Special K is coming to the VA. In a groundbreaking decision aimed at stemming the tide of suicide and self harm in the armed forces, the US Department of Veterans Affairs has approved the prescription of Spravato, an FDA-approved form of the Schedule II narcotic ketamine.

The first ketamine-based pharmaceutical with an FDA go-ahead for the treatment of clinical depression, Spravato users must be supervised by a physician and observed for at least two hours after use. For veterans, Spravato will be a last resort prescription, reserved for patients whose symptoms have been resistant to other medications. 

Originally used as an animal tranquilizer and later popularized as a recreational party drug, ketamine — and its active ingredient, esketamine — is a powerful anesthetic with euphoric and occasionally psychedelic properties. Even at lower doses, ketamine can trigger a “k-hole,” a dissociative effect where the consumer withdraws into a hypnotic-like state.

“We’re pleased to be able to expand options for veterans with depression who have not responded to other treatments,” said Robert Wilkie, a VA Secretary in a statement. “It reflects our commitment to seek new ways to provide the best health care available for our nation’s veterans.”

Ketamine treatments have long been available in generic forms from clinical physicians around the country. But with the approval of Spravato in March of this year, the drug gained a societal approval that previously hadn’t been cracked. For some veterans who have used ketamine in the past, however, the VA’s approval of Spravato comes with a host of unwanted side effects, including a painful reminder of the agency’s outdated stance on cannabis. 

“Ketamine was the most effective drug I’ve ever taken for suicidal thoughts — but it is not a long-term medicine you should use. I got psychologically addicted to it for four years,” Sean Kiernan, president of the Weed For Warriors Project, a veterans-focused cannabis advocacy group, told the Sarasota Herald-Tribune.

“The danger with ketamine is the side effects,” Kiernan continued. “I’ve had three surgeons telling me I need to have my gallbladder removed. My question is, why are you so willing and eager to accept something that, on the face of it, is the very thing you complain about with marijuana, like THC, which isn’t nearly as strong? This is hypocrisy, and it makes no sense.”

Even in states where it is legal, Veterans Affairs officials have continually denied returning soldiers’ access to medical marijuana, citing federal prohibition and potential threats to the agency’s funding. 

Spravato is now available to veterans in VA medical facilities across the country, with the drug’s high cost entirely covered by the federal agency.

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