Who's Watching the Drip? Study Exposes Regulatory Gaps in IV Hydration Spas

Intravenous (IV) hydration spas, despite their widespread popularity and promotion, operate largely outside established regulatory frameworks across the United States, raising significant concerns over patient safety, misleading efficacy claims, and the potential for serious adverse effects as they appear to "slip between the cracks of state and federal regulation", according to a news editorial published in JAMA.

A new investigation into IV hydration spas, reveals a systemic lack of oversight nationwide. These wellness facilities, which are part of the booming medical spa market that is valued at US$15 billion in 2022 with about 9000 medical spas in the U.S., make claims such as curing hangovers, boosting immunity, and detoxifying the body.

Regulatory Vacuum and Vague Oversight

A nationwide analysis of IV hydration spa regulation, published in JAMA Internal Medicine, ⁽¹⁾ has revealed a significant lack of oversight. Researchers examined laws across all 50 U.S. states and the District of Columbia, focusing on four key areas of regulation: governance, prescriber credentials, dispensing practices, and compounding practices. As of June 2024, none of the 51 jurisdictions had laws specifically targeting IV hydration spas.

While 32 states (63%) had policies that addressed at least one of the four oversight categories, only 4 states (8%) issued any guidance covering all four areas. Even then, the study noted that this was based on a "pretty permissive scoring system" and did not evaluate the adequacy or clarity of the existing policies.

Enforcement efforts by state medical boards and health departments were found to be weak or entirely absent, particularly when it came to newer businesses entering the market. One notable exception was Texas, which enacted new legislation in September 2023. This law was introduced in response to the death of a woman who received an IV infusion, and it explicitly outlines who is authorized to prescribe, order, and administer elective IV therapy.

Questionable Products and Unsubstantiated Claims

The products administered at IV hydration spas often fall into a regulatory gray zone. These facilities frequently use compounded versions of FDA-approved substances, mixing them with various vitamins, minerals, and electrolytes. While commercially manufactured IV fluids are regulated by the U.S. Food and Drug Administration (FDA), many of these spas qualify for an exemption under Section 503A of the Federal Food, Drug, and Cosmetic Act as independent compounding pharmacies.

Because of this exemption, the FDA’s oversight is significantly limited. The agency does not regulate critical aspects such as dosing consistency, packaging cleanliness, or labeling accuracy.

To better understand how these spas operate, researchers conducted undercover phone calls and reviewed clinic websites. All spas contacted offered IV hydration therapy, most commonly including ingredients like magnesium, glutathione, and nicotinamide adenine di-nucleotide. Nearly every website made claims about the benefits of these treatments, yet almost none provided scientific references to support their claims. When asked about risks, only a small portion of facilities disclosed any potential side effects.

Significant, Undisputed Risks

Medical toxicologists warn that the benefits of non-medical IV therapy remain scientifically unproven. Meanwhile, the risks seem well established. Common issues include bruising, bleeding, or infection at the injection site. In more severe cases, particularly when the IV solution contains unexpected or inappropriate substances, patients could experience allergic reactions or dangerous interactions with existing health conditions, with outcomes that could be life-threatening.

IV hydration treatments, which often come with a high out-of-pocket cost, are rarely covered by insurance due to their elective, non-medical nature.

Researchers caution clinicians not to assume these treatments are harmless. As Joseph Ross, MD, MHS, professor of medicine and public health at Yale University, who over saw the research into state policies and facility practices at IV hydration spas notes, oversight remains murky and unassigned, stating, “Nobody knows who’s supposed to be keeping watch” over this rapidly expanding industry.

However, the researchers hope their findings will prompt state legislators to recognize and address the regulatory gaps in this fast-growing industry. Dr. Ross emphasized the need for continued investigation, with the goal to “come up with an understanding of efficacy and safety of the treatments that are so widely promoted.”

In India, IV hydration and “wellness drip” therapies are rapidly gaining traction. Dozens of clinics in major cities now offer so-called glow, bridal, or immunity drips, often promoted as lifestyle enhancers rather than medical interventions. Yet, like in the U.S., oversight remains minimal, and claims of safety or efficacy are rarely backed by evidence. With the country’s spa and wellness industry expanding, this could be a timely wake-up call for Indian health authorities to establish clearer standards and ensure consumer protection before the trend evolves into a larger public-health concern.

Reference:

1. Sivakumar A, Forman HP, Wang I, Lurie P, Ross JS. State Policies and Facility Practices of IV Hydration Spas in the US. JAMA Intern Med. Published online October 06, 2025. doi:10.1001/jamainternmed.2025.5028

2. Schweitzer K. IV Hydration Spas Are Gaining Popularity, but Are They Safe? JAMA. Published online October 10, 2025. doi:10.1001/jama.2025.18832