A look at the wave of US doctors and telehealth startups prescribing ketamine online, aided by looser pandemic-inspired federal rules for controlled substances
Context & Ripple Effects
The online-prescribing playbook has been building for years: Hims-style drug sites drew public-health warnings back in 2019, and text-based care startups like CirrusMD and 98point6 normalized doctor visits over chat. The pandemic-era loosening of federal rules for controlled substances then opened the door to Schedule III drugs — first stimulants at scale via Cerebral and Done's 30-minute evaluations, now ketamine dispensed by a growing wave of doctors and telehealth startups.
First-order effects
- Telehealth startups gain a new high-margin controlled-substance line beyond ADHD meds, while US doctors prescribing online take on liability for a dissociative anesthetic without in-person evaluation.
- Patients seeking depression or pain treatment can now obtain ketamine through a screen, expanding access but bypassing the clinic-based oversight that previously gated the drug.
Second-order effects
- Regulators and DEA enforcement face pressure to tighten or clarify the pandemic rules, given the precedent of Cerebral and Done using looser controls and clinician pressure to drive stimulant volume — ketamine is likely to draw the same scrutiny.
- Marketing practices are already outrunning the medicine: telehealth companies running social media ads for unapproved uses set the template for how ketamine gets promoted, raising the odds of advertising crackdowns that would hit the whole category.
Third-order effects
- If the pattern holds, controlled-substance prescribing splits into two regimes — strict in-person rules on paper, loose platform-mediated distribution in practice — forcing a federal decision on whether pandemic flexibilities become permanent or get rolled back category by category.
- The structural risk is a repeat of the Hims-era critique at higher stakes: direct-to-consumer platforms commoditizing clinical judgment for powerful drugs, which could push regulators toward mandatory in-person exams and reshape telehealth business models built on rapid evaluation.
The trend: US telehealth is extending from lifestyle drugs and stimulants into progressively stronger controlled substances, with federal pandemic-era prescribing flexibility as the load-bearing rule.