Because healthcare in this country is a for profit industry and insurance companies want to keep premiums without actually having to provide care.

The doctors I was working with when we first discussed it said that the nasal delivery was only being prescribed for suicidal patients via Mental Health Department. It was a fight to get them to consider the infusion at all for pain and then they were only going to do 1 infusion of a small amount. I've touched base with a local ketamine clinic and will be working with them if the DSM doesn't reveal anything fixable. Also, ketamine infusions here are outpatient.