Oral works as well - no pain in the nose, etc - but it does take more ketamine. As for the IV... these are doctors administrating it. An IV allows for more precision, and a point of the treatment, it seems, is to avoid the K-hole effect - which would seriously disturb a lot of patients.
If I was using opiates for a medical purpose, I would want to be precise - heroin vs making poppy tea.
Many drugs undergo first-pass metabolism by the liver and their metabolites are much less active or much more non-specific. I don't know if that is the case for ketamine, but I suspect that it must be.
If I was using opiates for a medical purpose, I would want to be precise - heroin vs making poppy tea.