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Is Ketamine Therapy Legal in Tennessee?

Yes. Ketamine is a federal Schedule III controlled substance, and physicians licensed in Tennessee may prescribe and administer it — including off-label for depression, which means for a purpose the FDA has not formally approved.

The federal baseline

Ketamine and its mirror-image form esketamine are Schedule III controlled substances under federal law, which means they have accepted medical uses but can be misused. as of 18 Jul 2026 · U.S. Drug Enforcement Administration (source 1, opens in a new tab)Esketamine has no separate DEA listing; it is covered as an enantiomer of ketamine, and the Spravato label carries the CIII designation.

Only esketamine (Spravato) is FDA-approved to treat depression. Racemic ketamine given by IV, injection, or under the tongue has no FDA approval for any psychiatric condition and is used off-label — that is, an approved drug used for an unapproved purpose. as of 30 Apr 2025 · U.S. Food and Drug Administration (source 1, opens in a new tab)

The FDA approved Spravato (esketamine) nasal spray on 5 March 2019, for use with an oral antidepressant, for adults with treatment-resistant depression. as of 5 Mar 2019 · U.S. Food and Drug Administration (source 3, opens in a new tab)

Spravato is available only through a restricted safety programme called a Risk Evaluation and Mitigation Strategy (REMS), and may only be given in a certified healthcare setting under a provider's direct observation. Patients never take it home. as of 30 Apr 2025 · U.S. Food and Drug Administration (source 4, opens in a new tab)

Tennessee law: who may give it

In Tennessee, medical doctors and osteopathic physicians may administer ketamine within their scope of practice. An advanced practice registered nurse may prescribe Schedule II to V controlled substances only while holding a certificate of fitness from the Board of Nursing and having filed notice naming a collaborating physician, who keeps responsibility for prescribing. A physician assistant may prescribe them only as delegated by their primary collaborating physician. as of 8 Oct 2024 · Tennessee Code Annotated (source 6, opens in a new tab)

Who may own a clinic in Tennessee

Tennessee bars corporations from practising the healing arts, with specific exceptions for hospitals and their affiliates. In practice this shapes who may own a ketamine clinic in Tennessee, and clinics are commonly structured as physician-owned professional entities. as of 18 Jul 2026 · Tennessee Code Annotated (source 1, opens in a new tab)The best citable text we could retrieve is a secondary reproduction of the statute rather than the state's own site.

This matters to you only indirectly, but it shapes which clinics exist here and how they are structured.

Controlled Substance Monitoring Database (CSMD)

Prescription monitoring is where published information about ketamine most often goes wrong, because three different questions get collapsed into one. They have different answers.

What must be reported

Tennessee's monitoring system is the Controlled Substance Monitoring Database, usually called the CSMD, set up under the Tennessee Prescription Safety Act. Pharmacies and dispensers must send it their controlled substance dispensing records each business day, by the close of the business day after dispensing. as of 26 Jan 2022 · Tennessee Secretary of State (source 6, opens in a new tab)

When a prescriber must check

A Tennessee practitioner must look a patient up in the CSMD when a new episode of treatment begins, again before each later prescription during that episode's first ninety days, and every six months after that. Crucially, this duty is limited to opioids, benzodiazepines and Schedule II amphetamines — it does not extend to every controlled substance. as of 26 Jan 2022 · Tennessee Secretary of State (source 6, opens in a new tab)Material published elsewhere often describes this as covering all of Schedule II to V. It does not.

Does this apply to ketamine?

No routine check is required. Ketamine is a Schedule III medicine and is not an opioid, a benzodiazepine, or a Schedule II amphetamine, so it falls outside the classes that trigger Tennessee's consultation duty. A narrower duty still applies if a practitioner knows or reasonably believes a patient is seeking drugs for misuse or diversion. as of 26 Jan 2022 · Tennessee Secretary of State (source 6, opens in a new tab)

Telehealth

Tennessee does not require an in-person examination before a provider-patient relationship is established or before controlled substances are prescribed by telemedicine. Telehealth providers are held to the same standard of care as they would be in person. as of 2 Jan 2024 · Tennessee Code Annotated (source 10, opens in a new tab)Federal DEA telemedicine flexibilities run separately and expire at the end of 2026. Spravato cannot be prescribed for home use in any case, because it must be given in a certified setting.

Through 31 December 2026, clinicians registered with the DEA may prescribe controlled medicines such as ketamine after a video telemedicine visit, without an in-person examination first. as of 1 Jan 2026 · Drug Enforcement Administration (source 1, opens in a new tab)This is the fourth temporary extension. Each of the previous three was issued close to its expiry date, so the position may change late in 2026.

The DEA's proposed rule to create a special registration for prescribing controlled medicines by telemedicine, published on 17 January 2025, is still only a proposal and has not been finalised. as of 17 Jan 2025 · Drug Enforcement Administration (source 1, opens in a new tab)No final rule and no withdrawal notice has been published. A rule can also be shelved without a formal withdrawal, so this should not be read as a statement that the DEA intends to finalise it.

Two things are worth holding onto here. The federal flexibility has a hard end date and has been extended four times at short notice, so anything you read about telehealth ketamine access needs a date attached to it. And a stricter state rule still applies regardless of what federal law permits.

Spravato is a separate case entirely: it must be taken in a certified clinic under observation, so it cannot be prescribed for home use whatever the telehealth position is.

How to check a clinician before you book

  1. Go to the Tennessee Board of Medical Examiners licence lookup.
  2. Search by name, and confirm the licence is current and unrestricted.
  3. Look for disciplinary history. It is published for a reason, and it is the single most useful thing you can check in five minutes.
  4. If you are seeking Spravato specifically, confirm the clinic is REMS-certified using the official locator . No other directory, including ours, can tell you that.