Contribution short abstract:

This study investigates the ethical complexities and their biomedical basis within ketamine-assisted psychotherapy. Using interview data obtained in Norway, suggestions for critically examining and shaping ethically sound practices in the medicalization of psychoactive drugs are offered.

Contribution long abstract:

This contribution presents an investigation into the un/commoning of drugs by means of examining the ethical challenges and their construction encountered by medical doctors and psychologists working with ketamine-assisted therapy (KAT) in Norway. Drawing on 16 in-depth interviews, it focuses on the dynamics around ketamine in public and private psychotherapeutic contexts, analyzing how a drug characterized by an ambiguous regulatory and historical status is recontextualized within the dominant ethical norms of biomedicine. This research uses critical medical anthropology and social bioethics as frameworks to examine three key areas of concern: access to care, informed consent practices and therapeutic alliance. In line with this, barriers to distributive justice and accompanied meaning-making practices on the side of the interviewed health professionals are identified. Further, established informed consent practices and their limitations are assessed given the change in consciousness induced by ketamine and the consequent unpredictability of experience. Special emphasis is given to communications about efficacy, off-label use and stigma between patients and professionals. This includes how professionals navigate patient expectations to ultimately establish a robust therapeutic alliance. Aligning with the workshop's themes, this research examines the changes of a drug towards becoming a legitimate treatment option for mental disorders in the trenches of shifting regulatory frameworks and societal re/perceptions, while addressing structurally shaped ethical concerns. The findings provide insights into the development of ethically sound practices for novel health interventions as well as contributing to broader discourses on the commoning and medicalization of psychoactive substances.