What Is Ketamine Used For in Australia? Medical, Therapeutic, and Research Applications

Ketamine is a versatile medicine in Australia. Its applications span from operating theatres to specialised mental health clinics and pain management centres. As a Schedule 8 (S8) controlled substance, it is legally available only through prescription and under strict medical supervision. Consequently, its use is confined to specific clinical and research settings. Each setting operates under distinct regulatory frameworks. This guide examines the primary areas where Australians use ketamine.

Anaesthesia and Surgical Procedures: The Traditional Role

Ketamine has served as an anaesthetic agent in Australian hospitals for decades. The Therapeutic Goods Administration (TGA) approved it “as the sole anaesthetic agent for diagnostic and surgical procedures” that do not require skeletal muscle relaxation. Clinicians also use it “for the induction of anaesthesia prior to the administration of other general anaesthetic agents” and “to supplement low-potency agents, such as nitrous oxide.”

This remains the only TGA-approved indication for ketamine in Australia. Healthdirect confirms that doctors and vets use ketamine as a sedative for short procedures. It changes how the brain receives pain messages. The drug is best suited for short procedures. However, clinicians can use additional doses for longer procedures.

Treatment-Resistant Depression: The Emerging Frontier

The most significant recent development in Australian ketamine use is its application for treatment-resistant depression (TRD) . Doctors define this condition as depression that has not responded to at least two prior oral antidepressant drugs.

Esketamine Nasal Spray (Spravato)

Esketamine is the more pharmacologically active form of ketamine. The TGA has approved it for TRD, and it is now subsidised on the Pharmaceutical Benefits Scheme (PBS). Unlike oral antidepressants, patients cannot take Spravato at home. They must self-administer the nasal spray at a registered treatment facility under the supervision of medical staff.

In New South Wales, psychiatrists must obtain approval from the NSW Ministry of Health to prescribe esketamine or ketamine for TRD under certain circumstances. These circumstances include treating a drug-dependent person or providing continuous treatment exceeding two months. In Tasmania, psychiatrists must seek authorisation under Section 59E of the Poisons Act 1971. This involves review by a Ketamine Advisory Panel.

Injectable Ketamine (Off-Label)

Generic ketamine, administered intravenously or subcutaneously, is used “off-label” for TRD. The Royal Prince Alfred Hospital in Sydney is conducting the KET-DUAL trial. This is an open-label pilot evaluation of ketamine-enhanced psychotherapy in individuals with alcohol use disorder and co-morbid major depressive disorder.

Research published in 2025 confirmed that longer-term use of generic ketamine for severe depression is safe and effective. The study, led by UNSW Sydney and the Black Dog Institute, analysed real-world clinical data from 65 patients treated between 2021 and 2024. Depressive symptoms decreased during the first eight weeks of treatment. The benefit was sustained over six months.

Chronic and Acute Pain Management

Beyond anaesthesia and psychiatry, Australian clinicians use ketamine for pain management. A major clinical trial called ROCKet is investigating whether administering ketamine before surgery and for up to 72 hours post-operation can reduce chronic post-surgical pain.

Inpatient Ketamine Infusions

Several pain clinics across Australia offer ketamine infusions for chronic pain. Pain Specialists Australia in Richmond, Victoria, provides inpatient ketamine infusions among its interventional pain therapy services. The South Eastern Sydney Local Health District has published guidelines for ketamine infusions in adult patients with acute and chronic non-cancer pain. The guidelines recommend continuous intravenous or subcutaneous infusions at doses of 0.1 to 0.2 mg/kg/hour for acute pain.

A survey conducted by Painaustralia found that 88% of respondents reported having used ketamine for their chronic non-cancer pain. They said it alleviated their pain when other treatments, such as opioids, had not worked. One respondent described receiving “a week-long ketamine infusion every 8 weeks” for two years, alongside ketamine lozenges for breakthrough pain.

Pre-Hospital Emergency Use

In Western Australia, the WA Country Health Service has issued a Structured Administration and Supply Arrangement authorising ketamine for pre-hospital use. Approved indications include intramuscular administration as a first-line agent for severe pain of traumatic origin. They also include intravenous administration as a second-line agent post-fentanyl, and management of combative traumatic brain injury.

Ketamine-Assisted Psychotherapy

A growing number of Australian practitioners offer Ketamine Assisted Psychotherapy (KAP) programs. Dr Nikola Ognyenovits in Brisbane provides a KAP program that includes screening, preparation sessions, observed on-site ketamine sessions lasting 3 to 3.5 hours, and integration sessions.

The program emphasises that ketamine is part of a therapeutic process. A commitment to several appointments for supportive psychotherapy is essential. Dr Ognyenovits notes that no take-home ketamine is prescribed. All sessions occur on-site under observation.

The Regulatory Framework: Who Can Prescribe

Access to ketamine for depression is tightly controlled. Only AHPRA-registered psychiatrists can prescribe esketamine or ketamine for TRD. All other prescribers must refer the patient to a psychiatrist for prescribing and supply.

In New South Wales, psychiatrists must obtain approval from the NSW Ministry of Health under certain circumstances. Applications are submitted via the SafeScript NSW portal. This portal allows practitioners to receive real-time approval or a notification if an application needs review. Ketamine and esketamine must be administered under direct medical supervision in a healthcare setting. This setting must have established administration and patient monitoring procedures.

The Funding Challenge

Despite evidence supporting generic ketamine’s effectiveness, a significant funding gap remains. Professor Colleen Loo from UNSW and the Black Dog Institute explains: “Because the drug is generic and off patent, there is no commercial sponsor. Without a commercial sponsor, no matter how much evidence you have that the drug works, it will never be listed by the TGA for the treatment of this condition.”

This means generic ketamine treatment costs patients approximately $10,000 for six months. The medication itself costs only around $10 per dose. Professor Loo describes this as “a travesty.” She notes that “Australian public patients with difficult-to-treat depression are not having the treatment that is optimal for them because of cost.”

Summary

Ketamine’s use in Australia spans four primary domains. These are anaesthesia and surgical procedures, treatment-resistant depression, chronic and acute pain management, and ketamine-assisted psychotherapy. In the operating theatre, it remains a valuable anaesthetic agent with a long history of use. In psychiatry, esketamine nasal spray has become a PBS-subsidised option for TRD. However, strict supervision requirements mean patients cannot use it at home. Generic ketamine continues to be used off-label in specialised clinics. Research confirms its safety and efficacy over six months. Pain clinics across Australia offer ketamine infusions for chronic pain. Pre-hospital emergency services in Western Australia use it for severe traumatic pain.

The regulatory framework ensures that only psychiatrists can prescribe ketamine for depression. Some cases require additional state-based approvals. However, the funding gap for generic ketamine remains a significant barrier. Professor Loo notes that “clinical treatment is being distorted by the funding framework.”