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Ketamine infusion guidelines
These guidelines are in line with the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act) and the Accident Compensation Act 1985.
WorkSafe will have regard to these guidelines when making decisions for the provision of ketamine infusions to people who have an accepted claim under the Victorian Workers Compensation Scheme.
They aim to inform WorkSafe’s position on the use of ketamine infusions in the management of chronic non-cancer pain.
Other forms of ketamine, or ketamine infusions for the treatment of other conditions or clinical indications, will be assessed in line with the guidelines under the Non-established, new or emerging treatments and services policy.
Throughout these guidelines, any reference to WorkSafe also includes WorkSafe’s agents and self-insurers.
Ketamine infusions
WorkSafe can, in certain circumstances, fund ketamine infusions to assist people to effectively recover from workplace injuries and safely return to work and life.
These guidelines relate to the administration of ketamine by intravenous (into the vein) or subcutaneous (under the skin) infusion for specific clinical indications, where patients have failed to respond to first-line treatments.
In Australian medical practice, ketamine is occasionally used as an anaesthetic in surgical and trauma settings.
Outside of anaesthetic use there is insufficient evidence to support the use of ketamine infusions to treat chronic non-cancer pain as a first-line treatment. There is, however, evidence to support the use of ketamine infusions in limited circumstances.
What we can pay for
WorkSafe can pay the reasonable costs of the administration of ketamine by intravenous or subcutaneous infusion where required as a direct result of a work-related injury or illness under Victorian workers compensation legislation.
The treatment or service must meet the following criteria.
- Be clinically justified, safe and effective.
- Be likely to achieve measurable improvement in a person’s functioning.
- Promote progress toward a person’s functional independence, participation and self-management.
- Be for rehabilitation purposes for a work-related injury only.
- Be delivered in line with the Clinical Framework.
The treatment or service must be referred by a medical practitioner.
We can pay for ketamine infusions under the following circumstances.
- Where patients have failed to respond to first-line treatments for chronic non-cancer pain.
- To reduce opioid use in patients with limited options for managing chronic non-cancer pain.
- To reduce the use of opioids needed following a surgical procedure.
WorkSafe will periodically review a person’s entitlement to ketamine infusions to make sure treatment and services remain reasonable, clinically justified, outcome focused and payable under the legislation.
Services we will not pay for
Under the Victorian workers compensation legislation, WorkSafe cannot pay for the following ketamine infusion services.
- Services that are not required as a result of a worker’s accepted injury or illness.
- Services for a person other than the person with an accepted claim.
- Services that are not a reasonable cost as determined in accordance with the Victorian workers compensation legislation.
- Services provided outside of Australia without prior approval from WorkSafe.
- Services provided by a person who cannot practice in the relevant profession under the Health Practitioner Regulation National Law because they are either:
- not registered
- registered as a student, or
- hold non-practising registration.
WorkSafe will not pay for ketamine infusion services provided without prior approval from WorkSafe.
How much we can pay
WorkSafe will pay for ketamine infusions in line with the relevant fee schedules.
WorkSafe will assess the reasonable costs of a request for ketamine infusions to ensure they are in accordance with the following.
- Reimbursement rates for medical services.
- Private hospital fee schedules.
- Victorian Department of Health’s fee schedules.
Sometimes there is a difference between what a provider charges and what WorkSafe will pay as the reasonable cost. If the provider charges more than what WorkSafe will pay, workers will need to pay the difference. In this instance, WorkSafe recommend the provider advise the worker prior to providing any services.
Who can provide these services
WorkSafe will only fund ketamine infusions delivered by providers that meet the following conditions.
- Hold medical practitioner registration with the Australian Health Practitioner Regulation Agency (AHPRA).
- Be able to provide evidence of current professional indemnity insurance coverage of at least $2 million.
Find out how to register as a provider.
Accessing services
A request for funding of ketamine infusions must be accompanied by the following to be considered.
- Supporting documentation – medical practitioner
- An established and reliable diagnosis of the worker’s pain condition(s) that has resulted from an accepted work-related injury or illness.
- Evidence from the treating specialist that first-line treatments and services have been trialled for a period of time or that contraindications or side effects have resulted in the treatment not being appropriate.
- A list of the worker’s current or relevant past medications including the outcomes of those treatments from the treating specialist.
- Current pain and functional capacity standardised outcome measures. Refer to the preferred standardised outcome measure, The Brief Pain Inventory.
- Evidence that suitable mental health safety measures are in place, if a worker has mental health risk factors that increase the likelihood of an adverse psychiatric event.
- Review referral and initial request - WorkSafe agent
Once the information has been received, ketamine infusion requests will either be reviewed by:
- a WorkSafe Clinical Panel member
- an injury management advisor
- a suitably qualified person at the agent.
Contact with the requesting medical practitioner may be required to seek further information and/or discuss the proposed treatment or service prior to making a recommendation to the agent.
When all required information is received, notification of an outcome will be made within 28 days.
- Subsequent Requests – WorkSafe agent
WorkSafe will review subsequent requests in line with the Clinical Framework for the delivery of health services. This includes a review of pre- and post-treatment standardised outcome measures to ensure adequate improvement in pain and functional capacity or a reduction in opioid medication usage.
Timeframes for subsequent request
- WorkSafe will not consider ketamine infusion requests that are within 3 months of the initial treatment.
- WorkSafe will not consider subsequent ketamine infusion requests, following the second treatment, within a 6-month period, unless in exceptional circumstances.
Service delivery expectations
WorkSafe expects that all providers delivering ketamine infusions as part of the Victorian workers compensation scheme follow the below principles.
- Provide culturally safe and respectful services.
- Protect the person’s human rights and report any concerns of abuse, neglect or discrimination to an appropriate regulatory or complaints body.
- Support the person to maximise their independence, promote recovery and self-advocacy.
WorkSafe also expects that any treatment provided is reasonable, clinically justified, outcome focused, and in line with the Clinical Framework.
WorkSafe has reporting and engagement expectations for all providers delivering ketamine infusions. WorkSafe expects providers to communicate, collaborate and provide information to WorkSafe and other relevant parties as required.
For example:
- Providers should work with treating health practitioners or other providers, such as other medical practitioners to enable the most appropriate treatment.
- Providers should work with occupational rehabilitation providers, treating health practitioners and employers in relation to return to work.
Providers are required to comply with the requirements set out in these guidelines and in the Application for registration to provide services to workers.
If a provider does not meet these requirements or WorkSafe has concerns about the provider’s conduct or services delivered, WorkSafe may take appropriate action in accordance with the legislation.