ISO Ketamine troche providers in NYC, and fast.
June 27, 2023 2:17 PM Subscribe
After years of indescribably severe depression, things are finally looking just a little brighter wiith the help of months now of very high ( 100 mg/daily, though this does need to be increased further given my history and BMI, I think) ketamine troches (meltaway cubes). Like for so much else these days, an online subscription service with cutesy text-based customer care was happy to step in. They’ve become entirely too frustrating to deal wiith and even their “hardship” price too high for a basic anesthetic that should be prescribed like any other, where medically necessary. Thing is, they’re the only one I could afford on *very* limited means. Help me find a more NBD, conventional phone-call-to-the-local-compound pharmacy route to relief?
A few things to note:
I’m a 33 yo living in Queens, NY who has cerebral palsy as well as a documented history of severe depression and anxiety.
* I leave in a few days for a two-month stay abroad and have melted this month’s troches in the dryer like an idiot*
* I have tried desperately to get in touch with the people supposedly tasked with providing customer service. They’ve just been radio-silent despite my texting every one of the 10 numbers they text from, and this is the culmination of a pattern of the last few months of their attentiveness going downhill in a bad way*
Even at 70 dollars per month, they’re a significantly painful expense for someone needing to make do with 400 /mo in benefits/SSI. Even more painful considering I have a pretty excellent Medicaid plan (Healthfirst Medicaid) which would easily cover, I think, a medicine that happens to be helpful for both depression and pain from spinal fusion surgery last year, which I tolerate well and allows me to function.
* I am in no way interested in IV clinics, “integration therapy packages”, etc*. I have a long history of trying to go these routes. I couldn’t tolerate IV treatment and hated it, I am a long term meditator and hypnotherapy addict, and again… $$$. The troches are my only answer here.
*
I have also absolutely SCOURED Reddit and the internet and aside from the community’s go-to online doctors trolling the ketamine boards for new patients, and concierge or boutique practices here in the city, I can find nothing and no one who will pick up and continue what has been the only success I’ve had in this fight in 15 years, through telemedicine, by phone, text etc because my back is in constant spasm right now and can’t handle traveling to an appointment
Basically, I want what 15 years ago would have been Ketamine 100 mg qd in coconut oil base troche” scribbled on a piece of paper or called in, now is maybe e-prescribed, but because of its suffocating hype, has become complete drudgery to access for all but the tech bros
I need a doctor who doesn’t recoil at the request, whom I can see virtrually, *really* soon, who takes my insurance or can work with a lower fee, and whom I can access with the ease of a PCP/GP for both supervision and refills.
Hivemind, please tell me this unicorn is out there?
A few things to note:
I’m a 33 yo living in Queens, NY who has cerebral palsy as well as a documented history of severe depression and anxiety.
* I leave in a few days for a two-month stay abroad and have melted this month’s troches in the dryer like an idiot*
* I have tried desperately to get in touch with the people supposedly tasked with providing customer service. They’ve just been radio-silent despite my texting every one of the 10 numbers they text from, and this is the culmination of a pattern of the last few months of their attentiveness going downhill in a bad way*
Even at 70 dollars per month, they’re a significantly painful expense for someone needing to make do with 400 /mo in benefits/SSI. Even more painful considering I have a pretty excellent Medicaid plan (Healthfirst Medicaid) which would easily cover, I think, a medicine that happens to be helpful for both depression and pain from spinal fusion surgery last year, which I tolerate well and allows me to function.
* I am in no way interested in IV clinics, “integration therapy packages”, etc*. I have a long history of trying to go these routes. I couldn’t tolerate IV treatment and hated it, I am a long term meditator and hypnotherapy addict, and again… $$$. The troches are my only answer here.
*
I have also absolutely SCOURED Reddit and the internet and aside from the community’s go-to online doctors trolling the ketamine boards for new patients, and concierge or boutique practices here in the city, I can find nothing and no one who will pick up and continue what has been the only success I’ve had in this fight in 15 years, through telemedicine, by phone, text etc because my back is in constant spasm right now and can’t handle traveling to an appointment
Basically, I want what 15 years ago would have been Ketamine 100 mg qd in coconut oil base troche” scribbled on a piece of paper or called in, now is maybe e-prescribed, but because of its suffocating hype, has become complete drudgery to access for all but the tech bros
I need a doctor who doesn’t recoil at the request, whom I can see virtrually, *really* soon, who takes my insurance or can work with a lower fee, and whom I can access with the ease of a PCP/GP for both supervision and refills.
Hivemind, please tell me this unicorn is out there?
I feel for you, but ketamine is a schedule III drug--there's no NBD about it.
The DEA and NY state have temporarily lifted the requirement for an in-person visit before prescription of a controlled substance, so telemedicine (NOT a phone call or text; if you did not start your experience with this company with an a/v call or in-person visit, they're breaking the law) is theoretically possible. However, NY state forbids the refill of a schedule III drug more than 7 days before the end of the 30-day prescribing period unless the supply has been exhausted. I believe a prescriber has the discretion to treat a loss as exhaustion, but you would be asking to come in as a new patient, via telemedicine, with an urgent request to replace lost meds, which (sorry!) is going to look sketchy to, well, any non-sketchy doctor. The doctor is required to consult the NY state database for prior prescriptions before issuing one, so you can't just omit the fact of this month's prescription (in fact it would look worse).
Additionally, it doesn't look to me like ketamine for depression falls into any of the exemptions that permit a more than 30-day supply to be prescribed (maybe I'm wrong, but...it doesn't look like it), so your two-month trip would be a problem regardless.
Is there no one out there? I don't know, but I'm not surprised you're not finding anyone not an online semi-scammer. Please be careful, because you're threading a legal needle here. The only thought that comes to my mind is calling one of the more reputable local clinics, not for an infusion, but to see if they knew anyone you might be referred to, perhaps after an initial telemedicine visit to the clinic doctor. Good luck.
posted by praemunire at 7:55 PM on June 27, 2023 [12 favorites]
The DEA and NY state have temporarily lifted the requirement for an in-person visit before prescription of a controlled substance, so telemedicine (NOT a phone call or text; if you did not start your experience with this company with an a/v call or in-person visit, they're breaking the law) is theoretically possible. However, NY state forbids the refill of a schedule III drug more than 7 days before the end of the 30-day prescribing period unless the supply has been exhausted. I believe a prescriber has the discretion to treat a loss as exhaustion, but you would be asking to come in as a new patient, via telemedicine, with an urgent request to replace lost meds, which (sorry!) is going to look sketchy to, well, any non-sketchy doctor. The doctor is required to consult the NY state database for prior prescriptions before issuing one, so you can't just omit the fact of this month's prescription (in fact it would look worse).
Additionally, it doesn't look to me like ketamine for depression falls into any of the exemptions that permit a more than 30-day supply to be prescribed (maybe I'm wrong, but...it doesn't look like it), so your two-month trip would be a problem regardless.
Is there no one out there? I don't know, but I'm not surprised you're not finding anyone not an online semi-scammer. Please be careful, because you're threading a legal needle here. The only thought that comes to my mind is calling one of the more reputable local clinics, not for an infusion, but to see if they knew anyone you might be referred to, perhaps after an initial telemedicine visit to the clinic doctor. Good luck.
posted by praemunire at 7:55 PM on June 27, 2023 [12 favorites]
I've had multiple doctors say that ketamine would probably be life-changing for me, but no insurance company I've ever had would cover it, and I've searched for years for any source I could afford out of pocket, with no success.
posted by The Underpants Monster at 10:36 PM on June 27, 2023
posted by The Underpants Monster at 10:36 PM on June 27, 2023
In all honesty I'd reach out to friends to ask about buying ketamine for recreational use, then find diy troche recipes on Reddit or the like. You're much more likely to have luck with that at short notice, esp because ketamine is increasingly popular in non-clinical settings these days.
posted by knucklebones at 11:04 PM on June 27, 2023 [1 favorite]
posted by knucklebones at 11:04 PM on June 27, 2023 [1 favorite]
Uh, I wouldn’t be confident about the purity of recreational ketamine… unless it’s tested in front of your eyes by a rock solid testing kit/person ie someone from a public health unit. Lots of recreational drugs are being cut with fentanyl and other things (like Xylazine, which gives people necrotic sores. See https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf ). Please get it in a legit way!
posted by cotton dress sock at 1:21 AM on June 28, 2023 [7 favorites]
posted by cotton dress sock at 1:21 AM on June 28, 2023 [7 favorites]
Have you ever tried medical cannabis? It can potentially be helpful for a variety of ailments and might be more easily accessible.
posted by kinddieserzeit at 3:22 AM on June 28, 2023 [1 favorite]
posted by kinddieserzeit at 3:22 AM on June 28, 2023 [1 favorite]
I completely agree with the purity issues and need for testing, but shouldn't a large city like New York have a public testing facility? I live in a smaller city and we have a place where anyone can take their drugs to be professionally tested. I trust them not to test it in front of my eyes, they do take it and send it away and give you the results 3-4 days later.
posted by wheatlets at 6:17 AM on June 28, 2023 [1 favorite]
posted by wheatlets at 6:17 AM on June 28, 2023 [1 favorite]
I'm in biomed, and I'll second praemunire's and cotton dress sock's comments. I tangentially work in counterfeit pharm enforcement, and ketamine is currently the #1 most commonly counterfeited drug in the US in the sampling I'm privvy to. wheatlets, ketamine purity/identity testing is nowhere near that simple, fast, or reliable. If you want "real" identity/purity values, it's going to be through physicochemical assessments that will take a long time and cost figures ending in several zeros. Rapid test kits are either reagent approximation tests or antibody detection test kits, which might be kind of ok in a general sense but are often unreliable at best. They won't be returning dosage information, regardless. They're more like very limited scope identity/contamination tests.
I hate to say it, marsbar77, but this is a rock-and-a-hard-place situation. Your best (and maybe only) path forward is to be persistent with your subscription service (which... to be honest, I'm not sure what this outfit is and/or how legitimate their products and services are). I encourage caution in all aspects of this situation (like, is this a compounding pharmacy that shares with you a statement of assurance about the compunding/potency of the troches you're buying?). I have many questions, but those are above and beyond the request you've made here so I'll keep them to myself.
posted by late afternoon dreaming hotel at 6:41 AM on June 28, 2023 [4 favorites]
I hate to say it, marsbar77, but this is a rock-and-a-hard-place situation. Your best (and maybe only) path forward is to be persistent with your subscription service (which... to be honest, I'm not sure what this outfit is and/or how legitimate their products and services are). I encourage caution in all aspects of this situation (like, is this a compounding pharmacy that shares with you a statement of assurance about the compunding/potency of the troches you're buying?). I have many questions, but those are above and beyond the request you've made here so I'll keep them to myself.
posted by late afternoon dreaming hotel at 6:41 AM on June 28, 2023 [4 favorites]
I'd reach out to friends to ask about buying ketamine for recreational use
At this point, the danger of almost any street drug being contaminated with fentanyl is just shockingly high. There are test strips for the presence of fentanyl (and remember you'd have to test every dose separately, because contamination has no guarantee of being distributed evenly through your purchase), but then there's also xylazine coming in. Please don't do this.
posted by praemunire at 7:41 AM on June 28, 2023 [2 favorites]
At this point, the danger of almost any street drug being contaminated with fentanyl is just shockingly high. There are test strips for the presence of fentanyl (and remember you'd have to test every dose separately, because contamination has no guarantee of being distributed evenly through your purchase), but then there's also xylazine coming in. Please don't do this.
posted by praemunire at 7:41 AM on June 28, 2023 [2 favorites]
Response by poster: To clarify : I hadn't planned on going the DIY route for exactly the reasons mentioned above and also because it just has an ick/sketch factor to me that I'm not comfortable overlooking even if it were a safe thing to do. Answers unfortunately got way off track, though? gh that may be because I was trying to compose the question through miserable brain fog.
I'm absolutely not looking to "score K" or deal with anything or anyone shifty or irresponsible. Was just looking for an NYC doctor rec who both uses sound medical judgment and does not automatically shut down at the mention of ketamine for someone with legitimate, intractable and lifelong physical and mental pain. I absolutely welcome continued close monitoring and judicious care. I understand that maybe the question seemed to suggest I was fiending, had finished my monthly supply early etc but that is emphatically not the case and the assumption running through these answers is hurtful, even if well intended, if I'm honest. I'm just tired of the runaround and the faceless millennial services - I use Joyous which is the lesser evil of the Mindbloom/NueLife etc rolodex of problematic and prohibitively expensive outfits. Was looking for PCP level access to a medically necessary (for me) - controlled or not - treatment and through a legit NYC licensed pharmacy
posted by marsbar77 at 8:18 AM on June 28, 2023
I'm absolutely not looking to "score K" or deal with anything or anyone shifty or irresponsible. Was just looking for an NYC doctor rec who both uses sound medical judgment and does not automatically shut down at the mention of ketamine for someone with legitimate, intractable and lifelong physical and mental pain. I absolutely welcome continued close monitoring and judicious care. I understand that maybe the question seemed to suggest I was fiending, had finished my monthly supply early etc but that is emphatically not the case and the assumption running through these answers is hurtful, even if well intended, if I'm honest. I'm just tired of the runaround and the faceless millennial services - I use Joyous which is the lesser evil of the Mindbloom/NueLife etc rolodex of problematic and prohibitively expensive outfits. Was looking for PCP level access to a medically necessary (for me) - controlled or not - treatment and through a legit NYC licensed pharmacy
posted by marsbar77 at 8:18 AM on June 28, 2023
Late afternoon dreaming sock - is mass spectrometry reliable? That’s what the service near me uses.
posted by wheatlets at 8:19 AM on June 28, 2023
posted by wheatlets at 8:19 AM on June 28, 2023
Response by poster: I also don't have to have the urgency piece attached to it. If I have to go two months without (ugh) I'll deal, but I did want a longer term reliable and more normative solution.
posted by marsbar77 at 8:30 AM on June 28, 2023
posted by marsbar77 at 8:30 AM on June 28, 2023
Best answer: A thought: I know you mentioned you didn't find IV infusions helpful, but have you tried nasal esketamine? Columbia offers it, some insurance does cover it, and it would be long-term a lot more sustainable than any fly-by-night approach you might cobble together. I believe the initial administration is in a monitored setting, but am not sure about long-term therapy (they tout an "individualized" approach).
(I was not trying to imply that you were drug-seeking above; I was merely trying to explain why you were having trouble getting a prescription. Whether fair or unfair, doctors see drug-seeking in every shadow these days.)
posted by praemunire at 9:16 AM on June 28, 2023 [4 favorites]
(I was not trying to imply that you were drug-seeking above; I was merely trying to explain why you were having trouble getting a prescription. Whether fair or unfair, doctors see drug-seeking in every shadow these days.)
posted by praemunire at 9:16 AM on June 28, 2023 [4 favorites]
Best answer: Not adding to your woes, but what is the legal status of ketamine troches, even with a prescription, in the country you are going to?
posted by lalochezia at 9:25 AM on June 28, 2023 [4 favorites]
posted by lalochezia at 9:25 AM on June 28, 2023 [4 favorites]
Best answer: With full respect to you not wanting to do IV, I would still reach out to infusion/nasal providers and ask them for recommendations for compounding pharmacies (because they have existing relationships to compounding pharmacies) or ideas on what to do next. Specifically, explaining your situation and history as a patient. Well-established practices are going to be best and have the most resources for you and I think you will have a different experience with them than with the millennial boutique places. I would also reach out to MAPS, Kriya, or your local similar psychedelic organization. Good luck, sincerely. It's a hard time to be a ketamine patient.
posted by colorblock sock at 5:33 PM on June 28, 2023 [1 favorite]
posted by colorblock sock at 5:33 PM on June 28, 2023 [1 favorite]
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*My own PCP is refusing to handle this, and in general is the skittish/conservative type.
*I realize that either the provider or the compounded form/preparation of ketamine, or both, may not be covered by insurance. That’s okay for now, though I’m more prepared to pay for the medicine on an ongoing basis if the convenience of being personal/local to me is there, than I am for the visits, which I’m sure would be the higher of the two costs.
*I have never increased my dosage on my own and don’t plan to but I do feel like ketamine needs to be a daily thing for me for the foreseeable future. It has already been a good few days without it and I’m sliding back down very quickly and suffering quite a bit.
posted by marsbar77 at 3:27 PM on June 27, 2023