Blog
Does the DEA Treat Ketamine Differently from Opioids?
Contents
Yes – and the difference will probably surprise you. Ketamine faces LESS regulatory restriction than opioids, not more. Ketamine is Schedule III. Most opioids – oxycodone, fentanyl, morphine, hydrocodone – are Schedule II. Lower schedule number means stricter controls. The drug that killed 68,630 Americans in 2020 has more prescribing restrictions than the drug the DEA is now comparing to the “early days of the opioid epidemic.”
Welcome to Spodek Law Group. Our goal is to explain exactly how the DEA treats ketamine versus opioids – because this distinction matters enormously if you’re a provider under investigation or a patient trying to understand your legal situation. Todd Spodek has represented clients facing DEA scrutiny for controlled substance practices. The classification nuances could determine whether you’re operating within guidelines or facing federal charges.
If you’re a ketamine provider being investigated, or you’re facing charges related to ketamine prescribing, call us at 212-300-5196. Understanding how the DEA actually regulates these substances – and where the enforcement is heading – could change everything.
The Schedule Paradox – Why Lower Means Stricter
The schedule system works backwards from what most people assume. Schedule I is the most restricted – drugs with “no accepted medical use” like LSD and heroin. Schedule V is the least restricted – drugs like cough syrup with small amounts of codeine.
Heres where it gets counterintuitive. Schedule II has stricter prescribing rules then Schedule III. Most opioids are Schedule II. Ketamine is Schedule III. This means the drug that caused a national epidemic faces MORE regulatory oversight then the drug the DEA is now warning about.
The prescribing requirements reveal the paradox in practice. Schedule II drugs – your oxycodone, your fentanyl, your morphine – require written or electronic prescriptions. No phone prescriptions allowed except in emergencies. No refills permitted. Every single time a patient needs more opioids, they need a new prescription from there doctor.
Schedule III drugs like ketamine? Completly different. Prescriptions can be called in over the phone. Refills are allowed – up to five refills within a six-month period. A provider can write one ketamine prescription and the patient can refill it five times without any additional doctor contact.
Think about what this means. The drug that created 2-3 million opioid abusers in America requires doctor contact for every prescription. The drug the DEA compares to the “early epidemic” can be refilled five times with zero doctor involvement.
Thats the regulatory reality. It dosent match the rhetoric.
The Prescribing Rules That Actually Matter
If your a ketamine provider, you need to understand exactly how these prescribing differences work – becuase thats were enforcement attention goes.
For Schedule II opioids, the DEA created what they call a “closed system.” Manufacturers, prescribers, and pharmacies all register with the DEA. Every prescription is monitored. Every quantity tracked. The idea is that authorities can follow controlled substances from production to patient – no gaps, no diversions, no pill mills operating in shadows.
This closed system was supposed to prevent the opioid epidemic. It didnt. 91,799 drug overdose deaths in 2020, 75% involving opioids. The system that was supposed to track everything failed to prevent anything.
For Schedule III ketamine, the closed system has a hole. Yes, providers need DEA registration to prescribe ketamine. Yes, pharmacies track dispensing. But theres no federal regulation specifically governing ketamine infusion clinics. The oversight that exists for opioid treatment programs – updated as recently as 2024 – dosent exist for ketamine clinics.
Heres the uncomfortable truth. The DEA has more regulatory tools for the drug that already caused an epidemic then for the drug they say might cause the next one. Schedule II gives them more control over opioids. Schedule III gives them less control over ketamine. And yet the enforcement energy is shifting toward ketamine.
This isnt logic. This is politics responding to high-profile deaths.
Why the DEA Is Comparing Ketamine to Opioids
Matthew Perry died in October 2023. Ketamine was a factor. Within months, the DEA was publicly comparing the ketamine industry to the “early days of the opioid epidemic” and warning about “ketamine pill mills.”
One celebrity death is driving federal enforcement policy.
Meanwhile, 68,630 people died from opioid overdoses in 2020. That number didnt appear in a single headline the way Matthew Perry’s name did. The DEA had years of data showing opioid deaths climbing. The crackdown came slow. For ketamine, the crackdown rhetoric started almost immediatly after one famous person died.
Heres the irony the DEA probly dosent want you to think about. The opioid epidemic happened WITH Schedule II controls in place. Written prescriptions. No refills. Mandatory reporting. All of it. Schedule II controls didnt prevent 33,000 opioid deaths per year becoming the new normal.
Now the DEA is warning that ketamine – with LESS regulatory control – might become the next epidemic. If Schedule II couldnt prevent opioid addiction and death, why would Schedule III prevent a ketamine problem?
The answer is it probly cant. But thats not the point. The point is enforcement creates headlines. Headlines respond to celebrity deaths. And ketamine providers are the current target.
The growth numbers alarm regulators. Ketamine clinics went from fewer then 20 in 2018 to somewhere between 500 and 800 today. Thats 40x growth in six years. Every new clinic is a potential investigation target. Every telehealth ketamine prescription is a data point the DEA is watching.
OK so think about the timeline here. The opioid epidemic built slowly. It took years for regulators to recognize the pattern. Purdue Pharma started pushing OxyContin in 1996. The DEA didnt declare a national emergency until decades of deaths accumulated. The response was slow, reactive, and came after the damage was done.
For ketamine, the DEA is trying to get ahead of the curve. One celebrity death, growing clinic numbers, telehealth expansion – and suddenly the enforcement machinery is moving. Whether this is appropriate or overcorrection depends on who you ask. But the reality is clear: ketamine providers face a very different enforcement timeline then opioid prescribers did.
The Federal Oversight Gap
This is were the regulatory situation gets genuinly strange.
There are no federal regulations specifically governing ketamine infusion clinics. None. The DEA can investigate individual providers for prescribing violations. They can track suspicious ordering patterns. But there is no federal framework saying “this is how a ketamine clinic must operate.”
Compare that to opioid treatment programs. The Federal Guidelines for Opioid Treatment Programs were updated in 2024. They align with revised federal regulations (42 CFR Part 8). They specify accreditation requirements, certification standards, and treatment protocols. They made COVID-era flexibilities permanent while expanding access to care.
In other words: the drug that caused the epidemic now has comprehensive federal clinic oversight. The drug being compared to the epidemic has no federal clinic oversight whatsoever.
This means states are on there own. Each state makes its own rules for ketamine clinics – or dosent make any rules at all. Standards vary wildly by location. What passes for acceptable practice in one state might be illegal in another. The patchwork regulation is exactly what allowed the opioid epidemic to flourish faster in some states then others.
If your operating a ketamine clinic, you need to understand that federal protection dosent exist. Your operating in a regulatory gap. The only framework your answerable to is state law – and state law varies dramatically.
At Spodek Law Group, weve seen providers assume federal guidelines protect them when no federal guidelines exist. This is a dangerous assumption. The absence of federal regulation isnt permission – its exposure. When the DEA decides to investigate, they investigate under existing controlled substance law, not under ketamine-specific guidelines that dont exist.
The regulatory gap also creates liability exposure that providers dont always anticipate. Without federal standards, theres no safe harbor. No checklist you can follow to prove compliance. No federal framework to cite when explaining your decisions. Every prescribing choice is measured against general controlled substance law and whatever state regulations might apply.
What the Numbers Actually Show
The DEA is using “epidemic” language. Lets look at whether the numbers support that language.
Opioid overdose deaths in 2020: 68,630
Total Americans who used ketamine in 2022: 762,000
Read those numbers again. 68,630 people DIED from opioids. 762,000 people USED ketamine. Usage isnt death. If every single ketamine user in America died in 2022 – which they obviously didnt – it still wouldnt equal opioid deaths from one year.
Now look at the youth data. Ketamine use among 12th graders has stayed at 1% for the past decade. Flat. No increase. No epidemic curve. One percent, year after year.
The DEA isnt comparing ketamine to opioids becuase the mortality data is similar. The mortality data isnt even in the same universe. 82.3% of opioid deaths involve synthetic opioids like fentanyl. Ketamine isnt synthetic opioid. Ketamine isnt causing mass casualty events.
What ketamine IS doing is generating clinics, prescriptions, and media attention. The 500-800 clinics operating today represent a visible, targetable industry. The telehealth ketamine companies shipping controlled substances to homes represent an enforcement opportunity. The celebrity death provides the justification.
The numbers tell one story. The enforcement tells another.
Heres what providers and patients need to understand about this disconnect. The DEA isnt making enforcement decisions based purely on mortality statistics. There making decisions based on political pressure, media attention, and the perception of emerging problems. One celebrity death created more enforcement energy then years of overdose data. Thats not how public health should work. But thats how it actualy works.
The comparison to the “early days” of the opioid epidemic is particuarly problematic. In the early days of opioid prescribing, doctors genuinly believed they were helping patients with chronic pain. The addiction and death came later. For ketamine, the evidence suggests its being used primarily for treatment-resistant depression – patients who have failed multiple other medications. The patient populations are fundamentaly different. The risk profiles are fundamentaly different. But the DEA is using the same language anyway.
What This Means for Ketamine Providers
If your prescribing ketamine, the regulatory landscape is shifting under your feet – and the shift isnt toward clarity.
Heres the cascade effect. Schedule III classification means less restrictive prescribing requirements. Less restrictive prescribing means phone prescriptions and refills are allowed. Telehealth expansion during COVID made remote prescribing even easier. All of this enabled the industry growth the DEA is now concerned about.
But the same classification that enabled growth provides less protection when enforcement comes. Schedule III means the DEA has fewer automatic oversight mechanisms. No mandatory prescription monitoring in the way Schedule II requires. No federal clinic guidelines to point to and say “I followed the rules.”
This creates an asymmetry providers dont always recognize. You have MORE prescribing freedom then opioid providers. You have LESS regulatory protection when investigated.
Todd Spodek tells every ketamine provider who walks through our door: document everything. Your prescribing decisions need justification. Your patient selection needs documentation. Your clinic protocols need to exceed any state requirement becuase federal requirements dont exist. The absence of federal guidelines isnt a benefit – its a liability.
When the DEA investigates a ketamine provider, they apply general controlled substance law. Thats law designed for Schedule II opioids, adapted for Schedule III ketamine. The standards they hold you to may not match the standards you thought applied to your practice.
Spodek Law Group has represented providers who were completly surprised by what investigators considered problematic. Practices they thought were normal – telehealth prescribing, at-home ketamine for depression, refills without office visits – became the basis for investigation. The industry grew faster then the regulatory framework. Enforcement is catching up.
The providers who survive this regulatory shift are the ones who document obsessivly. Every patient interaction recorded. Every prescribing decision justified in the chart. Every follow-up scheduled and completed. If your treating ketamine like a casual prescription – the way Schedule III classification might suggest you could – your setting yourself up for problems.
Look at how opioid prescribers got prosecuted. Prosecutors didnt need to prove doctors were drug dealers. They proved doctors failed to meet standards of care. They proved prescribing patterns that showed negligence. They proved documentation gaps. The same playbook will apply to ketamine. The DEA is already investigating. The prosecutions will follow.
What This Means For Patients
If your recieving ketamine therapy, or considering it, understand what your walking into.
Ketamine therapy exists in a regulatory gray zone. Your provider is prescribing a Schedule III controlled substance, probly for off-label use, possibly through telehealth, potentially with refills that require no additional doctor contact. All of this is currently legal. None of it has specific federal oversight.
This dosent mean your treatment is unsafe. It means your treatment exists in a space where the rules are being written in real time. The DEA is watching the industry. Some providers will face investigation. Some clinics will close. If your provider is one of them, your treatment could be interrupted.
The telehealth ketamine prescribing that expanded during COVID is operating under temporary rules that extend until December 31, 2025. After that date, the regulatory landscape may change again. Telehealth providers shipping ketamine to your home may face new restrictions. The convenience you currently have isnt guarenteed to continue.
If your facing charges related to ketamine possession or distribution, the Schedule III classification matters for your defense. Schedule III penalties are lower then Schedule II. But “lower” still means federal controlled substance charges. The distinction between medical use and distribution can be the difference between treatment access and federal prosecution.
Heres something else patients should understand. If your provider gets investigated, your medical records become evidence. Your prescriptions become data points. Your treatment history becomes part of a federal investigation file. This dosent mean you did anything wrong. But it means your private medical decisions could become part of a public legal proceeding if your provider faces charges.
The regulatory instability affects you even if your doing everything right. Your following your doctors instructions. Your taking medication as prescribed. Your managing a condition that other treatments failed to address. And yet the rules governing your treatment could change, your provider could face investigation, and your access could be interrupted – all becuase of regulatory decisions that have nothing to do with your individual medical situation.
What This Means For You
The answer to “does the DEA treat ketamine differently from opioids” is yes – ketamine faces LESS restriction, not more. But that regulatory gap is closing. The DEA has made clear they see ketamine industry growth as a potential problem. Enforcement is increasing. Investigations are ongoing.
The paradox sits at the center of this situation. Schedule II opioids killed tens of thousands with more restrictive controls in place. Schedule III ketamine is being treated as an emerging threat with fewer controls available. The regulatory system dosent match the mortality data. It matches the political moment.
If your a provider, this means documenting everything becuase federal guidelines dont exist to point to. It means treating Schedule III like its Schedule II in terms of care and documentation. It means preparing for the enforcement wave thats already started.
If your a patient, this means understanding that your treatment exists in regulatory uncertainty. The telehealth prescription you recieve today might not be available the same way next year. The clinic you rely on might face investigation. None of this is your fault. But its the reality your operating within.
If your already facing charges or investigation, the Schedule III classification matters. It affects potential penalties. It affects defense strategy. It affects how prosecutors frame your conduct and what standards they hold you to.
The DEA treats ketamine differently from opioids in almost every regulatory dimension. Less restrictive prescribing. No federal clinic oversight. Lower schedule penalties. But the enforcement attention is shifting toward ketamine with an intensity that dosent match the relative harm data. One celebrity death, a growing industry, and political pressure have combined to create an enforcement environment that providers and patients need to understand.
Spodek Law Group is located at 233 Broadway in the Woolworth Building in Manhattan. We handle federal drug defense cases nationwide, including DEA investigations of ketamine providers and controlled substance charges. If your facing investigation, the Schedule III classification creates both opportunities and vulnerabilities that require careful navigation.
Todd Spodek has represented clients on both sides of this regulatory shift. Understanding exactly how the DEA treats ketamine versus opioids – and where enforcement is heading – could determine wheather your protecting a legitimate practice or defending against federal charges.
Call us at 212-300-5196. The consultation is free. The gap between what the regulations say and what enforcement does is were cases are won and lost.