State Policies and Facility Practices of IV Hydration Spas in the US.

Importance: While the number of intravenous (IV) hydration spas has grown over the past decade, information regarding their regulation and practices remains sparse, despite concerns about oversight and safety. Objective: To review state-level policies related to IV hydration spa oversight and regulation, and examine US facility practices, including product offerings, product claims, and staffing. Design, Setting, and Participants: In June 2024, a cross-sectional content analysis of state-issued, public-facing regulatory laws and statements was conducted for all 50 US states and the District of Columbia (DC). In July and August 2024, the websites of 5 IV hydration spas in each state and DC were reviewed. Finally, from August through October 2024, a secret shopper study was conducted of 2 randomly selected IV hydration spas in each state and DC from the website review. Main Outcomes and Measures: The policy analysis determined whether states explicitly addressed 4 aspects of IV hydration spa oversight: governance, prescriber credentials, dispensing practices, and compounding practices. Website review ascertained product offerings, product claims, and staffing at each site. The secret shopper script included questions on the availability of licensed health professionals, product offerings, pricing, and potential risks or waiver requirements as well as insurance coverage. Results: Although 32 states have issued some form of IV hydration spa-related guidance, policies varied widely and only 4 state policies addressed governance, prescriber credentials, dispensing practices, and compounding practices. Review of 255 facility websites found spa practices also varied with respect to product offerings, product claims, and staffing. All offered IV hydration therapy, most commonly combined with magnesium (n = 146 [57.3%]) and glutathione (n = 137 [53.7%]) and vitamin injections (n = 162 [63.5%]) were also commonly offered. All websites also included claims for beneficial uses, although only 2 (0.8%) cited sources for these beneficial health claims. The secret shopper study of 87 randomly selected facilities corroborated the website review: 24 (27.6%) required consultation with a licensed medical professional before treatment, 75 (86.2%) recommended specific therapies for proffered headache and cold symptoms, and 21 (24.4%) described potential risks. Conclusions and Relevance: This mixed-methods study found that state-level policies governing IV hydration spas and facility practices vary widely, suggesting more stringent oversight may be necessary to protect public health.