Ketamine (colloquially called “K,” “Special K,” or “Vitamin K”) is a potent, dissociative anesthetic. More specifically, it is a nonselective NMDA antagonist that initiates a wide array of physiological effects, already having ingratiated itself to a wider audience through its potential for abuse. Once used primarily in veterinary medicine, ketamine in recent years, however, has seen its medical applications extend beyond the realm of anesthesia, with clinical options now including treatment for depression, chronic and acute pain syndromes, headache, alcohol and substance use disorders, and anosmia. Despite a seemingly endless array and number of rave patient reviews, research into ketamine’s non-anesthetic powers is somewhat limited, especially in terms of its treatment for anosmia. With the COVID-19 age creating an even greater sense of urgency in the treatment of smell loss and smell disturbances, and anywhere from 35 to 70 percent of patients experiencing anosmia or hyposmia as a result of COVID-19, larger randomized controlled clinical trials and studies will be required to determine ketamine’s overall efficacy as an agent for smell regeneration. Nevertheless, given its potential as a neuromodulator and agent for cell growth, ketamine may just be the answer doctors and patients alike are looking for to treat smell disorders.
Private ketamine treatment centers have suggested for several years now that interested patients can be cured of all of their various aches and ailments through weekly or monthly infusions. All that is required is the opening of the pocketbook. Recently published, public reviews of everyday patient encounters and even highway billboards portray an overall sense of relief from the broadest array of conditions, including status epilepticus, post-traumatic stress disorder (PTSD), bipolar disorder, fibromyalgia, and obsessive-compulsive disorder (OCD), in addition to those already mentioned above. With anosmia now surfacing and cementing itself into the forefront of popular culture and conversation, ketamine infusion centers have now not surprisingly begun to market their services to treat this new and growing patient population. But should patients trust what is being advertised here?
Both debilitating and life-altering, smell loss represents a field of otolaryngology with research still in its earliest stages. While only a handful of published studies have looked into different non-surgical treatment modalities for anosmia and hyposmia, the gold standard and ultimate remedy remains absent and non-established. Vacancies like this one have traditionally held promise for private investors and companies, like those involved in ketamine infusion, the so-called “miracle treatment.” For the patient, the difficulty comes in weighing the complex relationship between ketamine and its suppliers. Although ketamine has shown promise outside of its anesthetic effects, the hard research backing up its use and mechanism of action is debatable at best. With case reports listing anosmia as a possible side effect of ketamine use, the clinical picture becomes much foggier. Ketamine is also a lucrative business, and despite a number of animal model studies elucidating the positive connections between olfactory cells and ketamine, there is still reason to be pessimistic and wary amidst the overall sense of hope and excitement posed by ketamine and its usage across the United States.
So, my plea to the general public right now can be summed up in two words: Please wait. Having never suffered from permanent smell loss, I can only imagine and try to sympathize with patients that are going through this frustrating disease process. I also understand that regaining even a single percentage of normal smell for those who have been suffering from anosmia or hyposmia for years would in and of itself be an achievement. But the science is just not there right now. Just ask the patients who tried Zicam in their desperate attempt to achieve complete allergy resolution. They’ll tell you the same thing I am. Please. Wait.
Theodore Klug is a clinical research fellow.
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