Aug 22, 2026

On Telehealth: At-Home Ketamine Is Healthcare

There is a robust history of the medically therapeutic use of ketamine beyond the medical setting

Michael DeMarco has specialized in emerging therapies (PhD Clinical Sexology) in psychedelic medicine (MAPS 2021, CIIS Certificate in Psychedelic Therapy & Research 2022), offering cognitive behavioral mental health support in person and via telehealth since 2003.

The discourse surrounding ketamine therapy often frames in-clinic IV infusions or intranasal esketamine as the gold standard, dismissing alternative routes of administration or settings as inferior or reckless. Proponents of these clinical monopolies have argue that bypassing first-pass liver metabolism and/or a sharp, immediate concentration peak in the bloodstream is uniquely effective. However, looking closely at pharmacology reveals that this argument collapses under the weight of everyday medicine, just as it does in traditional psychedelic medicine practice.

Common medications taken safely by mouth—such as the cough suppressant dextromethorphan—rely entirely on first-pass metabolism to generate active metabolites that drive their therapeutic effects. Just as potent psychiatric medications like diazepam or midazolam, previously only administered in clinical settings, now have oral counterparts safely managed at home with clear instructions for safe use, and known examples of misuse, overdose and other harms that society generally deems as an acceptable risk in the use of the medicine. Racemic ketamine follows a logical parallel. When administered orally or sublingually, its slower, gentler onset curve lends itself naturally to a less intrusive environment than group iv clinic touting posh furniture and flat-screen televisions. Safe home use in doses have a history of being commonly prescribed and reported in the literature, with known results of misuse and potential for subsequent harms.

While safety guardrails are essential, claims that home administration lacks scientific precedent or operates as an unregulated "wild west" often ignore established telehealth protocols and the regulation of modern, licensed healthcare. Rigorous medical screening, carefully calibrated dosing, and the presence of a trusted support person create robust safety frameworks outside of sterile clinical settings.Ultimately, patients have a right to choose a care setting that honors their autonomy and fosters true psychological safety while following the guidance of their medical provider on the type of treatment, dosing and setting.

While prescriptions remain strictly the domain of licensed medical providers, the broader ecosystem of healing—including preparation, support, and integration—embraces a diverse network of psychotherapists, chaplains, and trusted companions. These people offer support by phone, in person, by text, video call, church, temple, retreat, or wherever appropriate.

The value of human support

That human support which factors into your ongoing health and wellness is often minimized in pharmaceutical research, ignoring an ongoing and robust history of the evidence for cognitive behavioral therapy and its antecedents since the late 1800's. Before western medical research, there is a history of indigenous practice with various medicines which we began calling "psychedelics" in the 1950's. In the history of shamanic practice, as well as in psychedelic medicine research- human support has been some aspect of psychedelic and plant medicine practice. That human support has ranged from shaman to psychiatrist, from chaplain to licensed mental health counselor, coach or death doula. These humans make their living by conscientiously practicing their vocations, and have to earn a living in order to provide that human support.

There is a long, documented history of the effectiveness of telehealth, as well as a long, documented history of how humans fight against new technologies, from electricity, to automobiles, to the internet, and now large language models (LLMs). Technology in psychedelic therapy can only assist, but never replace human support. AI cannot have a psychedelic medicine experience, but only give you a prediction of a human experience, based on stolen thoughts making up human knowledge. Virtual support, or someone being on the phone with you during your psychedelic medicine journey, or an expert to help you prepare for the experience and make sense of it afterwards– these are irreplaceable parts of human social relationships. Community-based care and at-home care, with a large infrastructure of accessible human support is what helps prevent the misuse and harm of a medicine, that for many, has been lifesaving.

Bed-ridden people in palliative care, hospice care, autistic children at the dentist's office, migraine-sufferers, the severely agoraphobic people with no local in-person healthcare options available – few of many reasons why a strict REMS protocol as used in Spravato or similar arguments by IV ketamine clinics.

Ketamine by mouth is low cost, metabolizes similarly to other medicines, and an infrastructure exists to support its use in out of clinic, non-medical settings. Ketamine is a psychedelic medicine, and psychedelic medicines throughout time have been taken outside of clinics. Normalizing these generic molecules, which can be compounded cheaply, and supervised by in person and telehealth specialists, prescribed by licensed medical providers will minimize the misuse and harms of these medicines, supported by evidence-based harm reduction and recovery resources, like Smart Recovery.

In some proposals, it has been recommended that two therapists be present at all times while the person is working with a psychedelic medicine, citing safety concerns and appropriate therapeutic boundaries. This is less of a concern when working via telehealth while the patient has their emergency contact safe person at home with them looking in on them regularly as directed by their medical provider, with instructions to call 911 should there be an unforeseen bad reaction to the medicine. All medicine molecules we put into our bodies have the possibility of negative, or adverse side effects.

There is a way to support the prescription of ketamine in home and community-based settings beyond the escalated level of medical care needed for iv's and injections. Intranasal ketamine and esketamine are also generic molecules which have been prescribed for years for non-clinic administration for pain and mental health indications, as have suppositories and subcutaneous injection.

An example of the other extreme is companies whose only concern is offering a subscription to medicine prescribed for daily use, touting company-sponsored research that suggests human support, such as psychotherapy, is unnecessary. The idea that taking a daily pill will treat your chronic condition has not worked for psychiatry thus far, as long as psychiatry ignores the social and other determinants of health. While it may be true that leaving the healing to figure it out for themselves, may work in some cases, it is strange to presume that human support, especially documented cognitive behavioral mental health treatment would have no effect on the outcomes. CBT, and other types of psychotherapy have been quantitatively studied for over 100 years. Any attempt to write out the human support in health and wellness and replace it with AI support, or no support at all, will continue to fail the majority of patients, and prolong suffering of billions around the world. Restricting healthcare and support to clinical medical settings creates barriers for the people who suffer most, who cannot access in-person healthcare.

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Psychedelic practitioner and independent researcher Michael DeMarco, PhD (Clinical Sexology) is a psychotherapist (MS Psychology- Marriage and Family Therapy) specializing in ketamine-assisted therapy offering international consultation in emerging therapies and psychedelic medicines (MAPS MDMA-Assisted Therapy 2021, CIIS Certificate in Psychedelic Therapies and Research, 2022).