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Ohio Psychedelic Therapy & Integration Network

OPT-IN facilitator brief · Under Fire screening · 2026

Ketamine-assisted psychotherapy in 2026: what Ohioans should know

Watch the film: Under Fire premieres at DOC NYC in November 2026 · the short it grew from, An Act of Service, is free to watch now

Under Fire, Brandon Kapelow's first feature, follows Capt. Rob Christensen, an Idaho firefighter with PTSD, through a six-week program of ketamine infusions paired with work with a psychologist. Along the way he faces the calls he can't forget, an unstable childhood, life as a divorced parent and a fire-service culture that doesn't talk about any of it. The film grew out of Kapelow's 2024 New York Times Op-Doc, An Act of Service. We share the hope it carries for first responders who have been told to carry it all alone.

Ketamine is different from the other medicines in this series: it's legal now. Clinicians can prescribe it in Ohio, one form is FDA-approved for depression, and clinics are open across the state. So the questions for clients are about quality and fit: what kind of ketamine care they're getting, who is in the room, how they're monitored, and whether therapy is part of it. We meet clients where they are, with accurate information and without judgment, and we help them integrate.

The short version

  • Racemic ketamine is Schedule III, FDA-approved as an anesthetic, and legal to prescribe off-label for depression, PTSD and more. It's the ketamine in the film and in most KAP.
  • It's given by IV infusion, intramuscular injection or lozenge, and route, dose and monitoring vary from clinic to clinic. It's usually paid out of pocket.
  • KAP pairs ketamine sessions with psychotherapy. Quality varies widely, and the FDA has warned about compounded ketamine taken at home without monitoring.
  • A note on Spravato (esketamine): it's the FDA-approved nasal spray for depression, given only in certified clinics and often covered by insurance.

Federal

The evidence and the rules

Racemic ketamine has been an FDA-approved anesthetic for decades, and prescribers can use it off-label for mental health. The evidence is strongest for depression: in a 2023 New England Journal of Medicine trial of 403 adults with treatment-resistant depression, IV ketamine twice a week did at least as well as ECT. Evidence for PTSD is earlier and smaller.

In October 2023 the FDA warned about compounded ketamine, including oral forms used at home for psychiatric conditions, and in June 2026 it sent warning letters to websites selling ketamine online. DEA rules let prescribers send ketamine by telehealth without an in-person visit through December 31, 2026; what replaces them is still pending. Spravato is the exception to all of this: it's FDA-approved for depression and can only be given in a certified setting, with at least two hours of monitoring and no driving until the next day.

Ohio

How it works here

Clinics: a practice that stocks and gives ketamine needs a terminal distributor license from the Ohio Board of Pharmacy, which you can look up.

Cost: Ohio clinics report that IV infusions and KAP are usually paid out of pocket, often hundreds of dollars a session, while Spravato is often covered with prior authorization.

Without a prescription: possessing ketamine in less than the bulk amount is a first-degree misdemeanor, or a fifth-degree felony with a prior drug conviction.

The kinds of ketamine care clients find

Each comes with its own protections and gaps. Ask about it without judgment; clients rarely tell us about something they expect to be shamed for.

IV infusion clinics

Off-label · self-pay

A series of infusions with vital signs monitored, like the program in the film. Some clinics pair it with therapy; many don't.

Know: ask who monitors blood pressure and breathing, whether a therapist is involved, and what support looks like after the series ends.

In-office KAP

Off-label · therapy-centered

Ketamine by intramuscular injection or lozenge, given in the office with a prescriber and a therapist working together, and therapy built into the sessions.

Know: ask who prescribes, who stays in the room, and how sessions connect to ongoing therapy.

Research

Legal · limited

Trials continue to study ketamine for PTSD, depression and other conditions, sometimes paired with specific therapies.

Know: search ClinicalTrials.gov for "ketamine" and the condition. Legitimate trials don't charge participants for the study drug.

At-home telehealth

Legal · lightly supervised

Online companies mail lozenges after a video visit, often compounded. The FDA has warned about this kind of unmonitored use.

Know: a sober sitter, no driving, a set dosing plan, and a clinician who checks in between doses.

Unprescribed ketamine

Illegal without a prescription

Street and online ketamine is unregulated, and frequent use brings dependence and bladder damage. Ketamine was the main cause of actor Matthew Perry's 2023 death, and two doctors who supplied it have since been sentenced.

Know: if a client is self-medicating, that's a conversation about safety and supervised options rather than shame.

A note on Spravato

FDA-approved · often insured

Esketamine nasal spray, given in certified clinics with two hours of monitoring. It's a good fit for some clients, especially when cost is the barrier, though therapy usually isn't built in.

Know: ask whether therapy can run alongside it, and arrange a ride home every time.

Any route

Harm-reduction essentials

  • Don't stack sedatives: alcohol, benzodiazepines, opioids and sleep medications raise the risk of oversedation and breathing problems.
  • Route changes the dose: IV and intramuscular ketamine reach the body almost fully, while lozenges and swallowed ketamine absorb far less, so milligram doses aren't comparable across routes.
  • Blood pressure: ketamine raises it, so uncontrolled hypertension and heart disease need screening first.
  • No driving for the rest of the day, and someone sober nearby until the effects have fully worn off.
  • Watch frequency: frequent use is linked to bladder damage and dependence. Urinary pain or urgency, or needing more to feel the same effect, is a signal to talk with the prescriber.
  • Integration: the session is only part of the treatment, and the therapy around it is where change takes hold; that is where our work comes in.

Fireside Project (free peer support, during or after): 62-FIRESIDE (623-473-7433)

Trouble breathing, chest pain or no response: 911 · Crisis: 988 (veterans press 1)

For Ohio clinicians

Working in KAP

  • Can: provide the psychotherapy in KAP within your license, prepare clients, and do integration, working with a prescriber who handles dosing and medical monitoring.
  • Can't: prescribe, dose or keep ketamine outside your license, or take on medical monitoring you aren't trained and licensed for.
  • Check a partner clinic's Board of Pharmacy license and who carries medical responsibility in the room.
  • When unsure, consult your licensing board's guidance, your ethics code and a colleague. This brief is education, not legal advice.

After the film

Questions for the room

  1. What stayed with you from Rob's story, and why?
  2. First responders often carry trauma quietly. What would make KAP feel safe and reachable for them in Ohio?
  3. With so many kinds of ketamine care on offer, how do we help clients tell good care from fast care?

Prepared by OPT-IN, the Ohio Psychedelic Therapy & Integration Network, for the Under Fire community screening. Current as of October 24, 2026. Educational only: not medical or legal advice. Laws and timelines change quickly.

Sources: The Film Collaborative, Under Fire; BroadwayWorld, DOC NYC 2026 lineup; Arts & Voices, Under Fire producers; Short of the Week, An Act of Service; Anand et al., Ketamine versus ECT, NEJM (2023); Ketamine metabolism and formulation review (PMC); FDA, compounding risk alerts (ketamine, Oct. 10, 2023); FDA warning letter to an online ketamine seller (June 23, 2026); Holland & Knight, DEA telemedicine flexibilities through 2026; Spravato prescribing information and Medication Guide (2026); Ohio R.C. 4729.54 (terminal distributor licenses); Ohio R.C. 2925.11; Reach Behavioral Health, IV ketamine vs. Spravato in Northeast Ohio; Ketamine and bladder damage, review (PMC); Variety, doctor sentenced in Matthew Perry case; ClinicalTrials.gov: ketamine; Fireside Project; 988 Lifeline.