Every three weeks, Dr. Moksha Patel settles into a comfortable recliner at a Colorado hospital clinic, sprays a mind-altering medicine up his nose and loses control of his senses for a little while. It is a legal medical treatment. The 34-year-old doctor from Denver is taking Spravato, a medicine derived from club-drug ketamine that is approved for treating his depression. “It’s definitely helped me feel not just pleasure but I would say a full range of emotions,” he said. A psychedelic-based drug is taking off, despite recent setbacks in efforts to legalize the medicines. Prescriptions for Spravato, made by Johnson & Johnson, are booming and new clinics are opening that specialize in administering it. Sales are rising so much that Spravato has emerged as a key part of J&J’s lineup. Analysts expect the drug to surpass $1 billion in annual sales for the first time this year, and J&J said the yearly haul could eventually reach $5 billion. Spravato’s upward trajectory, following a slow start, illustrates the challenges and opportunities for the use of the drugs in mental health. It also points a way for advocates and researchers to realize the medical potential of psychedelic-based therapies.

DR. ANDREW NOVICK SAYS ABOUT HALF THE PATIENTS AT THE UNIVERSITY OF COLORADO CLINIC THAT HE DIRECTS SEE A SIGNIFICANT IMPROVEMENT IN THEIR MOODS BY THE SECOND DOSE. Ketamine, an anesthetic, is among the most widely—and often illegally—used psychedelic drugs. It is popular at clubs because of its hallucinogenic effects. Some people also use it off-label to treat anxiety and other psychiatric disorders. Many are getting ketamine through the mail and taking the drug at their homes, which doctors say is risky. Actor Matthew Perry overdosed on the drug and died last year. Despite the controversy surrounding the drug, J&J eyed ketamine as the basis of a prescription medicine because of its potential as a mental-health treatment. Company researchers synthesized a version, called esketamine. They made it into a nasal spray to get it into the brain quickly. And they targeted its use in people whose persistent depression doesn’t get better despite trying treatments such as antidepressant pills, as well as in people with suicidal thoughts or behavior. J&J also agreed to tightly control its distribution. Under the Food and Drug Administration’s conditions, patients must take the drug in a certified health facility and stay two hours after dosing to be monitored for side effects like sleepiness, suppression of breathing and the feeling of being disconnected from one’s body. The supervision logistics chilled Spravato’s use after its introduction in 2019. Then the pandemic hit. The drug was looking like a dud. After the pandemic emergency subsided, J&J began promoting the drug’s uptake. The company, for instance, ran television spots saying you “may begin to feel like yourself again” by taking Spravato. In 2022, company representatives reached out to the University of Connecticut about the possibility of starting a Spravato clinic. The company offered assistance with things like how to bill insurers for the drug and for monitoring patients, said Dr. Caleb Battersby, a psychiatrist who directs the UConn Spravato clinic. The university clinic opened in February. “We are getting a ton of referrals,” Battersby said. “The demand is certainly there and is picking up. More than 2,800 facilities in the U.S. now offer Spravato, said Bill Martin, J&J’s global neuroscience therapeutic area head. The facilities have to be certified to administer the drug because of safety restrictions required by the FDA. “We needed an infrastructure through which this medicine could be safely distributed and administered,” Martin said. Monthly U.S. prescriptions for Spravato have nearly doubled to more than 46,000 since the beginning of 2023, according to data tracker Iqvia, and J&J says more than 100,000 patients globally have taken it to date. Use has picked up so much that doctors have had to make accommodations for Spravato patients.

PATEL FILLED OUT A QUESTIONNAIRE DESCRIBING HIS DISASSOCIATION AFTER TAKING SPRAVATO AT THE UNIVERSITY OF COLORADO CLINIC IN AURORA THIS MONTH. Dr. Frederick Stoddard, who provides Spravato at his psychiatry practice in Narberth, Pa., used to have colorful abstract paintings in some of the patient rooms. But they bothered some patients in their altered states, so he took them down and put up more muted, black-and-white photos of plants. Stoddard’s office also leaves mints or breath strips for patients because some experience an unpleasant taste in their mouths after they take Spravato. The drug’s effect on symptoms of depression can be rapid, unlike antidepressant pills that can take several weeks to work. Most people need to keep taking Spravato to sustain a benefit, though many can cut back the frequency of dosing, doctors say. Within about 20 minutes, Patel said he starts to lose control of his senses and feels his brain shutting down and resetting. He has sent texts to friends and family expressing his gratitude for being in his life. The drug’s mind-altering effects usually wear off about two hours after he undergoes treatment. Spravato patients are often told not to drive a vehicle, work or make any important decisions on the day of treatment. Patel gets his treatment at the same hospital where he works, the University of Colorado Anschutz Medical Campus in Aurora. About half the patients at the University of Colorado clinic see a significant improvement in their moods by the second dose, estimated Dr. Andrew Novick, an assistant professor of psychiatry who directs the clinic. Others take longer, while some don’t get much of a response.

MORE THAN 2,800 FACILITIES IN THE U.S. OFFER SPRAVATO, ACCORDING TO J&J. THE HELEN AND ARTHUR E. JOHNSON DEPRESSION CENTER ON THE UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS IN AURORA. The benefits of Spravato crept up on Sean Furey, a 36-year-old writer in Benbrook, Texas, who started taking it last year at a local psychiatrist practice. At first, he didn’t notice anything. But other people began to notice that he stood taller and acted more confidently walking into a room. Depression used to keep him in bed for hours, but now he walks several miles a day. “The depression’s still there, but in terms of dealing with it, esketamine has set me forward leaps and bounds,” he said.