Currently marketed as the only legal option for embarking on a therapeutic ‘psychedelic’ experience, ketamine-assisted therapy clinics have been making their way through the U.S. with incredible celerity.
On today’s episode transcript of the Psychedelic Passage podcast, co-founders Nick Levich and Jimmy Nguyen explain why ketamine-assisted therapy has remained largely unchallenged by our legislative systems. How do these programs work at such a large scale without compromising the therapeutic integrity of these treatments, and what should you look out for when vetting potential clinics?
Episode 3: What Are the Benefits and Pitfalls of Ketamine?
Jimmy Nguyen: Welcome to the Psychedelic Passage podcast. My name is Jimmy Nguyen. This is Nick Levich. We’re the co-founders of Psychedelic Passage. Thanks for joining us today. This week we’re going to talk about ketamine and ketamine-assisted psychotherapy.
Ketamine has been really really popular and prevalent in the media and in people’s attention. We’re going to talk a lot about the ins and outs of ketamine, about searching for the right assisted therapy program, at home versus in-clinic, all of that good stuff.
Because what happens is that folks who come across psychedelics, they see that ketamine is one of the legal viable options. And Nick, do you want to share with them why that even is, why ketamine is treated differently than the other psychedelics?
Nicholas Levich: Yeah, so I mean, as a quick primer for those who may be new to the space, traditional psychedelics, meaning psilocybin, LSD, DMT, all remain schedule one substances, meaning federally – they are illegal. But ketamine has been used for hundreds of years.
It’s a dissociative anesthetic, it’s one of the cheapest and most well studied anesthetics used all across the world for various surgeries and medical procedures. And basically what they learned is that in moderate to high doses, it’s got psychedelic effects.
So essentially what’s going on right now is that there’s these clinics popping up that are administering ketamine in what’s called an off-label use, meaning for a use other than what it was originally intended.
And to Jimmy’s point, because it is legal in that sense, that’s why we see a lot of people turning to ketamine thinking that it’s a traditional psychedelic when in reality it’s not. And they’re going there specifically because it’s legal and they can have a doctor supply it to them.
Jimmy Nguyen: Yeah, so if you dislocated your shoulder and you went to the ER, likely they would give you some ketamine before they pop your shoulder into place, or if you were maybe going to go into surgery where you are going to get a general anesthetic.
Sometimes the combination of ketamine along with general anesthetic, along with other narcotics, can help to make sure that you don’t wake up in the middle of your appendix getting taken out or something like that. So then what we find is that it becomes that schedule three, it then is legally prescribed for off-label use. But ketamine, I feel, is in its own category as opposed to other psychedelics.
Nicholas Levich: I mean, it’s not a psychedelic like in the traditional sense, it induces hallucinations or altered states of consciousness, but by traditional definition it is in a totally different category than LSD, psilocybin, DMT, 5-MeO.
Jimmy Nguyen: I like what you said. So ketamine elicits an altered state of consciousness, but I think it’s very important to distinguish that it’s wildly different from what you think about (traditional psychedelics). I mean, what I find with ketamine, this is the best way that I can describe it, anecdotally at least first and foremost.
There is a very therapeutic potential to that dissociated state. I think therapeutic not only for your nervous system, but definitely therapeutic for folks who have treatment-resistant types of issues. Depression for a very long time, anxiety for a very long time.
Nicholas Levich: I think it would be helpful if you explain where the benefit comes in from that disassociation.
Benefits of Ketamine-Assisted Therapy
Jimmy Nguyen: Right. So here’s the way that I describe it. As you’ll hear us talking through this podcast quite a bit, there’s this connection between our body, what’s going on in our body connects to what’s going on in our mind. And then for some who agree or disagree, there’s also the spirit or the soul.
There’s something going on there. So when we go through things like treatment-resistant depression or bouts of anxiety, our nervous system in our body also responds and reacts that way. A lot of people think about this like the fight or flight mode or some of those things.
So one benefit right off the bat that ketamine can hold is that the dissociative state allows us to break almost that neural patterning whenever we feel like that anxiety attack or that depression comes in.
It puts a pause, I think, between your body’s reaction. Here’s the best way that I can describe ketamine. For me at least, it allows you to have very difficult conversations with yourself, but in a very gentle manner. That’s the best way that I can describe it-
Nicholas Levich: Because you can view yourself from basically like an unemotionally-attached third party, and you’re like, ‘oh, interesting, that’s what’s going on’.
Jimmy Nguyen: But in order to have that constructive conversation, you have to have a good priming and a set up to even know that it’s something that I can do.
Nicholas Levich: This is where things go south most of the time.
[Jimmy laughs]
Jimmy Nguyen: So what some people do is they go to these ketamine clinics with zero preparation, zero.
Nicholas Levich: I think we should describe for people who the staff is at these clinics and kind of what’s going on. Right?
Jimmy Nguyen: Yeah, for sure.
Types of Ketamine-Assisted Therapy
Nicholas Levich: Because there are several different ways you can get ketamine. There’s even at-home programs where they will mail you ketamine. Okay? So it’s really important for folks to understand that you can do this in your home with little to no guidance and with a clinic ranging from a lot of guidance to none at all. So there’s a spectrum, and that’s kind of the theme of what we want to paint today is the full spectrum of how ketamine can be used.
Jimmy Nguyen: Right. Because of the scheduling, the schedule three, the off-label use means that this is federally legal across all 50 states. So people are going to see ketamine clinics. If anyone does a Google search, you’re likely going to find a handful of ketamine clinics in your area, at-home programs, as Nick mentioned.
So to me there’s almost three categories. One is a clinical-only model where you’re realistically just going to get a prescription of ketamine. They’ll administer it either with an IV drip, intramuscularly with a shot, orally via some type of lozenge or something like that.
And then there are some models that also include mental health support and oversight. So this might be the same thing in a clinic, but maybe they’ll assign you a mental health professional to at least go through a few preparation sessions, possibly some integration sessions afterwards. Again, every clinic is different.
And then I think the X factor are these at-home programs which I think can be very beneficial, but there’s a lot of variables to it that people should be aware of. And that’s where you’ll end up going through likely some type of a telehealth meeting where the prescribing professional will write you a transcription and then they’ll mail you actually the lozenges or whatnot. And usually with the oral lozenges they’re at lower dosages so that you can be in a little bit of, I guess, a better parameter.
Nicholas Levich: There’s also the nasal spray as well. So there’s all different routes of administration.
The Downfalls of Ketamine-Assisted Therapy
Nicholas Levich: And so these clinics, basically what’s happening is they’re run by a doctor, a traditional MD typically, and then there’s a series of nurses typically on staff that make the rounds or actually check in with patients. And you’ll hear us talk about the importance of preparation and integration time and time again.
And the sad reality is that most of these clinics and at-home programs have none of that baked into it. What we tend to find at Psychedelic Passage (most of our clients are electing to sit with psilocybin) is that people are coming to us after having a lot of pretty horrific ketamine experiences.
So we’ll get someone that reaches out to us via consultation and they’ll say, ‘hey, I tried ketamine. It either didn’t work, the effects were short-lived, even though I got temporary relief, there’s not the lasting change’, or ‘I just had a straight up adverse or traumatic experience related to ketamine for one reason or another’.
So we’ve heard things like people driving home afterwards, which is really not a good idea. We’ve heard of doctors who are on the phone while the patient is journeying, just all kinds of things that from my perspective are wildly unacceptable.
Jimmy Nguyen: Laughing, not laughing, but it’s wild to me that the most legal mechanism for people to engage in altered taste of consciousness for their own therapeutic benefit is actually the one that has likely the most adverse things going on.
I was on the phone with somebody, who knows how long ago, and they were like ‘Yeah. The nurse was literally coming in just to check the drip line and then they ended up being the one sitting there talking to her for like 2 hours however long as they were going through and that person was not a mental health professional nor were they equipped nor are they ready to do that. They were literally just going in to monitor and make sure’.
Nicholas Levich: Well this goes back to the whole thing that I think is really important. Regardless of who your guide is, your facilitator, your support system – if they haven’t journeyed themselves and they’re not willing to roll their sleeves up and be with you, I really recommend you find somewhere else because I always use the analogy that you wouldn’t trust an airline pilot to teach you how to fly a plane if they’ve never flown it themselves. And the reality is that most of these doctors and nurses have never taken ketamine in the way that they’re administering it to their patients.
Jimmy Nguyen: Yeah and I’ll say that hours in the flight simulator is different from hours actually flying the plane.
Nicholas Levich: I hear you.
Jimmy Nguyen: I mean ultimately Nick, you and I probably agree we’re not fans of the medical, clinical-only model. I think that ketamine, though there should be that type of oversight and administration, ketamine opens up a lot of content.
It opens up a lot of content and then what do you do with that as a journeyer or as a patient? So if you don’t have a proper place to put that content then you’re going to just be in the cycle of needing this substance or this thing to continually get to that state. And this stuff is not cheap either.
Nicholas Levich: No they typically require you to do a minimum of six sessions and it will be several hundred dollars per session. So we’re talking about multiple thousands of dollars to get through a round of ketamine. And my whole thing is, if there’s no context, there’s no framing, there’s no prep and there’s no integration, people don’t get the results that they’re seeking.
The vast majority of people that are seeking some sort of intentional psychedelic use want lasting change. Nobody is looking to be reliant on the medicine or the substance in order to feel the way they want to feel. They want lasting change in their sober day-to-day life. And I think the biggest theme that we hear- because I would say, what percentage of people that reach out to you, to us, do you think have already tried ketamine?
Jimmy Nguyen: 40, 30%? I would say it’s fairly high.
Nicholas Levich: Which, to me, is proof that there’s a lot of people getting this treatment and very few people getting the results that they seek.
Jimmy Nguyen: And it’s that trope that you’re saying where they’re like either ‘mmm it’s nice, but I didn’t feel any benefit’ or ‘it lasted for a month’. So I always describe to folks in any conversation about ketamine that if we’re talking about lasting change, if we’re talking about integrating body, mind, spirit, if we’re talking about the more holistic side of what psychedelics can do for your personal growth, however you want to call it, ketamine can crack the door open, but it doesn’t fully open the door.
And you’ve still got to walk through it. You’ve still got to walk through it and do the work, and process all of that stuff. So what would you tell somebody who is looking for ketamine-assisted psychotherapy now? Are there tangible steps for folks to do this with a little bit more thought?
What to Look for In a Ketamine Therapy Clinic
Nicholas Levich: Yeah. So I think the most important thing that I want to stress, because we’ve been potentially a little bit skewed towards just caution in the episode up to this point, but what I will say is there are very good ketamine providers out there. They’re not the majority, but there are very good ketamine providers. There’s a couple of things that I would look for.
I would look into the level of care that you’re getting, meaning who’s doing the infusion of the administration? Are you getting support around preparation and integration? Have they journeyed before? Those are things that for me would be essential because I think the biggest challenge is not having the context or the framing around how to hold this.
And that’s what you were alluding to. If you unearth all this content or it’s your first time in an altered state of consciousness, who’s equipping you with a roadmap or some sort of map to navigate that terrain? Because if you don’t have that, it’s kind of like opening up a can of worms and then you’re not sure what to do with all the worms.
Jimmy Nguyen: Yeah. And a couple of other questions that I would ask are obviously, is it a clinical administration only model? Is there prep? Is there integration? What type of support are you going to receive? How are the nurse practitioners or mental health professionals trained in this?
Or maybe sometimes they’re not mental health professionals. By the way, I’ve seen some ketamine clinics, pair up with, let’s say, essentially trip sitter organizations to provide integration support. So it’s important just to ask how these folks are getting trained and coming about, because there’s a lot of different modalities.
And ultimately there is quite a range on the type of support that you can get from people trying to actively conduct a psychotherapy session with you while you’re in an altered state of ketamine. Which can be beneficial, but has to come with your consent.
It likely should be your own mental health professional in an ideal setting that you’ve been working with for quite some time. All the way to people with at-home clinics, and they’re like ‘I just got prescribed this. Now this clinic is saying that I need to have a trip sitter. What does that look like?’.
And so asking all these questions is really important. And I think one of the reasons why ketamine is getting so much interest is because it’s schedule three. That means that there is some accepted medical benefit or medical use which allows it to get researched in a different way than other schedule one drugs.
Schedule one drugs, like all the other psychedelics and like cannabis as well, are said to have no accepted medical benefit, and therefore, that really halts a lot of the research and studies. So we start to see ketamine pop up quite a bit in the effects of treatment-resistant depression.
A lot of the studies are going on in Johns Hopkins right now, and so that’s why we’re seeing so much interest. But then there’s kind of a gap when people are like, ‘okay, now I’m ready to go and look for these services’, and then there’s quite a few pieces missing, I think..
Ketamine is a Tool, Not a Cure-All
Nicholas Levich: Yeah. So I think the best way to explain this is like when you look at the literature coming out of a place such as Johns Hopkins and it says ‘look, this moves the needle for treatment-resistant depression’. What they don’t tell you is the intensive care that they’re getting before, during, and after.
And so what ends up happening? As a culture, we’ve been conditioned to think that the drug is what’s solving the issue, so to speak. When in reality, the drug is the tool. It’s the tool that is used to foster this healing, but it’s the supportive container, the prep, the integration.
We can call it facilitation or trip sitting during. That’s where that tool is actually used. And so I think that there’s a little bit of a misassociation in a lot of the minds of Western people where we think if we just take the drug, we’re going to get better.
Jimmy Nguyen: Well, that’s just our culture anyways, right? It’s like our culture is reliant on these things because it will ‘solve the core issue’. When we look at antidepressants and psychotropic medications, I don’t have a source for this, by the way. This is one of my clients who is an MD. And then they reported this back.
But I think there’s a study out there that says the efficacy of psychotropic medications is like five to 10% or eight to 12%, something in that range. And people are using those medications like it’s the end all, be all to their mental health. So just think about that for a second.
Something that has a one in 10 chance of being potentially beneficial to you is the cornerstone of a lot of mental health support that we find here in America, right?
Nicholas Levich: And so that just translates over into something like ketamine. It’s like, ‘oh, okay, there’s my magic pill, my silver bullet’, whatever kind of mental construct we’ve got around the medication.
Jimmy Nguyen: So these are just tools, I always say, like psychedelic substances and even like meditation to a degree. They’re all tools. They’re not replacements for the actual journey that has to happen.
They can obviously be very helpful, very beneficial, and help people achieve some real serious breakthroughs that they have been searching for many years and many decades. But to Nick’s point, everybody in these studies and trials and all of this stuff coming out, they’re getting a lot more care than what you see in the headlines out there.
Nicholas Levich: Weeks of integration and prep with someone who is suited to do the work. They understand the method of action. They understand the train. They understand how it impacts the mind, body and spirit. And they’re using all of that information to holistically help you shift. To get unstuck, to grow, to heal, to evolve. That’s what this journey is really all about.
Jimmy Nguyen: Yeah. The reliance on the substance is rather limiting. It is really about the support that you get around it. So if we’re talking very practically with ketamine, get additional support around you.
Either it’s through that clinic, through the person who wrote you the prescription, or you can go out and find your own sitter or integration specialist or a prep person. It doesn’t have to be an all-in-one package. And what you might find is ‘oh, well, I like the SOPs at this clinic. It seems like they do things safely.
It seems like their nurse practitioners are all super solid’, but maybe they only give you one preparation session or one integration session, if at all. So then you then have the opportunity to go out and find somebody who can hold that support for you. And the ketamine experience itself, it’s a pretty short-acting drug. So we’re talking about, depending on the dosage, 45 minutes to an hour and a half likely per session.
Whereas when we talk about LSD, that can be eight to 12 hours. So you’re kind of strapping in there. Even psilocybin is four to 6 hours. So you’ve got to be a little bit ready there. What else would you tell somebody who’s looking for assistance?
Nicholas Levich: Psychotherapy, I think one thing that you’ll hear us talk about a lot, and it applies perfectly to this, is that you have to be your own advocate. As crazy as it sounds, we live in a society where people are in this to make money. Fundamentally, as a business, if you’re not profitable, you don’t last.
And so these businesses have an incentive to see as many clients or patients as possible. They have an incentive to say ‘yes, this will help,’ even when they’re not sure whether it will or won’t. And so do your own research, be your own advocate. Advocate for the level of support and care that you seek. And basically, the more support, the better, when it comes to engaging with these medicines.
Jimmy Nguyen: Yeah. Also, I don’t know enough about this part, but there are ketamine analogs out there that I’m sure can be prescribed, either as ketamine or different chemical compounds, and things that kind of mimic or stimulate.
So I don’t know how much of that is out in regular ketamine clinics, but speaking to what you’re talking about as far as the profitability, the volume, the wanting to get people in and through the program because this is one of the few legal avenues of psychedelic use.
So what we find is that it’s almost like a stepping stone. Folks who want to get themselves involved in psychedelics often are opening up clinics and then they’re like, well then in the future we’ll open up MDMA and in the future will open up psilocybin. Well those are three very different substances that require very different protocols, that require very different levels of support.
And so it’s just important to ask all of these questions. And if you don’t feel like you have a full assurance either in your gut or in your mind, in your intuition somewhere, just know that there’s probably other options for you if you’re pretty set on ketamine. But again, remember, there’s kind of a budgetary kind of constraint here for some.
Nicholas Levich: So let’s actually talk about this for a second because that’s how these at-home ketamine services are marketed- is to save money and to do it in the comfort of your own home. What they don’t tell you is ‘we don’t help you at all’. And so be wary of the super low-cost option because sure they’ll give you the drugs, they’ll mail you the ketamine, but then what do you do with it?
They don’t even tell you the dosage you should take. It’s basically like a self-starter pack and you’re left to your own devices to figure out what to do with all of it. Which to me is fairly irresponsible. But that’s happening.
Jimmy Nguyen: Yeah, there’s a double edge to everything at the same time that there can be a lot of massive benefit and massive potential. There’s also a lot of potential for negligence and a lot of potential for things to go sideways. Like I was chatting with somebody who was basically like, well can I just lock myself in my room and just have this experience, my family and all that around?
And then I was like, well are they aware even of what you’re doing? It’s like, what does that look like? What if somebody knocks on your door? How are you going to handle that when you’re in a- we’re talking about a dissociated state here folks. We’re talking about disconnecting from your body. So you’re likely in the middle of a ketamine experience.
You’re likely not going to be able to get up and have a normal conversation with somebody or even to navigate where your feet are sometimes. So it’s important for you to be in a therapeutic setting. It’s super important.
But you’re right, an unfortunate thing that happens in our society now is that there is a lot of desperation out there. There’s a lot of folks out there looking for support, and then they see psychedelics as this thing, like, ‘oh my God, here’s this potential’. And then just because ketamine is associated with psychedelics, they’re like, ‘okay, I’m going to go down this avenue. I’m going to go down this route’.
And there are some folks who don’t find benefit from ketamine as well. And so a lot of the contextual things that Nick is talking about, I think, really plays in here. So, again, we’re speaking about this from a protective place, I think because we’ve heard so many horror stories. Folks basically have emotional breakdowns after ketamine experiences-
Nicholas Levich: -or just driving home after!
Jimmy Nguyen: You’ve got to get into an Uber or something like that, or just be released to the streets after. I mean, we’ve heard of all of these things.
Nicholas Levich: We don’t think ketamine is bad. It’s a very helpful tool.
Jimmy Nguyen: It’s been so therapeutic in my own journey, for sure.
Nicholas Levich: The challenge is just how it’s being administered. And if I could use an analogy, it’s kind of like the McDonald’s model, as opposed to the-
Jimmy Nguyen: I wanna hear this! [Jimmy laughs]
Nicholas Levich: –the farmers market. Right? So we’re basically in the rinse and repeat, treating as many people as possible, making it as cost effective as possible in some cases, but what goes out the window at the cost of that care is the level of care and support. And so I think there’s got to be a balance for anyone that seeks therapeutic ketamine.
I mean, just think about the words you’re using. If it’s therapeutic ketamine, but there’s no therapeutic aspect included, what’s the point?
Jimmy Nguyen: I see a world in like five years where ketamine is a tool in a vast array of tools available for folks. I hope in a more holistic or immersive setting, where right now all these things are siloed because they’re dependent upon the substance. So it’s like a ketamine-only option here.
An international ayahuasca retreat here and then psilocybin there. So I think that ketamine in conjunction or alongside your whole realm of care, can be really helpful. I don’t know, Nick. Have you ever heard of anybody who had gone through three programs of ketamine and they’re like ‘that was it for me. I’m good here.’?
Nicholas Levich: Unfortunately not. I’ve heard of it moving the needle, but I think folks typically then start seeking out more traditional psychedelics. That’s the path that I usually see.
Jimmy Nguyen: Yeah, I even think about folks who I chat with who have severe PTSD, and it helps them. There’s a lot of benefit there as far as helping folks to just get a little bit more stability, get a little bit more of that processing, that emotional processing, that grief processing. But to me, it’s not ‘the whole enchiladas’, as you like to say sometimes.
Nicholas Levich: Yeah. And one thing that I do think we should just touch on briefly is that ketamine has the potential to be abused. I mean, just like, all drugs. But if you’re prescribed an at-home kit, so to speak, and then you become reliant on that and have very little guidance on how to use it, you can become addicted to ketamine.
I mean, this is something that was used in a party setting at raves and concerts and things for years, right. And people have ruined their lives through ketamine.
Jimmy Nguyen: Yeah. Ketamine for sure is more habit forming than any of these other traditional psychedelics. It’s so funny because I was watching Stranger Things. I don’t know if you’ve seen the latest season or whatnot. There’s a scene where actually – I think Stranger Things is so dope – anyways, essentially there’s this one character who is going through something and she’s trying to block it out.
And so she goes over to one of the other characters’ places, and she’s like, do you have it? Do you have the Special K? And I was like, oh, my God. ‘Special K’ is what they were talking about when they’re talking about ketamine when we were kids.
I had a whole good internal laugh about it because that was one of the more demonized substances, for sure, when I was a kid. It was like ‘Special K, If you do one hit of LSD, you’re clinically insane forever’ and that it ‘stays stored in your spinal fluid’, and you’ll just ‘be crazy like on angel dust, PCP’.
So I heard Special K and I was like ‘that’s ketamine!’
Nicholas Levich: That’s wild.
Jimmy Nguyen: Yeah. So if anybody hasn’t seen Stranger Things, this is also a plug for Stranger Things.
[Nick and Jimmy laugh]
Jimmy Nguyen: But it was just wild to me, to make that connection when Chrissy was trying to talk to Eddie, and she’s like, ‘do you have the Special K? A one way ticket to pure bliss’, he said. I was, like, ‘a little more to it than just that.’
Nicholas Levich: Basically, to recap this, ketamine has the potential to be far more habit forming and traditionally addictive, as we think about it, than something like psilocybin. You take a big psilocybin journey, and you don’t want to do that again for a while.
And so I think there’s a way to use ketamine therapeutically. I also think there’s a way to use ketamine where you’re just kind of numbing out, that’s the dissociative piece. Where if it’s not held in a thoughtful way, it can definitely go the other direction.
What is a K-Hole?
Jimmy Nguyen: Yea. And in our modern society, that’s what people talk about, is the K-hole. There’s this thing that you ‘want to avoid’, which is like the K-hole. And ‘you have to be careful’. You have to be very careful. But then, realistically, that’s what these clinics are doing as they’re prescribing you K-holes, essentially. And so K-holes can be very beautiful and very therapeutic.
Nicholas Levich: Do you want to describe what that is for people?
Jimmy Nguyen: Yeah. So the best way that I can describe it, this also talks about dissociative-ness. In a really good setting, a K-hole can feel as close to what I can imagine as being in a womb, just like being supported and held. And you’re just in this part of your consciousness where everything is just kind of supported and everything has this warmth to it.
And that’s where a lot of these difficult conversations can happen with yourself. You’re looking at some issues or some trauma or some challenging content in your life that can be really beneficial. It can be also scary as s*** if you aren’t ready for that and you have no idea what your intentions are, why you’re walking through it, how prepared you are, all of that.
I’m sure we could talk about this more, but I feel like we’ve gotten to touch upon ketamine a little bit. I think we’ve given some folks some more tangible perspective and actionable advice around this.
Nicholas Levich: Basically, ketamine is a totally fine therapeutic option if you make sure that you’re getting the care that is commensurate with the level of transformation that you seek.
Jimmy Nguyen: That’s so correct. A powerful tool should have a powerful process around it so that you can wield it properly.
So thank you so much for listening in on this episode. You can download episodes of the Psychedelic Passage podcast. Subscribe to the show on Apple Podcast, Amazon, Spotify and IHeartRadio or wherever you get your podcast from, and we will see you all next time!
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