If Ketamine is So Great, Why Won’t My Institution Let Me Use It? (FR436)

•Implement and titrate ketamine in its various forms (topical, oral, IV, PCA) for pain and depression.•Weigh the risks and benefits of prescribing ketamine.•Overcome institutional barriers to prescribing ketamine. In our current context of a national opioid shortage, Palliative Care teams need to look at alternative options that can provide equal or better analgesia. While there is an emerging evidence base for the use of ketamine in the treatment of refractory depression1, the evidence base for the use of ketamine for palliation of pain remains thin, though primarily positive.2, 3 Ketamine has been used topically, orally and intravenously for the palliation of pain, and orally and intravenously for the treatment of refractory depression, though it is FDA approved only as an anesthetic. For these reasons, many Palliative Care teams wish to add ketamine to their armamentarium. Many, however, encounter institutional barriers in implementing its use. In this session we will briefly review the available literature regarding the risks, benefits, and questions on ketamine use for palliation of pain and depression. Using case examples, we will examine prescribing and titrating ketamine in various forms including topical, oral, and intravenous (drip, IV push and PCA). We will discuss when ketamine is the most effective and appropriate and discuss practical management of side effects seen. Finally we will explore institutional barriers and engage the audience on how to gain buy-in on various levels to implement ketamine, including sharing our hospital protocols and policies.1.Kim J, Mierzwinski-Urban M. Ketamine for Treatment-Resistant Depression or Post-Traumatic Stress Disorder in Various Settings: A Review of Clinical Effectiveness, Safety, and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Mar 1.2.Michelet, D, et. al. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized control trials. Eur J Pain. 2018 Apr;22(4):632-646.3.Bell RF1, Eccleston C, Kalso EA. Ketamine as an Adjuvant to Opioids for Cancer Pain. Cochrane Database Syst Rev. 2017 Jun 28;6:CD003351