IV vs IM vs SL: all about routes of administration
If you’ve dived into the world of ketamine therapy, you’ll notice that there’s a variety of ways that this medicine is administered therapeutically. Here are the most common ones.
IV stands for “intravenous”. At Innate, a tiny pediatric-sized polyurethane catheter is introduced into a vein via a one-time needlestick, and the medicine is delivered by an infusion pump. This offers tremendous control over dose, duration of infusion, how much is given up front (the “loading dose”). Additional medicines can be given in the IV if needed (for example, if someone develops nausea), and in the rare event that someone has a very difficult or adverse experience, the infusion can be stopped completely. Most of the research literature on ketamine has been published around intravenous infusion. Over 95% of the ketamine we administer at Innate is via IV.
IM stands for “intramuscular”. Most people refer to these as “shots” - medicine is drawn up into a syringe and injected by needle into a muscle. The most common sites are the deltoid (shoulder) muscle and the gluteus (butt) muscle. All of the medicine is delivered at once, and there is no control over the rate of absorption, which is usually very quick. This results in the ketamine experience going from zero to peak in about 3 minutes, which some people find disconcerting. Once the medicine is injected, you’re committed to absorbing the full dose. In general, this is a more convenient method of delivery than IV, and most medical offices are able to deliver IM injections, whereas IV requires more specialized skills and equipment. Often, to mimic the smooth experience of IV infusion, clients may receive multiple injections of small quantities of ketamine – so more shots.
SL stands for “sublingual” or under the tongue. Technically this route of administration is more properly termed transbuccal because the medicine is absorbed through the buccal (cheek) mucus membranes. Swallowing inactivates most of the ketamine through a mechanism called “first pass metabolism”, so the bitter-tasting medicine must instead be absorbed slowly by being held and swished in the mouth for approximately 15 minutes. Many people find this experience quite unpleasant. Additionally, the amount of ketamine that is absorbed by the SL route is highly variable and unpredictable, so dosing cannot be well-controlled. Additional doses require repeating the entire process again. In most states, folks licensed as therapists or psychologists are only able to use this route of administration (ROA) in their office, and cannot use IV or IM.
There’s a lot of confusion, even among many practitioners, between route of administration and style of treatment.
You may encounter folks who think that SL and IM ketamine equals a warm, supportive, psychologically-informed environment, known as KAP or “ketamine-assisted psychotherapy”. KAP is typically delivered in a therapist’s or psychiatrist’s office, usually in session from 2.5-3 hours long. Most states do not allow therapists to administer medicine, so your SL ketamine lozenges – remember, therapists can’t give shots - are prescribed by another medical provider and you have to bring them to your session.
These same folks are under the misapprehension that IV ketamine equals a cold, clinical, lonely and unsupported experience. In fact, route of administration – that is, whether ketamine is given IV, IM, or SL – has nothing to do with style of treatment.
To be fair, many (most?) IV ketamine providers are quite clinical in their approach and their environment. But it doesn’t have to be that way, and it’s certainly not the case at Innate.
At Innate, while we provide ketamine therapy primarily via the IV route, we work in a highly supportive manner, in a warm, welcoming, non-clinical setting. You’re never left alone. We provide plenty of time to process and interact before, during, and after your ketamine infusion.
We think we’ve hit a sweet spot in the ketamine therapy world - more affordable than most KAP providers, highly supported, integrated with your existing care team, and using the most reliable, flexible, and research-backed route of administration.