TL;DR
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Psychiatrists writing in MedPage Today argue that uneven safeguards for off-label ketamine prescribing can leave patients with addiction histories at risk. Presley Gerber’s death is under investigation as a suspected overdose, but his official cause of death is pending; reports about his treatment have not established that ketamine caused his death.
Three psychiatrists are calling for clearer safety standards for ketamine prescribing, citing reports that model Presley Gerber had received the drug for months despite a history of addiction. Gerber, 27, died on September 20; his death is being investigated as a suspected overdose, but his official cause of death is still pending, according to a commentary published by MedPage Today on October 11.
The commentary’s authors—Tucker Avra, Renée Sorrentino and Fernando Espi Forcen, psychiatrists who work with addiction—say uneven rules for off-label ketamine treatment can leave important risks unaddressed. Reports cited in the article say Gerber’s friends said a doctor prescribed ketamine for months while aware of his addiction struggles. The authors’ account is not a finding from an investigation, and the available source does not establish the doctor’s actions or the cause of Gerber’s death independently.
The authors compare the case with that of actor Matthew Perry. His autopsy identified acute ketamine effects as a contributing factor in his death. A doctor who had prescribed ketamine to Perry, despite knowing of his history of addiction, later pleaded guilty to distributing ketamine without a legitimate medical purpose, the commentary says. It also says the fatal dose came from another source. The two cases raise questions about prescribing decisions, but they are distinct and do not establish that all ketamine treatment is unsafe.
Ketamine has been used as an anesthetic since 1970. The FDA approved esketamine, sold as Spravato, for treatment-resistant depression in 2019; it is subject to a Risk Evaluation and Mitigation Strategy, or REMS. Ketamine itself is also prescribed off-label for conditions including depression, post-traumatic stress disorder and obsessive-compulsive disorder. The authors say off-label treatment does not have a comparable mandatory safety program.
The Safety Gap in Ketamine Care
The issue matters because ketamine can offer a treatment option while also carrying risks that require screening, monitoring and informed decisions. The psychiatrists say a patient’s history of substance use disorder should prompt careful assessment, consistent with guidance from the American Psychiatric Association and the Spravato prescribing label. For off-label ketamine, however, whether that assessment occurs may depend on the provider, according to the authors.
The commentary describes potential concerns including at-home use without adequate supervision, insufficient monitoring during intravenous or intramuscular treatment, online prescribing without in-person evaluations, and incomplete informed consent. These are risks the authors identify, not proof that every clinic or telehealth provider operates this way. They argue that consistent standards could help patients understand risks and give prescribers a clearer basis for deciding when treatment is appropriate or should be withheld.
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Different Rules for Ketamine Products
Ketamine clinics have expanded as demand from patients and clinicians has grown. The authors report that the Massachusetts General Hospital Ketamine Clinic for Depression has delivered more than 11,000 infusions and quadrupled its treatment volume since opening in 2018. They say research and their experience suggest ketamine use disorder is uncommon in supervised, in-person depression treatment, while cautioning that the effects of a shift toward longer-term use are largely unknown.
The commentary also cites a rise of more than eightfold over the past decade in the number of people starting treatment for ketamine addiction in the United Kingdom. It does not specify the underlying counts or provide a U.S. equivalent, so the figure should not be read as a measure of U.S. treatment trends. The authors say the American Society of Anesthesiologists has warned that access is expanding faster than safety standards and called for stronger oversight of at-home delivery and ketamine clinics.
The article says the U.S. ketamine market has exceeded $5 billion and is projected to surpass $14 billion by 2035. Those market figures frame the expansion of treatment, but do not by themselves establish how many patients receive ketamine or how often complications occur.
“Celebrity status does not alter the standard of care, and medical decisions should reflect medical necessity, not notoriety.”
— The commentary’s authors
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Gerber’s Cause of Death Is Pending
Gerber’s official cause of death remains pending, and the investigation is described as one into a suspected overdose. The source does not provide toxicology results or establish whether ketamine was involved in his death. Reports about a doctor’s prescribing and awareness of Gerber’s addiction history are presented in the commentary as accounts from his friends; they are not reported here as independently verified findings.
The broader evidence also leaves open questions. The authors say the long-term effects of chronic ketamine use are largely unknown and that ketamine addiction is poorly defined in psychiatric guidelines. The commentary does not supply a uniform estimate of risks across treatment settings, nor does it detail the outcomes of the lawsuits it mentions against telehealth companies.
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Calls for Consistent Prescribing Standards
The immediate development to watch is the outcome of the investigation into Gerber’s death, including any official cause-of-death determination. The commentary does not give a date for that finding. Until then, claims linking his treatment to his death should remain unconfirmed.
The authors call for an evidence-based standard of care that accounts for ketamine’s potential benefits and patient risks. They say prescribers should understand the drug’s risks, document the reasoning behind decisions involving patients with addiction histories, and decline treatment when risks cannot be managed. The source does not announce a new regulation or policy change; whether professional bodies or regulators will adopt additional safeguards remains unclear.
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Key Questions
Has ketamine been confirmed as the cause of Presley Gerber’s death?
No. His death is being investigated as a suspected overdose, but the source says his official cause of death is pending and gives no toxicology result.
What safety concern do the psychiatrists raise?
They say safeguards for off-label ketamine prescribing are inconsistent. In particular, assessment of substance-use history, treatment monitoring and informed consent may vary among providers.
How is ketamine treatment different from Spravato treatment?
Spravato is esketamine, a specific form of ketamine approved by the FDA in 2019 for treatment-resistant depression and subject to a REMS program. The authors say off-label ketamine prescribing does not have a comparable mandatory safety program.
No. They call for careful, documented risk-benefit decisions. They argue that prescribers should withhold treatment when its risks cannot be managed, rather than treating addiction history as an automatic rule in every case.
What happens next?
Gerber’s cause of death remains pending. The authors are calling for clearer, evidence-based prescribing standards, but the source does not report a new regulation or a timetable for policy action.
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