RESIDENT: A 42-month Report on Ketamine Prescriptions and Positive Urine Drug Screens in Alberta (UofA)
Presenting Author(s): Leslie TruongCo-Author(s): Dr. Jennifer Swainson, Dr. Carson Chrenek, Dr. Robert Tanguay, Dr. Esther Fujiwara
Date and time: 22 Mar 2025 from 12:45 to 13:00
Location: Hawthorn C
Abstract
Evidence for ketamine as an adjunctive treatment option for depression continues to grow, with intravenous (IV) ketamine being a 2nd line option and non-IV forms of ketamine such as sublingual and intranasal, being 3rd line options in the 2023 CANMAT guidelines.1 IV ketamine must be administered and monitored in a healthcare setting, which limits patients access due to low capacity of publicly funded programs, and due to cost of private clinics. To improve access, some clinicians in Alberta have elected to prescribe non parenteral forms of ketamine for patient use at home.2 Though abuse liability of ketamine has been considered low,3 home use brings potential for ketamine abuse and diversion. Our project aims to look at population data to understand whether there is a correlation between the numbers of ketamine prescriptions for depression (as per College of Physicians & Surgeons of Alberta) and the number of
positive urine drug screens in Alberta (as per Alberta Precision Labs) from December 1, 2020, to June 30, 2024. At the time of this submission, we have received ethics approval but are awaiting the data. We hypothesize that ketamine prescriptions have increased with increased evidence for its use in depression, but that positive drug screens have not. Data available to us at the time of APA will be presented. If there is a signal of increased positive urine drug screens for ketamine in conjunction with increased ketamine prescribing as that time-period progresses, clinicians and colleges may become alerted to reconsider safe prescribing practices.
Learning Objectives
1. Review recommendations for ketamine use for depression in the CANMAT 2023 guidelines;
2. Compare trends in ketamine prescribing for depression and positive ketamine urine drug screens in Alberta between December 1, 2020, to June 30, 2024; and
3. Propose safe prescribing practices of non-parenteral ketamine for depression in Alberta.
Literature References
1. Lam, Raymond W et al. “Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes.” Canadian journal of psychiatry. Revue canadienne de psychiatrie vol. 69,9 (2024): 641-687. doi:10.1177/07067437241245384
2. Chrenek, Carson et al. “Use of ketamine for treatment resistant depression: updated review of literature and practical applications to a community ketamine program in Edmonton, Alberta, Canada.” Frontiers in psychiatry vol. 14 1283733. 8 Jan. 2024, doi:10.3389/fpsyt.2023.1283733
3. Swainson, Jennifer et al. “Non-parenteral Ketamine for Depression: A Practical Discussion on Addiction Potential and Recommendations for Judicious Prescribing.” CNS drugs vol. 36,3 (2022): 239-251. doi:10.1007/s40263-022-00897-2