Where Is Ketamine Used in Australia? Medical, Therapeutic, and Research Applications
Ketamine is a versatile medicine in Australia, with applications spanning from operating theatres to specialised mental health clinics. 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 governed by distinct regulatory frameworks. This guide examines the primary areas where ketamine is used across Australia.
Anaesthesia and Pain Management: The Traditional Role
Ketamine has served as an anaesthetic agent in Australian hospitals for decades. The Therapeutic Goods Administration (TGA) approved it for use “as the sole anaesthetic agent for diagnostic and surgical procedures” that do not require skeletal muscle relaxation . It is also used for “the induction of anaesthesia prior to the administration of other general anaesthetic agents” and “to supplement low-potency agents, such as nitrous oxide” .
Acute Pain and Post-Surgical Applications
Beyond anaesthesia, Australian clinicians use ketamine for acute pain management. A major clinical trial called ROCKet (Reduction of Chronic Post-surgical Pain with Ketamine) is currently underway across 36 hospital and health networks in Australia, New Zealand, and Hong Kong . The trial involves more than 4,800 patients undergoing abdominal, thoracic, or major orthopaedic surgery. The study investigates whether administering ketamine before surgery and for up to 72 hours post-operation can reduce chronic post-surgical pain .
Treatment-Resistant Depression: The Emerging Frontier
The most significant recent development in Australian ketamine use is its application for treatment-resistant depression (TRD). Approximately one-third of patients with major depressive disorder have TRD, defined as depression that does not respond to two or more adequate courses of antidepressant medication .
Esketamine Nasal Spray (Spravato)
Esketamine, the more pharmacologically active form of ketamine, has been approved by the TGA for TRD and is now subsidised on the Pharmaceutical Benefits Scheme (PBS) . Unlike oral antidepressants, Spravato cannot be taken at home. Patients must self-administer the nasal spray at a registered treatment facility under the supervision of medical staff .
The treatment protocol typically involves twice-weekly administration in the first month, then weekly for the second month, and then weekly or fortnightly thereafter . Patients are monitored for two hours after each dose due to potential side effects including dissociation, sedation, hypertension, and nausea .
Injectable Ketamine (Off-Label)
Generic ketamine, administered intravenously or subcutaneously, is used “off-label” for TRD. The Royal Melbourne Hospital’s Advanced Interventions in Mood Disorders (AIM) Clinic provides a 3-week course of low-dose intravenous ketamine treatment, administered twice weekly, for eligible adults with difficult-to-treat depression . Referrals can only be made by psychiatrists, and the service is limited to patients within specific catchments .
The Regulatory Framework: Who Can Prescribe
Access to ketamine for depression is tightly controlled. Only AHPRA-registered psychiatrists can apply to prescribe or supply intranasal esketamine or injectable ketamine for TRD . Medical practitioners who are not psychiatrists must refer the patient to a psychiatrist for prescribing and supply .
In New South Wales, psychiatrists must obtain an approval from the NSW Ministry of Health to prescribe esketamine or ketamine for TRD under certain circumstances, including for a drug-dependent person or for continuous treatment exceeding two months . Applications are submitted via the SafeScript NSW portal .
Research and Clinical Trials
Australia contributes significantly to international ketamine research. Beyond the ROCKet surgical pain trial, the University of Melbourne’s Department of Psychiatry is leading studies investigating new treatment options for major depression and strategies to improve personalisation . The translational research team at Ramsay Clinic Albert Road has participated in multicentre trials evaluating esketamine’s impact on quality of life and comparing intranasal esketamine versus racemic ketamine given subcutaneously .
The Royal Prince Alfred Hospital’s Ketamine Treatment Clinic was the first public-sector ketamine treatment clinic for complex mood disorders in Australia . Its experience establishing and running a public-sector service provides valuable lessons for other health services contemplating similar programmes .
Public Sector Challenges
Public-sector ketamine treatment faces distinct challenges. A viewpoint published in the Australian & New Zealand Journal of Psychiatry notes that public clinics must balance individual patient needs while maximising benefit to the community . Unlike the private sector, public clinics have limited capacity. The rapid-acting antidepressant effect of single-dose ketamine often fades within a week, requiring repeat-dosing to prolong efficacy .
Staffing costs, rather than medication costs, represent the primary expense in operating a public ketamine clinic. The minimum staffing requirement includes a psychiatry registrar under consultant supervision and a registered nurse . Waitlists continue to grow, and many patients who cannot afford private treatment do not receive access .
Private Sector Access
Several private hospitals offer ketamine-based therapies. Brunswick Private Hospital launched a dedicated service for patients experiencing TRD and complex mood disorders, offering rTMS, esketamine (PBS listed), and IV ketamine treatment within a monitored therapeutic setting . Epworth Clinic has registered as an Esketamine Therapy Service and offers treatment in inpatient or outpatient settings.
Conclusion
Ketamine’s use in Australia spans three primary domains: anaesthesia and surgical pain management, treatment-resistant depression, and clinical research. In the operating theatre, it remains a valuable anaesthetic agent with a long history of use . In psychiatry, esketamine nasal spray has become an accessible, PBS-subsidised option for TRD, though strict supervision requirements mean it cannot be used at home . Generic ketamine continues to be used off-label in specialised clinics like the Royal Melbourne Hospital’s AIM Clinic .
The regulatory framework ensures that only psychiatrists can prescribe ketamine for depression, with additional state-based approvals required in some cases . Research continues to explore new applications, including the ROCKet trial investigating ketamine’s role in preventing chronic post-surgical pain . While access remains challenging in the public sector due to staffing and capacity constraints, the trajectory is toward greater integration of ketamine into Australian mental health care .