Singapore's health authorities have implemented comprehensive safeguards for the controlled use of esketamine nasal spray in treating Major Depressive Disorder (MDD), balancing therapeutic benefits with potential risks of abuse.
Senior Minister of State for Health Janil Puthucheary addressed Parliament on February 5, 2025, detailing the regulatory framework surrounding ketamine-based treatments. The Health Sciences Authority (HSA) approved esketamine, a ketamine derivative, for MDD treatment in October 2020, following successful clinical trials that demonstrated favorable risk-benefit outcomes.
Strict Control Measures
The regulatory framework includes multiple layers of security and oversight. "Ketamine is kept under lock and key, with stringent records of the product inventory," Puthucheary emphasized. The medication's distribution is exclusively limited to hospitals, with prescription authority restricted to registered psychiatrists.
Treatment administration occurs under direct nursing supervision, with mandatory monitoring protocols before, during, and after treatment. Patients must remain under observation for potential adverse effects before leaving the clinical setting, ensuring immediate medical intervention if needed.
Clinical Implementation and Patient Safety
Healthcare providers conduct individualized education and counseling sessions for patients and their families, ensuring comprehensive understanding of the treatment process and potential outcomes. Regular specialist reviews assess treatment effectiveness and monitor patient progress.
"The use of ketamine is not a substitute for all the other treatments that are available for the depression of the psychiatric treatment," Puthucheary clarified, noting that the treatment is targeted at a relatively small patient population.
Regulatory Context
The strict controls reflect the dual nature of ketamine in medical practice. While beneficial in controlled clinical settings, ketamine remains a controlled substance with severe penalties for illegal possession - including up to 10 years imprisonment or fines up to S$20,000.
The government maintains ongoing evaluation of ketamine treatment effectiveness, drawing parallels with other controlled substances. "There are many drugs with serious side effects or potential abuse and misuse, where use in a controlled setting is possible," Puthucheary noted, citing examples such as opioid and anesthetic agents that require similar regulatory oversight.
