Heroin and Ketamine Therapy | Tovani Health
Diacetylmorphine (Heroin) — Opioid (DEA Schedule I; illegal in the United States)
Verdict at Tovani Health
Schedule I and illegal; respiratory depression stacking with ketamine is the clinical issue.
Heroin is a DEA Schedule I controlled substance in the United States, with no accepted medical use in this country (it is legal medically in the UK and some other countries as diamorphine). Clinically, the concern is additive respiratory depression with ketamine plus the contamination problem in illicit heroin (frequently adulterated with fentanyl, which compounds the respiratory risk). We will not run a ketamine session in proximity to heroin use. Patients in active opioid use disorder benefit more from coordinated treatment (medication-assisted treatment with buprenorphine or methadone) than at-home KAP. After stable recovery on MAT, KAP becomes an option — buprenorphine and methadone have their own pages.
If you take Diacetylmorphine regularly and are considering at-home ketamine therapy, the combination is not currently a candidate. This page covers the brief pharmacologic context and what we do at intake.
How Diacetylmorphine interacts with ketamine
Heroin is rapidly hydrolyzed to morphine. Mu-opioid agonist with high abuse potential due to rapid CNS entry. Respiratory depression is the dominant cause of overdose death, multiplied by ketamine's CNS effects.
What we do at intake
We require treatment program coordination for any patient with active opioid use disorder. Disclosure matters; we are not an enforcement service. After stable recovery, KAP is workable.
Bottom line
Heroin is a DEA Schedule I controlled substance in the United States, with no accepted medical use in this country (it is legal medically in the UK and some other countries as diamorphine). Clinically, the concern is additive respiratory depression with ketamine plus the contamination problem in illicit heroin (frequently adulterated with fentanyl, which compounds the respiratory risk). We will not run a ketamine session in proximity to heroin use. Patients in active opioid use disorder benefit more from coordinated treatment (medication-assisted treatment with buprenorphine or methadone) than at-home KAP. After stable recovery on MAT, KAP becomes an option — buprenorphine and methadone have their own pages.
What would change this answer
We don’t prescribe at-home ketamine in this scenario today, but the situation can change. Talk to your prescribing physician about whether the underlying clinical picture (medication change, dose taper, indication shift, or stabilization milestone) might make you eligible later. We’re happy to revisit if your circumstances change.
For immediate mental health support, the 988 Suicide & Crisis Lifeline is available 24/7 (call or text 988).
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial. Bell RF, Eccleston C, Kalso EA. Cochrane Database of Systematic Reviews. 2017. PMID: 28657160
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 17, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.