Stringent safeguards in place to prevent abuse of ketamine spray used to treat depression

Esketamine, an anaesthetic derived from Ketamine, was approved for use in treating patients with Major Depressive Disorder (MDD) by the Health Sciences Authority (HSA) back in Oct. 2020.

Ketamine is a controlled drug, and those found illegally possessing the drug are liable to a maximum of 10 years of imprisonment or a fine of S$20,000 or both.

Ketamine, when abused, can be tremendously harmful and addictive.

Nevertheless, esketamine, a dissociative hallucinogen that is administered by nasal spray, can be beneficial within a clinical setting, Senior Minister of State for Health Janil Puthucheary explained.

"Clinical trials have demonstrated that ... the benefits of ketamine nasal spray outweigh its risks," Puthucheary said.

He was responding to a query raised in parliament on Feb. 5, 2025, by Member of Parliament Wan Rizal about the steps taken to regulate the use of ketamine for treatment in Singapore.

Several safeguards in place: Puthucheary

Puthucheary said that, despite being approved for use, ketamine is "kept under lock and key, with stringent records of the product inventory".

Ketamine can only be supplied to hospitals and can only be prescribed for use by registered psychiatrists.

It is also strictly administered under nursing supervision, Puthucheary explained.

"Patients are continuously monitored during and after the treatment for adverse effects before they leave the clinical setting. Specialists also review patients regularly to assess treatment effectiveness," he added.

Number of patients who can benefit is 'relatively small'

Puthucheary noted that the number of patients who could potentially benefit from ketamine treatment is relatively small.

"The use of ketamine is not a substitute for all the other treatments that are available for the depression of the psychiatric treatment," Puthucheary added.

Education and counselling for patients and their families are conducted on a one-to-one basis by the clinical providers, Puthucheary explained.

All the same, the government is continuing to study the effectiveness of ketamine treatment, Puthucheary said, adding:

"There are many drugs with serious side effects or potential abuse and misuse, where use in a controlled setting is possible.

This is something that we've been doing for, for example, opioid agents, anaesthetic agents, and many other controlled drugs and substances where there is a public protection. It is a drug of abuse outside this control setting."

Top photo from Keck School of Medicine of USC Website & Canva