Ketamine has been used as a treatment for depression, anxiety, and chronic for over 20 years now.
The biggest barrier to entry has always been aspects like cost, stigma, and accessibility (not every community has a ketamine clinic nearby, and many that do are booked out months in advance).
Online ketamine therapy is positioned as the answer to these problems. It seeks to deliver the same impressive capacity for healing that ketamine clinical therapy has to offer directly in the comfort of your own home.
With bold promises of quick results and affordability — companies like MindBloom, Better U, Nue Life, and Wondermed are leading the charge in this new therapeutic frontier. All 4 of these online ketamine providers (as well as four others we’ll explore later in this article) position themselves as the ultimate solution for society’s growing mental health crisis.
Is online ketamine a silver bullet? Or is the unrestrained capitalist movement toward commercialized ketamine only making matters worse?
Here, we examine the philosophy behind online ketamine therapy, how it works, how much it costs, who’s offering it, how to sign up, and why it’s important to be skeptical and pragmatic about how we apply online ketamine therapy.
How Online Ketamine Therapy Works
Online ketamine therapy was only made possible in 2020 after the federal government waived the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.
The Ryan Haight Act forced physicians to meet patients in person before prescribing drugs. It was created in response to Ryan Haight, who, at the age of 18, died from an overdose of prescription medications he had purchased from an online pharmacy without a legitimate prescription.
The act was temporarily removed during the pandemic to ensure patients had access to important medications in the face of mounting difficulties in visiting hospitals during the pandemic. It allowed doctors and patients to meet over Zoom to prescribe treatment.
With the removal of this act, signing up for online ketamine therapy is easier than ever. Most of these companies position themselves as a wellness company — but when you look under the hood, they’re much more a combination of a tech company and a pharmacy.
The user experience in terms of registering, paying, and meeting with a prescribing doctor follows the same principles as ordering yourself an Uber.
Here’s how it works:
Step 1: Fill Out An Online Assessment
Before you can get started, you’ll need to fill out some version of an online assessment. This is done to assess the moods of potential customers, ask questions about existing treatments and identify potential red flags that could rule you out of receiving the treatment.
Most providers do the bare minimum to rule people out, so you can expect some pretty generic questions about your mood or health history.
Step 2: Schedule a Virtual Appointment
An initial consultation is organized with a doctor who goes over some of the fine print for the treatment, collects some generic intake questions, and signs you up to receive your mail-order ketamine.
Very little is done to rule people out of treatment, and most of these appointments are concluded within about 15 minutes.
Step 3: Pay For Your Service
Payment with these platforms happens pretty quickly. MindBloom, Better U, and Nue Life ask for payment before you can make an appointment; others, like Joyous, do the appointment stage first.
Most companies require a down payment of at least 25% of the total cost of the service before you can move on to the next stage, with the exception of Joyous (the lowest cost and lowest dose option) and Safe Haven Health, which charge a monthly subscription fee of $129 and $250 per month, respectively.
Others, such as Nue Life, charge the full amount ($1400) right away.
In most cases, expect to pay at least $300 upfront before moving on to the next stage.
Step 4: Receive Your Starter Box
Once you’ve paid and had your initial consultation, you just have to wait for your package to arrive.
MindBloom calls it a Bloom box, Nue Life calls it a Welcome Box, and Better U calls it a Brain Box.
Whatever you want to call it, they’re all the same thing. They contain a journal to write in, an eyemask, a QR code to sign in to the company’s app (if applicable), and a little blood pressure monitor. Some have extra gimmicks like “intention cards,” or access to an “integration playlist.”
In most cases, you’ll receive the care box and the actual ketamine dose separately. There are a lot of reports with all of these companies where the actual ketamine itself can take weeks to arrive.
Step 5: Online Ketamine Session
Individual ketamine sessions generally take about 1.5–2 hours.
Some providers have you meet with a clinician who will spend about 30 minutes getting you ready with various meditations or journaling exercises. In most cases, these are pre-recorded sessions.
The ketamine itself is delivered via a ketamine lozenge or troche, which is held under the tongue until it’s fully dissolved.
The experience generally lasts about 60 minutes before tapering off.
Following the ketamine session, you’ll (usually) receive about 30 minutes of post-session exercises and journaling for integration.
Step 6: Follow-up Sessions
Most companies (including big ones like MindBloom) don’t offer much regarding proper clinical follow-up sessions. You usually have to pay extra for this level of support. The included sessions are often run by non-therapists (as this job posting from MindBloom implies). They’re more of a ketamine trip-sitter than anything else.
Follow-up sessions with a trained psychotherapist are essential to successful ketamine therapy. The integration after the experience is just as important (if not more so) than the session itself. Without it, users need to keep taking repeated doses of the medication long-term.
Companies like Joyous do even less in this regard — they check in “periodically” via text message.
If you’re using online ketamine and feel as though the included integration sessions are lacking (as many customers are reporting for all of the companies listed below) — it’s wise to seek the support of an outside therapist. This step should not be considered optional if the goal is to avoid having to use ketamine long-term.
Step 7: Virtual Integration Groups
Some companies offer access to ongoing integration groups. These groups are helpful for continuing the process of integrating your experiences with ketamine with the goal of not needing the medicine beyond the initial protocol.
Only MindBloom and Nue Life (from the provider list below) offer some form of ongoing integration group access.
How Much Does Online Ketamine Therapy Cost?
Online ketamine therapy is the most affordable form of legal ketamine therapy — but it’s still out of budget for most people.
A single session of full-dose ketamine can cost as low as $193 (MindBloom) — however, none of the current providers offer just one session. Most sell them in packages of 6 at a time for prices ranging from $1200–$1500 total.
Microdose or “low-dose” ketamine therapy from companies like Joyous or Wondermed is even cheaper ($4.33 and $100, respectively), but the therapeutic value of this kind of treatment is questionable at best. Much of the therapeutic benefit of ketamine comes from its powerful dissociative qualities and the therapy that follows — neither of these companies offers much in the way of psychotherapy, and microdose ketamine treatment is functionally useless — at least in the context these companies are marketing it.
Compare all this to the cost of IV ketamine, which averages around $400 per infusion. Clinics usually book sessions 1-2 times a week for a monthly cost of $1700–3500.
Intranasal ketamine is even more expensive — Johnson & Johnson’s Spravato costs between $600 and $900 for an applicator that contains just 2 doses. Spravato treatment is usually prescribed at 2 doses per week for a total monthly cost of $2400–3600.
Is Online Ketamine Therapy Covered by Insurance?
In general no, most insurance providers will not cover ketamine therapy. However, this space is rapidly evolving, and some insurance companies are starting to include approved programs in their coverage options (usually only for higher-tier plans).
In the US, you may use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for treatment.
Ketamine Lozenges vs. IV Ketamine vs. Intranasal Ketamine
The vast majority of online ketamine therapy sessions use ketamine-infused lozenges or troches, which are designed to dissolve slowly in the mouth over the course of about 15–20 minutes.
The effects of sublingual ketamine lozenges are significantly milder than intravenous ketamine or even intranasal ketamine. The lozenges take a while to absorb — some through the capillaries under the tongue, some through the digestive tract.
They’re designed to dissolve slowly to both dull the dissociative effects and lengthen the duration.
That said, lozenges will still provide some dissociative effects, which can help users reframe unconscious desires and emotions and offer the same benefits on things like neuroplasticity as intravenous ketamine.
Ketamine lozenges don’t produce full K-hole experiences but can provide a powerful “zen-like” state of consciousness, which offers a glimpse of hope for people who rarely experience this kind of tranquility.
Simply knowing this relaxed and tranquil state is possible is often enough for people to re-examine preconceived notions about how they should feel and why they feel a certain way about people, experiences, or events in their lives.
TLDR; IV, Intranasal, & Sublingual Ketamine Differences
- IV ketamine — offers the most direct and controlled method of administration but must be done in a clinical setting. This form carries the highest risk of abuse and overdose.
- Intranasal ketamine — offers a good balance of rapid onset of effects, high bioavailability, and improved safety profile over intravenous administration.
- Sublingual ketamine (lozenges) — offers the least invasive form of administration and can be used without medical equipment. The catch is that it’s much slower to kick in, and the effects aren’t nearly as intense.
Comparing IV, Intranasal, & Sublingual Ketamine:
|Sublingual Ketamine (Lozenges)||Intravenous Ketamine||Intranasal Ketamine (Spravato)|
|Average Dose||200 mg||1-4.5 mg/kg||56 mg|
|Average Cost Per Dose||$200||$400||$300|
|Onset of Effects||Within 5-10 minutes||Within seconds||Within seconds|
|Duration of Effects||Long (1–2 hours)||Short (Up to 30 mins from a single dose)||Medium (45–60 minutes)|
|Intensity of Effects||Mild||Very strong||Moderate|
What Do Ketamine Lozenges Feel Like?
Patients who take ketamine lozenges generally describe the feeling as smooth, slow, and gentle. They feel some degree of depersonalization and derealization — they remain aware of themselves and their environment but feel in some way detached from their body.
Some people feel like they’re looking down at themselves from above, beside themselves, or that their body doesn’t belong to them.
To anybody who hasn’t used ketamine (or other dissociatives), this language doesn’t make any sense — but that’s sort of the nature of this class of drug. It’s almost impossible to describe its effects using conventional language.
You may experience time dilation (time feels like it’s moving faster or slower than usual), your limbs may feel like they’re missing, and your own house or room may look totally unfamiliar.
At no point should you lose consciousness or become incapacitated while using ketamine lozenges.
Which Companies Offer Online Ketamine Therapy?
There are a lot of companies trying to squeeze themselves into the booming psychedelic sphere. Since the legislation around magic mushrooms and MDMA is moving at a snail’s pace, most companies are starting with ketamine — which is currently a Schedule III substance in the United States.
Ketamine is only formally approved as an anesthetic during surgical procedures — but it’s being prescribed off-label for basically any condition you can imagine.
The only exception is Johnson & Johnson’s Spravato, which is a nasal ketamine spray. This medication has been approved by the FDA for treatment-resistant depression.
It’s important to note that none of the online ketamine providers listed below offer Spravato as a form of treatment.
Here are the biggest players in the online ketamine space at the moment:
|Company||Ketamine Per Dose||Cost Per Dose|
|Better U||100–300 mg||$124–$149|
|Nue Life||125–750 mg||$233|
|Choose Your Horizon||Unclear||$158–$172|
|Safe Haven Health||100–600 mg||$25|
MindBloom is currently the largest online ketamine provider in the United States and has spent a ton of effort on marketing since the Haight Act was removed during the pandemic.
The introductory package starts at $1,158 ($386 due upfront) for 6 ketamine sessions (200–600 mg), the “Bloom Box,” 2 clinician consultations, 3 guided sessions, and access to group integration sessions. Once the first 6 sessions are finished, users are encouraged to purchase another 6 at a discounted rate.
MindBloom is available in: California, Kansas, New Jersey, New York, Arizona, Colorado, the District of Columbia, Florida, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Better U promises to help you “address the root causes of your depression and anxiety with breakthrough programs including holistic psychiatry, online ketamine therapy, talk therapy and integration coaching.”
This program is disappointing — offering the bare minimum in terms of helping users actually get to the “root cause.” This company is essentially just a ketamine pharmacy at this point.
Better U offers 2 packages; the first costs $596 for 4 DIY ketamine sessions and 1 integration session. The second option costs $996 for 8 DIY sessions and 2 integration sessions. Both include a “Brain Box” and a 15-minute “preparation appointment.”
Better U is available in: California, Nevada, Florida, Colorado, Arizona, Washington, Alaska, Texas, Oregon, and New York.
Nue Life launched in 2020 and has so far raised over $23 million from venture capital firms. They position themselves as a “next-gen mental wellness company that believes in the power of psychedelics to catalyze lasting change.”
The company’s introductory program (Nue.Reset) costs $1400 for 6 sessions and includes access to the company’s app, a month of “telemedicine care,” 3 follow-up visits, and 4 group integration sessions.
You can upgrade to the Nue.You program for 18 additional ketamine sessions for $2,999.
Nue Life is available in: Arizona, California, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kentucky, Massachusetts, Minnesota, Nebraska, New Jersey, New Mexico, New York, Ohio, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin.
Joyous was founded in 2021 and positions itself as the most budget-friendly online ketamine provider.
But you get what you pay for.
Each lozenge contains just 60 mg of ketamine, which is meant to be broken up into four 15 mg doses. This is nowhere near enough to provide the type of health benefits the research suggests for ketamine. This company appears to be riding the microdose hype wave and selling what we view as the most counterproductive ketamine lozenges on the market so far.
We recommend avoiding companies like this.
Along with an ongoing $129/month subscription, you get (30) 15 mg doses of ketamine (bundled into 60 mg breakable tablets) and virtually no clinical support. You’ll get text messages asking you how you’re doing and the occasional journal prompt.
Joyous is available in: Arizona, California, Colorado, Connecticut, Delaware, Florida, Iowa, Illinois, Massachusetts, Maine, Missouri, Montana, New Jersey, New Mexico, Nevada, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, Wisconsin, Wyoming
Wondermed was founded in 2020 and has so far raised about $4.2 million in venture capital funding.
This is another “budget-friendly” online ketamine provider. You can get 4 “low dose” ketamine lozenges for just $399. Included with this cost are a music playlist, one clinical consultation, and various “digital tools and integration support.” You’ll also get a starter box with an eye mask, blood pressure monitor, journal, and a few ginger capsules to help with nausea.
Wondermed is available in: California, New York, Florida and Texas.
Choose Your Horizon
Choose Your Horizon (rebranded from Choose Ketamine) was founded in 2021 and is based out of Austin, Texas.
This company is, by far, the most vague about its treatment options.
I argued with a “customer service rep” (probably a chatbot) for over an hour trying to get more details about the dose or how the company manages the therapy side of the process — but didn’t get anything but generic answers and links to their sign-up page.
This company sells 3 online ketamine packages:
- 4 treatments for $689
- 6 treatments for $948
- 8 treatments for $1264
Each package comes with 2 or 3 psychiatric evaluations, a welcome pack, and 4–8 guided sessions.
Choose Your Horizon is available in: Arizona, Colorado, California, Texas, Florida, Georgia, Ohio, Connecticut, Washington State, Michigan, Massachusetts, Iowa, and Minnesota.
Safe Haven Health
Safe Haven Health was founded by Giovanni Pierre in 2021. His company offers a subscription model that costs $250/month for ten 100–200 mg doses (per month).
What you get with this monthly subscription is one medical consultation (to prescribe the ketamine), a “personalized treatment plan,” coaching sessions, and general access to doctors who can answer questions that arise during the process.
No details on how many sessions, how frequent the personal sessions are, or what additional support is provided.
Safe Haven Health is available in: Maryland, Florida, Colorado, Virginia, Connecticut, Delaware, Oregon, Vermont, and New Mexico.
Is Online Ketamine Therapy Safe?
Ketamine itself has an impressive safety profile — especially in lozenge form. This is why the vast majority of online ketamine programs rely solely on this milder form of ketamine.
Ketamine is a potent dissociative and anesthetic in high doses but doesn’t interfere with breathing or heart rate the way other anesthetic drugs do. It also has a short duration of effect, which makes it much more difficult to achieve fatal overdoses.
But that doesn’t make it inherently safe — especially in the long-term, in a largely unconscious or escapist context, which is the way most of these companies are selling them.
The two biggest concerns with this form of therapy is the potential for addiction, and kidney/bladder disease.
What most ketamine providers fail to mention is that ketamine is, in fact, addictive.
The way it’s being distributed in packets of 6–30 doses at a time and marketed as being “totally safe” is misleading, at best.
MindBloom advertises, “In the largest ketamine therapy study of over 1200 Mindbloom clients, fewer than 5% reported any side effects.” They don’t mention any of the risks frequent and repeated ketamine use can lead to even once — addiction being a strong concern.
Ketamine is habit-forming and can become physically addictive over time — especially if people are conditioned into a habit of taking ketamine to “zen-out” (escape) whenever they’re feeling anxious or depressed.
Most online ketamine providers offer the bare minimum in terms of clinical support and advertise discounted medication refills to coax users to re-up whenever they run out. Joyous and Safe Haven Health even base treatment on an ongoing subscription service.
Many of these companies are building their model around long-term customers.
This runs completely antithetical to the original argument that psychedelic therapy (including ketamine) offers a rapid but long-term fix for depression, PTSD, and anxiety. The finger is pointed at conventional SSRI therapy as the bad guy — yet these companies set up treatment protocols that ensure customers need ongoing treatment to maintain efficacy.
A comparative ranking of 20 substances with the potential for misuse, led by psychedelic researcher David Nutt and his team, ranked ketamine as sixth overall based on a massive review of the available literature . The physical harm rating and dependency risk for ketamine were on par with drugs like benzodiazepines and amphetamines. Only heroin, cocaine, barbiturates, street methadone, and alcohol carried a higher risk for abuse than ketamine.
This comes despite the fact that ketamine shows fewer signs of physical dependence than most other drugs . The issue with ketamine is primarily psychological dependence — where people believe they need the drug to feel alright or to escape the pain of daily stress, depression, or trauma. Ketamine offers a “quick fix” for these feelings, but the more often you take it, the less able you become to deal with these emotions on your own.
Ketamine is also well-known to cause serious kidney and bladder disease when used over long periods of time . This condition is known as ketamine cystitis and is something inherent to most arylcyclohexylamines (including PCP, DCK, HXE, and dozens of others). It’s a well-known issue at this point, yet it’s something none of the online ketamine providers listed here are being honest about.
Upon searching for the keywords “bladder,” “bladder disease,” “LUTS,” and “cystitis,” only two companies offered any warning about this.
The first was MindBloom, but they only included this information on a hidden safety page. The front-facing safety page, which is linked to from everywhere else on the site, has no mention of bladder disease whatsoever — neither do any of their blog posts.
Nue Life is the other one. They suggest in their FAQ that bladder disease is very rare with long-term ketamine users. However, this study suggests otherwise — reporting an incidence of lower urinary tract symptoms (LUTS) — to be around 30% in frequent ketamine users . An even larger Hong Kong study reported LUTS at significantly higher rates among ketamine users — closer to 46% .
The main culprits of this issue are caused by several metabolites common within the arylcyclohexylamine family — including ketamine. These metabolites include norketamine, dehydronorketamine, hydroxyketamine, and hydroxynorketamine. These metabolites are toxic to the kidney and bladder epithelial cells.
With repeated exposure, these compounds lead to inflammation and destruction of the kidneys and the inside layer of the bladder — leading to significant pain and blood in the urine.
A 2022 study examining the long-term safety of sublingual ketamine troches (lozenges) found no difference in metabolite content between the troches and other forms of ketamine . This suggests the lozenges being sold through online ketamine pharmacies carry the same level of risk for bladder disease as anything else.
How Effective is Online Ketamine Therapy, Truly?
Ketamine therapy works surprisingly well — but there are some major caveats…
A MindBloom-funded study published in 2022 found roughly 17% greater improvements in symptoms with ketamine lozenges over “conventional” IV ketamine. The same study reported 54% greater results than psychotherapy alone and 36% greater than SSRI treatments .
The problem with this study, as pointed out by Jules Evans from Ecstatic Integration, is that this study was led by a non-academic paid advisor to MindBloom. This doesn’t make their findings null and void, but it does draw into question the validity of their study design.
It’s important to note that this study didn’t mention bladder pain once in the entire paper but did suggest, somewhat ambiguously, that one patient had to be removed from the trial after “visiting a urologist.”
The problem with research in this sphere is that companies will do whatever they can to inflate the success metrics of their clinical trials and deflate the risks. A skilled medical specialist with a demonstrated history of strong integrity and an understanding of ethical study design is essential for these studies to be taken seriously.
It’s easy to make alterations in intake criteria, exclusion criteria (especially during the study), and study design to pump up the figures and make outcomes look better than they are. We’re not saying MindBloom has done this, but we do want to issue a call to ketamine researchers to take a much closer look at this paper and others like it.
This problem isn’t isolated to MindBloom. Here’s what a typical ketamine research paper looks like in the “acknowledgements” section:
In the nature of fair and unbiased science, competing interests like this are a bit of a red flag.
One of the better meta-analyses we’ve seen also reported fast-acting improvements in depression scores following ketamine therapy in the short term but couldn’t vouch for the efficacy or safety of ketamine in the long term . In virtually all studies without significant competing interests, researchers were clear to suggest a need for larger and more detailed studies before making claims as significant as the MindBloom paper.
The Bottom Line: Online Ketamine Therapy
Online ketamine therapy can be safe. It uses a low-dose form of ketamine that’s pretty difficult to truly overdose on (though not impossible). Being medicalized, these clinics also offer much better assurance that the medication itself isn’t contaminated — which is already a significant improvement from street-level ketamine.
The problem comes from companies downplaying the risks of addiction or bladder disease — especially from long-term treatment.
Additionally, the truth behind these companies’ claims for “rapid treatment” is brought into question when you take a closer look at their treatment models.
In order for ketamine to be effective, it needs to be administered alongside high-quality, personalized therapy — something most of these companies are overpromising on. They list these services on the website, but most people who undergo these programs feel underwhelmed at the actual care provided in this regard.
Taking a single dose of ketamine offers an easing of depression symptoms that last just a few days. Without proper therapy, these effects will simply wear off, so the customer needs to come back for another dose of ketamine — and another and another after that.
How is this any better than conventional long-term depression or anxiety treatments?
If you want to truly benefit from online ketamine therapy, aim to take no more than the allotted 6 doses, find an external therapist to help you properly prepare for the process (starting 1 month or more before the first session), and at least 3 months afterward.
Don’t fall for gimmicks like “integration playlists,” apps, fancy care boxes, or “daily microdoses of ketamine.” Look for companies that aren’t trying to convince you that ketamine is going to magically make you a better person — it’s not. Ketamine is a tool to help uncover unconscious influences that are secretly directing your life, but it’s the therapy and integration of the insights it provides that offer true “long-term benefits.”
Remember that with psychedelic-assisted therapy, more doses do not equate to better care.
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