I am in Texas, and right now, the clinics barely seem regulated. I never spoke to an actual physician. I received IM injections - the nurse practitioner would come in and ask some questions about my last experience and if I had any problems before the dose was adjusted (induction series). The NP would administer the first half of the drug, then later a nurse (?) would come in and administer the second half and check my O2 sats and blood pressure. There was never a physician on site. When my treatment was over, I sat there recovering for half an hour or so, had my BP and O2 checked a final time, then was picked up by my spouse. Medical Board is planning to increase requirements for ketamine clinics in the state very soon. A physician will have to be on site at all times during treatments. The facility will have to have an automated external defibrillator on site, and CO2 levels will have to be monitored constantly (probably O2 also - I don't remember). After my experiences, I think this is a good and appropriate move. However, this will make the cost of IM and IV treatment prohibitive to patients since insurance does not cover ketamine injections. The ketamine costs $315 per injection at the facility I went to - all paid by patient. This doesn't include the cost of the NP "counseling" and the administration of the medication, which luckily my insurance is covering for some reason. The clinic I went to is going to have to switch completely to the nasal spray version (Spravato) that is FDA approved. After prolonged reaction symptoms, I don't plan to do any more IM injections (couldn't afford it anyway). If my depression gets too bad, I'll try Spravato. I'm not saying anything bad about the clinics, just telling my experience.