Esketamine

Regulated restrictive practice · chemical restraint reference

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Esketamine · RP Check

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Jurisdictional framework

Select your state to see jurisdictional framework, reporting obligations, and authority links. Substance information above is the same in every state.

Restrictive practice framework8 states

ACT2 citations
- In the Australian Capital Territory, use of Esketamine as chemical restraint is regulated by the Senior Practitioner Act 2018 (ACT), which establishes the Office of the Senior Practitioner with independent oversight across disability services, education, residential care, and child protection. A Positive Behaviour Support Plan must justify the practice as the least-restrictive option, with active reduction strategies. The ACT framework's stated aim is the reduction and elimination of restrictive practices.
  ↗ACT Office of the Senior PractitionerT3✓
- Statutory anchor: Esketamine use as chemical restraint in the ACT is regulated by the Senior Practitioner Act 2018 (ACT). The Act's stated object is the reduction and elimination of restrictive practices and it applies broader-than-NDIS oversight: disability services, education, residential care, and child protection all sit within scope.
  ↗Senior Practitioner Act 2018 (ACT)T3✓
NSW1 citation
- In New South Wales, use of Esketamine as chemical restraint by a registered NDIS provider must be authorised under the NSW Restrictive Practices Authorisation framework administered by the Department of Communities and Justice (DCJ). Authorisation requires a Behaviour Support Plan documenting the practice, evidence that it is the least-restrictive option, and a documented reduction strategy. Psychotropic medications used as restraint should be reviewed at least every six months by a medical practitioner and at least every twelve months by a psychiatrist.
  ↗NSW DCJ Restrictive Practices AuthorisationT3✓
NT1 citation
- In the Northern Territory, use of Esketamine as chemical restraint by a registered NDIS service provider requires authorisation by the NT Senior Practitioner via the Restrictive Practice Authorisation System administered by NT Health. Applications must include the Behaviour Support Plan, evidence of consultation with the participant and relevant others, particulars of the providers applying the practice, and a summary of every restrictive practice applied in the preceding 12 months.
  ↗Northern Territory NDIS Restrictive Practices AuthorisationT3✓
QLD4 citations
- In Queensland, use of Esketamine as chemical restraint on an adult with disability requires consent from a restrictive-practices guardian appointed by the Queensland Civil and Administrative Tribunal (QCAT), or short-term approval by the chief executive of the relevant disability service while a Positive Behaviour Support Plan is being developed. The Office of the Public Guardian acts as substitute decision-maker where appointed. Use must be the least-restrictive option to prevent serious harm and is subject to reduction planning.
  ↗Queensland Office of the Public GuardianT3✓
- In Queensland, use of Esketamine as chemical restraint by funded disability service providers is governed by the Disability Services Act 2006 (Qld) and the positive behaviour support / restrictive practices framework administered by the Department of Families, Seniors, Disability Services and Child Safety. Authorisation must follow assessment by an appropriately qualified practitioner, a Positive Behaviour Support Plan, and the legislative tests of least-restrictive practice and reduction planning. Authorisation is granted per restrictive-practice type — separate authorisation is required for each.
  ↗Queensland Department of Families, Seniors, Disability Services and Child SafetyT3✓
- Statutory anchor: substitute decision-making for Esketamine use as chemical restraint on adults with impaired capacity in Queensland is governed by the Guardianship and Administration Act 2000 (Qld). Chapter 5B Part 4 sets out QCAT's powers to appoint a restrictive-practices guardian and the Office of the Public Guardian's role as substitute decision-maker.
  ↗Guardianship and Administration Act 2000 (Qld)T3✓
- Statutory anchor: Esketamine use as chemical restraint by funded disability service providers in Queensland is regulated by the Disability Services Act 2006 (Qld), Chapter 5B of which sets out the positive behaviour support and restrictive-practice authorisation framework. The PBSRP Reform Bill 2024 lapsed in October 2024; the existing framework remains in force.
  ↗Disability Services Act 2006 (Qld)T3✓
SA2 citations
- In South Australia, use of Esketamine as chemical restraint is a Level 2 restrictive practice under the SA Restrictive Practices Authorisation Scheme (in force from 30 May 2022) and can only be authorised by the Senior Authorising Officer — Authorised Program Officers cannot approve chemical restraint. Authorisation requires a Behaviour Support Plan, advice from a Specialist Behaviour Support Practitioner, and consultation with the participant and their family. The scheme is administered by the Restrictive Practices Unit within the Department of Human Services.
  ↗SA Restrictive Practices Authorisation SchemeT3✓
- Statutory anchor: Esketamine use as chemical restraint in South Australia is regulated by the Disability Inclusion Act 2018 (SA), with the operative detail in the Disability Inclusion (Restrictive Practices — NDIS) Regulations 2021. Together they establish the two-tier authorisation scheme (Authorised Program Officer for Level 1, Senior Authorising Officer for Level 2 including chemical restraint) in force from 30 May 2022.
  ↗Disability Inclusion Act 2018 (SA)T3✓
TAS2 citations
- In Tasmania, use of Esketamine as chemical restraint by a disability service provider requires authorisation by the Tasmanian Senior Practitioner under the Disability Rights, Inclusion and Safeguarding Act 2024 (Tas). The Senior Practitioner authorises, oversees, and reports on restrictive practice use in NDIS-funded and Department of Communities Services–funded disability services, with a statutory requirement to protect the rights of people subject to restrictive practices to the greatest extent possible.
  ↗Tasmanian Senior Practitioner (Disability)T3✓
- Statutory anchor: Esketamine use as chemical restraint by disability service providers in Tasmania is regulated by the Disability Rights, Inclusion and Safeguarding Act 2024 (Tas), which establishes the Tasmanian Senior Practitioner with statutory powers to authorise, oversee, and report on restrictive-practice use in NDIS-funded and Department of Communities Services–funded disability services.
  ↗Disability Rights, Inclusion and Safeguarding Act 2024 (Tas)T3✓
VIC2 citations
- In Victoria, use of Esketamine as chemical restraint requires authorisation by the Victorian Senior Practitioner under the Disability Act 2006 (Vic). Authorisation must satisfy the legislative tests of necessity to prevent harm, least-restrictive option, and a documented reduction plan.
  ↗Victorian Senior PractitionerT3✓
- Statutory anchor: Esketamine use as chemical restraint in Victoria is regulated by the Disability Act 2006 (Vic), Part 7 of which establishes the Senior Practitioner role and the regulated-restrictive-practice authorisation framework. The Act's tests of necessity, least-restrictive option, and reduction planning are statutorily binding.
  ↗Disability Act 2006 (Vic)T3✓
WA1 citation
- In Western Australia, use of Esketamine as chemical restraint requires authorisation through a Quality Assurance Panel under the WA Department of Communities Authorisation of Restrictive Practices framework (effective 1 December 2020). The panel must include at least two decision-makers: a senior manager from the implementing provider and an independent NDIS Behaviour Support Practitioner external to that provider who did not write the Behaviour Support Plan. Unlike single-administrator state models, the panel decision is the authorisation.
  ↗WA Department of CommunitiesT3✓

From Wikipedia (Tier 4)

Esketamine, sold under the brand names Spravato (for depression) and Ketanest (for anesthesia) among others, is the S(+) enantiomer of ketamine. It is a dissociative medication used as a general anesthetic and as an antidepressant. Esketamine is the active enantiomer of ketamine in terms of NMDA receptor antagonism and is more potent than racemic ketamine. However, racemic ketamine may produce larger and more sustained antidepressant effects than esketamine.

Read the full article on Wikipedia

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↗PBST2✓

PBS-subsidised indications

Treatment resistant major depression
Show clinical criteria
Treatment resistant major depression Clinical criteria: Treatment Phase: Induction treatment The condition must have been inadequately responsive to at least two oral anti-depressant drug therapies. Treatment criteria: Must be treated by a psychiatrist, where prescribing must also be completed by the treating psychiatrist, AND Patient must be undergoing supervision at an accredited treatment centre for the administration of esketamine. The following must apply if reinitiating treatment: (i) at least four-week gap from last treatment course to reinitiation of treatment; and (ii) evidence, documented in the patient's medical record using a structured rating scale, of significant clinical therapeutic benefit of the prior course of treatment with esketamine; and (iii) evidence, documented in the patient's medical record using a structured rating scale, of a relapse in depression. The listed quantity of 24 units of nasal spray is intended for a dosage of 84 mg per treatment administration in the induction treatment setting.

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Mechanism & pharmacology

“Esketamine is approximately twice as potent an anesthetic as racemic ketamine.”
↗WikipediaT4fallback✓

“5 hours”
↗WikipediaT4fallback✓

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Jurisdictional framework

PBS-subsidised indications

Mechanism & pharmacology