Emergency declaration sets up pathway for sublingual ketamine to treat pain in service members
September 18, 2026
by Kristina Fiore(opens in new tab), Director of Enterprise & Investigative Reporting, MedPage Today
Health, Defense Secretaries Pave Way for Ketamine Drug | MedPage Today(opens in new tab)
The military is going to use ketamine to help treat moderate-to-severe acute pain caused by chemical, biological, radiological, or nuclear attack. While this might sound new, there are actually a lot of published medical articles on this very topic.
A history of ketamine for pain.
Ketamine was first published for pain control use and has been studied as far back as 1965. (DOMINO EF, CHODOFF P, CORSSEN G. PHARMACOLOGIC EFFECTS OF CI-581, A NEW DISSOCIATIVE ANESTHETIC, IN MAN. Clin Pharmacol Ther. 1965 May-Jun;6:279-91. doi: 10.1002/cpt196563279. PMID: 14296024.)
How does it work? Ketamine works by blocking the N-methyl-D-aspartate (NMDA) receptor.
Using ketamine for pain control might sound new to you, there are actually over 5000 published medical articles on the use of ketamine for pain control. So WHY is this not mainstream? The FDA is exceptionally reluctant to use any medication with a history of abuse. This is most disappointingly noted by the failure of the FDA to approve MDMA for treatment of PTSD, despite a 68% cure rate. The reasons the FDA failed to approve MDMA was due to very poor reasons., in my opinion. Well, actually, not just my opinion:
Personally, i believe that this attitude from the FDA holds back treatment from patients who would benefit from these, and other treatments.
Anyway, back to ketamine. It is approved by the FDA for use, however, at this time it is limited to surgical pain control. It is also approved for treatment-resistant depression, however, there are disappointingly strict use guidelines that prevent many patients from obtaining the medication for treatment.
Yes, there is a safety argument to be made, but these restrictions in my opinion, act as a road block and discourage many patients from trying this medication which may be life-changing.
So why is it news that a medication with already published data showing benefits in trials using IV, nasal and topical applications for treatment of pain is causing any controversy? Because the military decided not to involve the FDA. They can and DO have the ability to avoid many civilian laws and regulations, and they did just that in this case. The military basically just declared they would be using the medication this way and went forward with absolutely no FDA involvement.
While this only applies to the military, it did make news when they went around the FDA and declared they would just do it and had no concern or interest in the opinion of the FDA.
Also at issue is the delivery of the medication. The military will be using the medication sublingually or orally with the pill allowed to dissolve in the mouth under the tongue. Currently, there are no phase 3 trials exploring the efficacy of ketamine sublingually for use in pain.