjunction with the University of New South Wales.
Psychiatrist Professor Colleen Loo said her staff were fielding dozens of inquiries a week about Aura Medical’s trials.
“We don’t work with them, they are not collaborating with us and some of the things we are hearing are quite concerning,” she said.
“We don’t have clinical data on the long-term effectiveness and safety of giving ketamine as a clinical treatment, it’s something we need to look at further in research.”
Professor Loo said she was very concerned about claims the clinic was giving patients the schedule 8 drug to inject at home.
“I think it is extremely risky to be giving people vials to take home and inject themselves,” she said.
“I think the treating doctor has a clinical responsibility to see exactly how these treatments are being administered.
“(Doctors) also have a responsibility for following them up … who is monitoring these patients?”
The side effects seen in recreational ketamine users can include bladder and brain damage.
But Professor Loo is also concerned patients could be at risk of suicide without psychiatric support.
“If they have a rollercoaster ride of feeling better or worse you could place them at risk of ending their lives,” she said.
“It’s very important … this kind of treatment it is done in a very carefully monitored clinical context with experts in psychiatry and mental health.
“If people try to bypass that and prematurely use it clinically, and then maybe find people are having terrible side effects — maybe becoming suicidal, developing liver damage, damage to their bladder — that could derail the whole process of developing what could actually be a useful drug.
“That would be a great pity.”
Patient took home more than a dozen ketamine syringes
Another patient, who wants to be known only as Claire, visited Aura Medical’s Melbourne Clinic, suffering from major depressive disorder, bipolar disorder and post-traumatic stress disorder.
Claire said she initially felt better after the first few injections and was given several packages of the injections to take home.
“They were packed in a pink little zip-up case,” she said.
“The syringes had actually been backdated and were labelled with my name incorrectly spelled and a doctor’s name on it that I had never seen in my life.”
Receipts provided to the ABC showed Claire spent more than $2,500 on ketamine injections over several months.
“It’s wrong and they are getting a lot of money out of a lot of people. Some of these people, I don’t think they even understand what anxiety is and what it is to suffer from major depressive illnesses,” she said.
She said although she had experienced some short-term results, she could not afford weekly treatment.
“I had no other options, I still don’t until proper clinics can come up where they actually monitor people and there’s proper screening processes,” Claire said.
“They just need to really be closed down; they need to be closed down right now.”
Regulatory loophole in prescribing ketamine
Because ketamine is a schedule 8 prescription medication, being used off-label for depression treatment, its use is not governed by the TGA.
In a statement, NSW Health said it was generally concerned about any practice where patients were provided with injectable schedule 8 drugs for self-administration.
The Australian Health Practitioners Regulation Agency (APHRA) said it could only investigate complaints about individual doctors, nurses or pharmacists.
AHPRA encouraged anyone with any information about possible risks to public safety to contact them on 1300 419 495.
Last month the company’s medical director Professor Graham Barrett, a lecturer at the University of Melbourne, told the ABC he had resigned from the position, citing a conflict between his work as a medical researcher and the company’s profit-driven approach. Aura Medical has been contacted for comment.