💉 What if America’s Next Billion-Dollar Drug Craze... Gets You High?

Hello (and thank you!) to all my new readers who have subscribed over the past week. The overwhelming response to my first letter just reinforced to me why I started this project in the first place. There is so much about this industry that needs to be revealed and I’m super excited to continue sharing everything there is to know.

Last week, I tried to give you all a taste of something you’d never be able to see unless you actually work in healthcare.

This week, I’m shifting gears to call out something that’s staring us all right in the face…

If you’ve been paying attention to the news lately, you’ve probably heard the K-word.

Ketamine - yes, Special K, the dissociative anesthetic that the worst person you know snorted at Burning Man last year with the CEO of a unicorn startup - is no longer just a party drug. It’s that CEO’s next billion-dollar bet.

And like Ozempic before it, it’s being sold as both salvation and status symbol… depending who’s writing the press release.

Over the past year, three different ketamine-based approaches to treating depression have quietly exploded across the country:

One (in theory) is a highly regulated, clinic-administered protocol with tight federal controls (but the jury is still out on that).

One lets you experience therapy alone in your bedroom, as long as someone’s “nearby.”

And one feels like the final form of state-sponsored safe injection sites. (I won’t touch on this last one much today - it requires a full week’s focus to itself).

All are growing fast. All are making real money. And all are part of a bigger story that should feel very, very familiar.

Spravato is a nasal spray that came to market back in 2019 as the first and only FDA-approved ketamine-derivative treatment for depression. The active ingredient is esketamine - the S-enantiomer of ketamine (don’t worry if you don’t know what that means). Initially it floundered - too much friction, too little marketing. It requires patients to sit in a doctor’s office for monitoring for two hours after a dose is administered. But J&J saw the potential and adapted. Per the WSJ:

They’re even offering back-end help to providers by coaching clinics on billing, operations, and patient management.

It’s Ozempic all over again: a Big Pharma giant laying the infrastructure for mass adoption of a buzzy drug, tied to a personal crisis (this time, depression instead of obesity), with cultural momentum behind it.

But Spravato is only one piece of the story.

Enter: Mindbloom

If Spravato is playing by the FDA’s rulebook, Mindbloom is writing its own.

Think of Mindbloom like the HIMS of mental health and ketamine therapy. They made waves initially by shipping compounded ketamine lozenges direct to patients’ homes (after an online evaluation from a doctor to determine the need and write the prescription, of course 😉). But the company made headlines earlier this year for adding injectable ketamine to its offerings.

Let me repeat that: you can now legally get ketamine injections sent directly to your bedroom, with minimal training, as long as your blood pressure cuff is nearby.

To be clear, Mindbloom isn’t some back-alley operation. The doses they send for treatment are nowhere near the doses used by your cousin’s friend at Brooklyn Mirage last weekend. The company says it’s conducted over 650,000 at-home sessions, published the largest-ever peer-reviewed study on psychedelic medicine, and facilitated “life-changing results” for thousands of patients.

***this is me handing you a grain of salt***

When I see drugs and money mixing together in perfect harmony, I never take at face value anything said by the people doing the mixing. Experience has taught me to be skeptical of any healthcare company with the friendly UX of a DTC startup. Having said that, Mindbloom does at least seem to be making an effort to prove what they are doing is real.

But it’s also operating in a regulatory gray zone. As is usually the case in America, legal oversight has not caught up to what is going on here. This smells a lot like those infamous ADHD treatment platforms Done, Cerebral, etc… (another topic I will write about very soon!). As I mentioned in last week’s newsletter, never forget that healthcare is a business!

Last August, The Wall Street Journal published an investigative piece tying the actor Matthew Perry’s fatal ketamine overdose to the broader boom in at-home treatments. The headline…

There’s just one problem: Perry was never a Mindbloom patient. He bought the drug illegally. The WSJ reported that themselves in the body of the same article. But I don’t blame Mindbloom for getting pissed about the association.

A few days ago, Mindbloom CEO Dylan Beynon sued the Journal, accusing them of knowingly misleading readers, cherry-picking quotes, and pushing a pharma-friendly narrative that paints Spravato as safe and noble while casting at-home ketamine as reckless and criminal. This fight isn’t only about ketamine - it’s about who gets to control the narrative around modern medicine.

Beynon absolutely has a point. And I am totally on-board with exposing Big Pharma hypocrisy. But he’s also building a company that uses the US Postal Service to send a compounded Schedule III Controlled Substance direct to your door without an in-person evaluation. So… maybe some scrutiny is warranted. There’s gotta be a middle ground here somewhere.

I’m a pharmacist. I’ve spent a decade behind the counter. I believe in evidence-based medicine. But I also believe in pattern recognition.

And the pattern here is obvious.

We saw it with opioids. We’re living it with GLP-1s.
Now it’s ketamine’s turn.

And just like everything in this country, the conversation gets flattened into a binary: you’re either pro-treatment or you’re a dangerous skeptic sounding the alarm. Which is absolute nonsense.

I believe Ketamine can help people. It can also be addictive and exploited for financial gain.
It’s not a miracle drug. But it’s definitely not a joke to be dismissed.
I can’t tell you exactly where it lies between those extremes. But I can confidently say it’s just the latest reminder that in America, medicine is a market.

Ketamine therapy - legal, medical, and psychedelic - is going to become massive. Just like GLP-1s, it offers results people can feel. It addresses a widespread crisis (mental health). And it fits the cultural moment: quick, curated, and Instagrammable.

Spravato is just the beginning. Mindbloom is barely scratching the surface. This isn’t fringe anymore - it’s the frontier. The next great pharma gold rush.

But before we crown it the savior of psychiatry, we need to ask some real questions.

Who benefits from this hype?
Who’s making money on the margins?
And what story will we be telling ten years from now after the headlines fade and the lawsuits start piling up?

The question isn’t whether this will become the next drug craze.

The question is: Have we actually learned anything since the last one?

Giddy up.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy