Several public commenters raised concerns about ketamine and other remote-prescribed medications and their effects on client safety and the appropriate role of behavioral health licensees.

Dr. Allison Marks, a licensed psychologist who spoke as an individual, described two recent client cases in which out-of-state online medical providers prescribed ketamine for self-administration with limited dosing guidance, no scheduled follow-up and limited direct access to prescribing clinicians. Marks said her clients received vague instructions (for example, "take two milligrams the first week and then increase as you see fit") and received little assessment for contraindications or concurrent substance use. "The lack of medical oversight, minimal assessment, and absence of guidance on discontinuation or safety raise significant questions about liability and appropriate boundaries," she told the council.

Several council members and staff noted that the Texas Medical Board has been directed by the Legislature to study some ketamine issues and that the medical board's work is a primary venue for prescribing-related regulation. Council members said BHEC would monitor the medical board's study and asked staff to consider whether a BHEC town hall or invited testimony would be appropriate to gather additional information from practitioners about how ketamine and telehealth prescribing are affecting mental health practice.

Public comment also raised similar concerns about other medications prescribed through remote long-distance platforms (one commenter mentioned buprenorphine/Suboxone), emphasizing observed gaps in assessment, follow-up and communication with local mental health providers.

What happens next: Council members asked staff to monitor Texas Medical Board activity on ketamine and consider convening a practitioner town hall to solicit broader input before deciding whether BHEC should take additional policy or rulemaking steps. The council did not enact any immediate regulatory changes at the meeting.