— The path to safe care requires establishing standards built on protecting patients
by Tucker Avra, MD, Renée Sorrentino, MD, and Fernando Espi Forcen, MD, PhD
October 11, 2026 • 3 min read
Presley Gerber, a model and the son of the supermodel Cindy Crawford, died on September 20 at 27 years old, after years of public struggle with addiction. His friends say a doctor had been prescribing him ketamine for months, despite being aware of his strugglesopens in a new tab or window with addiction. While his death is being investigated as a suspected overdoseopens in a new tab or window, his official cause of death is still pending.
As psychiatrists who work with addiction and have published on ketamine addiction -- a condition that is still poorly defined in psychiatric guidelines -- the reports about Gerber's care are all too familiar.
Another high profile case tells a similar story: Matthew Perry was prescribed ketamine by a doctor who knew about his decades of addiction, and who later pleaded guiltyopens in a new tab or window to distributing ketamine without a legitimate medical purpose. Perry's autopsy confirmed the acute effects of ketamineopens in a new tab or window as a contributing factor to his death. The dose that killed him came from another source, but the doctor had already prescribed the drug for him.
In both the Perry and the Gerber cases, the doctor was allegedly aware of their patient's addiction history and still prescribed ketamine. Ketamine is a legitimate and effective treatment for several mental health conditions. Still, inconsistent standards of care, especially around off-label prescribing, allow a risk factor like a history of addiction to go unaddressed.
Ketamine was approved in 1970 as an anesthetic, and in 2019 the FDA approved esketamineopens in a new tab or window (Spravato), a specific form of ketamine, for treatment-resistant depression. Esketamine is only available through a Risk Evaluation and Mitigation Strategy (REMS). Ketamine is also prescribed off-label for a wide variety of conditions (major depressive disorder, post traumatic stress disorder, obsessive-compulsive disorder) but with no comparable safety program.
The emergence of ketamine clinics throughout the U.S. reflects the growing demand amongst both clinicians and patients. In our experience at tertiary care centers, ketamine clinics have become an integral part of outpatient clinics. The Massachusetts General Hospital (MGH) Ketamine Clinic for Depression, for example, has provided over 11,000 infusionsopens in a new tab or window and has quadrupled in treatment volume since opening in 2018. In such supervised and controlled, in-person ketamine clinics for depression, research and our experience suggest that the prevalence of ketamine use disorder is lowopens in a new tab or window.
However, we are witnessing a shift towards chronic ketamine use rather than acute ketamine courses, and the effects of chronic use are largely unknown.
In the U.K., the number of people starting treatment for ketamine addiction has risen more than eightfoldopens in a new tab or window in the last decade. Guidance from the American Psychiatric Associationopens in a new tab or window (APA) and the Spravato prescribing labelopens in a new tab or window highlight a history of substance use disorder as a reason for careful assessment before prescribing. For off-label use of ketamine, whether a patient gets this assessment can depend on which prescriber they happen to see, and unlike esketamine, no mandatory safety program backs it up.
Additionally, there is no single, consistently enforced standard of care across ketamine clinics and telehealth providers. The potential for ketamine malpractice includes unsupervised at-home use, inadequate monitoring of intravenous or intramuscular sessions, prescribing via online platforms without in-person evaluations, and lack of informed consent. This so-called "Wild Westopens in a new tab or window" terrain for prescribing has resulted in several lawsuits, including those against telehealth companies that provide at-home ketamine treatmentsopens in a new tab or window.
The U.S. ketamine market has passed $5 billionopens in a new tab or window, and is projected to reach more than $14 billion by 2035. The American Society of Anesthesiologists warns that access to ketamine is expanding faster than patient safety standards and have called for stronger oversight of at-home ketamine delivery and increased provider oversight in ketamine clinics.
Doctors prescribing ketamine should be trained in and familiar with the potential risks of ketamine. Importantly, prescribing ketamine to a patient with a known addiction history requires risk-benefit decision-making that is both discussed and documented in the medical record. Competent prescribing also requires doctors to withhold treatments that carry unmanageable risk, regardless of the patient's preferences or celebrity status. Celebrity status does not alter the standard of care, and medical decisions should reflect medical necessity, not notoriety.
The path to safe medical care will require establishing a standard of care built on protecting patients. No matter what Gerber's toxicology report shows, we still must ask: to what standard should we hold every ketamine prescriber? The answer must be a clear, evidence-based response that acknowledges ketamine's efficacy while balancing the risk to patients.